Two Track Model
Description
The Two-Track Model is a framework that is often employed when counselling individuals experiencing grief, loss, and trauma. The framework implies a focus on two intertwined areas. Based on the strategy, loss restoration-based processes are to be approached with the client.
Hence, it is essential to accept the loss as an event that cannot be changed or avoided while learning to live without the presence of the loved one who passed (Rubin et al., 2020). Emotional traumas severely affect those who suffer as a result of the pain. Hence, people tend to encounter challenges in socializing, maintaining a professional life, and doing things that would typically make them happy.
Strengths
One of the strengths of the frameworks is their comprehensive nature. In this case, the counselor can assist the client in making relatively direct and practical changes that improve well-being. This can be achieved by considering both loss-oriented and restoration-oriented stressors, as researchers have found that individuals tend to focus on a single aspect (Mullens et al., 2023). During grief, many tend to prioritize acceptance and center their attention on acknowledging what happened and accepting it. The action, while useful, may not be the most effective way to achieve direct results, since, as mentioned previously, individuals who have recently lost someone find it difficult to reintegrate into the world.
An additional strength is the flexibility of employment. The Two-Track Model can be applied in counselling regardless of the circumstances that generated the trauma. For example, Manevich et al. (2022) applied the technique to assess dementia-specific grief. As the pain from losing or seeing someone close suffer can vary in complexity, severity, and symptoms, it is critical to employ measures that are effective in contrasting settings.
Limitations
Regarding the technique’s limitations, its simplicity can also pose problems. As illustrated previously, the model is focused on two defined processes that can be addressed through counselling (Rubin et al., 2020). However, it is essential to acknowledge the importance of a client-centered approach, as each case is unique.
In one instance, a person’s cultural or religious background may affect how they process pain. Hence, one may not have problems socializing and functioning successfully in the world, but may only experience a sense of emptiness and loneliness. In other cases, the grief process is non-linear, and the two tracks may not coincide in terms of impact, effect, or ability to approach them simultaneously.
Meaning Reconstruction
Description
The Meaning Reconstruction framework employs a different way of addressing pain. Namely, the strategy implies finding a purpose or meaning in losing someone and living with this loss (Neimeyer, 2019). According to the theory, grief is an emotion that requires a rethinking of specific values and concepts, especially if the deceased person was extremely close to the individual in counselling.
As a significant portion of their life was dedicated to someone, it is essential to construct a healthy way of viewing what happened. The help provision process includes conversations about the person who died, their impact, and ways in which their death can be perceived from the point of view of those who suffer because of it. While it is a relatively complex and time-consuming technique, clients can experience highly positive results correlating with meaning reconstruction.
Strengths
One of the strengths of the method is the opportunities for personal growth. The statement is supported by relevant researchers (Neimeyer, 2020). When a client is encouraged to look for a new meaning in what happened, personal changes happen. They are more likely to find new hobbies, change their jobs if they cause them dissatisfaction, and make better choices that improve their overall well-being.
The therapy style facilitates a perception of pain through the opportunity to grow and develop, and such outcomes can significantly help a client who experiences emptiness and hopelessness. It is also a highly customer-centered counselling model, as the process of looking through a different lens is individual and depends on various factors. They include the relationship with the person who passed, the nature of that relationship, and the person’s personality.
Limitations
Regarding barriers and limitations, the practical implementation of the theory is complex and time-intensive. As suggested previously, each individual will require a unique approach (Neimeyer, 2020). Hence, depending on the person and the circumstances of losing a loved one, one may require an elaborate and multifaceted therapeutic plan.
Success also depends on a client’s compatibility with the framework. In some instances, people are not ready or are against focusing on the favorable circumstances linked to someone’s death, despite all ethical considerations being validated. Such an outcome is especially likely to occur in cases in which the death was sudden, the loved one was extremely close to the client, or the actions of the second party indirectly influenced the death.
Worden’s Task Model
Description
In contrast with Meaning Reconstruction, Worden’s Task Model is a very organized and structured approach to bereavement. Several steps can be highlighted regarding the style. Namely, the individual is to start by accepting the reality of someone’s death without avoiding admitting it. Additionally, the second task is to process the discomfort and hurtful feelings associated with the loss.
The third element is to learn how to navigate and live life without the loved one who died, implying that elements of a new identity are to be acknowledged. Last but not least, the client must connect with the memory and existence of the individual they lost, a step that can only be undertaken after their passing is entirely accepted (Khosravi, 2021). By following all the steps outlined in the theory, the client can develop a healthy relationship with the deceased, acknowledging sadness while understanding that it is essential to thrive despite the circumstances.
Strengths
As with the previous frameworks, Worden’s Task Model has both pros and cons if applied in a counselling setting. The initial benefit that can be suggested is its organized structure (Khosravi, 2021). Because people can follow the method closely, it yields positive results.
