Grief · 9 min

Grief: what it is, how it feels and when to seek help

Mark Mesa Oostlander
17 October 2026

Sooner or later, all of us go through grief. It is universal and part of life, but that does not make it easy: losing someone or something important hurts, unsettles our day-to-day life and sometimes changes the way we understand the world.

In this article, Mark Mesa Oostlander, a psychotherapist at Centro Elemental with experience in crisis intervention, looks at what grief is, why it is better not to think of it as a staircase of stages, and when it makes sense to ask for help.

What is grief?

Grief is the normal reaction to a loss: the process of adapting to the fact that something or someone who mattered to us is no longer there. There are many definitions, but almost all of them share three ideas: it is a response to a painful event, it involves a loss and it requires work to adapt.

We tend to associate it with the death of a loved one, but there is also grief when a relationship ends, when we lose a job or our financial stability, when our health changes or when a long-cherished plan fades away. What is experienced as a loss is worked through as a loss.

Normal grief and complicated grief

In most cases grief runs its course and, over time, resolves: the pain does not disappear completely, but it leaves room to carry on living. This is what is called normal or uncomplicated grief.

At other times the process gets stuck. Mark explains it with the image of a badly healed wound: on the outside it looks closed, but underneath it is still infected. It may seem that the grief has been overcome and then, two, three or four years later, the distress resurfaces. Some people come to therapy with suffering they cannot trace to any source and, as we follow the thread, a loss that could not be worked through comes to light.

Diagnostic manuals now include prolonged grief disorder for cases in which intense longing for the person who has died, or constant preoccupation with them, persists for a long time and significantly interferes with life: ICD-11 refers to at least six months after the loss, and DSM-5-TR to at least twelve months in adults. These are reference points for professionals, not a clock for measuring one’s own pain.

How long does grief last?

This is one of the most frequent questions. There is no ‘correct’ length: it depends on who has been lost, the circumstances of the loss, the bond there was, the support each person has and their resources for coping with problems. Many authors place typical grief at between six months and two years, but it is best not to be prescriptive: comparing yourself with a deadline tends to add guilt to a process that is already difficult.

Why don’t we talk about ‘stages’ of grief?

The idea that grief progresses through stages was popularised by the psychiatrist Elisabeth Kübler-Ross, who described five stages (denial, anger, bargaining, depression and acceptance) based on her work with people at the end of life. Other authors have proposed even more stages.

The problem with thinking in stages is that it suggests the process is linear and automatic, as if all you had to do was wait for them to pass. In practice it does not work like that: you move forward and fall back, some emotions blend with others and each person travels the path in their own way.

William Worden’s four tasks of mourning

Mark’s favourite description is that of the psychologist William Worden, who speaks of tasks rather than stages. They do not have to be completed in order or one at a time: they can overlap and be worked on at the same time.

Accepting the reality of the loss. Coming to terms with the fact that it is final and irreversible, not only intellectually but emotionally too.
Working through the pain. Allowing yourself to feel the sadness, anger or guilt instead of covering them up, and being able to talk about them.
Adjusting to a world without the person or without what was lost. Externally, by taking on roles and tasks that someone else used to do; internally, by reviewing how we see ourselves; and also in terms of the meaning of life, because a loss can change what we consider important.
Relocating the bond and carrying on living. It is not about forgetting or saying goodbye forever, but about finding a place for that person within us that allows us to move forward.

Along the same lines, the narrative therapist Michael White proposed ‘saying hullo again’ to the person we have lost: instead of severing the relationship, transforming it into a presence that keeps us company.

When is it a good idea to ask for help?

A psychologist can help both with complicated grief and with grief that is following its normal course. Some signs that it may be a good time to seek help:

A long time has passed and the pain is just as intense or getting worse.
You find it hard to function at work, at home or in your relationships.
You avoid everything that reminds you of the loss, or you cannot think about anything else.
You feel guilt, anger or emptiness that you do not know how to handle.
Sleep problems, anxiety or a distress you cannot trace to any source appear.
Quite simply, the anguish is so great that you would rather not go through it alone.

Seeking support does not mean your grief is ‘going wrong’. Many people are working through it well and simply want someone to guide them and be with them at a very hard time.

How we work with grief at Centro Elemental

We work from a brief systemic therapy approach: we look at the loss within the life of each person, their family and their relationships, and we build on the resources they already have. We agree on specific goals and review them together. Sessions can take place at our practice in Málaga’s Soho district or by video call, and last approximately one hour (€80). More information on individual therapy and online therapy (both pages are also available in English).

If you would like to hear Mark explain these ideas, you can watch his video on grief.

If you are at risk, or someone close to you is, call 112 or Línea 024, the suicide prevention helpline in Spain.