Grief Has No Stages

The question almost always arrives in the same words: which stage am I in. Sometimes in a worse variant, from someone who suspects they're behind schedule.

There's no answer, because the stages don't exist in the way they're described. And believing they do adds a worry that most people didn't need.

This article covers what we know about how grief actually unfolds, why most people move through a loss without treatment, and how to recognize the minority of cases where consulting someone is warranted. At the end there's a simple exercise for looking at your own situation.

It belongs to a series on why people look for a retreat. Grief sits inside the 73% who arrive seeking relief from something specific.

Where the five stages came from

Elisabeth Kübler-Ross published her model in 1969, based on interviews with patients who were dying. What she described was how those people related to their own imminent death.

She did not interview bereaved people. The application of the model to those who lose someone came later, from others, and it spread far faster than it was studied.

The model was never empirically validated. Reviews examining its support found no evidence that people move through denial, anger, bargaining, depression, and acceptance in that order or in any fixed order.

It circulates anyway, as though it were established fact. A survey compared what the general public believes with what mental health professionals believe: around 30% of the public holds that grief progresses through predictable stages, against roughly 8% of professionals. An analysis of how the stages are presented on websites found that many include no critical appraisal of the model.

Why the myth matters

A descriptive theory becomes a problem when people use it as a measuring stick.

Someone who never felt denial concludes they did something wrong. Someone who reached something like acceptance and then breaks down again on an ordinary Tuesday six months later believes they've gone backward. Someone who felt relief, common after a long illness, finds that relief in none of the five boxes and hides it.

The model also hands observers a timetable against which to measure someone else's grief. That's where the question about whether they shouldn't be better by now comes from, the one almost nobody asks aloud and many think.

What the research does describe

Margaret Stroebe and Henk Schut proposed a different model in 1999, built on observation of bereaved people. They called it the dual process model.

It describes two orientations. One faces the loss: remembering, crying, looking at photographs, missing, feeling the absence directly. The other faces ongoing life: handling paperwork, returning to work, learning to do what the other person did, taking on new roles.

The model's contribution is that healthy grief oscillates between the two orientations. A person confronts for a while and then gets distracted, deals with something practical, laughs. That back-and-forth is part of the process rather than an interruption of it.

Oscillation is not the same as balance. In the first weeks nearly all the weight sits on the loss side, and that's what should be expected. The proportion shifts over time and isn't the same for everyone.

Most people recover without treatment

George Bonanno and colleagues followed 205 older adults from before a spouse's death through 18 months afterward. Measuring before the loss is uncommon and makes the results more reliable, because they don't depend on anyone remembering how they were.

They identified five trajectories. The most frequent, at 45.9% of cases, was resilience: people with low levels of depression before the loss who maintained those low levels afterward. Chronic grief appeared in 15.6%.

They also found something that contradicted classical theory. There was no evidence of delayed grief, meaning people who appear fine and collapse months later. That pattern, taught for years as a warning, barely appeared in the data.

Those people hurt just as much. What the data show is that intense pain and clinical disorder aren't the same thing, and that most people go through the first without reaching the second.

The two kinds of day

With the oscillation model in hand there's a fairly simple way to look at your own situation. I call it the two kinds of day.

A loss day is one where you look at photographs, talk about the person, cry, feel the absence directly. A life day is one where you work, get something done, see people, laugh without guilt. Both are grief. Both count.

The exercise looks backward rather than forward. Go over the past week and note which kind each day was. Don't correct anything yet.

The question that matters isn't how many there were of each. It's whether there was any of the other kind. If no life day appeared in two weeks, that's information. If no day appeared in several months where the loss could be faced directly, that's information too, and it usually goes unnoticed because from the outside it looks like functioning well.

I know of a case that shows why visible behavior isn't enough to judge by. A person in their sixties lost their mother two years ago. They dream about her most nights, say it hurts as though it were yesterday, and post daily about the loss and about their mother. From the outside it looks like someone stuck.

Their life, however, keeps functioning. There's work, there are people, there are ordinary days. Their pain is quiet: visible, and bothering no one. Both kinds of day are there, even if only one of them is visible.

The reverse happens too. Someone who went back to work within a week, who posts nothing and cries in front of no one, may have gone months without a single day in which the loss could surface. Nobody notices, and that person does need help.