Grief can be complex, which is why feelings of confusion and discouragement are often reported. However, a roadmap of steps to be taken can be helpful, given the need for a more precise plan towards acceptance and moving on. Another benefit is its comprehensive approach. The model accepts that bereavement is complex and affects multiple aspects of one’s well-being, including emotional, physical, and social connotations. Hence, instead of focusing solely on acceptance or reintegration into a social circle, the method allows for a multifaceted solution.
Limitations
Regarding limitations, the theory’s rigid structure is considered the downside. Researchers note that some specialists believe it does not provide sufficient flexibility to address each client’s needs (Khosravi, 2020). Furthermore, it has exact steps toward the goal and is a linear theory. This implies that each concept is to be addressed in the order in which the researcher formulated them. However, each person has a different reaction to therapy and to grief itself, which may require a more individualized manner in which the issues are being processed.
Case Conceptualization
- Client Name: Lucy.
- Age: 48 years old.
- Employment status: Emergency veterinarian
- Relationship status: Divorced
- Reason for referral: Self-referred. After the death of her 19-year-old son, Jacob, Lucy struggles both emotionally and physically and seeks to find a way to deal with the grief.
Presenting Problems
- Grief: Lucy is going through significant grief as a result of her son’s death. In addition, the unknown circumstances of his death in Bali generate more confusion and frustration.
- Physical problems: As a result of the emotional turmoil, Lucy has lost weight, which highlights the effects of her son’s death on her physical well-being and ability to take care of herself.
- Professional issues: After what happened to Jacob, Lucy reports difficulty concentrating at work, which affects her ability to perform at a high level in her field of emergency veterinary care.
- Isolation and loneliness: The client avoids talking to Jacob’s friends and has become isolated since his passing.
Predisposing Factors
- Grief is a predisposing factor, as the recent loss of her son generates major vulnerability in terms of Lucy’s emotional state.
- The employment status can be an additional stressor, as Lucy is an emergency vet, which means she often has primary responsibilities.
- Social illustration generated from having an estranged husband abroad and not seeking communication with Jacob’s friends is also a predisposing factor.
Precipitating Factors
Lucy’s loss of Jacob was the catalyst for seeking help. She is emotionally exhausted, experiences health issues, and cannot cope with reality. Her frustration with her husband, who moved on, and the Balinese police has driven her pain further.
Perpetuating Factors
Lucy’s problems with cognitive functioning are exemplified by her reports of finding it challenging to concentrate at work. Emotional exhaustion is similarly generated as a result of feeling guilty for helping Jacob fund his trip and not having answers regarding how he died.
Protective Factors
Lucy has exemplified her personal strength by going to Bali to understand the circumstances of death. Her job also highlights her ability not to break down when difficulties arise.
Model Application
The Worden’s Task Model can help the client cope with grief and eventually overcome it. As highlighted previously, the first step is to accept the reality of losing a loved one (Khosravi, 2021). This implies that Lucy has to come to terms with the fact that her son’s death has happened. Researchers mention that both intellectual and emotional acceptance are necessary to fulfill the first task within the theory (Yousuf-Abramson, 2020). While intellectually, Lucy has seen her son’s body and cannot deny his death as a fact, emotionally, she has yet to recognize that what happened cannot be addressed.
The second step in the model would be to process the pain. Lucy was suppressing her pain as she had to deal with the practical elements of communicating with the police in Bali and travelling there to find out more about what had happened. However, the second Worden’s task is not about hiding pain but rather acknowledging it and validating the feelings (Yousuf-Abramson, 2020). Lucy cannot avoid the suffering following the death of her son, yet she can express it, seek support from her family, and find out about healthy coping mechanisms from the counselor.
The third step that Lucy is to incorporate through her therapy sessions is adjusting to the environment in which her son is absent. Researchers mention internal, external, and spiritual environments to tackle (Yousuf-Abramson, 2020). Externally, Lucy has changed her daily routine in small ways, such as learning to cook one portion instead of two and cleaning Jacob’s room without feeling guilty about getting rid of certain things. Internally, Lucy has to find a new sense of self and reinvent herself to an extent. Spiritually, Lucy has to find meaning in her life and its future without Jacob.
Last but not least, the client has to find a connection with Jacob while continuing life without him. According to researchers, successful mourning implies a positive attachment to the deceased (Khosravi, 2020). For Lucy, this can take the form of being able to talk about Jacob to remember him, yet not find herself immersed in feelings of sadness and loneliness.
Intervention Strategies
The aforementioned models align with existing evidence-based intervention strategies for addressing bereavement. First and foremost, a patient-centered therapy (PCT) approach can be identified across the three frameworks highlighted previously, as each patient faces a different situation and feelings to work through. Researchers report that it involves empathetic listening and linking feelings to events with the goal of improved insight and problem-solving (Vogel et al., 2021). Based on the resource, it is essential to discuss the loss from all of its perspectives. The client must have an outlet to express emotions such as anger, disappointment, sadness, guilt, frustration, and hopelessness.
