Grief and loss theories and models critical discussion and scenario application

Introduction: Grief and loss theories and models critical discussion and scenario application 

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Part A

First model

“The Two-Track model of Bereavement” is defined as the process of conceptualizing grief and handling it with proper guidance. Moreover, this model of grief suggests that the grief of a person can be managed efficiently by assessing the psychological and behavioral attitude. Other than this, the type of relationship the patient has with the deceased person also affects it. An individual can be said to lead a healthy life only when he or she is emotionally fit and strong (Smith & Ehlers, 2020). Therefore, when he is affected by grief due to the death of his dear ones then it is very essential to implement theories to draw him out of the situation. This Two-Track model was conceptualized to treat patients dealing with grief because of the loss that occurred to the close ones. 

Figure 1: The model of Bereavement

(Source: Breen et al. 2022)

Therefore, the strength of this first model of grief and loss can be defined as the ability to manage grief through management. Moreover, it allows the patient to come out of the grief and helps him to feel positive in life (counseling, 2022). The implementation of this model also requires the analysis of the relationship between the patient and the deceased person. In addition to this, it enhances the behavioral attitude and asymptotic response of the patient and helps him to cope in life (Zhai & Du, 2020). Moreover, the implementation of this model can affect an individual’s way of living and clarify the thoughts about bereavement. In addition to this, the model is implemented on the people who suffered the major losses of their dear ones (Breen et al. 2022). Therefore, this process is used to treat the parents who have lost their children and to treat the children for the loss of their parents and other family members. 

Human life is mostly affected by grief and loss in their lifetimes. However, grief can teach a person many life lessons. However, the grief of loss can affect a person badly but once that person can control it, he can understand the value of existence and mortality (pubmed, 2022). Moreover, it increases the value of family members, brings them closer to each other, and teaches them a feeling of understanding and empathy (Smith & Ehlers, 2020). However, the management of grief sometimes becomes unbearable; therefore, they go through the stages of depression. As a result, of which he or she faces different types of physical problems such as insomnia, hopelessness, worthlessness, lack of hunger, and many more.

Second model

The second model of grief and loss is d “The model of Meaning Reconstruction”. This model is based on the management of the grief of a patient. This model motivates the patient, encourages him to understand that growth is possible, and makes him understand the ways to revive the mourning situation (Eisma, Boelen & Lenferink, 2020). Moreover, this model deals with the management of grief through more advanced techniques and theories. This is formulated with the recent research in different case scenarios and has proved to be impactful in treating patients suffering from depression (Castiglioni & Gaj, 2020). In addition, this model can be implemented by analyzing the situation more precisely. Moreover, it enhances the patient’s capacity to understand the situation and lets him evaluate the sense of life. 

Therefore, patients going through grief and loss can be treated by this model, which will make them find advantages from the experience of loss. This will also make them understand the experience and reconstruct them to implement them in their lives for a positive impact. This model has many positive prospects for treating depressed patients (Neimeyer, 2019). Therefore, the reconstruction-meaning model of grief and loss aims at restoring the bonds between the members of the family or the individuals involved. Other than this, the implementation of this model will help the patients to deal with their bereavement and adjust to the situations of society. 

This type of model is used to treat parents who have lost their loved ones at an early and age and vice versa. Therefore, the implementation of this model will give them the motivation to adapt to the surroundings of the world without the presence of their loved ones. Moreover, this will reduce their feeling of hopelessness and loneliness (Dooley, 2019). In addition to this, they will understand the value of mortality and value the existence of their own lives, thereby improving their way of living. They will also try to adapt to new social rules in their lifestyle and get benefitted from them (Castiglioni & Gaj, 2020). Therefore, it can be said that this model aims to improve and manage the grief of patients suffering from depression due to the loss of their loved ones. 

The management of grief is very essential in the case of depressed patients. Moreover, death or other depressing reasons can affect the mental health of a person for a lifetime. Therefore, special attention is paid to retrieving an individual from the negative impacts of depression and giving him an emotionally healthy life.

Third model

The third model used to treat grief and loss involves “Worden’s task model” of grief. This model aims at a bigger picture of analyzing an individual's experiences with grief and other experiences of life to manage the mourning of loss. Human psychology states that mourning is a process that comes naturally in every individual during the loss of loved ones or other reasons (Khosravi, 2020). Therefore, according to this model, it is suggested that accepting the mourning of life can help an individual manage the grief and handle the situation more wisely. In addition, this model is not only used to treat depression due to the death of loved ones but to treat other depressing situations as well. The drastic changes in life due to involving in new relations or shifting from one place to another can also affect an individual (Yousuf, 2021). That person will feel lonely and depressed while adapting to new surroundings. 

