The first thing I almost always say to those who come to my practice after a loss is that grief processing is not about stopping the suffering, nor is it about “turning the page.”
It serves a different purpose: to make sure that loss, which will remain, finds a place within one's life instead of taking it all over.
The five stages are a myth: what research really says
Anyone seeking information about grief comes across the five-stage model: denial, anger, bargaining, depression, acceptance. It is the most widely cited model in the world, and also the most misunderstood.
Elisabeth Kübler-Ross formulated it in 1969 while observing terminally ill people, that is, those facing their own death — not those left behind. The extension to grief happened later, and has never been confirmed by research: studies find no orderly progression through defined stages, nor an identical sequence for everyone.
Why does this matter, practically? Because many people arrive convinced they are doing something wrong: “I'm still angry, I should already be at acceptance”. That sense of being behind schedule is an additional burden, and it is based on a model that does not describe reality.
How it really works
The most solid models of recent decades describe something less linear and much more recognizable.
An oscillating movement. The dual process model describes a continuous alternation between two poles: moments of immersing oneself in grief and memory, and moments of dealing with practical life and looking forward. These are not sequential phases: one moves from one to the other even within the same day. And that oscillation è is the process, not a sign of inconsistency.
This is why one feels guilty after laughing at a joke, or after a day spent without thinking about it. It is not betrayal: it is exactly how it should go.
Tasks, not stages. Another model speaks of tasks to work through: acknowledging the reality of the loss, going through the pain instead of avoiding it, adapting to a world in which that person is no longer present, and finding a way to carry them along while continuing to live. They have no mandatory order and can be revisited multiple times.
The bond should not be severed. This is perhaps the most important shift from the old idea of “letting go.” Research on continuing bonds has shown that maintaining an inner relationship with someone who is gone — talking to them, sensing their presence, keeping rituals and objects — is not a symptom. It is often part of the solution. What changes is not the existence of the bond, but its form.
What is normal to feel
Grief is not expressed only through sadness, and this disorients many people.
- Waves sudden, triggered by a smell, a song, a place, months after it seemed to have passed
- Physical symptoms: deep fatigue, a lump in the throat, chest tightness, sleep and appetite disturbances
- Anger, toward doctors, toward oneself, sometimes toward the person who died
- Guilt: for what was said, for what was not done, for having survived
- Relief, after a long illness — one of the most common and most unspoken feelings, because it seems monstrous. It is not
- Confusion and memory gaps: grief occupies real cognitive resources
- Searching for the person: illusions of having seen or heard them, dialing their number. It is common and is not a sign of imbalance
How long it lasts
There is no correct duration, and whoever states one is saying something they cannot possibly know.
What is observed is that intensity tends to decrease over time and that the intervals between waves grow longer. But the first anniversary, holidays, birthdays often reopen what seemed closed. This is expected.
There is, however, a clinical threshold. When the pain remains unchanged in intensity, occupies almost all thoughts, and prevents resuming life's activities beyond six to twelve months — the threshold varies according to diagnostic criteria — it is called prolonged grief, now recognized as a clinical condition in its own right. It is not a weakness: it is a condition that responds to specific treatment.
When to ask for help
- The pain does not change at all as the months pass
- You cannot resume work, relationships, or daily activities
- You systematically avoid everything that reminds you of the person, or you can't manage to do anything else
- Guilt has become pervasive and cannot be reasoned away
- The use of alcohol or drugs has appeared as a way to stop feeling
- The grief has added onto a pre-existing depression
- The death was sudden, violent, or by suicide
And above all: if thoughts of hurting yourself or the desire to reach the person who is no longer there appear, don't wait. Talk about it immediately with your doctor, go to the emergency room, or call the 112.
Some losses are more difficult
Sudden deaths leave no time to prepare, and often leave things unsaid that continue to demand space.
Suicide adds unanswered questions, guilt, and often social shame. Those who remain need a space where they can talk about it without filters.
Perinatal losses and “invisible” griefs — an unborn child, a miscarriage, a person with whom the bond was not socially recognized — are often minimized by those around. The pain is there regardless, and not being able to name it makes it more complicated.
Anticipatory grief begins before death, during a serious illness. It is the territory I know best: in psycho-oncological support at Careggi Hospital I worked with people and families in that phase. Those going through it often feel guilty for already processing something that hasn't happened yet. It is a normal process, and it takes nothing away from the person who is still there.
What helps
Don't rush the timing, neither your own nor others'.
Give shape to the memory. Write a letter to the person who is no longer there, keep an object, maintain a ritual. These are ways to transform the bond, not to interrupt it.
Keep the basics in place: sleep, meals, at least some movement. It seems trivial, and it's what holds up the structure while everything else fluctuates.
Allow yourself breaks. The days when you don't suffer are not a betrayal: they are the restorative pole of the oscillation, and they are needed.
Choose carefully who to tell. Not everyone knows how to be present with pain, and it's not their fault. One person who can hold steady is enough.
A therapeutic space, when the network around isn't enough or when the pain finds no words. In some cases, when the death was traumatic or the images keep coming back, I also consider working with theEMDR.
What not to say to someone experiencing grief
A few phrases that are often heard and that hurt, with the reason why they hurt.
“You have to be strong.” It turns pain into a failure and forces you to hide it.
“Time heals everything.” It's not true, and those in the midst of pain know it.
“At least they didn't suffer.” Phrases that start with “at least” always minimize.
“I know how you feel.” No one knows, not even someone who has lost someone.
“You have to move on.” It rushes a process that doesn't allow for it.
What works is much simpler: being present, naming the deceased person instead of avoiding their name, and offering concrete help instead of a generic “call me if you need anything.”
Frequent use
What are the stages of grief processing?
The five-stage model is very well known but is not confirmed by research, and it originated from the observation of terminally ill patients, not of those who are left behind. Current models describe an oscillation between pain and daily life, and tasks to go through multiple times, without a fixed order.
How long does grief processing last?
There is no standard duration. The intensity tends to decrease and the waves to become less frequent. If after six to twelve months the pain is unchanged and prevents you from living, it is called prolonged grief and it's worth seeking help.
Is it normal to feel guilty when you feel better?
Yes, and it's among the most common experiences. Feeling better doesn't mean forgetting, and loyalty to those who are no longer there isn't measured in suffering.
Do I have to remove the photos and objects?
No, there is no rule. Some people need to keep them, others need to put them away for a period. Both choices are fine, as long as they are choices and not impositions from someone else.
How do you help a child who has lost a parent?
By talking to them with real words suited to their age, without confusing metaphors, and without excluding them from the rituals. Children process grief intermittently — they cry and then go play — and this doesn't mean they haven't understood.
Can grief make you sick?
It has real effects on the body: sleep, appetite, immune defenses, blood pressure. It's not imagination, and it's one more reason not to face it alone.
A journey in Florence or online
If you are going through a loss and feel like you can't cope alone, you can contact me for an initial introductory session. I receive in my office in Florence, at Via Tommaso Campanella 5, in the Campo di Marte – Coverciano area, and online.
You can also find two more personal reflections on the topic: Grief work and death and processing it in psychotherapy.
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