Elisabeth Kubler-Ross published the five stages of grief in 1969, and they have shaped how we think about loss ever since. Denial, anger, bargaining, depression, acceptance. The model was originally developed from interviews with terminally ill patients about their own dying process, not from research on bereavement. It was not designed as a sequential roadmap. Yet it became one, and the cultural expectation that grief should follow that order, within a reasonable timeframe, has caused a significant amount of additional suffering to people who were already in enough pain.

Actual grief research is far more varied, and more compassionate, than the five-stage model suggests. Psychiatry.org’s clinical overview of prolonged grief disorder notes that grief responses are highly individual, shaped by the nature of the loss, the relationship with the deceased, prior mental health history, and social support. Grief stages as popularly understood do not reflect the clinical reality of how people grieve. This blog covers what grief actually looks like, when it becomes clinically significant, and what grief therapy actually involves.

What Grief Stages Actually Look Like

The research on grief stages and grief trajectories over the past three decades has produced a more accurate picture than the five-stage model. George Bonanno’s longitudinal bereavement research identified several distinct trajectories:

• Resilience: The most common trajectory. The majority of bereaved people experience relatively stable functioning, with grief that is present and real but does not significantly disrupt daily life. This does not mean they are not grieving or did not love the person
• Recovery: A period of significant disruption and impairment followed by gradual return to baseline functioning over 12 to 18 months
• Chronic grief: Persistent, intense grief that does not improve over time. This is now recognised as Prolonged Grief Disorder in the DSM-5-TR
• Delayed grief: 

The crucial finding: most people do not move through five sequential stages. Grief is not linear. It is non-sequential, can resurface around anniversaries and triggers, and varies enormously in its expression and duration. The absence of intense visible distress does not mean the person is not grieving or is in denial. For many people, resilience following loss is genuine, not suppressed.

Types of Grief That the Five-Stage Model Does Not Capture

Types of grief extend well beyond the expected mourning following a death:

• Anticipatory grief: Grief experienced before the loss, during a terminal illness or a relationship ending that is in progress. The loss has not yet occurred but its certainty is known
• Disenfranchised grief: Grief for losses that are not socially recognised or validated: miscarriage, the death of a pet, the end of a friendship, losing a relationship that was not formally acknowledged, grief after estrangement from a living person
• Complicated grief: Grief complicated by the circumstances of the loss (sudden death, violence, suicide) or by the relationship (ambivalent, abusive, or estranged relationships can produce grief that is intensified by unresolved feelings)
• Cumulative grief: Multiple losses in close succession without adequate time or support to process each one
• Collective grief: 

Prolonged Grief Disorder: When Grief Becomes Clinical

Prolonged grief disorder (PGD) is a new diagnosis in the DSM-5-TR, recognising that a subset of bereaved people experience grief that does not follow a recovery trajectory and produces significant, sustained impairment.

Psychiatry.org’s clinical guidance describes the diagnostic criteria: intense longing or yearning for the deceased, difficulty accepting the loss, and associated symptoms (difficulty engaging with life, feeling that part of oneself has died, bitterness, avoidance of reminders) that persist beyond 12 months after the death of an adult (6 months for children) and cause clinically significant distress or impairment.

Risk factors for prolonged grief disorder include:

• Sudden or traumatic circumstances of the death
• Anxious attachment style or strong emotional dependence on the deceased
• Prior history of depression, anxiety, or trauma
• Limited social support during the grief period

The recognition of PGD as a formal diagnosis is significant because it validates the experience of people whose grief has not followed the expected trajectory, and because it means there is now a specific evidence base for treating it. It also matters because prolonged grief frequently co-occurs with, but is distinct from, depression: treating one does not automatically treat the other.

If grief has not moved in the direction of any kind of relief and it has been more than six months, a professional assessment is worthwhile. The Therapy Park offers grief therapy for people navigating loss of all kinds, in Kolkata and online across India.

Grief and Mental Health: The Connection

Grief and mental health intersect in complex ways that are worth understanding clearly.