Figure 2: Worden’s Four-task model

(Source: Khosravi, 2020)

Worden’s model of grief suggests that the process of grief involves different types of tasks that are analyzed to understand the sources of grief and how to eradicate them. The four tasks of mourning include adjustment, acceptance, acknowledgment, and reinvestment. The analysis of these four tasks in the patients can give the detailed structure of the patient's source of grief and loss and allow the doctors to treat them accordingly (Khosravi, 2020). Moreover, the main objective of this model is to manage grief and accept the reality of life. 

The first task involves the process of adjusting to the surroundings of life without the presence of loved ones. In addition to this, the death of a loved one can affect an individual to an extent that the person feels hopeless and worthless t the same time. This affects their way of living and disrupts their reality. Apart from mourning due to death, depression can also occur due to the change in the surrounding (Dooley, 2019). The second task deals with the acceptance of the changed reality without the presence of the loved one. In addition to this when a person shifts from one neighborhood to another due to some personal reasons in their lives, they can face difficulties in adjusting to the new locality. In the case of the death of a loved one, an individual can feel affected by the absence of their loved one as they will feel lonely and depressed without their presence in life (Khosravi, 2020). The next two tasks of Worden’s model state that an individual can face difficulty in acknowledging the causes of grief and making them feel disconnected from the entire world. Therefore, the implementation of this model will help the management of grief in an individual.

Part B

Case Conceptualization

The case scenario of the 13 years old, Carissa, provided in the case study can help to better analyze the Grief loss theory. Carissa is Aboriginal and lives in the Arnhem Land of the Northern Territory of Australia. She had to move with her uncle Reggie to the inner parts of Sydney, as her mother became sick. Her mother has given the responsibility of her daughter to her brother, while she treats herself. Carissa is known to be a promising student and extremely talented, as she is skilled in traditional Aboriginal music and dance. Carissa is having difficulty adapting to the new change in scenarios in Sydney. Her grades have deteriorated after moving to Sydney and she only has one friend currently. She has been referred to counseling by the school.

This case scenario of Carissa can be analyzed properly with the 5Ps. This case scenario evidently points out the Presenting problems as the loneliness and isolation issues that Carissa might be facing. Carissa’s mother is sick currently and she misses her family whom she had to leave behind in Arnhem Land. This can be presented as the Predisposing Factor for her change in behaviors. Her only passion for dancing is also affected, as she cannot find a proper Aboriginal dance class in Sydney. This can be presented as the Precipitating Factors that are influencing Carissa’s grief and loss.

She has made only one friend, Chen-Mai, after moving to Sydney. Chen-Mai is engaged in a lot of extracurricular activities thus, they do not see each other much outside school time. This can serve as a psychological mindedness to her not being able to continue her dancing and Perpetuating Factor of her grief. Thus, it is very clear that Carissa is suffering from loneliness. Her uncle Reggie is also engaged in his sports program and it is clear that he cannot afford much time to spend with Carissa. The case study has also mentioned that Carissa is missing her family and siblings in particular. These might be the Protective Factors behind Craissa’s grief. She is having a hard time adjusting and coping with her loneliness. This is affecting her social behaviors and her overall grades in her new school.

Model application

This particular case scenario can be analyzed properly with the application of Worden’s Task Model. According to this model, an individual comes with a strong reaction of feeling while4 dealing with grief (Khosravi, 2021). These feelings can include loneliness, sadness, self-reproach, and guilt. All of these feelings are identifiable in Carissa's case scenario. The model also refers to certain cognitions that an individual might be going through. Carissa’s cognition can be identified to be her having difficulty concentrating and confused thinking. These factors are affecting her social behaviors and studies (Bull & D’Arrigo-Patrick, 2018). The behavioral issues mentioned in the model can be linked to Carissa’s absent-minded behavior and her withdrawal behaviors.

