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Bereavement in family context: Coping with the loss of

a loved one
a
Margaret S. Stroebe
a
Department of Clinical Psychology , Utrecht University , The Netherlands
Published online: 04 May 2011.

To cite this article: Margaret S. Stroebe (2010) Bereavement in family context: Coping with the loss of a loved one , Family
Science, 1:3-4, 144-151, DOI: 10.1080/19424620.2010.576081

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 Family Science
Vol. 1, Nos. 3–4, June–October 2010, 144–151

REVIEW ARTICLE
Bereavement in family context: Coping with the loss of a loved one1
Margaret S. Stroebe*
Department of Clinical Psychology, Utrecht University, The Netherlands
(Received 23 October 2010; final version received 24 March 2011)

The loss of a close family member through death is associated not only with detrimental mental and physical health effects,
but it also has interpersonal consequences. This research is first briefly reviewed and the conclusion drawn that, while most
people suffer intensely in the weeks and months following the loss of a loved relative, a majority are able in time to come
to terms with their bereavement. It becomes important to examine for whom intervention is appropriate and whether it
Downloaded by [University of Saskatchewan Library] at 23:41 12 January 2015

is effective. Furthermore, we need to understand processes of coping associated with (mal)adjustment. Major theoretical
perspectives in the bereavement field have focused on the necessity to do “grief work” in order to come to terms with
loss. There are shortcomings to this conceptualization. Importantly, the family context of grief and grieving is neglected. The
limitations in theoretical formulations led to the development of the Dual Process Model of Coping with Bereavement (DPM,
Stroebe & Schut, 1999). It is shown how an interpersonal perspective can be incorporated into the model and illustrations of
its application to the family context are given.
Keywords: grief; bereavement; family; health; coping; interpersonal relations

Introduction It is important at the outset to define a few terms that

There can hardly be a greater life transition than the expe-
rience of loss through death of a loved person. It is a life
event that impacts on individuals and families in complex
and varied ways, and it is associated with inter- as well as
intrapersonal consequences. Indicative of the strength of its
impact is the fact that the Social Readjustment Rating Scale
(Holmes & Rahe, 1967) ranked “death of a spouse” as the
event requiring the most intense readjustment, with “death
of a close family member” also ranking very highly, in fifth
place. In this paper, research on the impact of bereavement
for individuals and families is reviewed, selecting key find-
ings. This leads to discussion about the implications for
intervention. If bereaved people suffer deleterious conse-
quences, can they be helped by counselling or therapy?
Following this line of argument, analysis of how peo-
ple cope is relevant for understanding both differences in
adjustment and for guiding intervention programs: What is
effective coping? Theories of coping are examined and our
own model, the Dual Process Model of Coping with Loss
(DPM; Stroebe & Schut, 1999, 2010) is described. This
model was designed to address a number of shortcomings
inherent in previous models. In the context of the family,
an important shortcoming was the focus on intrapersonal
rather than interpersonal processes of coping. It is shown
how this is dealt with in the DPM.
are frequently used in the context of the loss of a loved
person. Bereavement, the objective situation of having lost
someone significant, is an event that typically occurs with
increasing frequency across the life span, with people hav-
ing to face the death of parents, siblings, partners, friends,
or even their own children. The intense distress associated
with bereavement is termed grief , defined as a primarily
emotional (affective) reaction to the loss of a loved one
through death (Stroebe, Hansson, Stroebe, & Schut, 2001).
Although it is sometimes used interchangeably with grief,
the term mourning is here defined as the social expressions
or acts expressive of grief that are shaped by the practices
of a given society or cultural group (Stroebe et al., 2001).
Intra- and interpersonal health consequences of
bereavement
The most extreme physical health consequence would be
the death of the bereaved person him or herself. Indeed,
through the centuries the notion that one can actually die
of a “broken heart” has remained part of popular culture.
For example, the following epitaph was written in the sev-
enteenth century by Sir Henry Wotton (1568-1639) on the
death of the wife of a gentleman named Albert Morton.
This lady’s death - apparently from grief - occurred shortly
after that of her husband:

∗
Email: m.s.stroebe@uu.nl

ISSN 1942-4620 print/ISSN 1942-4639 online

© 2010 Taylor & Francis
DOI: 10.1080/19424620.2010.576081
http://www.informaworld.com

He first deceased;
She for a little tried
To live without him;
Liked it not, and died.
Is the “broken heart” a valid assumption; is there scien-
tific evidence to back it up? Analyses of cross-sectional,
national data sets on mortality by marital status provide
the first clues. To illustrate, patterns of mortality by mar-
ital status reported by Shurtleff (1955) were based on the
death rates of adults in the United States from 1949 to
1951. Shurtleff (1955) recorded high excesses in mortality
among widowed persons compared to those of other mar-
ital statuses, relatively higher excesses at earlier ages, and
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relatively higher excesses for widowers than for widows.
Such patterns have frequently been replicated.
However, clear though these patterns seem to be, one
cannot actually assume that such excesses for the widowed
are caused by the psychological impact of loss. Selection
and statistical artefacts could account for at least part of
the increase in mortality rates; and other explanations such
as homogamy or joint unfavourable environment of the
couple could challenge the conclusion that the increase is
due to a broken heart (Kraus & Lilienfeld, 1959).
Fortunately, longitudinal investigations are available
too, which have managed to control for such factors and
which have typically confirmed the age and gender patterns
found by Shurtleff (1955). One classic study was con-
ducted by Parkes, Benjamin, and Fitzgerald (1969) among
older widowers. There was a higher risk of these men
dying (compared with married counterparts) in the first
six months of bereavement. Recent well-controlled stud-
ies have also confirmed the excesses for bereaved people.
Most findings indicate an early excess risk of mortality,
although excesses have indeed been shown to persist for
longer than six months after bereavement. It is impor-
tant to note that sex difference patterns vary across types
of loss. Whereas partner loss appears to affect men rela-
tively more than women, death of a child seems to have an
even greater excessive mortality risk for mothers than for
fathers. A national-level study in Denmark by Li, Precht,
Mortensen, and Olsen (2003) showed that excess risk of
dying for bereaved mothers compared with mothers who
had not lost a child extended across the 18 years of the
study, with deaths attributed to both natural and unnatural
causes, whereas for fathers, greater risk was noted early on
in bereavement, particularly from unnatural causes.
Although mortality is a drastic consequence of losing
a loved one, it must be remembered that it affects just
a very small proportion of bereaved people. However, if
some actually die, and from a variety of causes, many
more are likely to suffer from diverse mental and phys-
ical health consequences. There is considerable evidence
that bereaved people suffer more from a variety of men-
tal and physical health problems (e.g., post traumatic stress
Family Science 145
disorder, depression, chest pains, infections) than do the
non-bereaved (for a review, see Stroebe, Schut, & Stroebe,
2007). For example, the Tübingen Longitudinal Study of
young widowed compared with matched married persons,
20% of the widowed (compared with 3% of the married)
suffered from severe physical symptoms at four to six
months post-loss. After two years, the rate among the wid-
owed declined to 12% (Stroebe & Stroebe, 1993). The
percentages for mental and physical health difficulties vary
considerably, due not only to the type of debility and its pre-
cise measurement, but also to sample characteristics (e.g.,
type and nature of bereavement). For example, rates for
complicated grief vary from as few as 5% but up to 33%
of the bereaved (Middleton, Raphael, Martinek, & Misso,
1993; for a review see Forstmeier & Maercker, 2006).2
Nevertheless, the overall picture is clear: for each type
of debility substantial minorities of bereaved individuals
do suffer from severe and quite lasting consequences fol-
lowing bereavement. A rough but possibly conservative