• Grief is not the same as depression: Normal grief, even intense grief, is not a depressive disorder. The distinction lies in self-esteem (bereaved people typically do not experience the pervasive worthlessness of depression) and in the preservation of the capacity for pleasure in some contexts
• Grief can trigger depression: In people with a prior history of depression or significant vulnerability, the stress of major loss can trigger a depressive episode that overlays and complicates the grief
• Grief can trigger anxiety: Loss can shatter existing assumptions about safety, predictability, and the reliability of the world. The anxiety that follows significant loss is common and often underrecognised
• Grief can produce physical symptoms: 

Understanding grief and mental health as distinct but interactive phenomena matters for treatment: grief does not require antidepressant medication unless a clinical depression has developed alongside it. It typically requires time, support, and in some cases, specific therapeutic intervention.

Coping With Grief: What Actually Helps

Coping with grief is not about moving through stages or achieving acceptance within a given timeframe. It is about finding ways to carry the loss and eventually integrate it into a continuing life.

• Allow the grief without managing it: The pressure to be “doing well” or to have moved on within a culturally expected timeframe is real and harmful. Grief that is suppressed resurfaces; grief that is acknowledged tends to metabolise more naturally
• Maintain connection rather than cutting off: Continuing Bonds Theory, a significant development in bereavement research, found that maintaining a continuing psychological connection with the deceased, rather than “letting go,” is associated with better long-term adaptation for many people
• Seek social support, but also allow solitude: Being with others is important; so is having space to be in the grief without performing normalcy
• Address the practical and the emotional separately: Early grief is often dominated by practical demands. The emotional processing often happens later, when life has quietened enough to allow it
• Seek professional support early if the grief is traumatic: 

Grief Therapy: What It Involves and When It Helps

Grief therapy is appropriate when grief is significantly impairing daily functioning, when it meets criteria for prolonged grief disorder, when it is complicated by trauma, or when the person has no adequate social support.

Evidence-based approaches include:

• Complicated Grief Treatment (CGT): A specific protocol for prolonged grief disorder that combines elements of cognitive therapy and exposure, addressing both the trauma of the loss and the restoration challenges of ongoing life
• Trauma-focused approaches (including EMDR): When the circumstances of the death were traumatic, trauma processing is often a necessary part of grief work
• Acceptance and Commitment Therapy (ACT): Works with values and psychological flexibility, helping the person build a meaningful life that includes rather than erases the loss
• Narrative therapy: 

Frequently Asked Questions

Do the 5 grief stages happen in order?

No. The five grief stages model was not originally designed as a sequential roadmap and is not supported by bereavement research as such. Grief is non-linear, varies enormously between individuals, and does not follow a predictable sequence. Research on grief trajectories shows that most people follow a resilience or recovery pattern, not the five-stage model.

What is prolonged grief disorder?

Prolonged grief disorder is a DSM-5-TR diagnosis characterised by persistent, intense yearning for the deceased, difficulty accepting the loss, and significant associated symptoms that cause clinically significant distress or impairment beyond 12 months after the death of an adult. It is distinct from normal grief and from depression, and has a specific evidence-based treatment protocol.

How do I know if I need grief therapy?

Grief therapy is appropriate when grief is causing significant impairment in daily functioning, when it has not moved in any direction of relief after 6-12 months, when the circumstances of the loss were traumatic, when grief is complicated by depression or anxiety that is not improving, or when social support is insufficient to carry the experience. You do not need to meet formal clinical criteria to benefit from professional support.

What are the types of grief?

Types of grief include anticipatory grief (before the loss), disenfranchised grief (for unrecognised losses), complicated grief (complicated by trauma or ambivalence), cumulative grief (multiple losses without adequate processing time), and collective grief (shared by communities). Each type has slightly different features and may require different forms of support.

Final Thoughts

Grief stages as a linear model are less useful than the actual research on how people grieve: variably, non-sequentially, and according to trajectories that are shaped by the relationship, the circumstances, the person, and the support available. Grief does not have a correct pace. What matters is that it has space.

At The Therapy Park, grief therapy and support for loss of all kinds is available with practitioners who understand both the research and the lived experience of grief. In-person in Kolkata and online across India.