Previously I talked about the huge variety of incidents that can lead to grief, personal or collective. Now I want to focus on some of the models for bereavement grief. Grieving is a natural process, a part of living. People need to explore bereavement grief in order to process it.  This processing is very personal. However, there are a number of models that people might find helpful.

Some now classic research based on the work of Elizabeth Kubler-Ross (On Death and Dying, 1973) suggested that there are various stages of bereavement. Kubler-Ross was one of the first to talk to the dying, to hear of their fears and opinions. And how their fears, opinions and desires, might have conflicted with those of the family and friends around them. But now, thankfully, there are many hospice movements and doctors, nurses and therapists explicitly working in palliative care.

The Kubler-Ross model, which in some cases is still used, describes the stages of grief as follows:

• Denial – feelings of disbelief, panic or confusion
• Anger – feelings and behaviours such as blaming yourself or blaming others
• Bargaining – feelings of guilt often raising questions like "If only I had done more"
• Depression – feeling tired, hopeless or helpless – like you have lost perspective or feel isolated
• Acceptance – this does not mean that you like the situation, it’s about accepting your loss and being ready to move forward

Some of the newer models of grief find the above stages too prescriptive and have developed greater flexibility to allow for the array of different emotions that people experience across different timescales. These newer models include:

1. Iceberg of grief. What you see on the surface, the tip of the iceberg, is the loss of someone the person loved. What you don’t see, the bulk of the iceberg below the surface, is potentially loss of identity, loss of security, loss of the past/the future, loss of relationships, loss of finance or a lifestyle, loss of hope. These elements below the surface can often manifest as anger, shame, guilt, or self-pity. So, people supporting those in the grief process need to recognise that what is being shown and talked about, is only the tip of the iceberg. We need to be aware of and hold what is underneath, which at some point will need to surface.
2. Stroebe and Schut, 1999 – the dual process model of grief. This suggests that people oscillate between loss oriented activities and restoration oriented activities. The first is the work of grief, sadness, mourning, internal withdrawal, visiting the grave, denial, reminiscing, yearning. The second is attending to life tasks, new roles and responsibilities, changes in goals or purpose, meaning making, change in relationships, denial/avoidance of grief. Both are recognised as important and people can swing suddenly between them, but it is important to note that restoration can be just as emotionally taxing as mourning and both aspects deserve support and validation from others.
3. Lois Tonkin – growing around the grief model. The premise is that no matter how much time passes, our grief remains the same size, but our lives expand around it so that there is space for the grief, but space for other things too.
4. Tony Walter – continuing bonds theory. No-one is truly dead if we remember them. We are now who we are in part because of who they were. In this model, people maintain an ongoing connection with the dead in various ways. It recognizes that relationships do not end with death but change and grow over time. So healthy grieving may involve finding new, evolving ways to stay connected to the person who has died. These ongoing bonds may take many forms: through memories, rituals, inner dialogue, values passed on, or a sense of presence.

These models and more can be used both by a person who is grieving and by those around them to help make sense of their actions and emotions. But as in almost all human connections of course, listening, space, safety are the keys.