Written by Dr Ray Owen
You might have heard the saying, “There’s nothing so useful as a good theory.” In an area like grief, where there are numerous theories – some well known – it can sometimes feel like there’s a gap between understanding the models and knowing what you can actually do to help people, beyond explaining concepts.
Useful models of grief
Two particularly useful models of grief are the dual process model, originally described by Stroebe and Schut, and continuing bonds, developed by Klass and Silberman.
The dual process model
This model suggests that grief involves oscillating between two states:
- Loss orientation: Focusing on the pain, memories, and the emotional impact of the loss.
- Restoration orientation: Focusing on rebuilding life, adapting to the loss, and creating a new way of living.
Dr Julie Stokes, a psychologist and founder of the child bereavement charity Winston’s Wish, reframed these concepts for children and teenagers as “The Land of Loss” and “The Land of Rebuilding” in her book You Will Be OK (2021). This reframing simplifies the idea that people move between these two states – often multiple times a day – rather than finishing one phase before moving to the next.
The continuing bonds model
This model challenges the idea that grief is about “letting go” of the deceased. Instead, it highlights the importance of renegotiating the relationship with the person who has died, carrying them forward in a way that evolves over time. This aligns with the understanding that grief is often a lifelong process, even though its intensity may change.
These models provide helpful frameworks for understanding grief, but they also raise the question: How do we apply these ideas in therapy to support people practically?
Challenges of rebuilding and decision-making
One key challenge is that rebuilding life cannot be postponed until “grief is over” – because grief never truly ends. Instead, we must make decisions, develop new skills, and choose where to focus our energy, all while carrying the immense pain of loss.
This becomes especially difficult when the person who has died played a significant role in decision-making. For instance, perhaps the client always consulted their partner on major life questions or relied on their advice. Without that person, even practical decisions – like whether to sell a house or move closer to family – can feel paralysing.
However, while the person may no longer be physically present, they are often still part of the client’s internal world.
The internal model in our minds
Much of the time, our relationships – even with a living person – are shaped by our mental representation of them, rather than the person themselves. For example, if you’re watching TV with your partner and they leave the room, you still “know” how they would react to certain scenes because you carry an internal model of them in your mind.
This internal model doesn’t disappear when someone dies; it simply becomes harder to access due to the pain of grief. By acknowledging this, we can help clients maintain their relationship with the deceased in a way that adapts to the reality of their absence – as described by the continuing bonds model.
Supporting clients in decision-making
When clients feel stuck in grief-related dilemmas, therapists can help them access their internal model of the deceased to predict what that person might have thought. For example, you might ask, “What do you think [the deceased] would have thought about this decision?”
To deepen this process, you can take it a step further using an “empty chair” technique. Here’s an example of how this could be introduced:
- Therapist: “Would it be OK if we try something? Let’s imagine [the deceased] were here with us right now. If they were sitting in this chair, listening to the dilemma you just described, what do you think they might say? What might they think is the right thing to do?”
This exercise can help clients access their internal model of the deceased more fully, providing clarity or perspective. However, it’s important to approach this carefully, as it can evoke strong emotions.
Tips for using this approach
If you decide to use this exercise, here are some important considerations:
- Gain explicit consent: Always ask for the client’s agreement before trying this. For example, “Would you be willing to give this a go?”
- Be mindful of emotions: This exercise can be very emotional, so avoid it if the client is likely to feel overwhelmed when thinking about the deceased. Grief often includes complex emotions like anger, guilt, and anxiety, so be prepared to explore these if they arise.
- Timing is key: Avoid using this exercise near the end of a session, as you may need time to help the client process any strong emotions that emerge.
- Normalise disagreement: Emphasise that even if the client gets a clear sense of what the deceased might have thought, they are not obligated to agree or act on it. For example, “Remember, just because you think [the deceased] might have said this doesn’t mean you have to follow their opinion. You may have disagreed with them in life, after all.”
In some cases, this exercise can also reveal other dynamics, such as a sense of obligation to follow the deceased’s wishes, which can be explored further in therapy.
Extending the approach
While this technique is especially useful for decision-making, it can also be applied to other aspects of grief, such as:
- Resolving unanswered questions or conflicts.
- Processing difficult relationships or ill-treatment from the deceased.
These areas often contribute to more complicated grief responses but require careful and sensitive exploration to ensure the work is both safe and effective.
Conclusion
In practice, this approach combines elements of the dual process model (supporting clients in balancing loss and rebuilding) and the continuing bonds model (helping clients maintain a meaningful connection with the deceased). It also incorporates gentle exposure to mental imagery and relationship dynamics, promoting healing and movement through grief.
Reference
Julie Stokes (2021), You Will Be OK, Wren & Rook Press.