Deconstructing Stage Models in Modern Bereavement Therapy

This article critically evaluates the place of stage models in modern bereavement therapy and introduces evidence-based, client-centred alternatives.

Related articles: Assessing and Treating Prolonged Grief Disorder, Helping Clients Navigate Death Anxiety, Working with Loneliness: Interventions to Support Lonely Clients.

Introduction

For decades, mental health practitioners and the public have relied on structured, stage-based frameworks to understand the grieving process. Among these, Elisabeth Kübler-Ross’s five-stage model has had the most cultural and clinical influence. However, as the field of grief and bereavement research has matured, contemporary scholars have raised concerns about the limitations of these models. In their place, newer frameworks highlight meaning-making, cultural nuance, and relational continuity in grief.

This article critically evaluates the place of stage models in modern bereavement therapy and introduces evidence-based, client-centred alternatives along with practical tools, interventions, and conceptual frameworks for navigating grief with greater flexibility and empathy.

Overview of the Kübler-Ross model

Elisabeth Kübler-Ross (1969) introduced the five stages of grief – denial, anger, bargaining, depression, and acceptance – based on her work with terminally ill patients. Over time, this model was broadly applied to individuals experiencing bereavement, despite its original focus on the dying process rather than those mourning a loss. The model offered an accessible language for understanding grief and helped destigmatise strong emotional responses. It also normalised grief as a process rather than a pathology.

While the simplicity and structure of the model contributed to its popularity, it is now widely recognised that this linear approach fails to account for the diversity of grieving experiences.

The limitations of stage-based grief models

Although the Kübler-Ross model offered an initial framework for understanding emotional responses to loss, it is increasingly viewed as reductive. Contemporary research shows that grief does not unfold in predictable stages. Rather, it is a complex, individualised, and contextually shaped experience. For instance, Bonanno et al. (2002) found that resilience, rather than distress, is the most common grief trajectory. Furthermore, rigid stage-based models can pathologise normal grief, mislead clients, and set unrealistic expectations for how bereavement “should” unfold (Turner & Stauffer, 2023).

Additionally, these models often fail to accommodate cultural, spiritual, and systemic factors that influence how grief is experienced and expressed. Shapiro (2023) highlights the limitations of Western grief theories in non-Western cultural contexts and stresses the need for greater cultural sensitivity and narrative flexibility in therapy.

Contemporary grief theories and models

In response to these limitations, grief research has moved towards more nuanced and integrative models. These contemporary frameworks better reflect the lived experience of bereavement and allow clinicians to tailor interventions to the client’s needs, values, and contexts.

Meaning-making and reconstruction models

The meaning-making model views grief as a process of reconstructing a sense of identity, coherence, and purpose following a loss (Neimeyer, 2020). This process involves sense-making (understanding why the loss happened), benefit-finding (identifying any personal growth), and identity reconstruction. Clients may, for instance, explore how their worldview has shifted, how they wish to maintain the legacy of the deceased, and how they imagine their future self.

Lichtenthal et al (2019) outline how meaning-centred grief therapy supports clients in locating a sense of purpose in life after loss, even in the face of traumatic or sudden bereavement. Interventions often focus on narrative techniques, metaphor, and existential reflection.

Dual process model

Stroebe and Schut’s (1999) dual process model (DPM) identifies two types of coping processes in grief: loss-oriented (e.g., yearning, sadness, reflecting on the deceased) and restoration-oriented (e.g., attending to life changes, adapting to new roles). Healthy adaptation involves oscillating between both. Tay and Neimeyer (2021) note that this model validates the flexible, non-linear nature of grief and offers clients permission to engage in everyday life without guilt, while still honouring their grief.

In practice, this model supports alternating therapy sessions or self-care plans that balance deep emotional processing with actionable, forward-looking behaviours.

Continuing bonds theory

Early grief theories often emphasised the need to “let go” of the deceased. In contrast, the continuing bonds model (Klass, Silverman, & Nickman, 1996) highlights that ongoing emotional or symbolic connections with the deceased can be adaptive. These bonds may take many forms—visiting graves, speaking to the deceased, rituals, dreams, or internal dialogues.

Recent research supports this perspective, showing that continuing bonds are especially important in cultures with ancestral traditions and in cases where the loss occurred suddenly or traumatically (Wilson, 2018). Therapy can assist clients in exploring how to maintain meaningful, healthy connections to their loved one without becoming stuck in unresolved grief.

