Abstract
Bereavements that occur under external traumatic circumstances increase the risk for dysfunction, trauma symptomatology, as well as disordered and prolonged grief. While the majority of individuals who have experienced traumatic bereavements do not meet formal criteria for posttraumatic stress disorder (PTSD), persistent complex bereavement disorder (PCBD), or prolonged grief disorder (PGD), the degree of distress and dysfunction for these bereaved can be quite significant. The assessment and intervention paradigms in use with traumatic bereavements often prioritize the trauma and bypass the centrality of the interpersonal loss. By using a bifocal approach in conceptualizing bereavement, the Two-Track Model of Bereavement (TTMB) rebalances the approach to the class of traumatic bereavements. Track I examines biopsychosocial functioning and symptoms of trauma, and track II focuses on the nature of the ongoing relationship with the deceased and the death story that may also have elements of traumatic response. The model and its application serve to identify both adaptive and maladaptive responses to loss along both axes to optimally focus interventions where needed. The story of the death, the psychological relationship with the deceased, and the presence of biopsychosocial difficulties each have a part to play in assessment and intervention. A case study of assessment and intervention following traumatic bereavement due to suicide illustrates how attention to each of these factors in the TTMB can facilitate change. Ultimately, the relational bond with the deceased is a major vector in grief and mourning. Assessment and intervention with traumatic bereavements require attention to dysfunction and symptoms of trauma as well as to the death story and the state of the relationship to the deceased.
Highlights
Bereavement following the death of a loved one is universal
In our own studies of heightened grief scores with the two-track bereavement questionnaire for complicated grief years after the loss, we noted that the elevated scores that characterized only 5% of adults bereaved of their parents, applied to 10% of the spousal bereaved and to fully 25% of those who had lost children [26]
The decidedly interpersonal aspects of bereavement, grief and mourning should remain squarely in the center of the understanding of traumatic loss. It is a mark of the maturation of the bereavement field that many clinicians with a bereavement focus pay particular attention to circumstances of trauma
Summary
Bereavement following the death of a loved one is universal. How one grieves and mourns that loss, and how a broad array of variables influence grief and its outcome have received increasing attention and specification. Helen’s current functioning involved significant suffering and many symptoms associated with post-trauma not sufficiently meeting criteria for a DSM-5 diagnosis of PTSD The experience of her husband’s suicide met the criterion for exposure to a traumatic event; there were intrusions of the death scene; avoidance of places that triggered memories; negative alterations in mood, and a degree of hyper alertness as manifest in her response to phone ringing. The ongoing sense of shock in the way the death event was experienced interfered strongly with her ability to fully describe her husband and the many years of their relationship This aspect of the death-related trauma is rated on track II because of its significance in impeding grief and mourning and for its interference with access to the interpersonal relationship and the continuing bond with the deceased. The death story remained one that she had been unable to integrate and weave into the story of their relationship
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