Simon Shimshon Rubin

THE TWO-TRACK MODEL OF BEREAVEMENT: OVERVIEW, RETROSPECT, AND PROSPECT

Sustaining meaning in life, maintaining emotional well-being, and balancing attachments to the living and the deceased are features associated with the psychological (and often private) impact of loss. In the Two-Track Model of Bereavement, the loss process is conceptualized along two distinct but interactive axes that attend to these overt and covert aspects of the response to loss. Whereas Track I is concerned with biopsychosocial functioning in the wake of loss, it is Track II that focuses on the bereaveds ongoing emotional attachment and relationship to the deceased. The contributions of the model to theory and research can serve to clarify our thinking about bereavement as a process resonating throughout ones life. Initially, research and clinical findings from bereaved parents are presented to illustrate the Two-Track Model and its contribution to the deepening of our understanding of loss throughout the life cycle. The contributions of the model to clinical practice are then considered for their ability to clarify our thinking and interventions. Two clinical cases illustrate situations where a predominant focus is on one or the other of these tracks. Ultimately, the Two-Track Model of Bereavements use extends to the organization and clarification of theory, research, and clinical work.

A TWO‐TRACK MODEL OF BEREAVEMENT: Theory and Application in Research

Much remains to be learned about the long-term effects of adult bereavement. A two-track model, considering both affective attachment to the deceased and extent of personality change, is used in the present study to examine aspects of the maternal reaction to sudden infant death. It is suggested that this two-track perspective offers greater specificity in studying the nature and duration of the effects of loss.

TRAUMA AND BEREAVEMENT: CONCEPTUAL AND CLINICAL ISSUES REVOLVING AROUND RELATIONSHIPS

The article re-examines trauma and bereavement and the category of loss considered to be traumatic bereavement. It is argued that the perspective of the relation to the deceased is an insufficiently acknowledged source of traumatic disruption following bereavement. The significance of the relational aspect in bereavement is present in the paradigm of the Two-Track Model of Bereavement (S. Rubin, 1981, 1999). The implications of this approach are examined in the case of a soldier exposed to trauma and death. The case is examined from a traditional trauma perspective stressing exposure to life threat and again from a perspective stressing the significance of the relationship to the deceased. An examination of the different intervention strategies and their outcome lends support to the importance of the relational aspects in this case of trauma and supports the use of the Two-Track Model of Bereavement. The location of trauma as basic to the experience of all bereavement for its impact on the reorganization vis á vis the representation of the loved one now deceased is considered as fundamental to the trauma of all bereavement. Theadditional contribution of bereavement occurring under conditions of life threat (traumatic situations) is an important feature potentially impacting the bereavementprocess, but it is not what makes bereavement traumatic per se. An additional source of trauma in bereavement, occurring when the previous representation or introject of the deceased is shattered, is considered for its status as an additional source of complication in the traumas of bereavement.

Adult Child Loss and the Two-Track Model of Bereavement:

The Two-track Model of Bereavement suggests that response to loss can be more effectively assessed when both the behavioral-psychological functioning and the internalized relationship to the deceased are considered [1–4]. Research based on this paradigm examined the experiences of 102 Israeli parents bereaved of sons four and thirteen earlier and a comparison group of seventy-three non-bereaved parents. All parents completed measures of functioning, anxiety, evaluation of self and son, written description of the son, and measures of the current life situation. Results indicated that the bereaved parents manifested difficulties in functioning and in their covert relationship to the deceased son. Differences between and within the bereaved groups by time and sex are considered. Regression documented an association between functioning and relationship to the deceased, and lent support to the assumptions underlying the Two-track Model of Bereavement. This discussion addresses the course of bereavement for adult sons with some implications for bereavement research and intervention.

Death of the Future?: An Outcome Study of Bereaved Parents in Israel.

Child loss has been described as the most devastating of bereavements. To explore this multidimensional phenomena, thirteen Israeli parents bereaved of young children were compared with forty-two parents who had lost sons to war. Although all parents demonstrated pronounced mourning, those bereaved of adult sons were particularly affected by the loss. This was true for the initial year as well as the current status of the bereavement response, an average of ten years post loss. These findings are discussed and implications for the family are considered.

The Two-Track Model of Bereavement Questionnaire (TTBQ): Development and Validation of a Relational Measure

The Two-Track Model of Bereavement Questionnaire (TTBQ) was designed to assess response to loss over time. Respondents were 354 persons who completed the 70-item self-report questionnaire constructed in accordance with the Two-Track Model of Bereavement. Track I focuses on the bereaveds biopsychosocial functioning and Track II concerns the bereaveds ongoing relationship to the range of memories, images, thoughts, and feeling states associated with the deceased. Factor analysis identified 5 factors that accounted for 51% of the variance explained. In accord with the theoretical and clinical model, 3 factors were primarily associated with the relationship to the deceased (Track II): Active Relational Grieving, Close and Positive Relationship, and Conflictual Relationship; and 2 factors with aspects of functioning (Track I): General Biopsychosocial Functioning and Traumatic Perception of the Loss. Construct and concurrent validity were examined and were found satisfactory. Differences by kinship, cause of death, gender, and time elapsed were examined across the 5 factors, the total TTBQ, and the ITG. The new measure is shown to have both construct and concurrent validity. Discussions of the results and implications for the measurement of response to loss conclude the article.

Maternal Attachment and Child Death: On Adjustment, Relationship, and Resolution

When an infant dies at the height of the mother-child attachment period, the experience is traumatic and shattering for the mother. Examining successful resolution of this loss requires a distinction between adjustment to the external reality of loss and the nature of the ongoing internal relationship to the representation of the deceased. Resolution may best describe and muted intrapsychic relationship characterized by a flexible and psychologically comfortable stance vis a vis the dynamic memories and representation of the deceased child.

Therapeutic Issues and the Relationship to the Deceased: Working Clinically with the Two-Track Model of Bereavement.

Psychological intervention with the bereaved can provide critical assistance to individuals, families, and communities contending with the loss of significant others. In the organizational paradigm of the Two-Track Model of Bereavement, the outcome of both successful and problematic mourning are manifest along two distinct but interrelated tracks of functioning and relationship to the deceased. Reworking relationships to the deceased can help people resume authorship of their life narratives following loss. Two cases of spousal death are presented and significant features of the treatments discussed. The Two-Track Model of Bereavement emphasizes that the dimensions of a persons functioning reflect only part of the response to loss. The ongoing relationship with the complex of memories, thoughts, emotions, and needs associated with the person who has died is no less important. Although the domains of general functioning and relationship to the deceased are related, they are far from identical. Attending to the memories and emotions bound up with the deceased should continue to demand our sustained attention as therapists.

Terror, trauma, and bereavement : Implications for theory and therapy

Abstract How is interpersonal loss incurred in a terror event similar and different from loss under non-terror conditions? Because terror and bereavement are located in the individuals experience of the event, this has important implications for assessment and intervention. In the Two-Track Model of Bereavement (TTMoB), the relationship between life threat, symptomatic response, and the ongoing relationship to the deceased allow therapy to target difficulties in functioning as well as relationship to the deceased. Two case vignettes are presented to ground the discussion.

Psychotherapy and supervision with a bereaved Moslem family: an intervention that almost failed.

Families responding to loss are units that function and are embedded in particular cultural frameworks. The adequate clinician learns to work with different individuals and problems over time, and in this process he or she learns about the importance of a range of variables including sex roles, age, socioeconomic circumstance, and the like. In parallel fashion, the developing clinician also learns to work with different cultural and religious contexts as they affect and frame the clients experiences.