estimate of around 20-30% prevalence emerges from the
different health vulnerability areas. These figures receive
confirmation from a different line of research conducted by
Bonanno, Boerner, and Wortman (2008) who has investi-
gated resilience in bereaved people. Again, a majority of
people are indeed resilient.
Given the actual number of people who are bereaved
in any one year, we are talking about large numbers of
people at risk. In the Netherlands, for example, approxi-
mately 130,000 persons have been estimated to die each
year, leaving four persons on average bereaved. Thus, at
any one time, in this quite small country (with a population
just under 17 million), 500,000 persons will be coming to
terms with the death of a significant person in their lives
(van den Bout, Boelen, & De Keijser, 1998).
So far the mental and physical health impact of
bereavement in the first months and years following loss
(i.e., during the acute grieving period, which varies between
individuals and cultures) has been outlined. But are there
longer-term consequences, as suggested in the Li et al.
(2003) study on parent’s excess mortality? Considerable
research effort has focused particularly on the long-term
consequences of the loss of a parent in childhood. For
example, Luecken (2008) reviewed this body of literature
and identified important patterns. Notably, she found that
psychological (e.g., depression) and physiological (e.g.,
cortisol reactivity) reactions in adulthood were linked to
parental loss in childhood. However, two important risk
factors for such difficulties in adulthood were (1) neglectful
parenting and (2) poor coping of the surviving parent.
These post-loss factors seemed to be the critical features,
rather than the event of loss itself. In this context, it is
important to know that psychotherapeutic intervention pro-
grams, such as the Family Bereavement Program developed
by Sandler and his colleagues (Sandler et al., 2010), have
been shown to be effective for children and adolescents.
 146 M.S. Stroebe
The Family Bereavement Program is a theoretically derived
intervention program for children who have experienced
parental death. It was designed to be implemented with
bereaved families, to improve multiple risk and protective
factors (e.g., effective discipline; adaptive control beliefs)
which were hypothesized to lead to improvements in child
functioning. The program is delivered in 12 group sessions
and 2 individual sessions, with 5 sessions including joint
activities for the caregivers and children.
To summarize: Regarding the intrapersonal conse-
quences of bereavement, in general one can say that there
are a wide range of reactions and health consequences,
from mild and short-lived to extreme and long-lasting.
However it must be remembered that, although most people
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suffer intensely, only a minority have severe mental and/or
physical health complications. Bereavement is, after all, a
normal, natural life event, one that nearly everyone has to
face sooner or later.
Turning from intrapersonal to interpersonal conse-
quences, again, a wide range of bereavement effects could
be reviewed, ranging from older widowed persons percep-
tions of intergenerational support (e.g., Ha, Carr, Utz, &
Nesse, 2006) to meaning-making in bereaved families (e.g.,
Winchester Nadeau, 2008), to bereavement experiences of
close family members after the death of an old person (e.g.,
Moss, Moss, & Hansson, 2001). Two other consequences
can usefully be highlighted in the context of the family: (1)
the possibility of marital disruption following the death of a
child and, taking a very different aspect, (2) the experience
of emotional and social loneliness following the death of a
spouse. Many claims have been made that there is high risk
of parental separation after the death of a child. However,
important though this issue is, the literature is unfortu-
nately still unclear. On the one hand, one recent study by
Rogers, Floyd, Seltzer, Greenberg, and Hong (2008) found
that bereaved parents had a higher rate of separation or
divorce than non-bereaved (religious participation, or hav-
