Thursday, February 4, 2010

Thursday's Therapy - Ways We Grieve, Part Five - Horowitz's Model of Loss/Adaptation

Thursday's Therapy

Ways We Grieve

Part Five

Horowitz's Model of Loss/Adaptation

Psychiatrist Mardi Horowitz divides the process of normal grief into "stages of loss." These stages are typical, but they don't occur for everyone or always in this exact order.

  • Outcry. People often get extremely 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 in order to decrease the intensity of the feelings, or they may spill out uncontrollably. In either case, initial outcry feelings take lots of energy to sustain and tend to last for only a short period of time.

  • Denial and Intrusion. As people move past the initial outcry stage, they will often enter a period characterized by movement between 'denial' and 'intrusion.' On one end of the continuum, people distract themselves so thoroughly with other activities and thoughts that they don't think about the loss (Denial). At the opposite end of the continuum, the loss is felt very strongly, almost as intensely as during the initial outcry stage (Intrusion). It is normal for people to bounce between these opposites of denial and intrusion. People may also feel guilty when they experience the denial portion of the continuum (out of fear that they may be betraying their lost loved one by not remaining faithful to them). It is important to keep in mind that the presence of some medium amount of denial is not so much a betrayal as it is a sign that healing of the emotional wound created by the loss has begun. Denial serves to decrease the intensity of feelings so they are more manageable and less overwhelming.

  • Working Through. As time goes by (days, weeks, months), the movement between denial and intrusion slows 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 start to figure out new ways to exist without the lost relationship. Plans and goals during this stage might include making preparations to date again (or just starting to think about it - assuming the loved one was a spouse), developing new friendships and strengthening existing ones, finding new hobbies, engaging in new projects, etc.

  • Completion. At some point (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 important anniversaries (marriage dates, birthdays, holidays, etc.), but such upwelling of hurt feelings tend to be temporary in nature.


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