Dual Process Grief | Counseling | Therapy

Dual Process Grief

Dr. Erica , LCSW, DSW — Therapist

You may be familiar with the stages of grief conceptualized by Elisabeth Kubler-Ross, or the acronym DABDA. The model consists of stages that are cyclical, sometimes repetitive, and come in no particular order. The stages include denial, anger, bargaining, depression, and acceptance.

Kubler-Ross' theory has been popularly applied for decades in different areas of grief therapy, self-help books, popular culture and more. However, there are lesser known, but even more applicable, models of grief and grieving that represent the "new" school of grief theories that can help individuals as they struggle with the loss of a loved one. Not only was DABDA originally born out of Kubler-Ross' interviews with the dying (not the bereaved!), but some research today has even suggested that the model is far too simplistic and doesn't encompass the many nuanced experiences of the grief process.

If DABDA has been helpful for you as you grieve, feel free to hold onto it! However, it might be helpful for you to learn about other models that help us understand the process of grief and grieving. Below, I offer the first of many other models to consider as you grieve.

The Dual Process Model

According to researchers Stroebe and Schut (2010), the dual process model explains how individuals cope with the loss of a loved one. The model encompasses two main concepts: Loss Orientation and Restoration Orientation. Loss Orientation centers around the grief work individuals do as they attempt to cope with loss, and might look a whole lot like traditional expressions of grieving, such as dwelling on the lost loved one, crying, and searching for connection with the deceased. On the other hand, Restoration Orientation consists of how individuals cope with the consequences of death, including rethinking and reorienting oneself in a new life without one's deceased loved one. In one's everyday experience, there is a constant dual processing of expressions of both Loss and Resolution orientation. Here are a few more examples of each:

Loss Orientation: grief work, intrusion of grief, letting go or continuing bonds*, denial and avoidance of changes related to restoration

Restoration Orientation: attending to life changes, doing new things, distraction from grief, new roles and identities, denial and avoidance of changes related to grief

Stroebe and Shut's work builds on an earlier model centered on tasks of grieving by William Worden. They advocate the importance of the following tasks and actions:

"Accept the reality of loss...and accept the reality of a changed world. Experience the pain of grief...and take time off from the pain of grief. Adjust to life without the deceased...and master the changed environment. Relocate the deceased emotionally and move on...and develop new roles, identities, relationships." (Stroebe & Shut, 2010, p. 278)

So, what might a dual process model of grieving actually look like in a person's life? Consider the case of Daphne, who was forced to make the heartbreaking decision to end a pregnancy at 20 weeks gestation, due to a rare fetal anomaly. After recovering physically from the termination, Daphne's dual process involved many aspects. Primarily, she placed extreme value on continuing bonds, in which she maintained a close connection to the baby she lost. For Daphne, this meant creating a memory box, celebrating her baby's angelversary by listening to special music, and working through feelings of guilt she had about the decision to terminate. This all represents Daphne's process of loss orientation. At the same time, Daphne also began to consider trying to have another baby, and because the loss was her first child, she began to reconceptualize herself as a grieving mother, not simply a woman who lost a baby. This represents her restoration orientation. Sometimes, Daphne experienced deep sadness over the conflict between her love for her baby as a mother, and the painful decision to end the pregnancy. This is an example of her engaging in the dual process model, simultaneously attending to both loss and restoration. By working with a therapist to honor both processes of grief, Daphne was able to create deeper meaning from her loss experience. Can you see how the dual process model may provide a richer, deeper understanding of grief than the DABDA model?

Certainly, there is no uniform or one-size-fits-all model for grief. Every grief experience is as unique as the individual grieving. However, the dual process model represents a fresher take on how we experience love and loss, and attempt to come to terms with it as we move forward in life without our loved ones.

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