Figure 3: Five stages of Grief

(Source: Prigerson et al. 2021)

J.W. Worden has mentioned in his model that there are 5 stages of grief. These 5 stages can be listed as denial, anger, bargaining, depression, and finally acceptance. Carissa’s case scenario and her process of grief can be linked with these five stages (Prigerson et al. 2021). Carissa had to leave her family and come to stay with her uncle. She had problems adjusting to life in Sydney but she still did not complain. This can be identified as the stage of her denial. The next stage of grief that Carissa faced was anger as even being a great student her grades started dropping.

Carissa tried to bargain by attempting to continue her Aboriginal dance classes, but she never found a suitable place. This led her to depression slowly as she became worried about her mother and started missing her family. She slowly started to accept her situation as she went with her uncle to his fitness program. This is proof of her trying to adjust to the changing situations. She also made a friend d Chen-Mai, though they barely got time to meet each other. Worden has also mentioned four tasks that an individual can go through to overcome their grief (Wallace et al. 2020). These four tasks include accepting the situation, acknowledging it, adjusting accordingly and then reinvesting in own self.

Part C

Intervention Strategies

The case scenario and the case conceptualization of Carissa can be improved by the application of the 3 C’s method. This intervention strategy refers to the processes of choosing, connecting, and communicating (ketteringhealth, 2022). Carissa is suffering from loneliness and isolation due to the changing places. Thus, her method of counseling should start by letting her choose what is best for her. She has to be the one taking care of her the most. She has to choose how to lead her life in a more engaging and enjoyable way, by making a list of it. The following C stands for connecting, it is important that she connects with her Uncle Reggie and friend Chen-Mai (Atienza Carrasco et al. 2020). She needs to share what she feels about these people, as they are the closest to her now.

Figure 4: 3 C’s Intervention strategy for grief loss

(Source: Kochen et al. 2020)

She needs to communicate more with the people around her about what she desires. She should ask her uncle for help in finding her an Aboriginal dance class. This would help her to cope with the adjustment and she would be able to concentrate on her studies more (Kochen et al. 2020). She needs to engage more in her life in Sydney by restructuring her extracurricular activities. This will let her not over think about or miss the family she left behind in Arnhem Land. After all her mother agreed to her shifting keeping in mind her future.

I also think that Carissa needs to process her whole situation by herself. Her counselor can help her in this process. She is only 13 years old, so it is the responsibility of her family, especially her uncle to provide her with more time (helpguide, 2022). This will make her adjusting process a lot easier. Her counselor or her uncle can also arrange a way for her siblings to come meet her in Sydney.

Part D

Critical Reflection

I think the models and intervention strategies included in this report are greatly useful in the process of grief and loss. The strength of the Grief and loss models is that they can help a mourning individual to get back to their life. The processes are prolonged but if followed properly they can drastically improve the emotional aspects of a grieving person. My personal opinion is that there are not enough models and theories about the grieving processes related to adjustment or financial crisis, or even separation. Most of the grief models are based on the emotional changes required by a person dealing with the death of their loved ones. Thus I suggest that counselors and psychiatrists should not overlook other situations that lead to grief and mental distress.

The intervention method proposed in this report can also be efficient for the improvement of an individual suffering from loneliness or isolation. I think that these intervention strategies lack a proper psychological and scientific outlook. These practical approaches can help to deal with a situation like that of Clarissa. The overall conceptualization process Clarissa was highly reflective in getting into the mind of young individuals. Especially the ones who have to live estranged from their parents. I think that child counseling should be applied more in schools. Children suffering from loneliness like Clarissa should be taken care of by the school authorities and extra care should be provided to these individuals.

