This is a resource providing easy access to a theory of grief – the Range of Response to Loss model (RRL) – and practice tools associated with it e.g. the Adult Attitude to Grief scale (AAG) and Attitude to Health Change scales (AHC), which have been devised and developed by Linda Machin.
Practice guidance is given for using the scales for assessment, as tools for conversation and as indications for therapeutic intervention.
This innovative approach to working with grief has emerged from Linda’s practice and research experience. It is shared here to help practitioners working in bereavement and palliative care settings.
Guidance for Practitioners
The Range of Response to Loss model as a theory for practice
The Range of Response to Loss identifies patterns which emerged from the bereavement practice and research of Linda Machin. The RRL is represented as a two-dimensional model made up of:
- core grief – reflexive or automatic reaction to loss (a reaction which will have been learned or observed and incorporated into the individual style of reacting to loss) on a spectrum of reactions from ‘overwhelmed’ to ‘controlled’
- coping responses occur as a conscious process of managing the emotional, cognitive, social and spiritual consequences of loss, on a spectrum from ‘vulnerable’ to ‘resilient’.…
The Adult Attitude to Grief scale (AAG)
The Adult Attitude to Grief scale (AAG) was originally devised to test the validity of the concepts in the Range of Response to Loss model (RRL). In addition to confirming the categorical distinctions – overwhelmed reactions, controlled reactions and, resilient coping – it also demonstrated the potential for profiling individual experiences of grief. The AAG scale has now been validated and adopted by many bereavement services and is used to explore the dynamics of grief and calculate an indication of vulnerability. Additionally, the items in the scale are used to prompt qualitative comments and therapeutic conversation. The AAG is also used as a research tool for studies into bereavement. (The AAG is a 9-item Likert scale inviting responses from strongly agree to strongly disagree.)
The AAG in practice
The AAG is introduced to the client so that they understand that its purpose is to help them and the practitioner gain a clear picture of their grief and to determine support needs. The scores provide the practitioner with an individual profile of the client’s grief i.e. how the responses to the nine items in the scale contribute to relative vulnerability and resilience. The role of the AAG is equally important in prompting a focused conversation about the experience of loss and the goals for support. Together the quantitative scores and the qualitative conversations provide a framework for assessing need and engaging therapeutically with the client.
The RRL and AAG as a guide to intervention
The RRL model and the AAG responses together provide a framework for considering six focused intervention, which aim to facilitate a balance between feelings and functioning, and a move from vulnerable coping to increased resilience. A person centred and narrative approach underpin a flexible pluralistic way of working with grieving people.
Other scales derived from the RRL and AAG
The Attitude to Health Change scale (AHC) is being used in a number of hospice settings to assess patients’ psychosocial needs as they face life limiting illness. A companion version of the scale explores the impact of the patient’s illness on their informal carer(s). Work to validate the psychometric properties of the AHC scales is in progress.
The Children’s Attitude to Grief scale (CAG) is in use in a small number of services and is also awaiting validation.