stages of the loss process

What are the stages of the loss process?A loss experience involves the following five stages of emotional response: denial, bargaining, anger, despair and acceptance.* These five stages can occur in either the sequence presented or in any variety of sequence.* The stages can recur during a loss experience.* One stage can last a long time, uninterrupted.* These five stages can occur in either the sequence presented or in any variety of sequence.* The loss process can last anywhere from 3 months to 3 years.* These stages of grief are normal and are to be expected.* It is healthier to accept these stages and recognize them for what they are rather than to fight them off or to ignore them.* Working out each stage of the loss response ensures a return to emotional health and adaptive functioning.* Getting outside support and help during the grieving process will assist in gaining objectivity and understanding.Stage 1: Denial* We deny that the loss has occurred.* We ignore the signs of the loss. We begin to use:* Magical thinking--believing this loss will go away "magically."* Excessive fantasy believing nothing is wrong; this loss is just imagined; when I wake up everything will be OK.* Regression believing that if we act childlike and want others to reassure us that nothing is wrong.* Withdrawal believing we can avoid facing the loss and avoid those people who confront us with the truth.* Rejection believing we can reject the truth and those who bring us the news of our loss to avoid facing the loss. Stage 2: Bargaining* We bargain or strike a deal with God, ourselves or others to make the loss go away.* We promise to do anything to make this loss go away.* We agree to take extreme measures in order to make this loss disappear.* We lack confidence in our attempts to deal with the loss, looking elsewhere for answers. We begin to:* Shop around believing we look for the "right" agent with the "cure" for our loss.* Gamble believing we can take chances on "cures" for our loss.* Take risks believing we can put ourselves in jeopardy financially, emotionally and physically to get to an answer or "cure" for our loss.* Sacrifice believing in our pursuit of a "cure" to change the loss we can ignore our real needs. Stage 3: Anger * We become angry with God, with ourselves or with others over our loss.* We become outraged and incensed over the steps that must be taken to overcome our loss.* We pick out "scapegoats" on which to vent our anger, e.g., the doctors, hospitals, clerks, helping agencies, rehabilitation specialists, etc. We begin to use:* Self-blaming--believing we should blame ourselves for this loss.* Switching blame--believing we should blame others for this loss.* Blaming the victim--believing we should blame the victim for leaving us.* Aggressive anger--believing we have a right to vent our blame and rage aggressively on the closest target.* Resentment--believing our hurt and pain is justified to turn into resentment toward involved in our loss event including the victim. Anger is a normal stage. It must be expressed and resolved; if it is suppressed and held in, it will can lead to a maladaptive condition of depression that drains our emotional energy.Stage 4: Despair* We become overwhelmed by the anguish, pain and hurt of our loss; we are thrown into the depths of our emotional response.* We can begin to have uncontrollable spells of crying, sobbing and weeping.* We can begin to go into spells of deep silence, morose thinking and deep melancholy. We can begin to experience:* Guilt believing we are responsible for our loss.* Remorse believing we should feel sorry for our real or perceived "bad past," deeds for which this loss is some form of retribution or punishment.* Loss of hope believing that because the news of our loss becomes so overwhelming that we have no hope of being able to return to the calm and order our life held prior to the loss.* Loss of faith and trust believing that because of this loss we can no longer trust our belief in the goodness and mercy of God and mankind. We need support to assist us in gaining the objectivity to reframe and regroup our lives. If we are not able to work through our despair, we risk experiencing events such as mental illness, divorce/separation, suicide, inability to cope with the aftermath of our loss, rejection of the family member who has experienced the loss, and detachment, poor bonding or unhealthy interaction with the parties involved in our loss.Stage 5: Acceptance* We begin to reach a level of awareness and understanding of the nature of our loss. We can now:* Describe the terms and conditions involved in our loss.* Fully describe the risks and limitations involved in the treatment or rehabilitation for the loss involved.* Cope with our loss.* Test the concepts and alternatives available to us in dealing with this loss.* Handle the information surrounding this loss in a more appropriate way. We begin to use:* Rational thinking believing we are able to refute our irrational beliefs or fantasy thinking in order to address our loss from a rational perspective.* Adaptive behavior believing we can begin to adjust our lives to incorporate the changes necessary after our loss.* Appropriate emotion believing we begin to express our emotional responses freely and are better able to verbalize the pain, hurt and suffering we have experienced.* Patience and self-understanding believing we can recognize that it takes time to adjust to the loss and give ourselves time to "deal" with it. We set a realistic time frame in which to learn to cope with our changed lives.* Self-confidence believing, as we begin to sort things out and recognize the stages of loss as natural and expected, that we gain the confidence needed for personal growth. We can be growing in acceptance and still experience denial, bargaining, anger and despair.To come to full acceptance we need support to gain objectivity and clarity of thinking. It is often useful to gain such assistance from those who have experienced a similar loss. For example, groups of parents who have experienced the death of a child or who have had a child with a developmental disability.Peer support from strangers is often the best way for a person to deal with the grieving process.Post a comment
Last Updated: January 27, 2009
James J Messina, PhD, is a licensed psychologist with more than 35 years of experience counseling individuals and families. Messina, who specializes in adult and children psychotherapy, serves as Director of Psychological Services at St. Joseph’s Children’s Hospital in Tampa, Fla. He has a private practice in Tampa and is also a member of the American Psychological Association.