Understanding the Acceptance Stage of Grief

Acceptance is one of the five stages of grief. The five stages of grief is a model also known as the Kübler-Ross model after Swiss-American psychiatrist Elisabeth Kübler-Ross, who coined the phrase in her 1969 book, On Death and Dying^[1].

Although the Kübler-Ross model was developed as a way to support terminally ill people in facing their imminent death, other types of mental health practitioners found it so helpful the model was adapted as a way of thinking about grief in general.

The five stages of grief, as outlined by Kübler-Ross, are:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

This article focuses on the acceptance stage of grief – what it is, what it’s like, and how to manage if you don’t accept the loss you’ve experienced. You can find articles on the other four stages of grief elsewhere on the site.

What is acceptance?

Acceptance is a word many of us use daily without questioning it. However, understanding acceptance from a psychological or spiritual perspective is helpful when used in the context of grief.

According to the spiritual teacher Eckhart Tolle, acceptance is a “surrender to the now” response to anything occurring in any moment of life^[2]. Tolle focuses on the strength, peace, and serenity that become available when we stop struggling, resisting, or hanging on to any particular outcome or situation.

In other words, acceptance simply means allowing unwanted private experiences (thoughts, feelings, and urges) to come and go without struggling with them.

What is the acceptance stage of grief?

The American Psychological Association defines the acceptance stage of grief as ‘the last of the five stages of grief‘ described by Elisabeth Kübler-Ross. It is characterized by some degree of emotional detachment, objectivity, or resignation on the part of oneself or an important other to the reality of impending or actual death, other great loss, or trauma.’.

If you consider acceptance as related to denial, you can understand why the acceptance stage of grief is so important. It marks a shift from resistance to a less rigid way of thinking and feeling about the loss you’ve experienced. In other words, we stop fighting the loss.

It’s important to note that acceptance does not mean we are okay with the loss. Acceptance doesn’t imply an absence of distress, emotions, or trauma, nor does it suggest you approve of what happened or is happening.

Acceptance means we accept the reality of the situation. It involves recognizing what you are struggling against, acknowledging your desire to fight back, and aligning yourself with the present moment’s reality. It means avoiding getting stuck in other stages. Cultivating mindfulness and an unbiased, inquisitive outlook can support this process.

One study from 2008^[3] found that as grief falls, acceptance of the loss rises, suggesting that grief and acceptance may be opposite sides of the same coin. The study’s research team suggests that:

Grief and its associated features reflect an emotional inability to accept the loss of something cherished. Grief may be the emotional unrest and frustration of wanting what one cannot have. Acceptance, by contrast, may represent emotional stability – a sense of inner peace and tranquility that comes with letting go of a struggle to regain what is lost or being taken away.

Prigerson & Maciejewski, 2008

What does the acceptance stage of grief involve?

The acceptance stage of grief is the final stage of the grieving process. This stage is characterized by a sense of peace and a willingness to move on from the loss. It is essential to note that this stage does not necessarily mean individuals have wholly come to terms with their loss, but instead, they have accepted the loss has occurred and must move forward.

The acceptance stage of grief involves several vital components. These include:

• The first step in the acceptance stage of grief is acknowledging the reality of the loss, which involves accepting it has occurred and cannot be changed. This can be a difficult step, as it often requires facing the pain and sadness of the loss.
• Making peace with your emotions is the second step and requires you to come to terms with the range of emotions that accompany grief, including sadness, anger, guilt, and more. This can be challenging as these emotions can be overwhelming and difficult to cope with. Remember the courage and resilience you’ve shown.
• The final step is finding meaning in loss and learning to live with it. Honoring your experiences before the loss and acknowledging that life will never be the same allows you to find a way to move forward in rebuilding your life. Rather than focusing on what you’ve lost, concentrate on the positives, such as happy memories, learnings, and insights.

The process of grieving is painful and can take time. Even if you begin to accept the loss, it is natural sometimes to feel angry, sad, or upset. Your support system is crucial during the grieving period, so keep loved ones close and accept their offers of help.

Some people find it helpful to acknowledge the importance of what they’ve lost through rituals, such as on holidays or special occasions, to honor the memory of your loss and help you cope.

When you feel prepared, begin to plan and think about the future. Although it may not turn out exactly how you envisioned, you’ll eventually come to a place of acceptance.

What does the acceptance stage of grief look and feel like?

According to the University of Washington, the acceptance stage of grief can look like:

• Engaging with reality as it is
• “This is how it is right now”
• Being present in the moment
• Mindful behaviors
• Able to be vulnerable and tolerate emotions
• Assertive, non-defensive, honest communication
• Adapting, coping, and responding skillfully
• Taking care of yourself

It can feel like:

• “Good enough”
• Courageous
• Validation
• Self-compassion
• Pride
• Wisdom

Depending on your grieving process, this might be experienced in many ways.

If you’re grieving the loss of a loved one, acceptance might be about revisiting memories of the happier times you spent together and cherishing those experiences. This would mean you are less focused on the painful feelings you’ve felt over the loss.

If you have been diagnosed with a terminal illness, acceptance might be spending the time you have left focused on making sure you use that time wisely and do the things you want to do instead of railing against the diagnosis.

Suppose you’re grieving the loss of a romantic relationship. In that case, acceptance might take the form of understanding everything you’ve learned and experienced in this relationship to bring this wisdom into future relationships.