Cognitive-behavioral therapy (CBT) can similarly be employed in the intervention. Every model illustrated previously has a strategy that involves accepting what happened rather than denying it. The relevant literature suggests that CBT reduces avoidance of specific feelings and improves their acknowledgment (Boelen et al., 2020). For example, the case study presents Lucy’s emotion of guilt as she believed she had contributed indirectly to her son’s death by paying for her trip. The remorse should be discussed in terms of supporting her son’s hobbies and contributing to his happiness.
Solution-focused approaches similarly align with the three grief theories. In this case, the counselor intervenes by amplifying existing strengths rather than focusing on the barriers. An example is helping clients find new ways to express themselves and reinvent themselves.
Authors identify self-care as a key component of solution-based interventions (Hsu et al., 2022). The counselor is to motivate the client to talk about hobbies they would like to pursue. For example, Lucy can feel guilty about travelling after what happened to Jacob. The goal is to improve her sense of worthiness and motivate her to do the things she never allowed herself to do.
Critical Reflection
During the analysis of existing frameworks built to help deal with grief, I realized the limitations and strengths of specific strategies. What worked for me was a more structured approach, such as Worden’s theory. I appreciate the comprehensive roadmap with multiple well-defined steps. I also believe cognitive-behavioral therapy to be effective as clients experiencing bereavement typically have negative thought patterns that need to be identified and challenged. I did not perceive meaning reconstruction to be efficient in cases such as the one presented in the case study. Clients who deal with grief, especially in the initial stages, cannot be persuaded to associate anything positive with the loss.
Additionally, I acquired an understanding of the vitality of client-centered therapy. Each person is unique in how they perceive the traumatic events, the feelings that they report, and how the counselor can help them. Hence, it is difficult to pinpoint a single practical theory; rather, it is best to select one for each case.
I learned that I would instead aim for a lengthier process of accepting the death of a loved one, yet see positive changes alongside the recovery. Building an honest and transparent relationship with the client can take time. However, the outcomes will include more open conversations and a deeper connection with the care provider. In this case, the individual is likely to share thoughts that they would otherwise avoid or dismiss. In conclusion, it is essential to employ evidence-based models to address grief, as it is a complex feeling that involves changes in a person’s emotional, spiritual, and external life.
References
Boelen, P. A., Eisma, M. C., Smid, G. E., Keijser, J. de, & Lenferink, L. I. (2020). Remotely delivered cognitive behavior therapy for disturbed grief during the COVID-19 crisis: Challenges and opportunities. Journal of Loss and Trauma, 26(3), 211–219.
Hsu, W.-S., Chen, H.-Y., & Chen, H.-J. (2022). The effectiveness of solution-focused group counseling for Taiwanese unmarried females’ post-breakup loss: A pilot study. Journal of Solution Focused Practices, 6(1).
Khosravi, M. (2020). Worden’s task-based model for treating persistent complex bereavement disorder during the coronavirus disease-19 pandemic: A narrative review. Open Access Macedonian Journal of Medical Sciences, 8(T1), 553–559.
Khosravi, M. (2021). Worden’s task-based approach for supporting people bereaved by COVID-19. Current Psychology, 40(11), 5735–5736.
Manevich, A., Rubin, S. S., Katz, M., Ben-Hayun, R., & Aharon-Peretz, J. (2022). The two-track model of dementia grief and spousal response to illness and death. Death Studies, 47(5), 592–599.
Mullens, A. B., Rees, B., Chinchen, C., Plessis, C. du, Purnell-Webb, T., Machin, T., Brown, S., Beel, N., Murray, J., Ayre, K., Gilmour, J., Falcon, J., Flanagan, J., Brown, J., Krishnamoorthy, G., Bryce, I., Malengret, C., Dall’Osto, C., & King, D. (2023). Grief and loss. Common Client Issues in Counselling: An Australian Perspective.
Neimeyer, R. A. (2019). Meaning reconstruction in bereavement: Development of a research program. Death Studies, 43(2), 79–91.
Neimeyer, R. A. (2020). What’s new in meaning reconstruction?: Advancing grief theory and practice. Grief Matters: The Australian Journal of Grief and Bereavement, 23(1), 4–9.
Rubin, S. S., Malkinson, R., & Witztum, E. (2020). Traumatic bereavements: Rebalancing the relationship to the deceased and the death story using the two-track model of bereavement. Frontiers in Psychiatry, 11.
Vogel, A., Comtesse, H., Nocon, A., Kersting, A., Rief, W., Steil, R., & Rosner, R. (2021). Feasibility of present-centred therapy for prolonged grief disorder: Results of a pilot study. Frontiers in Psychiatry, 12.
Yousuf-Abramson, S. (2020). Worden’s tasks of mourning through a social work lens. Journal of Social Work Practice, 35(4), 367–379.