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). While confirming the categorical distinctions – overwhelmed, controlled, resilience – it also demonstrated the potential for profiling individual grief responses (Machin, L. 2001) (1).

The AAG scale has now been adopted by many bereavement services and is used to appraise the relative overwhelmed, controlled and resilient characteristics shown by bereaved clients and to use these characteristics collectively to provide an overall indication of vulnerability. The AAG is a 9-item Likert scale inviting responses from strongly agree to strongly disagree. Additionally, the items in the scale are used to prompt comments and conversation.    

The AAG was psychometrically validated as was its use to identify vulnerability (Sim, J., Machin, L. and Bartlam, B. (2014) (2).

The relationship between the RRL model and the Adult Attitude to Grief scale concepts

The AAG a tool for practice

The scale is set out below and shows the 9 items in the AAG scale clustered into the overwhelmed, controlled and resilient categories. 

The numbers show their actual position in the scale – they are randomly mixed to ensure the response a client makes to each item is not affected by their responses to the other items in the cluster.    

The concept of vulnerability is incorporated through the scoring system which adds together the overwhelmed, controlled and reverse order resilient scores to provide an indication of vulnerability. 

The AAG scale

The AAG shown in categorical clusters
Overwhelmed2. For me, it is difficult to switch off thoughts about the person I have lost
5. I feel that I will always carry the pain of grief with me
7. Life has less meaning for me after this loss
Controlled 4. I believe that I must be brave in the face of loss.
6. For me, it is important to keep my grief under control.
8. I think its best just to get on with life in spite of this loss.
Resilient 1. I feel able to face the pain which comes with loss.
3. I feel very aware of my inner strength when faced with grief.
9. It may not always feel like it but I do believe that I will come through this experience of grief.

The scoring system is described in more detail on the AAG in Practice, page.  

Two studies were undertaken to explore the clinical usefulness of the AAG scale (Machin, L. and Spall, R. (2004) (3) and (Machin, L. (2007)(4)

Examples of experiences fr​om practice

Practitioner comments:

  • ‘AAG statements helped clients identify what they were feeling and talk more openly’.
  • ‘The overwhelmed items help people get their story of loss out’.
  • ‘Clients all agreed it was an accurate reflection of their grief’.
  • ‘Identification and affirmation of areas for most need of support’.

Client comments:

  • ‘The feed-back was very shocking. I didn’t realise how low I was’.
  • ‘I feel freed by gaining confidence and thinking things through’.
  • ‘I feel happier and can understand my own feeling more’.
  • ‘Going through the questions again helped me see how much I’d grown in strength’.

References

  1. Machin, L. (2001) Exploring a framework for understanding the range of response to loss; a study of clients receiving bereavement counselling. Unpublished PhD thesis: Keele University, UK.
  2. Sim, J., Machin, L. and Bartlam, B. (2014) Identifying Vulnerability in Grief: Psychometric properties of the Adult Attitude to Grief scale. Quality of Life Research. 2014;23(4):1211-20.  
  3. Machin, L. and Spall, R. (2004) Mapping grief: a study in practice using a quantitative and qualitative approach to exploring and addressing the range of response to loss. Counselling and Psychotherapy Research 4: 9–17.
  4. Machin, L. (2007) The Adult Attitude to Grief Scale as a tool of practice for counsellors working with bereaved people. A study report sponsored by Age Concern, Tameside and Keele University.