Many well intentioned people interpreted Dr. Kubler-Ross' description of the grief process as "The One and Only Grief Process" all grieving people must experience.  However, Dr. Kubler-Ross' descriptions of denial, anger, bargaining, depression, and acceptance may or may not apply to the process a particular person experiences after the death of a loved one.  The nature of the grief process varies depending on many factors.

As friends and family of the person whom has experienced the loss, we need to remember that they may or may not experience the reactions that Kubler-Ross describes.  These reactions do occur in any special order and may occur simultaneously.  Grieving individuals may be angry at the medical system one day, depressed the next, and the become angry again the next day, this time at the person who died.  On the other hand, when a death is expected and "appropriate," family members may feel sadness but little or no anger or depression.

We need to remember that each person experiences and processes grief differently.  Some may feel more grief than others and some may be more open about their grieving.  We need to respect the manner in which each person experiences grief, particularly when the process id different then expected.

The concept of grief as occurring in stages is fraught with difficulties.  Sometimes we feel that we need to push the griever on to the next stage.  We become concerned when the griever is angry for to long, or depression seems to last for weeks on end.  Most of the time, the best intervention for those who are grieving is supportive listening and reassurance as they experience the feelings of grief.

Common Reactions and Interventions are Shock, Denial/Disbelief, Anger and Hostility, Bargaining, What If's and If Onlies; Depression, Acceptance/Reconciliation:

Shock - This a common occurrence when a loved one dies, particularly when the death is sudden and unexpected. 

• Reaction: Inability to concentrate or think clearly, not being able to make decision, feeling cold, weak, stunned, or numb; experiencing rapid swings in emotion.
• Intervention: Provide a quiet, softened environment to reduce stimulation.  Provide chairs or couches for the grieving to sit on.  If they are restless, encourage them to walk or pace until they feel calmer.  If they cry hysterically, let them.  Ten or twenty minutes is usually as long as uncontrolled crying lasts.  Provide water, juices, and soft drinks, the less the caffeine they ingest the better.  

Denial/Disbelief - No matter if the death of the loved one was expected or not, their is a feeling of unreality when the death occurs.  

• Reaction: Denial and disbelief range from statements like, "I can't believe she's dead!" "It couldn't have been him!" "No, I won't let this happen!" to the hope that the person is only away temporarily to more serious problems such as refusing to recognize the body and even attempts to feed the corpse, or "mummifying" the deceased's room or clothes for years.
• Intervention - Respect the need for denial.  Resist the impulse to force the truth on anyone.  Listen and be supportive.  Shock, denial, and disbelief act as protection against something that can't yet be faced.  take your cues from the griever.  If they say, "He's not coming back, is he?" provide gentle confirmation.  If serious denial occurs, such as refusal to recognize the body, be patient and give the mourner more time to adjust.  If strong denial persists, referral to a grief counselor may be necessary.

Anger and Hostility - are two of the most common reactions to grief.  Whenever we feel helpless and out of control, we tend to get angry and blame someone else for our own painful feelings.  When a loved one is dying, family member discover they are powerless to provide a cure.  Regardless how much the may want to, family members can't make everything OK.  Becoming frustrated and angry, they displace their anger on whoever is closest.

• Reaction:  They will often feel shocked at how enraged they are with their loved ones for dying and leaving them alone, or furious with God for letting something so terrible happen.  Then they will feel guilty for those feelings.  Sometimes a physician is the target of their anger, and sometimes it is just the nearest person.
• Intervention: We need to refain from meeting anger with anger or histility with hostility.  If appropriate, validate the reasons for the anger.  Remember that trying to make the family member see things more sensibly is not appropriate during a period of intense anger.  

Try to remember that the expression of anger is a gift.  People often express their anger to those they trust the most.  Even in the midst of their most intense grief, the mourner is aware they might be abandoned by those who are unable to cope with their emotions.  They may save their anger and hostility and express it to people who won't walk out on them. Just remember to not take it personally.

If anger becomes disruptive or abusive, setting limits is appropriate.  If fighting occurs next to a patients bedside, they should be asked to leave and settle their differences else where.  If you are dealing with verbal abuse, you can call for a "time out" and explain you are there to listen, but they they need to calm down before conversation can continue.

You may try suggesting a positive outlet for their anger.  Such as walking, jogging, cleaning the house, providing physical care for the patient, or writing down all their feeling on paper.

Bargaining, Guilt, and "If-Onlies" - Real or imagined guilt is a common reaction to grief.  Family members realize they are unable to alter distressing family events that may have occurred in the past and are unable to retract decisions that did not turn out for the best.  In any close relationship hurtful things are sometimes said.  Frequently, in the rush of living, we don't get around to doing things we later wish we had.  Or we do things we later wish we hadn't.  Imperfections are normal.  No relationship and no person is perfect.

• Reaction: Family members are sometimes overwhelmed by thoughts of: "If only we had seen a different doctor, this wouldn't have happened;" If only we had gone to the doctor earlier, we would have caught the cancer earlier;" If only I had cooked more broccoli and less meat, the cancer wouldn't have occurred;", etc, etc.

Bargaining during grief may include praying extra hard or trying to be extra good so the loved one would reappear.  Sometimes those who are grieving attempt to stay so busy they won't have time to experience their grief.  They make bargains by saying to themselves: "If I stay really busy, I won't have to feel so bad." Others may worry because they don't feel "bad enough" and then feel guilty about their lack of grief.

Intervention: Listen.  Then help family member work through their irrational expectations of themselves.  Normalizes the guilty feelings and "if-onlies" by explaining to family members their feelings of guilt are normal.  Instead, try to help them forgive themselves as they would forgive a friend.  Suggest that they contact their spiritual/religious leader.

• Intervention: Listen.  Then help family member work through their irrational expectations of themselves.  Normalizes the guilty feelings and "if-onlies" by explaining to family members their feelings of guilt are normal.  Instead, try to help them forgive themselves as they would forgive a friend.  Suggest that they contact their spiritual/religious leader.

Depression - This can be the longest-lasting and most difficult reaction to grief because it involves utter despair and can seem endless.

• Reaction: constant crying, fatigue, tremendous feelings of sadness, inability to concentrate, sighing, anxiety, irritability, and sleeplessness are all normal symptoms of the depression of grief.
• Intervention: Reassure mourners that depression is a normal reaction and that depression comes and goes and eventually fades.  Depression can be helpful because it allows the griever to experience the pain of the loss.

Offer support, empathy, reassurance, and try to avoid medication.  Medication may relieve some symptoms of depression, but it does not resolve the grief.  Although most mourners are able to negoiate the journey through grief without professional help, grief can trigger an episode of major depression or emotional difficulties.  Complicated grief is more likely to occur if: the death was violent and unexpected; multiple deaths occurred; or the mourner has a history of depression.  When grief becomes complicated the appropriate intervention is referral to a grief counselor.  

Acceptance/Reconciliation - This means the mourner understands, both intellectually and emotionally that death has occurred.  They understand that their loved one will no longer be physically present in their lives.

• Reaction: Mourners are afraid of the word "acceptance" because they think that learning to accept the death means they are supposed to like the fact their loved one died.  Mourners can also be afraid that accepting the death means they are supposed to forget the person who died.  
• Intervention: Reassure the mourner that grief is a process; a gradual decrease in the intensity of grief is normal.  Also provide reassurance that reconciliation to a death does not mean forgetting a loved one.  Beginning to focus on the future and taking up life once again is a sign of healing.