References

Journals

• Atienza?Carrasco, J., Linares?Abad, M., Padilla?Ruiz, M., & Morales?Gil, I. M. (2020). Experiences and outcomes following diagnosis of congenital foetal anomaly and medical termination of pregnancy: A phenomenological study. Journal of clinical nursing, 29(7-8), 1220-1237. DOI: 10.1111/jocn.15162
• Breen, L. J., Kawashima, D., Joy, K., Cadell, S., Roth, D., Chow, A., & Macdonald, M. E. (2022). Grief literacy: A call to action for compassionate communities. Death studies, 46(2), 425-433. https://doi.org/10.1080/07481187.2020.1739780
• Bull, B., & D’Arrigo-Patrick, J. (2018). Parent experiences of a child’s social transition: Moving beyond the loss narrative. Journal of Feminist Family Therapy, 30(3), 170-190. https://doi.org/10.1080/08952833.2018.1448965 
• Castiglioni, M., & Gaj, N. (2020). Fostering the reconstruction of meaning among the general population during the COVID-19 pandemic. Frontiers in Psychology, 11, 567419. https://doi.org/10.3389/fpsyg.2020.567419
•  Dooley, C. M., Carroll, B., Fry, L. E., Seamon-Lahiff, G., & Bartone, P. T. (2019). A model for supporting grief recovery following traumatic loss: The tragedy assistance program for survivors (TAPS). Military medicine, 184(7-8), 166-170. https://doi.org/10.1093/milmed/usz084
• Eisma, M. C., Boelen, P. A., & Lenferink, L. I. (2020). Prolonged grief disorder following the coronavirus (COVID-19) pandemic. Psychiatry Research, 288, 113031. https://doi.org/10.1016/j.psychres.2020.113031.
• Farinha-Silva, S., & Reis-Pina, P. (2020). COVID-19: From grief and mourning to prolonged grief disorder. Acta Médica Portuguesa, 33(10), 709–709.https://doi.org/10.20344/amp.14701. 
• Khosravi, M. (2020). Worden’s task-based model for treating persistent complex bereavement disorder during the coronavirus disease-19 pandemic: A narrative review. Open Access Macedonian Journal of Medical Sciences, 8(T1), 553-559. https://doi.org/10.3889/oamjms.2020.5502 
• Kochen, E. M., Jenken, F., Boelen, P. A., Deben, L., Fahner, J. C., van den Hoogen, A., ... & Kars, M. C. (2020). When a child dies: a systematic review of well-defined parent-focused bereavement interventions and their alignment with grief-and loss theories. BMC palliative care, 19(1), 1-22. http://dx.doi.org/10.1037/ccp000043893
• Neimeyer, R. A. (2019). Training and Certification Program in Meaning Reconstruction in Loss and Transition Module 1_Core Training Courses November 1, 2 and 3. 2019. Palau Macaya (Doctoral dissertation, Department of Psychology, The University of Memphis). https://doi.org/10.36367/ntqr.11.e541
• Prigerson, H. G., Kakarala, S., Gang, J., & Maciejewski, P. K. (2021). History and status of prolonged grief disorder as a psychiatric diagnosis. Annual Review of Clinical Psychology, 17(1), 109-126. https://doi.org/10.1146/annurev-clinpsy-081219-093600 
• Smith, K. V., & Ehlers, A. (2020). Cognitive predictors of grief trajectories in the first months of loss: A latent growth mixture model. Journal of consulting and clinical psychology, 88(2), 93. https://doi.org/10.1037/ccp0000438
• Wallace, C. L., Wladkowski, S. P., Gibson, A., & White, P. (2020). Grief during the COVID-19 pandemic: considerations for palliative care providers. Journal of pain and symptom management, 60(1), e70-e76. doi: 10.1016/j.jpainsymman.2020.04.012
• Yousuf-Abramson, S. (2021). Worden’s tasks of mourning through a social work lens. Journal of Social Work Practice, 35(4), 367-379. https://doi.org/10.1080/02650533.2020.1843146 b
• Zhai, Y., & Du, X. (2020). Loss and grief amidst COVID-19: A path to adaptation and resilience. Brain, Behavior, and Immunity, 87, 80–81. https://doi.org/10.1016/j.bbi.2020.04.053. 

Websites

• counseling, (2022), Meaning reconstruction model, Retrieved from: https://www.counseling.org/docs/default-source/vistas/a-shift-in-the-conceptual-understanding-of-grief---using-meaning-oriented-therapies-with-bereaved-clients.pdf?sfvrsn=4acab18c_12#:~:text=Some%20of%20the%20core%20goals,connection%20can%20serve%20as%20positive [Retrieved on: 29th November, 2022]
• helpguide, (2022), Grief coping mechanisms, Retrieved from: https://www.helpguide.org/articles/grief/coping-with-grief-and-loss.htm [Retrieved on: 29th November, 2022]
• ketteringhealth, (2022), 3 C’s method of intervention, Retrieved from: https://ketteringhealth.org/grief-and-the-holidays-use-the-3-cs-to-help-you-heal/ [Retrieved on: 29th November, 2022]
• pubmed, (2022), Two track model of bereavement, Retrieved from: https://pubmed.ncbi.nlm.nih.gov/10848088/#:~:text=In%20the%20Two-Track%20Model,of%20the%20response%20to%20loss [Retrieved on: 29th November, 2022]