The Seven Stages of Grief

Kübler-Ross (1967)

Elisabeth Kübler-Ross (1967) outlined what has been the traditional five stages of grief:

• Denial: Shock is replaced with the feeling of “this can’t be happening to me.”
• Anger: The emotion confusion that results from this lose may lead to anger and finding someone or something to blame.
• Bargaining: The next stage may result in trying to negotiate with one’s self (or a higher power) to attempt to change what has occurred.
• Depression: A period of sadness and loneliness then will occur in which a person reflects on their grief and loss.
• Acceptance: After time feeling depressed about their loss, a person will eventually be at peace with what happened.

The grief model is expanded by Wright (2011). She is a licensed and registered critical care nurse who offered her own interpretation of Kübler-Ross (click to see her page):

1. Shock & Denial: A numbed disbelief occurs after the devastation of a loss. A person may deny the reality or gravity of their loss at some level to avoid pain. Shock provides emotional protection from being overwhelmed all at once. This may last for weeks.
2. Pain & Guilt: Shock wears off and replaced with suffering of excruciating pain. It’s important to experience the pain fully and not numb it artificially.
3. Anger and Bargaining: Frustration leads to anger. Uncontrolled, it can permanently damage relationships. May result in trying to negotiate with one’s self (or a higher power) to attempt to change the loss that has occurred.
4. Depression, Reflection, & Loneliness: A long period of sad reflection overtakes a person and the magnitude of the loss sets in.
5. The Upward Turn: Life becomes calmer, more organized as one starts to adjust to life with the loss that occurred.
6. Reconstruction & Working Through: As a person starts to become more functional, realistic solutions seem possible for life after the loss.
7. Acceptance & Hope: The last stage – a person learns to accept and deal with the reality of their situation. A person is more future-oriented and learns to cope.

In Clinical Practice

Wright’s model provides a solid foundation for psychoeducation to individuals going through loss. Loss can be very devastating and the painful experiences and feelings that a person goes through after a loss is normalized through the intervention. While Kübler-Ross has been established for a longer period of time, Wright’s model emphasizes important aspects of human emotion and provides guidance in what to expect during each phase.

In using this with clients, I have received positive feedback and indication that feelings experienced by a client have been normalized. In reflecting on my own losses in my life, the model appears to be a valid and logical progression of resolving them.

A clinical social worker I consulted with reminds me that clients should know that the progression of processing grief is not necessarily linear and that while these stages are typical and common, one may not smoothly go through the process of grieving. Clients “sometimes [take] two steps forward, one [step] back, one visit to two stages for a day, then back”.

Limits to Intervention

This document has not been empirically validated for effectiveness and my previous commentary is anecdotal. Evaluation of effectiveness may be considered in a group or individual context.

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Reference:

• Kübler-Ross, E. (1967). On Death and Dying. New York: Macmillan, 1969.
• Wright, J. (2011). 7 stages of grief: through the process and back to life. Retrieved from http://www.recover-from-grief.com/7-stages-of-grief.html