After my father was diagnosed with a lung disease that has no known cause and no cure, I spent some time talking with psychotherapist Edy Nathan, MA, LCSWR. Her new book, It’s Grief: The Dance of Self-Discovery through Trauma and Loss, is based on more than 20 years of personal and clinical experience in the field of grief and loss. The pages walk readers through the complexities of the self that a person experiences after a traumatic loss and explores how to journey through what she refers to as the “11 phases of grief.” In addition to discussing what these 11 phases mean, I also spoke to her about some of the less publicized emotions and thoughts that may accompany the loss of a loved one. 

What to Expect After a Loss: 11 Phases of Grief

A major component of Nathan’s book is an in-depth description of 11 phases of grief, which expand on the traditional five stages (ie, denial, anger, bargaining, depression, acceptance) to include a broader spectrum of emotions. The original five were proposed in 1969 by Swiss-American psychiatrist Elisabeth Kubler-Ross who was inspired by her work with the terminally ill. Nathan’s 11 touch on Kubler-Ross’ 5 but have been reworked to include the following:

  • Emotional Armor: Numbness, Hysteria, Denial and Protest, Shock
  • Role Confusion
  • The Three D’s: Distraction, Depression, and Detachment
  • Fear and Anxiety
  • Anger, Rage, and Despair
  • Regret, Guilt, and Shame
  • Sadness
  • Forgiveness
  • Re-patterning, Calibration, and Integration
  • Resolution
  • Grace

Nathan specifically uses the term “phases” as opposed to the more conventional “stages” of grief to hone in on the fact that individuals experiencing grief are likely to enter and exit each emotion at different times, and not always in a particular order. They may even revisit certain phases, such as on the anniversary of a loss. She writes, “When you move with the flow of grief, seeking to understand its power, purpose, and process can make your journey to the other side a bit better.” Nathan also emphasizes that grief is like a “fingerprint,” as no two people experience it in the same way. For instance, a person’s prior experience with trauma or loss, their gender, and their personality type (ie, introvert, extrovert, ambivert) all play a role in the way they process grief. “Grief can even tie back to how we handled separation from our mothers as a child,” says Nathan. “We return to the coping methods we know.”

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Thus, there is no “normal” way to process grief, she explains. In fact, she says, if a loved one has been given a terminal diagnosis or is in the process of dying, don’t be surprised if grief shows up before they pass (read Part 1 in this series to learn more about anticipatory grief). 

What You Might Not Expect With the Loss of a Loved One

From denial and anger, to sadness and eventual hope, there are many emotions people expect to have when they lose or are about to lose a parent, a spouse, a sibling, a child, or a friend. But there are other feelings, integrated into the 11 phases noted above, that can sneak in during this time, feelings that I and likely others find more difficult to share or to admit. Nathan talks through a few of these below.

Stuckness
For the past several months, I have often felt “stuck” when thinking about my father and the short future ahead. It is difficult to make any major plans as I do not know when he may pass, or when I will need to jump in the car and rush to his bedside. For those who serve as primary caregivers, like my mom, they may feel unable to leave the house, to enjoy a meal out, or to maintain their work schedule.

When a loved one is dying, says Nathan, it’s common to feel “stuck” in the situation. But “stuckness” can also emerge when you worry about what things will be like after your loved one dies, she adds. For example, I often wonder how my family dynamic will change and what get-togethers may be like in the future? My mom is stuck wondering how she will manage logistical things, such as finances and major house maintenance—issues my father took leadership of over the years. And we both, like many in this situation, can’t help but think, who will I be, without this person? As Nathan tells me, when you are caught in the phases of grief, you find yourself unable—or unwilling—to look to the future or to move on.

The way people emote grief to friends and coworkers can also make one feel at a standstill, or even detached from what is going on. As a prideful society, reaching out for help may be considered weak, explains Nathan. “We don’t want to be judged about the way we handle our grief, about how long it takes, or how we cope,” she says. However, putting on a smile and showing acceptance of a loss, while pushing down other feelings, only keeps us stuck in our grief.