Cultural considerations in grief therapy

Cultural traditions deeply shape how individuals experience, express, and process grief. Western therapeutic models—largely based on individualistic and expressive norms—can be misaligned with the collectivist, spiritual, or ritual-oriented mourning practices of many cultures.

Shapiro (2023) stresses that clinicians must take cultural diversity seriously, not only in expression but in conceptualisation of grief itself. In some cultures, talking openly about the deceased is discouraged, while in others, elaborate rituals are necessary to ensure spiritual peace. Assumptions about “closure” or “moving on” may not apply across all worldviews.

Clinicians are encouraged to:

• Conduct culturally informed grief assessments.
• Use open-ended questions about cultural rituals and beliefs.
• Validate culturally specific expressions of grief (e.g., stoicism, somatisation, or spiritual experiences).
• Incorporate or acknowledge important community or spiritual practices into therapy.

Practical strategies and clinical interventions

Grief therapy is not a one-size-fits-all process. Clinicians must tailor their interventions to the client’s stage of adjustment, cultural background, type of loss, and personality. The following are robust, evidence-informed approaches that draw on contemporary grief theory.

Narrative therapy

Narrative therapy supports clients in reconstructing a coherent life story in which the loss has a place, meaning, and legacy. This helps individuals re-integrate the deceased into their self-narrative without overwhelming distress.

Techniques include:

• Externalisation: Naming “grief” as something outside the client to gain distance (e.g., “the storm of sorrow”).
• Re-authoring conversations: Exploring how the deceased influenced the client’s values or decisions.
• Letter writing: Writing unsent letters to or from the deceased to foster symbolic communication.

This approach is particularly useful with disenfranchised or sudden losses, helping clients reconstruct identity and agency (Neimeyer, 2020).

Expressive arts therapy

Creative modalities allow access to emotional experiences that may be difficult to verbalise, particularly for children, neurodivergent individuals, or trauma survivors.

Techniques include:

• Grief collages or memory boxes to honour the deceased.
• Music therapy (where clients express grief through composition or playlists).
• Sandplay or clay modelling to explore complex emotional states without words.

According to Tay and Neimeyer (2021), metaphor and symbol are powerful tools for meaning-making in grief, particularly where trauma complicates expression.

Meaning-centred grief therapy

Meaning-centred grief therapy (MCGT) focuses on exploring clients’ sources of meaning in the wake of loss and helping them re-orient their lives toward values and purpose (Lichtenthal et al., 2019).

Techniques include:

• Values clarification: Using tools like the Valued Living Questionnaire to explore guiding principles.
• Legacy projects: Memorial art, events, or initiatives that reflect the deceased’s influence.
• Future narrative work: Encouraging clients to visualise a meaningful life that integrates the loss rather than avoids it.

This approach can be especially helpful for grief complicated by existential crisis or loss of identity.

Cognitive behavioural therapy (CBT)

CBT can assist in addressing maladaptive cognitions and behaviours that prolong or intensify grief, particularly in clients with comorbid anxiety or depression.

Techniques include:

• Thought records to challenge beliefs such as “I should have prevented their death.”
• Exposure-based strategies for avoided stimuli (e.g., going through belongings).
• Behavioural activation to re-engage with pleasurable or meaningful activities.

CBT’s structured approach is helpful for clients who seek practical tools alongside emotional processing.

Group therapy

Group therapy offers mutual support, normalisation, and communal healing. It can be structured around specific populations (e.g., parents, widows, siblings) and creates a shared space for meaning-making and ritual.

Approaches include:

• Closed groups with psychoeducation and weekly themes.
• Open grief circles incorporating ritual, storytelling, and spiritual practices.
• Creative group activities like collaborative memorial projects or guided writing exercises.

Group therapy is particularly effective in reducing isolation and providing a range of coping models (Turner & Stauffer, 2023).

Conclusion

Grief is not a problem to be solved or a sequence of steps to be completed – it is a complex, relational, and evolving process. While stage models like Kübler-Ross’s have served as foundational starting points, they are insufficient for capturing the realities of modern bereavement. Contemporary grief models emphasise meaning, identity, culture, and continuing bonds, offering richer frameworks for clinical work. Therapists must adopt flexible, culturally sensitive, and evidence-informed approaches that empower clients to honour their loss, reconstruct their world, and engage meaningfully with life again.

