The Chat with Dr.

Dave
Therapeutic Thoughts of the Week

Loss and Grief

In acknowledgement of Veterans Day this weeks Dr. Daves Therapeutic Thoughts of the
Week pertains to the treatment area of loss and grief. The concept of loss and the definition of
loss may be defined by the individual as well as the intensity of the grief associated with the
individuals loss. For the purpose of this weeks Therapeutic Thoughts of the Week the
concept of loss will be defined by the separation from ones primary caregiver. As therapeutic
providers to children involved with the Department of Family Services (DFS) where the legal
guardian is identified as the DFS Case Worker the separation for a child from their natural
parents and/or primary caregivers may be viewed and experienced by the child(ren) as an
enormous sense of loss, which then may be followed with various emotional and behavioral
manifestations of grief. These feelings of loss and grief may also be experienced by the natural
parents or primary caregivers who temporarily have lost their legal right to parent their
child(ren). As a treatment provider to both the child as well as to the the parent/primary
caregivers I would like to present one model of loss and grief that may guide us in
conceptualizing how to support our patients in creating understanding around their feelings
associated with their loss and feelings of grief.
Dr. Elizabeth Kubler-Rosss model of loss and grief from her book Death and Dying is based
upon her identification of five stages of grief that individuals experience when they have lost a
loved one. Dr. Kubler-Rosss work focused on the bereavement associated with the death of a
loved one; however her concepts and stages of grief may also be applied to the loss of a primary
caregiver. Dr. Kubler-Ross identified the following five stages of grief:

First Stage: Denial

In this stage the individual is unwilling to accept the loss or imminent loss and may perceive that
their experience is that of feeling stuck in a bad dream and that life will get back to normal.

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Therapeutic Thoughts of the Week
Second Stage: Anger
In this stage upon the individual acknowledging the loss or that the loss is imminent the
individual may begin to experience feelings of anger and abandonment. Feelings of anger may
be associated with the unfairness of the loss.
Third Stage: Bargaining
In this stage the individual may experience thoughts of bargaining with their higher power
and may make promises of making behavioral changes in exchange for the reversal of the loss.
Fourth Stage: Depression
In this stage the individual may begin to experience symptoms of depression as they realize the
inevitable of the loss and their helplessness to change the situation. Depression may on-set and
present differently for each individual; however the individual may also place blame on
themselves for being unable to control or change the situation.
Fifth Stage: Acceptance
In this stage the individual may begin to accept the loss and move into a mindset of thinking how
they will move forward into the future and begin to re-engage into daily life activities that once
brought pleasure.
This weeks Dr. Daves Therapeutic Thoughts of the Week is to provoke insight regarding the
emotional and behavioral responses that may be presented by the child and/or natural
parents/primary caregivers when the separation/estrangement in this relationship occurs. The
Kubler-Ross model provides a conceptual framework for the provider in understanding how to
identify and assist the individual(s) in processing and creating coherency around their loss and
guiding them through the healing process.