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Mapping Grief
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Mapping Grief
Linda Machin PhD
2011
Exploring the Landscape of Loss
1. A model for recognising diversity in response to loss.
2. A mapping tool for exploring individual grief dynamics.
1. A model for recognising diversity in response to loss
The Range of Response to Loss model (Machin 2001; 2009)
Overwhelmed - a state dominated by distress
Controlled - a state dominated avoidance of distress
Resilience - a capacity to balance the emotional, social and practical consequences of loss (accept the loss, make sense of its consequences, an optimistic life perspective and an ability to make use of social support)
Conceptual links with other theories
Range ofResponse toLoss
Overwhelmedby loss
Resilientresponse toloss
Controlledresponse toloss
AttachmentStyleAinsworth etal (1978)
Anxious/ambivalentattachment
Secureattachment
Avoidantattachment
Dual ProcessModelStroebe +Schut (1999)
Lossorientation oscillation
Restorationorientation
An emerging picture of grief
overwhelmed controlled
balanced (resilient)
The nature of grief
Primary reactions - disbelief, sadness,anger, guilt, despair etc
learned/acquired reflexive responses to loss
Secondary responses - engagement with the consequences of loss by -
regulating emotion
adjusting to changed relationships
adjusting to changed social realities
making sense of the loss etc.
Exploring primary grief reactions
Immediate, passive reactions to grief:
overwhelmed controlled
Dominance of feelings- sadness,
anger, guilt, despair,desolation etc
bringing a sense of powerlessness
Dominance of emotional avoidance, giving an illusion of
powerfulness
Images as grief stories – Overwhelmed
Images as grief stories - Controlled
Exploring secondary grief responses
Active engagement with the consequences of loss - coping
Resilience Vulnerability ( a new, fourth dimension in the RRL model)
Acceptance of the loss and the feelings
associated with it, effective management of day
to day life, finding a sense of meaning,
making good use of support etc
Difficulty in facing the loss and the feelings
associated with it, problems in managing day to day life, lack of a sense of meaning,
makes poor use of support etc
Coping as a mediating factor in grief (Stroebe et al 2006)
Acquired coping stylesAttitudes to difficult life eventsThe extent to which stress factors exceed
the capacity of an individual to manage the consequences of the loss
The role of perception in shaping resilience and vulnerability
Seligman - Learned Helplessness Resilience (1975/92) (1999)
Permanence bad events seen as bad events seen as
permanently effecting life temporary
Pervasiveness a failure in one area of life bad events seen as
produces helplessness in specific not
others universal
Personalisation poor self esteem results bad events
from self blame when attributed
things go wrong to external factors
Factors which contribute to resilience in bereavement
Personal resourcefulness- flexibility, courage, perseverance, sense of self worth
A positive life perspective- optimism, a capacity to make sense of experience
Social embeddedness- availability of support, capacity to access support
Resilience
Overwhelmedfocus on feelings
A capacity to balance and accept the competing
forces of grief
Controlledfocus on thinking
and action
Images as grief stories - Resilient
Disorganised/disorientated attachment
Main (1991) described this as a fourth attachment style where there might be evidence of -
a mix of anxious and avoidant responses
Stress factors which contribute to vulnerability in bereavement
Circumstantial risk factors - unexpected death, untimely death, horrific death, multiple losses, stigmatised death etc and concurrent stresses e.g. caring for others, financial problems etc
Personal risk factors - insecure attachment with with the deceased, young children, adolescents etc and physical, psychological problems, past history of difficulty in coping with stressful situations etc
Interpersonal risk factors -lack of social support, and /or makes poor use of support, loss of a child etc
Vulnerability
An inability to balance the competing forces of grief - tension between feeling, thinking and acting
Overwhelmedfocus on feelings
Controlled focus on thinking
and action
Images as grief stories - vulnerability
The RRL model showing the interaction between grief and coping
vulnerable
overwhelmed controlled
resilientCore grief impact responses Coping mechanism
A template for exploring grief in practice
vulnerable
Debilitating
personal and / or circumstantial factors socially - isolated and / or disconnected
Overwhelmed Controlled Enabling
personal and / or circumstantial factors
socially integrated and / or support felt to be adequate to needs
Resilient
Feelings ofgrief dominate + make day to
day life difficult
Denial of orstruggle with, the
reality of loss
Comfortableengagement with
the reality ofloss
Strong emotions are accepted as part of the consequences
of loss
A practice Matrix based on the RRL model (Relf, Machin & Archer 2010) (using scales of always, most of the time, sometimes , never, NK)
Factors (personal, circumstantial and social) contributing to vulnerability
Overwhelmed +vulnerable Vulnerability Controlled + vulnerable
struggle to manage
Strong emotions competing forces loss of control undermines
dominate + disable Inability to make capacity to deal with
day to day functioning sense of experience life demands
Comments Comments
Overwhelmed + resilient Resilience Controlled + resilientAble to face and accept Reconciliation between Able to think + act clearly
