Working with the Two Track Model of Bereavement: P erspectives on grief and loss Simon Shimshon Rubin, Ph.D.

University of Haifa Department of Psychology Haifa, Israel 31905 Email : [email protected]

http://psy.haifa.ac.il/~rubin

One-Day Symposium on Death, Dying & Bereavement Society for the Promotion of Hospice Care, Hong Kong 2005

How does one think about, measure, and if need be, intervene following loss and death?

2 Many laypersons and professionals consider how one is “managing”. This that can mean: health or illness; degree of sadness or depression; anxiety; ability to function at work; ability to find support in family, culture, or religion; meaning structures; etc.

Simon Shimshon Rubin

What about the uniquely relational and interpersonal aspects of the death of a loved one? How and where do professionals and laypersons look at that? This that can mean: How often one thinks of the loved one; whether one feels only sadness or also support from the memory; how strong is the yearning and what is yearned for; and many other aspects of the unique relationship between self and the deceased. 3 Simon Shimshon Rubin

The TWO TRACK MODEL OF BEREAVEMENT (Rubin, 1981, 1984, 1991, 1996, 1998, 2000, etc.) focuses on both domains of response to loss: (Track I) The way people “manage” to live their lives following the death of a significant other and (Track II) the way in which the uniquely relational and interpersonal aspects of the connection with the deceased are maintained in the minds and hearts of the bereaved

The Two Track Model of Bereavement ASSESS BOTH TRACKS and DECIDE WHERE TO INTERVENE Track I: Function

Somatic Depression Anxiety Meaning Structure Psychiatric Symp.

Investment in ?

Work Self Esteem Famiial Interpersonal

-

C o n str ic tio n C o n flic t Id e a liza tio n " S ta g e s" o f L o ss R e la tio n sh ip to S e lf P r e o c c u p a tio n D ista n c e N e g a tive A ffe c t P o sitive A ffe c t

5 (Rubin,1996)

6 TRACK I assesses function – in bereaved and non-bereaved

For Example How productive at work is the bereaved person 1 week, 1 month, 1 year, after loss?

Simon Shimshon Rubin

TRACK I: GENERAL FUNCTIONING DOMAINS TO ASSESS Somatic problems Depression Anxiety Meaning Structure Psychiatric Symp.

Emotional Investment in ?

Work Self Esteem Family Relations Other Interpersonal Post-trauma (PTSD)

The Two Track Model of Bereavement

Track II Relationship to the Deceased 8 Nova Scotia memorial 05 Simon Shimshon Rubin

For Example How does the bereaved person think about the deceased 1 week, 1 month, 1 year, 10 years, after the loss?

TRACK II: RELATIONSHIP TO THE DECEASED – DOMAINS TO ASSESS Constriction Idealization Conflict Grief "stages Self Preocupation Pos affect Neg affect Soothing Other

The Two Track Model of Bereavement

Relationship to the Deceased – Track II – emphasize continuing bonds: This means ongoing attachment that focuses us on questions of: the nature, the intensity, the predominance, the quality, the uniqueness, the quality of those ongoing bonds for the individual, family, and culture.

10 Simon Shimshon Rubin

What are the factors that should concern us following interpersonal loss?

Q: Is it how one manages “life” tasks or is it how the person manages “reorganization”/(not detachment) vis a vis the deceased? Answer: BOTH!

11 Simon Shimshon Rubin

THERAPEUTIC IMPLICATIONS of Two Track Model of Bereavement

Select your focus – Track I (and why) Track II (and why)

Listening versus intervening – not same Continuing involvement with memories of deceased is normative for many cultures and traditions in East and West – but WHAT is the nature of the involvement? EXPLORE THAT as Simon Shimshon Rubin

THERAPEUTIC IMPLICATIONS of Two- Track Model of Bereavement

Help loosen what is frozen, for example:

Is trauma blocking access to thoughts and feelings?

Is emotional conflict to the deceased blocking access?

Is intense focus on deceased blocking access to life ?

Are gender differences, personality style differences complicating things?

13 Simon Shimshon Rubin

14

Closing Remarks: Relationship to the deceased is all around us. This is one source, from the website of the Tzur family. Asaf was killed in 2003.

Website: “Asaf Tzur (Blondi). Angel of 17. Born 27.4.86. Died 5.3.2003. Killed … in the Suicide bombing in

Simon Shimshon Rubin

Haifa.

”

Website: From the inscription on the gravestone: Asaf loved the sea, friends, music, and life. Asaf, we love you, we will always remember you, and we will miss you every day. The website contains these pictures and explanation: “ The monument on his grave was designed as a surfboard that goes out to the sea. The design was designed by his parents to keep alive this love. This way, he will surf for all eternity ….”

15 Simon Shimshon Rubin ידי לע רחבנש בוציע , םילג תשילגו םיה תא בהא ףסא םיה ילג ךותמ אצויה ןשלגכ הבצוע ורבק לעש הבצמה ...

םיחצנ חצנל שולגי אוה וז ךרדב .

וז הבהא תחצנהל וירוה

• • • •

Two Track Model of Bereavement

Select References

Rubin, S. (1981). A Two-Track Model of Bereavement: Theory and research. American Journal of Orthopsychiatry, 51(1), 101-109.

Rubin, S. (1999). The Two-Track Model of Bereavement: Overview, retrospect and prospect. Death Studies, 23(8), 681-714.

Rubin, S. & Shechter, N. (1997). Exploring the social construction of bereavement: Perceptions of adjustment and recovery for bereaved men. American Journal of Orthopsychiatry, 67(2), 279-289. Rubin, S., Malkinson, R. & Witztum, E. (2003). Trauma and bereavement: Conceptual and clinical issues revolving around relationships. Death Studies, 27, 667-690.

16 Simon Shimshon Rubin

17

Two Track Model of Bereavement

Further Resources • • • • •

Questionnaire assessing Functioning, Relationship, History of Relationship, and Traumatic Elements. Clinical version and research version. Research studies Theory Clinical Material WEBSITE HAS ARTICLES and MATERIALS: http://psy.haifa.ac.il/~rubin THANK YOU

Simon Shimshon Rubin