Dual Process Model of Grief


Any death of someone close to us is painful. No matter how old the person or the manner of their dying, death demands that we grieve for those we have lost. Everyone I know who has lost someone they love, speaks of waves of grief that come and go, sometimes when you least expect them; often without any discernible trigger.


In the early throes of loss it can feel overwhelming, particularly if the death was sudden and unexpected and/or violent, as in suicide. The waves come hard and fast and threaten to drown us in their intensity, more a tsunami than the gentle waves in my picture. The majority of bereaved people will say however, that over time, the pain softens, the trauma subsides, and the darkness lightens.


Over the past century a number of models have been developed to elucidate and clarify what happens to us psychologically when we grieve. One I find very helpful is The Dual Process Model of Grief (1999) which describes a collaborative process between us, the bereaved and our grief, during which we "oscillate" between two different states. In my experience, these very gradually become apparent some time after the first phase of acute shock has passed.


Loss Orientation

The periods when, particularly at the beginning of our loss, we are in raw, visceral, all-consuming pain, the times when we feel as though we may die from the anguish and agony, when we feel as though we are drowning in our own tears, are when we are in loss orientation. In other words we are orientated towards or facing the loss. At these times, in the first 2 years, I can remember being vehemently opposed to considering anything other than the pain; I was unable to contemplate a world without my son and at the same time 100% convinced that my life would hold nothing but pain from this moment on.


During these bouts of raw grief we are very emotionally connected to our loss, and suffering dreadfully. However, although we may not be aware of it at the time, these periods will contain what is often called grief work, the methods by which we gradually process the loss, emotionally and psychologically: thinking about the person who has died, acknowledging how much we will miss them, how much it hurts knowing we will never see them again. I think of this pain as essential, in order for us to adjust to our loss. If we don't experience the pain we will never learn to live alongside it. As most of us know, the difficult and hurtful things we hide from or avoid have a tendency to come back and bite us.


Losing someone is supposed to hurt; if we are not in pain at least some of the time, its likely we are suppressing our grief, or that the trauma associated with the loss is preventing us from processing it (this may resolve itself naturally over time, or we may want to seek help from a trauma therapist). Over time, the periods of loss orientation become less severe overall, though there are still occasions when the raw grief can return with full force, such as when we sorted through Anton's clothes recently.


Restoration Orientation

Between those periods of loss orientation are times when we may be having to deal with the practical consequences of the loss itself, for example when we are having to organise a funeral, deal with administration, or attend an inquest. These are excruciatingly painful things to do, yet somehow we find the strength to do them, and whilst engaged in these activities we are sometimes able to 'park' our emotions for a short while.


Similarly, after the initial shock, most of us have to meet the other demands of life: taking care of children or other dependents, cooking meals, going to work. Incredibly, despite the enormity of our loss, we continue to function. I remember reading a piece on a forum that went something like this: I cried. I cooked my children's dinner and washed the dishes. I cried. I fed the cat. I cried. Our minds and bodies allow us to slightly dip out of grieving to do the things we absolutely need to do. These episodes are described in the model as restoration orientation.


During these periods, we are actually tending to restoring our life in some way, and speaking personally, I think I was also trying to restore a sense of control over those things I was able to control. The bomb blast has changed our lives and our perceptions irrevocably; it has smashed our belief that things will work out in the end, challenged many of our assumptions about the world. The feeling that everything has spun out of control is terrifying; so we instinctively seek to impose some sense of order where we can.


At times, being in restoration orientation for me felt quite numb and disconnected. Although I was in need of respite from my tsunami, I was disconcerted by the feeling of being cut-off from my emotions about Anton, I felt afraid of what this might mean. Was I forgetting Anton, or grieving in the 'wrong' way? I remember asking myself "Where is Anton?" and thinking that it wasn't right that I wasn't in pain every minute of every day. So I was both relieved and reassured to read about this natural process of oscillation. As Julia Samuel says "Alternating 'letting go' with 'holding on' is something we need to learn to live with"(1).


I now think of my early restoration episodes as the very beginning of my very gradual adaptation to, and integration of losing Anton.




Stroebe & Schut's Dual Process Model:



As months and years pass, periods of restoration may also include starting new activities or hobbies, taking on different roles and responsibilities, connecting with others, and finding a sense of meaning in our life. I've described some of the ways I have done this so far in my three posts about Growing a Garden of Hope around the Black Hole 1 2 3


These restoration phases are an important and valuable part of our grief journey, because they provide us with some of the resources we need to continue growing our lives around the loss, develop coping strategies, find hope and meaning, and identify reasons to keep going. Equally importantly, especially in the first years, they allow us to rest from the work of grieving, which is emotionally and physically exhausting.


After almost 3 years, I still have waves of excruciating pain during periods in loss orientation but I find I spend much longer now in the phases of restoration orientation where I am slowly adjusting to life without Anton, and finding ways of rebuilding my life around the loss. Crucially, these include the various means by which I take Anton with me into my future life, the Continuing Bonds (post coming soon) that ensure he stays with us always.


❤️


References

Bowlby, J. (1980). Attachment and loss. London, England: Hogarth Press & Institute of Psychoanalysis

Dr Michael Duffy, Queen's University Belfast. One Day Workshop (February 2022). New approaches to trauma and traumatic grief. Responding to unexpected and traumatic grief: A cognitive approach to traumatic and complex grief.

Duffy, M & Wild, J (2017). A cognitive approach to persistent complex bereavement disorder (PCBD) The Cognitive Behaviour Therapist vol. 10, 1-19

Kubler-Ross, E. (1969). On death and dying. New York, NY: Macmillan

Murray Parkes, C & Prigerson, H.G. (2010). Bereavement: Studies of grief in Adult Life 4th Edition.

Margaret Stroebe, Henk Schut , and Kathrin Boerner (2017) Cautioning Health-Care Professionals: Bereaved Persons Are Misguided Through the Stages of Grief OMEGA—Journal of Death and Dying 2017, Vol. 74(4) 455–473

Julia Samuel (2017) Grief Works: Stories of Life, Death and Surviving (1) P.xx

Stroebe, M & Schut, H, Utrecht University, The Netherlands. The Dual Process Model of Coping with Bereavement: A Decade on OMEGA - Journal of Death and Dying Vol. 61(4) 273-289, 2010





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