emotions of grief feelings and functioning + manage life demands
effectively
Factors (personal, circumstantial and social) contributing to resilience
2. A mapping tool for exploring individual grief dynamics.
A nine-item self report questionnaire5 point scale from strongly agree to strongly
disagreecurrent research - exploring use of the scale
to identify vulnerability
The Adult Attitude to Grief Scale
‘Overwhelmed’ items
2. For me, it is difficult to switch off thoughts about the person I have lost
5. I feel that I will always carry the pain of grief with me
7. Life has less meaning for me after this loss
Notions of grief contained in the overwhelmed items on the scale
Stressful
irreversible
uncontrollable (Mikulincer and Florian 1998)
The Adult Attitude to Grief Scale
‘Controlled’ items
4. I believe that I must be brave in the face of loss
6. For me, it is important to keep my grief under control
8. I think its best just to get on with life after a loss
Notions of grief contained in the controlled items on the scale
Restricted acknowledgement of distress
A need to be self reliant
Avoidance of grief through choosing a dominant focus on day to day life
(Mikulincer and Florian 1998)
The Adult Attitude to Grief Scale
‘Resilient’ items
1. I feel able to face the pain which comes with loss
3. I feel very aware of my inner strength when faced with grief
9. It may not always feel like it but I do believe that I will come through this experience of grief
Notions of grief contained in the resilient items on the scale
The capacity to face grief with:
courageresourcefulnessoptimism
(Greene 2002; Seligman 1998)
The Machin 2001 study demonstrated that:
The AAG scale was able to validate the DIFFERENT CATEGORICAL THEMES conceptualised within the RRL model when tested with other measures e.g. the Beck Depression Inventory, the Impact of Events scale and the Leiden Detachment scale.
BUT more importantly, It revealed the COMPLEX BIASES AND BLENDS
of overwhelmed, resilient and controlled reactions taking place within INDIVIDUALS
The biases and blends revealed by the AAG scale
overwhelmed controlled
resilient
O+C
O+RC+R
O+C+R
Two studies (2004, 2007) exploring the clinical usefulness of the AAG scale
The scale worked well for clients i.e. face validity It was an effective tool for the initial appraisal of client’s
grief It provided a structure for telling the grief story It provided a way of exploring (mapping) the complex and
sometimes contradictory aspects of grief It showed changes in grief response taking place over time It indicating the therapeutic focus necessary for nurturing
resilience
The AAG scale - a structure for qualitative responses (with some client responses)
Overwhelmed responses:2. For me, its difficult to switch off thoughts about the person
I have lost.
‘She’s there every minute of the day’
5. I feel that I will always carry the pain of grief with me.
‘I don’t think I will ever get over it’
7. Life has less meaning for me after this loss.
‘This loss has turned my life upside down’
The AAG scale - a structure for qualitative responses (with some client responses)
Controlled responses:4. I believe that I must be brave in the face of loss.
‘I do believe that I must be brave for my family’
6. For me it is important to keep my grief under control.
‘I’ve always thought that showing emotions is weak’
8. I think its best to get on with life after a loss.
‘Seems very hard to pick up the pieces for me’
The AAG scale - a structure for qualitative responses (with some client responses)
Resilient responses(an absence of agreement with these items demonstrates vulnerability):
1. I feel able to face the pain which comes with loss.
‘I just feel like the world has fallen in’
3. I feel very aware of my inner strengths when faced with grief.
‘I thought I was a strong person but this has floored me’
9. It may not always feel like it but I do believe that I will come through this experience of grief.
‘Can’t see me coming through this’
Client comments about their experience of the AAG scale (2007)
‘The feed back was very shocking. I didn’t realise how low I was’.
‘I feel freed by gaining confidence and thinking things through’.
‘I feel happier and can understand my own feeling more’.
‘Going through the questions again helped me see how much I’d grown in strength’.
Counsellor comments about their experience of using the AAG scale (2007)
‘AAG statements helped clients identify what they were feeling and talk more openly’.
‘The overwhelmed items help people get their story of loss out’.
‘Clients all agreed it was an accurate reflection of their grief’.
‘Identification and affirmation of areas for most need of therapy’.
The AAG scale - introducing a fourth dimension
vulnerability
(tension)
overwhelmed controlled
(balance)
resilience
Vulnerability and attachment theory
Main (1991) defined the most problematic attachment style as:
Disorganised/disorientated attachment where there is a mix of anxious and avoidant responses to separation and loss
A new research development using the
AAG scale (exploring the fourth dimension)
Calculating a vulnerability scoreThe method (proposed formula currently being researched):
The core grief responses (i.e. overwhelmed and controlled scores) combined, and the positive coping responses (i.e. resilient scores) deducted
= vulnerability score
O + C - R = V
Calculating vulnerability - it is proposed that by reversing the scores for the resilient items and adding together all nine
AAG responses gives an indication of vulnerability on a scale 0 - 36
strongly agree neither disagree strongly
agree agree nor disagree
disagree
2 4 3 2 1 0
5 Overwhelmed 4 3 2 1 0
7 4 3 2 1 0
4 4 3 2 1 0
6 Controlled 4 3 2 1 0
8 4 3 2 1 0
1 0 1 2 3 4
3 Resilient 0 1 2 3 4
9 0 1 2 3 4
Working with loss in practice
A
anticipated loss B C D breaking bad news/ working
discussing life- alongside loss retrospective
changing events reflection on
loss
Goals for practice
Confront appraise the
the pain possibilities
personal resourcefulness
positive life perspective
social embeddedness
Access and use of support