This is an ongoing series called The Psych Writer. Last week, we explored the first phase or stage of grief: shock and disbelief. This week, we’ll take a closer look at phase two: denial.

This stage used to be lumped into the first stage of shock and disbelief, which makes sense, but over time, therapists have discovered that denial takes on a life of its own.

Now, the standard caveat that you will be able to repeat with me by the end of the grief series: these phases are organized for the benefit of the clinician. They are not set in stone and the patient will likely not feel these things in order, or one at a time. They might, but they might not. Grief is individualized.

This phase is usually the “second phase” because of its proximity to shock and disbelief. It seems easy to fall into denial. Keeping in mind not everyone experiences this phase (see the note above), some people find their shock and disbelief is extended. For some, it becomes more elaborate.

For example, little Tommy was four years old when his mother died suddenly. Unable to accept or cope with the loss of his mother, Tommy begins to believe a story that she’s gone on a trip and will be “back soon.”

Another example: Greta is a 55-year-old who has been diagnosed with a terminal illness. When her husband asks her about it, she says she doesn’t know anything and doesn’t want to know anything about it. She doesn’t want to lose sleep over “worrying about it.”

Denial from the Patient’s POV
This phase is a more elaborate, amplified version of shock and disbelief. The person experiencing denial may appear quite strong to family and friends. They hold their heads high, or say things such as, “I have to keep on going.” They appear to have accepted their fate. Or they act more like Greta, and say things such as “I can’t think about this right now.”

The person in denial often has internal dialog of the wandering mind. They cannot concentrate, or are forgetful surrounding the loss. The person may find himself setting an extra place at the dinner table. She may reach for the phone to call the loved on to tell them some bit of good news. They may leave the person’s room untouched and not sell or get rid of all items (keeping heirlooms and keepsakes do not count), and get livid if you move them or disturb them.

In the extreme, rooms become shrines to the lost one, or the person turns to substance abuse to aid in suppression of pain.

Denial from the Therapist’s POV
Boy, have you got your work cut out for you. As a good therapist (remember to do the opposite if you’re writing a crappy one), it’s your job to serve as a point of reality for the patient. Your reminders for the patient that the loved one is gone or the job will not suddenly return need to be consistent. Be with the patient in his/her denial and empathize without sympathizing (the difference being that this is about the patient and their unique experience, not about you and your own grief).

Here’s an example of how a session might go, and how the therapist would guide the patient into reality:

Patient: I reached for the phone to tell Grandpa the good news about my promotion.
Therapist: What happened?
Patient: I didn’t call. I put down the phone and made coffee.
Therapist: So you didn’t complete the call, and distracted yourself with something else, then?
Patient: I guess I did. I just can’t accept that he’s gone.
Therapist: How do you feel about him being gone, and that you can’t call him with good news anymore?

The therapist is extracting information to find out how the patient is processing the loss and where they are in their grief. How deep is this denial? Do they get tearful in their response? Do they get angry? Confused? Delusional?

Fictionalize it any way you like, of course. What would happen if Grandpa had answered?

What this Means for You, the Writer
If you are writing someone in the phase of denial, you’ll be the one to decide how extreme it is or if there are any paranormal elements. Consider how long the phase will last (the more extreme cases of denial last longer than six weeks and sometimes for years), and the elaborate lengths your character will go do to keep their denial going.

If you came here looking for psychological assistance, please contact your local crisis line. Dial 2-1-1 in the US for the United Way, or contact the Samaritans in the UK. For a list of international crisis lines, click here.

Remember that when you write this phase, it’s important to think of it as a more elaborate trick of the mind to protect your character from pain. If you are writing from the therapists point of view, remember your goals are of a facilitator and you are there to cushion the blow of brutal reality for your patient. You are the bridge back to healthy grief processing, and it is up to you to provide tools for the patient to get beyond this stage so he or she can begin functioning once again. Additionally, remember that you are not to foster dependency on you as the therapist (unless you’re writing a bad or unethical one). You are there with the tools for your patient. If you’re portraying an unethical therapist, be sure to exploit this phase by assisting in expanding patient denial.

Be well and get writing.

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Well that was yet another heavy topic, I know, and there will be more to come soon, so brace yourselves. For some lighthearted things, check out myFacebook and Twitter. Or for some entertaining fiction, grab a copy of Exit 1042.