Phases of Grief

Denial, Anger and Negotiation of the news

The Kübler-Ross model describes the emotional process in the face of imminent death or great loss.

The first phase is Denial and Shock: a temporary defense mechanism where the person (or their partner) refuses to accept the reality of the diagnosis ("it must be a lab error", "it's not me").

This cushions the initial shock but must give way to reality. When denial falls, Anger or rage arises.

The patient asks "Why me?" and may project hostility toward physicians, family, partner or God. It is vital that the environment does not take these attacks personally.

Subsequently, Bargaining appears: an attempt to postpone the inevitable through "deals" with a higher force or behavioral changes ("if I behave myself/stop smoking, I will live until my son's wedding"). It is an attempt to regain control over an unmanageable situation.

Depression and Final Acceptance

When the disease progresses and negotiation fails, Depression arrives. It is not a clinical pathology, but an appropriate response to the great loss ahead.

The patient begins to say goodbye, to mourn what will be left behind and to prepare for separation. It is an anticipatory grief.

Trying to artificially "cheer up" the patient at this stage is counterproductive; he needs space for his sadness.

Finally, if there is enough time, Acceptance can be reached. It is not happiness, but a peace devoid of intense feelings. The patient stops struggling and accepts his finitude.

At this stage, the circle of interest narrows, the need to talk diminishes and silent companionship becomes the language of love.

For the surviving couple, reaching their own acceptance of the outcome is key to allowing the other to leave in peace.

Communication and therapeutic accompaniment

The role of the therapist is not to "fix" the death, but to accompany in the truth. One of the most difficult tasks is communication with children.

Adults often try to "protect" them with euphemisms ("grandfather fell asleep"), which generates confusion and nighttime fears.

One should speak with age-appropriate honesty, explaining that the body has stopped functioning and that death is irreversible but not a voluntary abandonment. With the terminally ill patient, therapy focuses on active listening and validation.

They often need to talk about their fears, review their life, close unfinished business or simply be recognized as a living person