Self-compassion is a valuable mindset to help you move towards acceptance. Remind yourself that most other people in your situation may feel similarly angry, anxious, or resistant to accepting what you’ve experienced. This can help with the process of reaching acceptance.

How long does it take to reach the acceptance stage of grief?

It’s a cliché, but time is a healer. The results of a study in 2007^[4] into the stage theory of grief found that disbelief, yearning decline, and acceptance increase between one and twelve months post-loss. Similarly, from six to twenty-four months post-loss, disbelief, yearning, anger, and depression decline, and acceptance increases.

The study looked at different types and causes of death, finding that these play a part in how well survivors can reach a point of acceptance.

A high degree of acceptance, even in the initial month post-loss, is the norm in the case of natural deaths. This contrasts with individuals who survived a family member’s traumatic death and those who met the criteria for complicated grief disorder, both of whom have significantly lower levels of acceptance. Losing a loved one to a terminal illness with less than six months left after a diagnosis resulted in less acceptance than when a diagnosis suggested the person had six months or longer. This result is one of many that suggest preparation for death is associated with better psychological adjustment to the loss.

In the previously mentioned study from 2008, however, the researchers made it clear that peaceful acceptance is not necessarily an achievable goal for everyone confronting loss:

We recognize that some individuals will neither want nor have the capacity to accept loss peacefully. We are not suggesting that all dying patients or bereaved survivors be implored to confront death with peace and tranquility, nor that complete death acceptance is a realistic goal. We recommend that enhanced degrees of acceptance and reduced grief appear to be associated with less suffering, implying that there may be benefits to promoting acceptance.

Prigerson & Maciejewski, 2008

What happens after the acceptance stage of grief?

Moving through the five stages of grief linearly is uncommon, and fluctuations in mood, thoughts, attitudes, and behaviors are typical. It may be challenging to remain accepting when things feel unacceptable, and it’s also tricky to stay accepting when you are reminded of your loss. For this reason, people who had previously thought they’d reached a point of acceptance of their grief may find themselves revisiting old patterns of thinking and feeling about grief around the time of anniversaries, birthdays, or other significant dates.

Sometimes, people may think they have reached the acceptance stage of grief only to realize they have returned to the denial stage. What you feel is acceptance may be another way your brain is trying to make sense of the loss. This could be a desire to forget what has happened or to pretend you’re okay with it to avoid feeling how much the loss has affected you.

True acceptance requires you to find ways to process the loss from every angle, to ‘own’ your feelings about it, to take responsibility for how you are feeling and behaving, and to move forward toward a future that can accommodate your grief and loss.

Does everyone go through all five stages of grief?

No. Some people go through some but not all five stages. Some never get to a place of acceptance. Grief is a complicated, challenging, and unique experience, with everyone reacting to it in their own way.

As Kubler-Ross herself says in the opening paragraph of On Grief and Grieving:

The stages have evolved since their introduction and have been misunderstood over the past three decades. They were never meant to help tuck messy emotions into neat packages. Many people have responses to loss, but there is not a typical response to loss as there is no typical loss. Our grief is as individual as our lives. Not everyone goes through them or in a prescribed order.

The results from the 2007 study^[5] indicate that in the circumstance of natural death, the bereaved typically describe their experience of grief as dominated by acceptance and yearning for the deceased, with all of the negative grief indicators in decline by approximately six months post-loss.

The researchers are clear about the persistence of these negative emotions beyond six months as reflecting a more difficult than average adjustment, and this suggests the need for further evaluation of the bereaved survivor and potential referral for treatment.

People find other models of grief helpful – these are mentioned in the ‘What are the five stages of grief after a significant loss’ article.

What should I do if I cannot cope with grief?

Help is out there for you if you feel you cannot cope with your grief or how you are managing it is harmful. Equally, for some, grief can trigger a deep depression that can become entrenched.

Bereavement or grief counseling is available for those who need help in processing their loss. This type of therapy allows you to talk your feelings through with a professional experienced in this field, who can allow you the time and space to talk about your loved one and the emotions you’re experiencing. Don’t suffer alone.

The Center • A Place for HOPE is an award-winning treatment facility with over 37 years of mental and behavioral health leadership. We are a top ten facility for depression treatment, meaning that our caring and experienced staff are well-placed to provide you with professional excellence in various treatment options.

1 – Kübler-Ross, E. (2002) On death and dying; questions and answers on death and dying; on Life after death. New York: Quality Paperback Book Club.
2 – Tolle, Eckhart (1999). Practicing the Power of Now. Vancouver, British Columbia: Namaste Publishing. p. 107.
3 – Prigerson, H., & Maciejewski, P. (2008). Grief and acceptance as opposite sides of the same coin: Setting a research agenda to study peaceful acceptance of loss. The British Journal of Psychiatry, 193(6), 435-437. doi:10.1192/bjp.bp.108.053157
4 – Maciejewski PK, Zhang B, Block SD, Prigerson HG. An Empirical Examination of the Stage Theory of Grief. JAMA. 2007;297(7):716–723. doi:10.1001/jama.297.7.716
5 – Maciejewski PK, Zhang B, Block SD, Prigerson HG. An Empirical Examination of the Stage Theory of Grief. JAMA. 2007;297(7):716–723. doi:10.1001/jama.297.7.716