The Dual Process Model of Grief: An Alternative Approach

The elaboration of the mourning before a certain loss becomes a very complex event for the individual, both from the emotional, cognitive and behavioral point of view.

The differentiation on the difficulty involved in this process seems obvious, taking into account the external circumstances that surround the patient. said loss, such as the particularities in which it has taken place (whether it has been abrupt or gradual), the type of link between the grieving object and the survivor or the skills available to that individual to handle these types of situations, etc.

In this article we will focus on the Dual Process Model of Grief and its implications.

• Related article: "Grief: coping with the loss of a loved one"

The first approaches: the stages in the elaboration of the duel

In a more traditional way, on the one hand, a certain consensus has been established among various expert authors in the field. set of stages through which people must go through the psychological elaboration of the process of duel. Even so, the idea that

not all individuals follow the same pattern in experiencing these phases.

For example, the renowned Elisabeth Kübler-Ross Model (1969) assumes the following five stages: denial, anger, negotiation, depression, and acceptance; while Robert A. Neimeyer (2000) refers to the «cycle of mourning» as a highly variable and particular process where vital adjustments take place permanent during avoidance (lack of awareness of loss), assimilation (assumption of loss with a predominance of feelings of sadness and loneliness and isolation from the social environment) and accommodation (adaptation to the new situation in the absence of mourning object).

Despite such discrepancies in terms of the number of stages or the conceptual label given to them, it seems like a nuclear phenomenon to understand mourning as a transition period from non-acceptance to assimilation, where feelings of sadness, longing, anger, apathy, loneliness, guilt, etc. are conjugated. with a progressive return to obligations, responsibilities and personal life projects.

At first it presents a greater weight the first set of emotional reactions, but little by little the second element related to behavioral activation is gaining more relevance, until it becomes balanced with respect to those. This allows the person to evaluate said loss from a more global perspective, since the fact of resuming the routine allows the person to connect more realistically with the world that surrounds him and moves the focus of attention away from him in a certain way, moving it from the object of loss to the vital re-adaptation of the different personal areas.

The dual grieving process model

This idea is the one defended by Margaret Stroebe in her Model of «Dual Process of Grief» (1999), where the researcher explains that the assumption of grief involves the person moving continuously between the realms of "loss-oriented operation" and "reconstruction-oriented operation".

Loss-oriented operation

In this first process, the person focuses her emotional charge on experimenting, exploring and expressing different ways (verbally or behaviorally) in order to understand the meaning of loss in your own life.

A) Yes, the survivor is in a period of introspection, which could be metaphorically understood as a “behavioral energy saving” process in order to consolidate this primary objective. The most characteristic manifestations in this first cycle are: being in contact with the loss, concentrating on their own pain, crying, talking about it, maintaining a passive behavior, presenting feelings of despondency, isolation, having the need to discharge emotionally, promoting the memory or finally, denying the possibility of Recovery.

Reconstruction Oriented Operation

At this stage, small episodes appear in the individual of a "reconstruction-oriented functioning", which increase in frequency and duration with the passage of time. Thus, it is observed in the person as invests his effort and his concentration in the adjustments he has to make in the different areas of life: family, work, social. This presents the purpose of being able to channel outwards the affectation experienced in the most acute stage of grief.

This operation is based on actions such as: disconnecting from the loss, tending to deny the situation, being distracted, minimizing the affectation, rationalizing the experience, avoid crying or talking about the loss, focus on redirecting vital areas, become more active, or focus on fostering relationships interpersonal.

The denial of loss as a central element of the model

In this model, it is proposed, as can be seen in the previous paragraph, that denial of loss takes place throughout the process of elaboration of the duel, being present in both types of functioning, and not being found exclusively in the initial phases, as proposed by other more traditional theoretical models.

Said denial, is understood as an adaptive response that allows the individual not to constantly focus on the reality of the loss, but to get used to it more gradually. This gradation avoids the experience of too intense (and unacceptable) pain that would imply the fact of confronting the loss from the outset and abruptly.

Among many others, some experts like Shear et al. (2005) have designed a psychological intervention program according to Stroebe's postulates. These studies have focused on working with patients the indicated component of anxious denial (or loss-oriented functioning) and depressive denial (or reconstruction-oriented functioning) of the lost. The core elements of this type of therapy have included components of personalized and gradual behavioral exposure and cognitive restructuring.

Shear and his team obtained very promising results in terms of the efficacy of the interventions carried out, while They had a sufficient level of scientific rigor when designing and controlling the different experimental situations. In sum, it seems to have been observed that cognitive-behavioral approaches provide an adequate level of efficacy in these types of patients.

• You may be interested: "Cognitive Behavioral Therapy: what is it and on what principles is it based?"

Conclution

The model presented in this text aims to offer a conceptualization of mourning centered on the process and intends to move away from a perspective more "of phases" as defended by proposals previous. The low level of uniformity in the experience of personal grief does seem to be contrasted, assuming the particularity with which this phenomenon operates in each individual.

This is explained by differences in coping skills and psychological or emotional resources available to each individual. Thus, although the general efficacy of psychological interventions linked to this objective has been growing in recent decades, they still have with a limited and improvable index of effectiveness, which must be linked to the continuation of research in this area of ​​knowledge.

Bibliographic references:

• Neimeyer, R. A., & Ramírez, Y. G. (2007). Learning from Loss: A Guide to Coping with Grief. Paidos.
• Shear, K., Frank, E., Houck, P., & Reynolds, C. (2005). Treatment of complicated grief: A randomized controlled trial. JAMA, 293,2601-2608.
• Stroebe M., Schut H. & Boerner K. (2017) Coping models in grief: an updated summary. Psychology Studies, 38: 3, 582-607.
• Stroebe, M. S., & Schut, H. TO. W. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23,197-224.