Understanding grief — when loss doesn’t ease with time

Grief is one of the most deeply personal experiences we can go through. There is no single way to grieve, and no point at which you are supposed to be “over it.” Some days may feel almost manageable; on others, a memory, a familiar place, a song or an ordinary moment can bring the loss close again. You may move through sadness, anger, relief, numbness or even moments of happiness — sometimes within the same day. Grief can soften, change and return in ways that are difficult to predict, and none of this means you are grieving incorrectly.

This article looks at what grief might feel like, why some losses can be particularly difficult to carry, when grief may benefit from professional support, and how therapy can help.

Grief does not follow a set pattern

Many people have heard of the five stages of grief: denial, anger, bargaining, depression and acceptance. The model became enormously influential after Elisabeth Kübler-Ross described these experiences in her 1969 book, On Death and Dying.1 Importantly, her original work was based on conversations with people facing terminal illness, rather than on research into how bereaved people grieve after someone has died.

Kübler-Ross later clarified, in a book written with David Kessler, that the stages were not intended to describe a fixed sequence that everyone would follow.2 Contemporary understanding of grief similarly recognises that people respond to loss in very different ways.

You may experience some of these feelings, several of them at once, or none of them in any recognisable order. There is no particular emotional sequence you need to complete, and no particular way you need to grieve.

What grief can feel like

Grief often changes from moment to moment. There may be periods when the loss feels very close, followed by times when you are able to work, laugh, concentrate or simply get on with the ordinary parts of the day. Then something unexpected may bring the grief back into focus. A song. A smell. A familiar street. A photograph. Someone with a similar voice or mannerism. A date on the calendar. These moments can arrive without warning.

For many people, the intensity of grief gradually changes over time, but this does not necessarily mean that the loss becomes unimportant or that thoughts of the person disappear. Grief can remain part of someone’s life while becoming more manageable and less overwhelming. Research on bereavement has also challenged the idea that adapting to loss necessarily means letting go of the person completely. Continuing bonds, such as memories, traditions, conversations, photographs or a sense of an ongoing connection, can have an important place in the way some people live with loss.3

Grief can also appear in ways that are less immediately recognisable. You might notice:

These experiences can occur as part of grief.

Why some losses can feel particularly difficult

Not all losses are experienced in the same way. The circumstances surrounding a loss, the nature of the relationship and what else was happening in your life can all influence how you experience it.

Grief may feel particularly complicated when:

There is no simple hierarchy of loss. The significance of a loss is deeply personal, and what matters to one person may be difficult for someone else to fully understand.

When grief remains particularly difficult

Grief does not need to disappear for someone to be adjusting well. At the same time, sometimes grief remains so intense or persistent that it significantly affects a person’s ability to function or engage with life.

Prolonged Grief Disorder is a recognised mental health condition in both the DSM-5-TR and ICD-11.4 It is not diagnosed simply because someone is still grieving after a particular period of time. Diagnosis involves a pattern of persistent grief-related symptoms, significant distress or impairment, and consideration of the person’s cultural and social context. For adults, the DSM-5-TR specifies that the loss must have occurred at least 12 months previously before Prolonged Grief Disorder can be diagnosed.4

Possible features can include:

These symptoms need to be understood within the person’s circumstances and culture. Having a difficult period of grief does not mean that you have Prolonged Grief Disorder. A diagnosis can only be made through an appropriate professional assessment.

Grief and depression are not the same thing

Grief and depression can sometimes look similar, and they can also occur together. Grief may involve profound sadness, changes in sleep and appetite, reduced concentration and periods of withdrawal. These experiences can be part of a normal response to loss. Depression involves a broader and more persistent pattern of symptoms and may require specific assessment and treatment.

If you are finding it difficult to function, feel persistently hopeless or worthless, or notice that your emotional state is becoming increasingly difficult to manage, it may be worth speaking with a mental health professional. If you are experiencing thoughts of harming yourself or ending your life, please seek urgent professional support. If you are in immediate danger, please go to your nearest emergency department or contact your local emergency services. Our emergency resources page lists crisis lines operating around the clock in South Africa.

The intensity of grief can fluctuate

One of the less talked-about aspects of grief is that people need breaks from it. You may spend an hour thinking about the person who died and then find yourself laughing at something completely unrelated. You may have a good day and feel guilty afterwards. You may enjoy a meal, go to work, see friends or become absorbed in something you love. These moments do not diminish the importance of your loss.

Bereavement research has described grieving as involving movement between attending to the loss and attending to the practical demands of living. This is sometimes described as the dual process model of coping with bereavement. It recognises that people may move between confronting the loss and taking periods of respite from it.5 In other words, you do not need to be thinking about your loss every moment for your grief to be real. There can be room for grief and for life.

What therapy can offer

Therapy is not about trying to make you move on before you are ready. It can provide a place where the loss can be spoken about honestly, including the parts that may be difficult to share with other people. There may be sadness, anger, guilt, relief, love, resentment, longing or uncertainty. Sometimes there are feelings that seem contradictory. Therapy can provide space to explore them without needing to resolve them immediately.

Where the death was traumatic, psychological treatment may also involve working directly with distressing memories or images. Particular therapeutic approaches, including trauma-focused therapies such as EMDR, may sometimes be considered where clinically appropriate following an individual assessment. EMDR is an established treatment for post-traumatic stress disorder and is recommended in clinical guidance for trauma-related difficulties.6

Therapy can also help when grief has begun to affect everyday life. The work may involve:

For some people, grieving also involves finding a way to live with the absence while continuing to carry the relationship in a meaningful way.3 This might involve remembering the person, maintaining traditions, or finding ways to honour what they meant to you. The aim is not to forget the person or leave the relationship behind, but to find a way for the loss to become part of your life without it having to take the place of life itself.

When might it be worth reaching out?

You might consider speaking with a psychologist if:

You do not need to have a clear explanation for why you are struggling before reaching out. Sometimes having someone listen carefully to the whole story is a useful place to begin.

Grief may change shape over time. Some days may feel lighter and others may bring the loss close again. You may find yourself surprised by how much you can enjoy something, followed by a moment when the absence feels overwhelming. These experiences can coexist. If your grief feels difficult to carry, you do not have to carry it entirely on your own.

You are welcome to get in touch if you would like to explore whether psychological therapy may be appropriate for you.

This article provides general educational information about grief and bereavement. It is not a diagnosis and is not a substitute for individual psychological or medical assessment, professional advice or treatment. Grief varies considerably between individuals and across cultures and circumstances. If you are experiencing severe or concerning psychological or physical symptoms, please seek appropriate professional help. If you are in immediate danger or experiencing thoughts of ending your life, seek urgent assistance through appropriate emergency or crisis services — see our emergency resources.