“Becoming aware of how fragile life is is part of the stuckness,” says Nathan. “As a society and as humans, we are fighters, and to realize that we cannot control or change the course for a loved one affects our inner selves and our relationships with others. But, watching someone die can also help you get unstuck,” she says.

For some, this may mean pursuing that “bucket list” even more feverishly than before. For others, it may involve changing the way they make decisions or how they value certain aspects of their lives, including their current relationships, says Nathan. “We care so much about those we love and what they think, that we often can’t be our full selves until after they are gone. Some individuals even find a fuller sense of self after their lives are less intertwined with those they are losing, or have lost,” she adds.

Clinging

Lately, I have found myself feeling overprotective of things my father once gave me—a purple stuffed bear named “Grape Soda,” a walking stick he used to climb Mt. Fuji in Japan, as well as the photographs of us together. I am even saving and printing little texts and emails. I cling to those items almost as if they were him.

Nathan tells me, holding onto a few pieces of clothing or a voicemail from the person you may lose or lost is not unusual. “We hold onto these things for connection,” explains Nathan, “and it doesn’t hurt anyone to do so.” Yet, if you hold onto an entire closet or keep a room the same for years, instead of keeping the memories alive, you are keeping the grief alive, she says, and this could be a sign of complicated grief. Nathan emphasizes that, if grief lingers for more than 3 years, it may be worth talking to a therapist.

Other individuals may not wish to see any objects or images of the deceased as they are too painful to bear, says Nathan. But, when you feel ready, consider placing a few items of theirs in a special box and keep it in a place that is important to you. When you find yourself revisiting one of the phases of grief, open the box and spend some time with the items as a way remember and cherish your loved one.

Relief
Every once in a while, perhaps after my dad has a really bad day or when my mom calls me crying because she just can’t do the 24-hour caregiver thing anymore, I feel a tinge of hope that it will all be over soon. No more suffering. No more crying. No more emotional exhaustion. And then I immediately feel guilty for even harboring such thoughts. I ask Nathan about this…

When a loved one is suffering over a long period, it’s not uncommon to experience relief when they finally pass, she tells me. If you are a caregiver attending to a person’s every need for months at a time, you may find yourself feeling thankful when it ends. If you have felt trapped in a bad or abusive relationship, you may come across a sense of freedom after they are gone. And yet, it may be difficult to share any of these emotions with others. In the same way that we try to put on a hopeful face when faced with trauma, in certain circumstances, we also may avoid telling the truth about what a loss really means to us.

Take a painful or terminal illness, for example. “Watching someone you love go through treatments and not have successes… to see the tubes, the setbacks, the lack of dignity in the dying process… others do not picture how painful that experience is,” says Nathan. “And often, we do not share it.”

Instead, you may find yourself looking forward to what comes next. You may juggle a group of emotions as you try to balance what’s expected of you as “a person in mourning” and your desire for healing. Remember that grief can be “a big moment and a tiny moment at the same time,” says Nathan. “Think of it as a game changer. Things will never be the same after a loss, and that’s OK, because otherwise nothing would be learned.”

For example, Nathan shares how she learned how to take better care of herself after watching her father suffer from obesity. “There are many gifts that come from grief, and we can pay these forward.” 

Staying True to Yourself

Remember, advises Nathan, grief is different for everyone. No one experiences the loss of a loved one, whether the relationship was positive or negative, in the same way. Your journey through grief will be your own. Ensuring that you talk, write, or share your thoughts with others will help you move through the phases of grief more easily.

As I write this article, I couldn’t agree more. Putting my thoughts to paper has been more than therapeutic; it has also re-opened my creative door. It has allowed me to share what my family is going through with others facing the same situation in hopes that they know their feelings—whether pouring out or hiding on the inside—are okay.

Consider taking a fuller look at Edy Nathan’s book, It’s Grief: The Dance of Self-Discovery through Trauma and Loss (2018), or utilizing her grief-focused meditations, available on her website.

Last Updated: Mar 19, 2019