Stage of Grief Models: Horowitz

Stages and Process of Grief

Even though everyone grieves losses in slightly 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.