ing other children were both associated with less marital
disruption). On the other hand, Eilegard and Kreicbergs
(2010) reported that dissolution of the partnership was not
more common among parents who have lost a child to
cancer, than it was among non-bereaved parents. A fairly
recent review concluded that: “...insufficient empirical evi-
dence exists to assert that divorce rates are higher among
bereaved parents when compared with non-bereaved par-
ents (p. 362)” (Murphy, Clark Johnson, & Lohan, 2003).
More research and careful review needs to be done, for
example, it would be useful to extend the Eilegard and
Kreicbergs (2010) study to loss of a child through causes
other than cancer, since it is conceivable that marital dis-
ruption is relatively higher following certain types of death
(e.g., suicide) than others. A possibility that was raised
over a decade ago needs further consideration: Dijkstra
and Stroebe (1998) drew attention to the possibility that
some couples draw together (perhaps mending a previously
unstable marriage), while others may be driven apart by
the loss of their child, not understanding each other’s grief
or experiencing incompatibility in dealing with their loss
(so that overall calculations of the number of disrupted
marriages would remain somewhat unchanged).
The second interpersonal issue, loneliness following
partner loss, has implications both for theory and prac-
tice. Given that bereavement involves the loss of a loved
person, by its very nature it is an interpersonal event, one
that is spoken to by a major perspective in the bereavement
field, namely attachment theory (Bowlby, 1980). For exam-
ple, in one longitudinal study of the impact of the loss of a
child on bereaved parents, security of attachment-predicted
adjustment of these parents (e.g., they had lower levels
of grief symptoms) over and above the personality factor
of neuroticism (Wijngaards et al., 2007). Parents who felt
secure in their relationships, not only to their partners but
to other persons in general (e.g., they endorsed question-
naire items indicating that they did not worry that their
partner loved them; they were not uncomfortable being
close to others), adjusted better to the loss of their child
during the first two years of their bereavement. Along dif-
ferent lines, but still following the attachment perspective,
Weiss (1975) made a major distinction between emotional
and social loneliness. Emotional loneliness refers to a sense
of utter aloneness and isolation, whether or not others are
accessible, as illustrated by an item on a scale measuring
this construct: “I feel lonely even when I am with others.”
A remark by Francis Bacon seems to capture the essence
of this type of loneliness: “A crowd is not company, and
faces are a gallery of pictures.” By contrast, social loneli-
ness has been defined as the feeling that there is nobody
to count on for support, absence of an engaging social net-
work, lack of a sense of social embeddedness, as illustrated
in the statement: “I don’t have a really good set of friends.”
The occurrence and impact of these two types of loneliness
across the first two years of bereavement were investigated
in the Tübingen longitudinal study of bereavement men-
tioned above. Loneliness was examined in relationship to
depression among young widows and widowers, as was the
impact of social support from others on loneliness (Stroebe,
Stroebe, Abakoumkin, & Schut, 1996). Does support pro-
tect from the loneliness of bereavement? It was found
that widowed persons were particularly emotionally lonely
compared with their married counterparts. Examining the
patterns according to social support by marital status more
closely, a remarkable difference in the occurrence of the
two types of loneliness was discovered. Social support was
helpful in reducing social loneliness (for bereaved and non-
bereaved persons). However, importantly, it was found that
social support from friends and family did not reduce emo-
tional loneliness. Another thing that analyses showed was
that emotional loneliness in bereavement-predicted depres-
sion. These data underline the attachment theory principle
that persons to whom we are closely emotionally bonded