One clarification before going on. This exercise is a way of looking, not a treatment. The dual process model describes grief well, but no trials show that teaching people to oscillate deliberately improves outcomes. If looking backward reveals that only one kind of day has appeared for months, the right step is to consult someone rather than persist with the exercise.

One in ten

So far we've covered the grief that doesn't need treatment. Now the other case.

Lundorff and colleagues (2017) pooled fourteen studies and estimated the prevalence of prolonged grief disorder at 9.8% of adults who experience a non-violent loss. The same review found that higher age is associated with higher prevalence.

The disorder entered the American Psychiatric Association's DSM-5-TR in 2022. It can be diagnosed when acute grief remains disabling beyond twelve months in adults, with persistent yearning or preoccupation with the person who died, alongside symptoms such as difficulty accepting the death, avoidance of reminders, or a sense that life has lost meaning.

The figure varies considerably by manner of death. After natural deaths, estimates hover around 10%. After deaths by suicide, homicide, or accident, studies report substantially higher proportions.

Twelve months isn't a magic threshold or permission to stop feeling. It's a marker research uses to separate grief that's running its course from grief that has stalled, and it remains under discussion within the field.

What works, and for whom

There's an apparent contradiction in this literature worth explaining, because two opposite claims get drawn from it and cited separately.

Currier, Neimeyer, and Berman (2008) pooled 61 controlled studies of interventions for bereaved people and found a small effect at the end of treatment and no statistically significant benefit at follow-up. That was cited for years as proof that grief therapy doesn't work.

The most complete review to date says something else. Avis and colleagues (2025) examined 33 systematic reviews and meta-analyses published between 2001 and 2021, with Stroebe and Schut among the authors. They conclude that interventions are generally helpful: seven reviews with unconditional support, twenty-four with conditional support, and only two with no evidence of support. Their overall conclusion reads: the more complicated the grief, the greater the benefit of intervention.

Both findings are accurate because they concern different populations. Offering therapy to anyone who has just lost someone produces little. Treating someone with prolonged grief produces a good deal.

The numbers for that second population come from three randomized trials led by Katherine Shear. In the first, with 95 participants, a therapy designed for complicated grief obtained a 51% response rate against 28% for interpersonal psychotherapy. In the second, with 151 people over fifty, the difference was 70.5% against 32%, with a number needed to treat of 2.56. In the third, with 395 participants and a placebo control, the therapy with placebo obtained 82.5% response against 54.8% for placebo alone; the antidepressant on its own did not outperform placebo, and the therapy did.

A number needed to treat of 2.56 means fewer than three people have to be treated for one to respond. In psychotherapy that figure is strong.

A later meta-analysis of 31 randomized trials also found significant effects (Johannsen et al., 2019). And the reviews converge on three conditions that improve outcomes: that the person has high levels of distress, that time has passed since the loss rather than intervening in the first weeks, and that the request for help comes from the person rather than being recruited.

The role of rumination

One mechanism shows up often when grief stalls, and it's the same one that shows up in anxiety and depression: rumination. The mind circles the loss without that movement going anywhere.

Eisma and colleagues (2015) compared two brief internet-delivered interventions against a waiting list, in people with complicated grief and elevated rumination. Exposure reduced complicated grief, post-traumatic stress, depression, and rumination, with effect sizes between 0.7 and 1.2. Behavioral activation reduced complicated grief, post-traumatic stress, and rumination, with effects between 0.8 and 0.9.

What that suggests in practice is that rumination doesn't yield to a decision. It yields when someone does something concrete, or approaches what they've been avoiding. Resolving to think about someone less doesn't work; walking on Thursdays at six can.

The relationship doesn't end

For much of the twentieth century, the goal of grief was taught as detaching from the bond with the person who died in order to reinvest that energy elsewhere.

Klass, Silverman, and Nickman documented in 1996 that bereaved people do something different, and that it tends to work for them: they maintain the relationship in transformed form. They speak to the person who died, keep objects, notice their influence on decisions, dream about them. They called these continuing bonds.

Later evidence qualified the finding. Maintaining the bond can accompany good adaptation or can accompany stalled grief, and what seems to make the difference is whether the person accepts the death while keeping the relationship. The behavior alone doesn't indicate which case it is.

Returning to the person who posts daily about their mother: that can be a continuing bond working well, or it can be rumination. What distinguishes them isn't the posting but whether life days are also present. In that case they are.