Key takeaways

• Stage models of grief are outdated and risk oversimplifying complex, personal experiences.
• Modern frameworks emphasise meaning-making, oscillation, and continuing bonds.
• Cultural considerations are essential – grief is not universally expressed or understood.
• Narrative, expressive, cognitive-behavioural, meaning-centred, and group therapies all offer unique clinical value.
• Clinicians should personalise interventions and remain flexible in their approach.

Questions therapists often ask

Q: Why should I move beyond using stage-based models (like the Kübler‑Ross model) when working with bereaved clients?

A: Because grief rarely unfolds in neat, universal stages. The article points out that stage-based models tend to oversimplify grief and may even pathologise normal, highly individual variations in grieving.

Q: What are some of the alternative models to stage-based frameworks that better reflect clients’ real experiences of grief?

A: The article highlights several contemporary models — including the Meaning‑Making model, the Dual Process Model (DPM), and the Continuing Bonds theory — each of which emphasises flexibility, personal meaning, ongoing connection to the deceased, and oscillation between loss-oriented and restoration-oriented coping.

Q: In practical therapy, how can I help a client reconstruct their life narrative following a loss?

A: Use techniques like narrative therapy: encourage clients to externalise grief (for instance, calling it “the storm of sorrow”), reauthor their life story to integrate the loss, and perhaps use symbolic rituals (e.g., writing unsent letters) to maintain a healthy internal dialogue with the deceased.

Q: How do I account for cultural and spiritual differences in grief expression when working with clients from diverse backgrounds?

A: The article urges clinicians to conduct culturally informed grief-assessments, ask open questions about a client’s cultural and spiritual mourning practices, validate non-Western expressions of grief (which might include stoicism, somatisation or ritual), and adapt interventions accordingly rather than imposing Western “closure”-oriented expectations.

Q: When might structured interventions like cognitive-behavioural therapy or group therapy be useful for bereaved clients — and when might more flexible, meaning-centred approaches be preferable?

A: Structured approaches (e.g., CBT, behavioural activation, group therapy) can provide practical support, especially when grief is complicated by anxiety, depression or functional impairment. But for clients struggling with existential distress, identity disruption, or disenfranchised loss, meaning-centred interventions (narrative therapy, expressive arts, legacy work) may offer deeper opportunities to reconstruct identity and integrate loss authentically.

References

• 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 pre-loss to 18-months post-loss. Journal of personality and social psychology, 83(5), 1150–1164. https://doi.org/10.1037//0022-3514.83.5.1150
• Klass, D., Silverman, P. R., & Nickman, S. L. (1996). Continuing bonds: New understandings of grief. Taylor & Francis.
• Kübler-Ross, E. (1969). On death and dying. New York: Macmillan.
• Lichtenthal, W. G., Catarozoli, C., Masterson, M., Slivjak, E., Schofield, E., Roberts, K. E., Neimeyer, R. A., Wiener, L., Prigerson, H. G., Kissane, D. W., Li, Y., & Breitbart, W. (2019). An open trial of meaning-centered grief therapy: Rationale and preliminary evaluation. Palliative & supportive care, 17(1), 2–12. https://doi.org/10.1017/S1478951518000925
• Neimeyer, R. A. (2020). Meaning-making in bereavement transitions: Review and clinical relevance. In E. Milman & R.A. Neimeyer, Navigating Life Transitions for Meaning. Elsevier.
• Shapiro, K. (2023). Grief, loss, and bereavement: Understanding concepts, clinical manifestations, and cultural considerations at end of life. In C. Banerjee (Ed.), Understanding End of Life Practices: Perspectives on Communication, Religion and Culture (pp. 105–113). Springer.
• 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
• Tay, D., & Neimeyer, R. A. (2021). Making meaning with metaphor in grief therapy: A single-session segmental approach. Cognitive Linguistic Studies 8(1) DOI:10.1075/cogls.00070.tay
• Turner, R. B., & Stauffer, S. D. (2023). Disenfranchised grief: Examining social, cultural, and relational impacts. New York: Routledge.
• Wilson, J. (2018). Therapy for grief resolution: Accepted theories and new developments. Retrieved from https://johnwilsononline.org/187-2/