Stage of Grief Models: Horowitz
Kathryn Patricelli, MA, edited by Mark Dombeck, Ph.D.Stages and Process of Grief
Even though everyone grieves losses in different ways, there are some regular patterns or stages of grieving that people usually experience. These patterns describe the emotions and mental processes that may be felt at different stages of the grief process.
Horowitz?s Model of Loss/Adaptation
Psychiatrist Mardi Horowitz divides the process of normal grief into the following "stages of loss." These stages are typical, but they don't occur for everyone or always in this exact order.
- Outcry. People often get upset when they first realize that they have lost someone important. They may publicly scream and yell; cry and collapse. Alternatively, they may hold their distress inside and not share it with others. Outcry feelings may be suppressed by the person who is feeling them so that the feelings are not felt too strongly, or they may spill out uncontrollably. In any event, initial outcry feelings take a lot of energy to sustain and tend to not last too long.
- Denial and Intrusion. As people move past the initial outcry, they will often enter a period characterized by movement between 'denial' and 'intrusion'. This means that people will experience periods where they distract themselves so thoroughly in other activities and thoughts they don't think about the loss, and also periods where the loss is felt very strongly and acutely, perhaps even as intensely as during the initial outcry stage. It is normal for people to bounce between these opposites of engagement and disengagement. People may feel guilty when they realize they are no longer constantly feeling their loss and are able to engage in other activities and emotions, but it is a good thing that this happens. Distraction and disengagement break up the intensity of feeling characteristic of the acute pain of loss so it is more manageable and less overwhelming.
- Working Through. As time goes by (days, weeks, months), the movement between denial (not thinking about or feeling the loss) and intrusion (thinking about and feeling the loss very intensely) tends to slow down and becomes less pronounced, with people spending more time not thinking about or feeling the loss, and less time being overwhelmed by it. During the working through stage, people think about and feel their loss, but also start to figure out new ways to manage without the lost relationship. Such new ways of managing might include making preparations to date again (or just starting to think about it), developing new friendships and strengthening existing ones, finding new hobbies, engaging in new projects, etc.
- Completion. At some point in time (months, years), the process of grieving is completed or rather, "completed enough", so that life has started to feel normal again. While memories remain of what has been lost, the feeling attached to the loss is less painful and no longer regularly interferes with the person's life. Temporary reactivation of grief feelings may occur on anniversaries important to the lost relationship (marriage and engagement dates, etc.), but such upwellings of hurt feeling tend to be temporary in nature.
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Resources
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Articles
- Introduction to Grief and Bereavement Issues
- Grief is a Normal and Natural Process
- Stage of Grief Models: Horowitz
- Stage of Grief Models: Kubler-Ross
- Stage of Grief Models: Rando
- Symptoms of Grief
- Coping With Your Own Grief
- More About Coping With Grief
- Understanding When Grief is Complete
- Helping Other Adults Cope With Grief
- Helping Children Cope With Grief
- What To Tell Children About Grief Depends on Their Age
- Cultural and Religious-Spiritual Implications of Grief
- Understanding Pathological Grief
- Grief Resources
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Questions and Answers
- Do You Know What's Wrong With Me?
- Recent Loss of my Mother is Causing Problems...
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- Ending Therapy
- Am I Depressed?
- Therapist Was Fired
- My husband has left me for another woman. How do I let go?
- Is a friendship possible after dating/living together for 3 years
- Children's role-play after loss. Is this an instance of denial?
- How do I help my grieving, substance abusing daughter?
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- How can I help a grieving sister who is angry with me?
- how do i deal with the fact that my therapist is dying?
- Death of both parents
- How to Help My Grieving Mother?
- Sister's Death
- death of a dear friend
- My Fiancee Can't Get Over His Late Wife
- My friend cant get out of love
- love rejection
- I am the product of a rape
- i can't seem to get over any of this
- Lingering Feelings for my old affair partner
- one year out and just starting to deal with grief
- Finding It Very Difficult To Forgive
- Embarrassed and Ashamed of My Weakness
- Grieving All The Time
- Longing For My Son
- Why Did He Back Away?
- Grieving and Clueless
- Sudden Loss
- Bereavement and Grief
- Smoking To Remember Mom
- Trauma/Tragedy
- Broken Heart
- The Aftermath of Suicide
- A Recent Loss
- Losing a Father
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Book & Media Reviews
- 12 and Holding
- 3 NBS of Julian Drew
- After You'd Gone
- All Alone in the Universe
- All Rivers Flow to the Sea
- All Seasons Pass
- Bereft
- Bodies in Motion and at Rest
- Catalyst
- Closure
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- Comfort
- Death of a Parent
- Don't Go Where I Can't Follow
- Driving My Father
- Emma Jean Lazarus Fell Out of a Tree
- Feather Boy
- Fortress of My Youth
- Going Through Hell Without Help From Above
- Good Grief
- Goodbye Rune
- Healing Conversations
- Honoring Grief
- How We Grieve
- I Remain in Darkness
- I Wasn't Ready to Say Goodbye
- Is There a Duty to Die?
- It Takes a Worried Man
- Liberating Losses
- Life after Loss
- Lost in the Forest
- Love Is a Mix Tape
- Love That Dog
- Michael Rosen's Sad Book
- Name All the Animals
- Nobody's Child Anymore
- Remembering Georgy
- Saving Grace
- Saying It Out Loud
- Seeing the Crab
- Speak to Me
- Still Here
- The Bad Beginning
- The Carnivorous Carnival
- The Color of Absence
- The Dead Fathers Club
- The Death of a Child
- The Hostile Hospital
- The Lovely Bones
- The Measure of Our Days
- The Miracle
- The Scar
- The Truth About Grief
- The Undertaking
- Understanding Grief
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- What Dying People Want
- Wild Awake
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Links
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Videos
- The Journey Through Loss and Grief
- Acute Grief: The Initial Response to Bereavement
- We don't "move on" from grief - We move forward with it
- Complicated Grief: Q & A with Dr. M. Katherine Shear
- Grief through a Child's Eyes
- The Adventure of Grief: Dr Geoff Warburton
- The Grieving Process
- 12 Suggestions for Dealing with Grief and Loss
- Dealing With Loss and Grief
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More Information
- An Interview with George Bonanno, Ph.D., on Bereavement
- An Interview with Holli Kenley, MA, on Surviving Betrayal
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