Bereavement and Traumatic Bereavement: Working with the Two-Track Model of Bereavement

Bereavement following loss through death is a universal human experience, but how it is experienced and understood is mediated by many variables. In this article, we stress the importance of a bifocal approach to understanding, assessing and intervening following the loss of significant persons using the framework of the Two-Track Model of Bereavement. This model examines both biopsychosocial functioning as well as the nature of the ongoing relationship with the deceased and the death story in working with the bereaved. It is particularly suited to identify adaptive and maladaptive responses to loss and to optimally focus interventions where needed. Two case vignettes are presented to orient the discussion. Traumatic bereavements, a term indicating the interface between trauma and loss, increase the likelihood of complications following loss and these are considered. Bereavements that occur under external traumatic circumstances increase the risk for dysfunction, symptomatic difficulties and complicated grief. In addition, there are forms of traumatic bereavement that arise due to subjective elements related to aspects of the psychological relationship to the deceased and the relational bond with him or her. Clinically, there is a need to identify and understand the various aspects of the traumas of bereavement and to intervene appropriately. Interventions based on the Two-Track Model of Bereavement will be described.