Cautioning Health-Care Professionals

Abstract

Science and practice seem deeply stuck in the so-called stage theory of grief. Health-care professionals continue to “prescribe” stages. Basically, this perspective endorses the idea that bereaved people go through a set pattern of specific reactions over time following the death of a loved one. It has frequently been interpreted prescriptively, as a progression that bereaved persons must follow in order to adapt to loss. It is of paramount importance to assess stage theory, not least in view of the current status of the maladaptive “persistent complex bereavement-related disorder” as a category for further research in DSM-5. We therefore review the status and value of this approach. It has remained hugely influential among researchers as well as practitioners across recent decades, but there has also been forceful opposition. Major concerns include the absence of sound empirical evidence, conceptual clarity, or explanatory potential. It lacks practical utility for the design or allocation of treatment services, and it does not help identification of those at risk or with complications in the grieving process. Most disturbingly, the expectation that bereaved persons will, even should, go through stages of grieving can be harmful to those who do not. Following such lines of reasoning, we argue that stage theory should be discarded by all concerned (including bereaved persons themselves); at best, it should be relegated to the realms of history. There are alternative models that better represent grieving processes. We develop guidelines to enhance such a move beyond the stage approach in both theory and practice.

Bereavement stressors and psychosocial well-being of young adults following the loss of a parent – A cross-sectional survey

“…Nowadays, process theories are more common, as they reflect the grieving individual's bereavement experiences, thoughts and emotions as well as the process of dealing with loss. 77 The theory of psychosocial transition by Parkes 78,79 theorizes that grief can lead to a psychosocial transition. This is achieved if the grief largely affects the assumptive world (i.e., the world as we know it); if the transition happens within a short period of time (i.e., with no time to prepare oneself); and if it has a long-lasting effect due to feelings of unsafety and loss of control that obstructs adaption to a new assumption of the world.…”

Coming to understand the child has autism: A process illustrating parents’ evolving readiness for engaging in care

“…Importantly, these findings provide explicit rationale for separating and logically ordering any support to address these two delays to readiness-since denial that prevents accepting the possibility of autism must be overcome before grieving is possible. This distinction is salient for two reasons: (a) these processes are sometimes still confounded with each other in the literature (Fernańdez-Alcántara et al, 2016;Mitchell & Holdt, 2014) despite major concerns with a stage model of grieving (Stroebe, Schut, & Boerner, 2017) and (b) the findings suggest that appropriate clinical support should be tailored differently for denial than for grieving, in view of the fact that parents in this study described them as separate sources of delay to engaging in care.…”

Models of coping with bereavement: an updated overview / Modelos de afrontamiento en duelo: un resumen actualizado

“…Perpetuation of the DABDA model not only by professionals but also among the bereaved themselves and those around them is unfortunately still rampant; in line with our general line of argument here, our plea (cf. Stroebe, Schut, & Boerner, 2017) is to abandon this stage model and move on to theoretically based and empirically tested/testable process models, such as those described below. Difficulties related to coping assessment add to these more general theoretical concerns (see van Heck & de Ridder, 2001).…”