How we work with this

At the Healing Studio, work with grief rests on two frameworks.

The first is logotherapy. Viktor Frankl held that unavoidable suffering isn't eliminated, and that what can change is a person's relationship to that suffering and the meaning they manage to build around it. Applied to grief, the question isn't how to stop missing someone but what to do with what remains. I trained in that approach at the Centro Costarricense de Logoterapia.

The second is the work with what the loss stirs up, which is rarely only the loss. A death rearranges family bonds, reopens old histories, changes the position a person occupies. That's clinical material and it takes time.

For those who can travel, the seven acres of tropical dry forest offer something a consulting room doesn't: a place where the ordinary-life side demands nothing. No paperwork, no explaining to anyone how you're doing, no pretending. In the structure of the retreats, that unscheduled time is planned for, and it isn't wasted time.

A word about what a retreat can do with grief. It can provide space, and space matters in grief. It doesn't replace treatment when prolonged grief is present, and a week doesn't resolve two years of a stalled life. If there's risk, suicidal ideation, or an ongoing depressive episode, what's needed is close, accessible care rather than a remote place.

What to look at

People who reach a text like this are usually trying to find out whether they're doing it right. According to the available data, most people in that situation are.

The signals that do warrant consulting someone are concrete: more than twelve months with no change in intensity, a life organized entirely around the absence, no day of the other kind appearing at all, sustained avoidance of places or people, or increased use of alcohol or other substances in order to sleep or to go out.

None of those signals means weakness or failure. They mean the process stalled at some point, and for that there's treatment with measured results.

And if none of them appear, even if it still hurts a great deal, what you're doing is most likely grief.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

Avis, K. A., Missler, M., van Deursen, D., Lenferink, L. I. M., Stroebe, M., & Schut, H. (2025). The efficacy of bereavement interventions: A systematic umbrella review. Harvard Review of Psychiatry, 33(3), 127-148. https://doi.org/10.1097/HRP.0000000000000426

Bonanno, G. A., Wortman, C. B., Lehman, D. R., Tweed, R. G., Haring, M., Sonnega, J., Carr, D., & Nesse, R. M. (2002). Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology, 83(5), 1150-1164.

Currier, J. M., Neimeyer, R. A., & Berman, J. S. (2008). The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review. Psychological Bulletin, 134(5), 648-661.

Eisma, M. C., Boelen, P. A., van den Bout, J., Stroebe, W., Schut, H. A. W., Lancee, J., & Stroebe, M. S. (2015). Internet-based exposure and behavioral activation for complicated grief and rumination: A randomized controlled trial. Behavior Therapy, 46(6), 729-748. https://doi.org/10.1016/j.beth.2015.05.007

Frankl, V. E. (2006). Man's search for meaning. Beacon Press. (Original work published 1946)

Johannsen, M., Damholdt, M. F., Zachariae, R., Lundorff, M., Farver-Vestergaard, I., & O'Connor, M. (2019). Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders, 253, 69-86. https://doi.org/10.1016/j.jad.2019.04.065

Klass, D., Silverman, P. R., & Nickman, S. L. (Eds.). (1996). Continuing bonds: New understandings of grief. Taylor & Francis.

Kübler-Ross, E. (1969). On death and dying. Macmillan.

Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I., & O'Connor, M. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders, 212, 138-149. https://doi.org/10.1016/j.jad.2017.01.030

Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F. (2005). Treatment of complicated grief: A randomized controlled trial. JAMA, 293(21), 2601-2608. https://doi.org/10.1001/jama.293.21.2601

Shear, M. K., Wang, Y., Skritskaya, N., Duan, N., Mauro, C., & Ghesquiere, A. (2014). Treatment of complicated grief in elderly persons: A randomized clinical trial. JAMA Psychiatry, 71(11), 1287-1295. https://doi.org/10.1001/jamapsychiatry.2014.1242

Shear, M. K., Reynolds, C. F., Simon, N. M., Zisook, S., Wang, Y., Mauro, C., Duan, N., Lebowitz, B., & Skritskaya, N. (2016). Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry, 73(7), 685-694. https://doi.org/10.1001/jamapsychiatry.2016.0892

Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197-224. https://doi.org/10.1080/074811899201046

Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning health-care professionals: Bereaved persons are misguided through the stages of grief. Omega: Journal of Death and Dying, 74(4), 455-473.