Wednesday, September 24, 2008


Another issue sometimes connected with the acting out cycle is grief. Various theories have talked about the process of grief. The theory I like best is provided by Kubler-Ross where she identified five stages of grief. Her original research has focused on death of a loved one through terminal cancer. Subsequent researchers have modified or adapted her model, but the common reference in all of those models is a comparison to the original model. The five stages of grief according to Kubler-Ross are denial, bargaining, anger, depression and acceptance.

Three adaptations or expansions of the model that I include are: one, the role of perceived losses and two, the role of small losses, and three the “time focus” of grief. Sometimes feelings of grief result from a loss such as a death of a loved one as originally highlighted by Kubler-Ross. Grief from other losses can have a powerful impact in a person’s life. Feelings of grief may be due to the end of a relationship or friendship. It is important to highlight that grief may be due to the loss of hopes, dreams, and/or fantasies. For example, in the coming out process, depression is sometimes present because of the loss of the expectation that life was supposed to be a certain way and recognizing a same-sex identity brings an end to the expectation. Sometimes, the symbolic meaning of an event, location or person triggers a great experience of loss. Moving from your home results in a recognition of the end of a relationship. These perceived losses can have the same impact as a tangible loss. The feelings associated with the loss of a dream can parallel the loss of a partner. Third, some feelings of grief are anticipatory; in this situation, I might “see” the end of something. This may show up as “This is a bad relationship; I need to get out of it so I have sex with a third person to cause a rupture in the relationship causing it to end.” Another example is getting yourself fired because you don’t like your job.

As you review your acting out cycle, pay attention to how the following stages of grief may have played out. I’ve provided a few examples that are descriptive of how the stage might be expressed.

Denial. In this stage, this is an active thinking process of avoiding grief. For some people, they might start overworking and then use the overwork to justify the acting out behavior. With some clients who discover they are HIV+, their acting out behavior may increase because of the sense that it simply doesn’t matter anymore. Another example might be the loss of a relationship, and engaging in sexual contact because you’re lonely.

Bargaining. In this stage, there is recognition of the grief, but the coping mechanism is toward minimizing the impact of grief. “It’s not a big deal.” Or, starting to date before the grief is resolved. Another way this may be present is selecting a new partner with the thought “He/She is better than no-one.” A final example is “He/She isn’t like the last one!”

Anger: In this stage, the energy of the process of coping with grief is extended outward. Statements such as “All men are like that” may reflect an avoidance of relationships or forms of intimacy. As you could guess, these feelings might lead to isolation resulting in a subsequent acting out cycle.

Depression: Common thoughts in this stage might include “why try” or “it doesn’t matter” or even “It’ll never work out.” One of the difficulties is distinguishing between depression and grief is that depression is part of the grief process. Review the topic on depression. Might any of the symptoms you’re experiencing of depression be related to grief?

Acceptance: By this point, the grief is recognized, integrated and while present, has lost most of the power. In my mind, this means that you can acknowledge the loss, but the loss doesn’t result in a barrier to healthy relationships or daily functioning of the individual. In some cases, the loss may actually facilitate transformation. These are signs of successful adjustment to grief.

One of the critiques of Kubler-Ross’ model is the perception that the process of coping with grief is linear; that you simply go through one stage to the next, followed by stages 3, 4, and 5. My experience suggests that is cyclical; you might see parts of each stage in the moment and depending on the circumstances of the moment, experience the grief differently. The key for me is to recognize whatever the situation, it is acceptable and healthy to be present to your thoughts and feelings. A second critique is the implication that process occurs once and is rather “quick.” The manual used by the mental health field suggests that grief only lasts two months which may be too short. My experience also suggests that in some circumstances grief can exceed a year or more. And you can re-experience grief when certain rituals, anniversaries or memories are triggered.

In addressing grief and the acting out cycle, I will request clients complete the following task: Take a piece of paper, and create three columns. In the first column, list 100 experiences of real, perceived, major and/or minor experiences of loss. While 100 may seem like a lot, my experience is that people can identify more losses than they realize. Usually, this part of the assignment can take days and weeks to complete. Complete this part of the assignment before you move to columns two and three. In the second column, explain why this loss still impacts you today. Why does it have so much power now? In the third column, identify possible thinking errors or plans to address the loss. The example below can be helpful.

Type of Loss
Major loss (death)
Minor loss (plans cancelled)
Real (relationship ended)
Perceived (loss of my idea how the future would look. Explanation.
How does it impact me today?
Why does this loss have so much power? Plans and corrections.
How will you address this loss?
Is the loss based on a thinking error, if so, what is your correction?
My partner left me. I feel alone and hurt
Shame (it’s my fault).
I will never find anyone
Nobody loves me
I will talk about it with my support group and therapist. I will read a book on dating.
I didn’t get the job I’m no good
They don’t like me. I can find another job.
My job doesn’t define me.
I’m gay.

I won’t be able to have children. Everybody judges me.
I will be alone
It is a sin. I could adopt.
There are happy gay people in connected loving relationships.
Not everyone believes it is a sin; in fact some people think it is a blessing.

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