are not easy to replace. They highlight the central role of
loneliness in the bereavement process and perhaps lead
one to modesty about how much others can actually help
a bereaved person to adjust to his or her bereavement. This
leads to the next topic, namely, the impact of professional
intervention.
The efficacy of intervention
For whom is intervention after loss appropriate? Is inter-
vention effective? Review of the literature has shown that
intervention which is open to all bereaved persons (the
criterion for participation being simply that one has expe-
rienced a loss through death) is generally not very effective
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(Schut & Stroebe, 2005; Schut & Stroebe, 2010; Schut,
Stroebe, van den Bout, & Terheggen, 2001 ). Interventions
which are confined to high-risk groups - those who can be
regarded as more vulnerable to the health risks of bereave-
ment (e.g., high levels of distress, traumatic loss, concur-
rent life events, loss of a child) - are more promising. In
the context of family transitions, it is important to mention
the Family Focused Grief Therapy program of Kissane and
his colleagues. These researchers have worked for years
to develop this program for high-risk families, and have
had considerable success in reducing distress of bereaved-
treated families, compared with untreated controls (e.g.,
Kissane & Lichtenthal, 2008). Finally, interventions which
are designed for those who suffer from complicated grief
have mostly been found to be helpful. The general conclu-
sion - which has been supported by additional reviews in
the meantime (e.g., Currier, Neimeyer, & Berman, 2008)
- is that it is not appropriate to offer intervention to peo-
ple simply based on the fact that they have suffered the
loss of a loved one. Intervention should rather be planned
for high-risk groups and those who have complicated grief
manifestations.
The efficacy of intervention can be illustrated through
a research project by Henk Schut (see Schut, Stroebe, de
Keijser, & van den Bout, 1997). He conducted a study
of widowers and widows, mean age 54 years, who were
assessed to be moderately to highly distressed just over
a year after their bereavement. A number of these per-
sons were offered intervention and compared with a control
group who did not receive intervention. The intervention
group was randomly assigned to one of two conditions:
either they received client-centred therapy, focusing on
their emotions, or they received behaviour therapy, focus-
ing on tackling the problems that occur as a result of
bereavement. The intervention took place in seven ses-
sions, from 14 to 17 months post-loss. Their levels of
distress were measured before therapy, after it and at
follow-up.
In general, the therapies were quite effective. However,
there were notable gender differences. It is interesting
to consider potential predictions about these differences:
Family Science 147
Would one expect widowers (compared with widows) to
benefit more from problem-focused intervention, since
men typically focus less on emotions than do women (van
Heck & de Ridder, 2001). Or would one expect that wid-
owers would gain from “switching” to emotion-focused
coping, since the preferred coping style had not worked
so far? What emerged from this research was that, for
those who need help, in the long-term: Emotion-focused
intervention was found to be more helpful for widowers,
while problem-focused intervention was more helpful for
widows, thus supporting the second of the two hypotheses
considered above. This study also illustrates the importance
of different ways of coping in coming to terms with loss,
suggesting the need for flexibility. Theoretical analysis of
the coping process promotes understanding of its rather
complex relationship to adaptation.
Coping in theoretical perspective
Major theoretical perspectives in the bereavement field,
including the psychoanalytic (Freud, 1917) and attachment
(Bowlby, 1980) perspectives, have focused on the neces-
sity for bereaved persons to do their “grief work” in order
to come to terms with loss. It has also been a fundamental
principle in the design of therapy and counselling pro-
grams. In particular, it is fundamental to Worden’s (1991,
2009) “Task Model” as described in his classic “Grief
Counselling and Grief Therapy” handbook. In short, it was
understood by both theorists and practitioners that one must
go over the events before and leading up to the death, and
review the relationship with the deceased person. Without
such confrontation with one’s loss, adjustment would not
occur. Bowlby’s (1980) well-known phases cover shock,
yearning/protest, despair, and restitution. Worden’s (1991)
four tasks1 cover accepting the reality of loss; experienc-
ing the pain of grief; adjusting to life without the deceased;
and withdrawing emotional energy from the deceased and
reinvesting it in another relationship.
While there is much to be said in favour of its impor-
tance, there are also shortcomings to this “grief work”
