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
loss to Loss model (Machin 2001; 2009)
The Range oftoResponse
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 of
Response to
Loss

Overwhelmed Resilient
by loss
response to
loss

Controlled
response to
loss

Attachment
Style
Ainsworth et
al (1978)
Dual Process
Model
Stroebe +
Schut (1999)

Anxious/
ambivalent
attachment

Secure
attachment

Avoidant
attachment

oscillation

Restoration
orientation

Loss
orientation

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 styles
Attitudes to difficult life events
The 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

permanently effecting life

bad events seen as

temporary

Pervasiveness

a failure in one area of life

bad events seen as

produces helplessness in
others

specific not
universal

Personalisation poor self esteem results

from self blame when
things go wrong

bad events
attributed
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
A capacity to balance and accept the competing
forces of grief
Overwhelmed
focus on feelings

Controlled
focus 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
Overwhelmed
focus 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

resilient
Core grief impact responses

Coping mechanism

A template for exploring grief in

practice
Feelings of
grief dominate
+ make day to
day life
difficult

vulnerable
Debilitating

Denial of or
struggle with, the
reality of loss

personal and / or
circumstantial factors
socially - isolated and / or disconnected

Overwhelmed

Controlled

Strong emotions
are accepted as part
of the consequences
of loss

Enabling
personal and / or
circumstantial
factors

Comfortable
engagement with
the reality of
loss

socially integrated and / or support felt to be adequate to needs

Resilient

A practice Matrix based on the RRL model

(Relf,
Archer 2010)
(using scales
of always,
most of the time,
Factors Machin
(personal,&circumstantial
and social)
contributing
to vulnerability
sometimes , never, NK)
Overwhelmed +vulnerable

Vulnerability

Controlled + vulnerable

struggle to manage
Strong emotions
dominate + disable
day to day functioning

competing forces
Inability to make
sense of experience

Comments

Overwhelmed + resilient
Able to face and accept
emotions of grief

loss of control undermines

capacity to deal with
life demands
Comments

Resilience
Reconciliation between
feelings and functioning

Controlled + resilient
Able to think + act clearly
+ 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 questionnaire
5 point scale from strongly agree to strongly
disagree
current 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:
courage
resourcefulness
optimism
(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

O+C

controlled

O+C+R
O+R

resilient

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 clients 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.
Shes there every minute of the day
5. I feel that I will always carry the pain of grief with me.
I dont 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.
Ive 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.
Cant see me coming through this

Client comments about their

experience of the AAG scale (2007)
The feed back was very shocking. I didnt
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 Id 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 score
The 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

agree

neither

disagree

agree nor
disagree

strongly
disagree

2
5 Overwhelmed
7
4
6 Controlled
8

4
4
4
4
4
4

3
3
3
3
3
3

2
2
2
2
2
2

1
1
1
1
1
1

0
0
0
0
0
0

1
3 Resilient
9

0
0
0

1
1
1

2
2
2

3
3
3

4
4
4

Working with loss in practice

A
anticipated loss

breaking bad news/

working

discussing lifechanging events

alongside loss

D
retrospective
reflection on
loss

Goals for practice

Confront
the pain

appraise the
possibilities
personal resourcefulness
positive life perspective
social embeddedness

Access and use of support