The Range of Response to Loss model as a theory for practice

What shapes our personal experiences and expressions of grief?

Grief and how it is experienced and expressed is shaped by each person’s life journey. Personal history, cultural and ethnic identity, and current life circumstances all play a part in the nature of the attitudes and perspectives people bring when they seek support in their bereavement.

During the covid pandemic separation from a dying relative/friend has heightened distress and together with depleted social support at the time of the funeral and in subsequent weeks, has intensified the experience of grief for many people. 

The RRL as a two-dimensional model

While we bring this range of individual differences to challenging life events, patterns can be observed in human response to loss. The Range of Response to Loss identifies patterns which were evident in the bereavement practice and research of Linda Machin ^[1] Machin, L. (2014) Working with Loss and Grief. London: Sage. (2nd edition) .

The RRL is represented as a two-dimensional model (see diagram below), made up of: 

1. 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 from ‘overwhelmed’ to ‘controlled’ 

                                      and 

2. coping responses which occur as a conscious process of managing the emotional, cognitive, social and spiritual consequences of loss, on a spectrum from ‘vulnerable’ to ‘resilient’ .

Attig (2011) has identified these two distinct elements of grief ^[2]Attig, T. (2011) How We Grieve: Relearning the World. New York: Oxford University Press.

Conceptual links with other theories

It was important to look at how the concepts proposed in the RRL are reflected in other well researched theories used in practice.

Attachment theory and the Dual Process model are two important theories which are echoed in the RRL.  

Exploring the characteristics of the RRL model:

Primary grief reactions          

Grief reactions where feelings, thoughts and behaviour are instinctively prompted by loss and may for a temporary period be experienced as disorientating:                  

• Feelings: sadness, despair, guilt, anger etc.
• A sense of: disbelief, powerlessness, injustice etc.
• Thoughts: confused, contradictory, ruminative etc.
• Behaviour: passive or over-active, maladaptive e.g. use of drink/drugs etc.
• Physical: fatigue, heart palpitations, health can worsen or new conditions arise etc

Coping processes

Coping, the process of reorientation to circumstances of loss, which takes place at a conscious level by seeking to:

• regulate emotion i.e. acknowledging feelings while finding ‘safe’ options for expressing them
• adjust to changed relationships e.g. new roles and responsibilities 
• adjust to changed social realities e.g. a widow not a wife, reduced finances, need for housing changes etc. 
• make sense of the loss e.g. exploring the how and why of the loss, reviewing beliefs etc.

The range of coping characteristics:

 Vulnerability

1. Innate consequence of loss and grief: initial emotional, mental, social, spiritual disorientation.
2. Circumstantial factors: complex issues around the last illness and death; practical demands e.g. responsibility as a carer; physical/mental health concerns; economic worries; lack of support.
3. Personal factors: inflexibility; low self-worth; pessimism; unable to make sense of loss; difficulty in making use of support.

Most people will feel the initial disorientation of a significant loss as a state of vulnerability but may move to a situation of acceptance. A life context which has stressful circumstantial factors will also make coping with loss more complex compared with situations which are less demanding. Personal factors play an important part in the tendency for vulnerability or resilience.       

 Resilience

1. Innate consequences of loss and grief: accepted and embraced as a natural part of experiencing and facing life losses.
2. Circumstantial factors:  uncomplicated last illness and death; manageable practical demands; limited health concerns; few economic worries; adequate support available.
3. Personal factors: flexibility, courage, perseverance, sense of self-worth; optimism, able to make sense of loss; able to make use of support

It is important not to see vulnerability and resilience as fixed opposites but as factors which can fluctuate.

The RRL model as a template for practice

The RRL model provides a template for practice in which core grief reactions interact with coping responses to produce broadly identifiable and distinctive grief patterns. 

It is important to recognise that often bereaved people or those facing a serious illness are experiencing normal grief, with vulnerability being evident for a time immediately after a (significant) loss has been suffered. Responses to loss are frequently shifting and changing; what we observe at any one time is only true at that time and may be replaced with very different responses as the loss is processed and life adjustments made.