conceptualization. To summarize the main arguments of
Stroebe and Schut (1999, 2010): the usefulness of grief
work has been examined empirically and found not to work.
People who “worked through” their grief were no better
adjusted over time than those who did not. Importantly
too, the grief work model fails to take account of other
sources of stress that need to be coped with during bereave-
ment (e.g., dealing with the finances, learning how to cook,
sorting out legal affairs, and so on). Neither did it fit
other cultural prescriptions: grief work does not seem to
be evident in some cultures, yet adaptation takes place (cf.
Wikan, 1988, 1990). To illustrate, Wikan (1988) reported
vastly different patterns among Muslim communities in
Egypt and Bali. While in Egypt “... the bereaved are
encouraged to dwell profusely on their subjective pain in
 148 M.S. Stroebe
an atmosphere where ... others also immerse themselves in
tragic tales and expressed sorrow”, in Bali “... laughter and
cheerfulness fill the air while the bereaved are enjoined to
contain their sorrow and may be made to feel they com-
mit an injustice to others should they fail to abide by this
demand”. (p. 445)
In the present context, a major limitation of the
grief work model is that the process of working through
grief has been viewed as largely intrapersonal in nature.
Accordingly, examination of interpersonal influences has
been neglected. Yet people do not typically grieve in iso-
lation, other persons around them, in particular, family
members, are also affected by the loss of a loved one, and
this is likely to have consequences for a person’s adjust-
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ment to bereavement. For example, it would seem likely
that one family member’s grief intensity and way of griev-
ing will impact on that of another and vice versa. Extending
scientific investigation to include an interpersonal perspec-
tive would enable one to examine such influences, and it
would facilitate assessment of their impact on adjustment
of family members. The question we had to solve was how
to improve on the previous models. The so-called Dual
Process Model was developed as an alternative framework
to try to provide some guidance regarding these concerns.
The dual process model of coping with bereavement
(DPM)
The DPM is a taxonomy for describing how people cope
with bereavement, one which we think addresses the lim-
itations of previous models mentioned above. The main
parameters are sketched in Figure 1.
As can be seen, two types of stressor were postulated,
namely, loss- and restoration-oriented ones. Loss-oriented
coping involves dealing with those stressors to do with
Everyday life
experience
Loss-
oriented
Grief work
Intrusion of grief
letting go-continuing-
relocating bonds /
ties
Denial/avoidance
of restoration
changes
oscillation
Figure 1. The dual process model of coping with bereavement.
the deceased person, and grief work is incorporated here.
Restoration-oriented coping has to do with secondary stres-
sors that come about as a result of loss, things which also
cause anxiety and distress, for example, in partner loss,
learning the skills that the deceased had taken care of, or the
need to develop a new identity without the deceased. The
model places the coping process within everyday life expe-
rience (one is not coping all the time). Fundamental is the
idea of oscillation, an emotion regulatory process, which
we needed to postulate, since one cannot deal with loss
and restoration stressors at the same time. This dynamic
process distinguishes this model perhaps most significantly
from the other coping models, as does the addition of the
restoration dimension. The latter would extend the four
more loss-oriented tasks of Worden (1991) to include par-
allel, restoration-oriented ones that can be summarized as:
acceptance of the reality of the changed world; taking time
off from the pain of grief; mastering the changed (sub-
jective) environment; and developing new roles, identities,
and relationships. It is interesting to note that in the most
recent edition of his book, Worden’s (2009) third and fourth
tasks have become more restoration-oriented, namely, to
adjust to a world without the deceased and to find an endur-
ing connection with the deceased in the midst of embarking
on a new life.
Some evidence in support of the model is beginning
to accumulate (see Stroebe & Schut, 2010). For exam-
ple, Shear, Frank, Houck, and Reynolds (2005) conducted
a study of the efficacy of intervention for bereaved per-
sons with complications in their grieving. They were
either assigned (randomly) to traditional interpersonal psy-
chotherapy (IPT), or to a treatment program that followed
the principles of the DPM, called complicated grief treat-
ment. Treatment was administered in 16 sessions during
an average interval of 19 weeks per participant. The DPM
Restoration-
oriented
Attending to life
changes
Doing new things
Distraction from grief
Denial/avoidance
of grief
New roles/
identities/
relationships

