Theories of Stages of Grief

I have found a way to come to terms with the issue of clients lying to me, as per the previous post. I discussed it briefly with colleagues and all this can be reconceptualized as the client's "readiness to change", instead of truth detection per se. I now can do my work with an easier heart.

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Today we talk about grief. Elisabeth Kubler-Ross's model of grief is probably the most well-known, comprising the five stages of denial, anger, bargaining, depression, and acceptance. However that Wikipedia article provides a link to a JAMA 2007 empirical study on another model of grief, Jacobs' model, which according to a reference of that paper has the four stages of numbness-disbelief, separation distress (yearning-anger-anxiety), depression-mourning, and recovery.

That JAMA 2007 paper by Maciejewski et al., contrary to its claims, is not a convincing empirical study of Jacobs' grief stage model on two major counts. First major count: The authors used single items obtained from a scale called the Inventory of Complicated Grief-Revised, formerly known as the Traumatic Grief Response to Loss. The reference given for this Inventory is in a book which I do not have ready access to; however it needs to be proven instead of merely asserted, that a shortened form of a scale has similar explanatory properties as the full scale. Cronbach's alpha test is commonly used as such proof. The authors have not proven this.

In addition, I am most disturbed that even the online version of the paper does not provide the actual single items used in querying the respondents. Surely JAMA, the Journal of the American Medical Association, supports the inclusion of supplementary material. (Later note: Yes it does.) The lack of the actual questionnaire used in the paper can only be a horrific oversight by the authors.

The authors further shoot themselves in the foot by saying in an aggregate letter of response to all preceding letters of response to their paper, that "these [single] items have been evaluated and found to be among the most informative and unbiased in the evaluation of prolonged grief disorder", and that they had "removed [excluded] cases of prolonged grief disorder" from the study sample so to provide a representative sample of grief.

Second major count: As noted by Bonanno and Boerner in a letter of response, even in the earliest months of bereavement, the mean frequency of acceptance experienced by participants was between daily and several times a day, significantly more than any other grief item. Acceptance is the last stage of grief in both Kubler-Ross's and Jacobs' models - grieving is considered to be over when this stage is attained. If acceptance is consistently highest of all grief feelings assessed throughout the study, this only begs the question of what exactly the questionnaire used for assessment was.

The paper does not live up to its claim of being an empirical study of the stage theory of grief.