Sub-Module 8.4 – Identifying Clients’ Grief Trajectories and Adapting Interventions Accordingly
The model of grief trajectories developed by George Bonanno provides a nuanced and differentiated perspective on how individuals adapt to the loss of a loved one over time. According to this model, there are four main grief trajectories: resilience, chronic grief, delayed grief, and acute grief followed by gradual recovery. Each trajectory is characterized by specific patterns of emotional, cognitive, and behavioral reactions, which evolve distinctively over time. As a GRIEF COACH, it is essential to be able to identify these trajectories in order to propose interventions tailored to the needs and resources of each mourner, thus promoting their progress towards a positive outcome.
The resilience trajectory refers to people who manage to maintain relatively stable and adapted functioning despite the loss, without significant or enduring symptoms of distress. These individuals typically have strong internal and external resources, such as high self-esteem, effective coping strategies, a satisfactory support network, and an ability to make sense of their experience. They naturally experience painful emotions related to grief, but manage to regulate them and continue with their activities and commitments. The GRIEF COACH can help them identify and mobilize their strengths, normalize their experience, and cultivate their resilience, offering them personal development and prevention tools.
The chronic grief trajectory refers to people who show high and persistent levels of emotional distress, anhedonia, and dysfunction, persisting beyond the first year of bereavement. Often, these people have vulnerability factors, such as a history of mental disorders, unresolved traumas, conflictual relationships with the deceased, or particularly difficult circumstances of death. They may struggle to accept the reality of the loss, regulate their emotions, find meaning in their experience, and reinvest in their life. The GRIEF COACH can help them identify and address underlying blockages by proposing targeted therapeutic interventions, such as EMDR, cognitive-behavioral therapy, or mindfulness therapy.
The delayed grief trajectory refers to people who show little or no grief reactions in the early stages following the loss, but who develop significant and debilitating symptoms of distress several months or years later. These individuals often have employed strategies of avoidance or denial to cope with the loss, such as hyperactivity, substance use, or over-involvement in others. They may struggle to connect with their emotions, express their grief, and allow themselves to experience their mourning. The GRIEF COACH can help them become aware of their process, validate their experiences, and create a safe space to explore their emotions, providing them with creative expression and emotional regulation tools.
The acute grief followed by gradual recovery trajectory refers to individuals who show intense and disruptive grief reactions in the months immediately following the loss, but who gradually manage to regain emotional and functional balance. These individuals typically go through the classical stages of grief, with ups and downs, moments of despair, and moments of peace. They may require sustained support during the first phase of grief to help them contain their emotions, find their bearings, and mobilize their resources. The GRIEF COACH can help guide them towards acceptance and reorganization by providing tools for ritualization, problem-solving, and future projection.
A telling example of identifying grief trajectories is the case of two sisters, Julie and Lucy, who suddenly lost their father to a heart attack. At our first meeting, a month after the death, I was struck by the difference in their reactions. Julie was collapsed, in tears, expressing deep distress and an inability to function in her daily life. Lucy, on the other hand, seemed calm, rational, and focused on practical aspects of the succession. By exploring their experiences empathetically and without judgment, I understood that Julie was going through acute grief, characterized by high emotional reactivity and a sense of chaos, whereas Lucy was going through delayed grief, marked by an emotional distancing and control overinvestment. I then proposed closely spaced sessions for Julie, focused on emotional expression, meaning-making, and resource mobilization, to help her through this acute phase. With Lucy, I adopted a more gradual approach, reassuring her about her experience and providing a compassionate space for connecting to her grief at her own pace. Over the months, Julie gradually found balance again, experiencing moments of sadness and re-engagement in her life, while Lucy began to express more intense emotions and explore the painful aspects of the loss. By adapting my support to their respective trajectories, I was able to help them towards a positive outcome, respecting their individuality.
Identifying grief trajectories requires great clinical finesse and the ability to perceive the nuances and evolutions of mourners’ experiences. The GRIEF COACH must be able to spot the emotional, cognitive, and behavioral patterns characterizing each trajectory, without pigeonholing people into rigid categories. They must also be aware of risk and protection factors influencing these trajectories, such as personal characteristics, social resources, circumstances of the death, or concurrent stressors. This requires a comprehensive and dynamic assessment of each mourner’s situation, as well as flexibility in choosing interventions.
By incorporating the model of grief trajectories into their practice, the GRIEF COACH has a valuable framework for understanding the diversity of reactions to loss and adjusting their support accordingly. They can thus identify individuals at risk of complications early on and propose targeted interventions to prevent unfavorable progression. They can also identify resilient individuals and help them cultivate their resources to promote their adaptation. Finally, they can monitor the evolution of grief reactions over time, and modulate their approach according to the progress and challenges encountered. This model reminds us that grief is a highly individualized and multidetermined process, which requires flexible yet personalized support, grounded in rigorous assessment and a solid therapeutic alliance.
Key Points to remember:
– George Bonanno’s model of grief trajectories describes four main trajectories: resilience, chronic grief, delayed grief, and acute grief followed by gradual recovery.
– Each trajectory is characterized by specific patterns of emotional, cognitive, and behavioral reactions that evolve differently over time.
– Identifying these trajectories allows the GRIEF COACH to propose interventions that correspond to the needs and resources of each mourner.
– The resilience trajectory involves those who maintain stable functioning despite the loss. The GRIEF COACH can reinforce their strengths and resilience.
– The chronic grief trajectory involves high and ongoing distress beyond one year. The GRIEF COACH can offer targeted therapies such as EMDR and CBT.
– The delayed grief trajectory is characterized by an initial lack of reactions followed by delayed symptom onset. The GRIEF COACH can help validate experiences and explore emotions.
– The trajectory of acute grief followed by recovery involves those going through classic stages of grief. The GRIEF COACH provides sustained support then helps guide toward acceptance.
– Identifying trajectories requires clinical finesse to perceive nuances and evolutions in the experience, without confining to rigid categories.
– The model helps identify complication risks, resource reserves, monitor progress, and adjust support in a personalized way.
👉 To download docx (Editable) file click here : Click here
👉 To download PDF file click here : Click here
👉 To download MP3 file click here : Click here