condition involved description of the DPM model itself
and also asked about loss and life goals at the outset. In
the main part of the therapy, loss and restoration processes
were addressed in tandem, focusing on issues to do with
the loss itself and restoration of a satisfying life. Finally,
progress was reviewed, plans were made for the future, and
feelings about completing the therapy were discussed. For
those in the DPM treatment condition there was greater and
quicker improvement than in the IPT condition.
The application of the DPM framework to gender
differences has implications for a family perspective on
grief. Traditional Western gender differences can be rep-
resented in the DPM, which are not evident in the grief
work models described earlier. In line with the focus of
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women on their emotions and of men being more problem-
oriented, women would typically be more loss-, men more
restoration-oriented.
In line with this, it is important to note interper-
sonal coping processes that the model has the potential
to incorporate, acknowledging that one person’s way of
grieving impacts on that of another. The gender differences
described above provide an illustration: if, say, a bereaved
father is more restoration-oriented, a mother more loss-
oriented, attributions may be made in terms of differences
in extremity of grief, for example, a mother might assume
“he is grieving less than I am” rather than what may actu-
ally be the case, that “he is grieving differently”. Making
the former attribution could negatively impact on the cou-
ple’s adjustment to bereavement. Evidence from recent
research regarding the influence of such interpersonal cop-
ing processes from a DPM perspective has been found:
Wijngaards et al. (2008) used the DPM framework to exam-
ine the relationship between a bereaved parent’s own and
their partner’s way of coping in relationship to their adjust-
ment to the death of their child. Interpersonal factors were
indeed found to play a part in coping and adjustment. For
example, one of the main findings was that, for fathers, hav-
ing a wife who was high in restoration-oriented coping was
related to positive adjustment.
The following two statements by a bereaved couple
in one longitudinal study of bereaved parents, four years
after the loss of their newborn child, reflect the gender dif-
ferences in coping that we have just identified (Dijkstra,
2000). These were the mother’s words: “Generally I think
of our son the whole day. Then my husband comes home,
and asks how I feel. Well, at such moments I almost
explode. ‘You know how I feel’ I snap at him then.” The
father had this to say: “If I have been working, I am usu-
ally in a good mood. I can really find some distraction in
my work. But the closer I get to home, the tenser I feel,
because I know she will be feeling down again.”
To broaden from gender differences between partners
who have lost a child to bereavement in families: Earlier
it was mentioned that for every death, an average of four
people have been estimated to be deeply grief-stricken,
Family Science 149
many of whom will be family members. Grieving is often
very much a family affair (Kissane & Lichtenthal, 2008;
Moss et al., 2001; Sandler et al., 2010). Take the case of a
widow and her two children wherein the mother oscillates
between loss- and restoration-orientation, while one of
her children, her daughter, is more loss- the other, her
son, more restoration-oriented. These patterns influence
each other and ongoing ways of coping. Some of our
own ongoing research is directed towards identifying
how bereaved parents’ perceptions of their own and their
partners’ coping affect grieving over time. Clearly, there
is scope for further extension of such lines of research,
for example, to include other family members such as
bereaved siblings. Unfortunately, this was beyond the
scope of our own investigation.
Summary and conclusions
Negative health consequences across a variety of outcomes
and for some different types of bereavement have been
documented, and interpersonal consequences have been
illustrated. It was noted that grief is a normal, natu-
ral process following bereavement. Most reactions are
not complicated and for most bereaved persons, family
and friends, religious and community groups and vari-
ous societal resources will provide the necessary support.
Professional psychological intervention is generally neither
justified nor effective for uncomplicated forms of grief.
Considerable scientific effort has been directed towards
understanding (mal) adaptive forms of grieving, not least
because coping is a variable that can be influenced and
potentially changed. A number of shortcomings are asso-
ciated with the traditional Western notion that in order to
cope well and get over one’s loss, one has to work through
one’s grief. The DPM was put forward as a framework
to overcome some of the shortcomings. In particular, this
model incorporates analysis of the interpersonal dynam-
ics that occur following the loss of a loved one, and the
interactive dynamics of families that may impact on pat-
terns of grieving and adjustment. There is no doubt that
future scientific investigation in the bereavement field can
benefit from further integration of perspectives from fam-
ily relations research, and hopefully, the latter field will find
dialogue with bereavement researchers fruitful too.
Notes
1. This article is based on a keynote address presented at
the European Society on Family Relations 5th Congress,
“Family Transitions & Families in Transition” Milan, Italy,
29th September–2nd October, 2010.
2. Complicated grief has been defined as “a deviation from
the (cultural) norm (i.e., that could be expected to pertain,
according to the extremity of the particular bereavement
event) in either (a) the time course or intensity of specific or
general symptoms of grief and/or (b) the level of impairment
in social, occupational, or other important areas of function-
ing” (Stroebe, Hansson, Schut, & Stroebe, 2008, p. 7).
 150 M.S. Stroebe
3. Recently, Worden (2009) has adapted his tasks, with more
attention to ongoing relationships and restoration tasks.
Given that the current focus is on origins and reasons for
development of the DPM, the tasks that were available at that
time are detailed here.
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