The Range of Response to Loss: an innovative theory of grief and a framework for use in practice and research

This paper describes the development and authentication of the Range of Response to Loss (RRL), an innovative theoretical model for understanding loss and grief. The model references existing theories on loss and grief while also providing a paradigm shift in defining the dynamics of grief, which have then become embedded into its practice and research application. The RRL model evolved over four decades and consists of three developmental phases. Phase one comprised an intersectional analysis of my practice observations and research with existing theories of grief. This resulted in a new three-category conceptual framework capturing the range of responses prompted by loss: overwhelmed, controlled and resilient. This then led to devising a novel measure to support validation of the proposed concepts in the framework: the nine-item Adult Attitude to Grief (AAG) scale. The research process, which took place in a practice setting, supported the RRL concepts. In addition, an unexpected outcome was that practitioners involved in the research highlighted the potential for the AAG scale to be used as a practice tool that could both quantitatively capture an individual’s response, and also enable a qualitative exploration of their experience. In phase two this clinical perspective led to considering a fourth concept, vulnerability, a key presenting factor in practice. I looked at the implications of this in the light of changing theoretical perspectives on loss and grief. This then led to considering the nature of the inter-relationship between the four concepts and the consequences for the structure of the framework. The result was the reframing of the RRL into a two-dimensional model: (i) instinctive and spontaneous reactions to loss experienced and expressed on a spectrum from overwhelmed to controlled ; and (ii) conscious coping responses on a spectrum from vulnerable to resilient. Using the AAG, the model underwent psychometric testing, which validated the inclusion of vulnerability as a fourth concept. Furthermore, this process added evidence of the validity and usefulness of the AAG as a practice tool. Phase three documents the on-going ways in which practice and research continue to develop around the RRL and AAG, in the UK and internationally, and includes details of the development of other RRL related measures to address grief in palliative care settings and the grief of children. The bridge provided by the AAG in the research and theoretical development of the RRL and its practice application has been crucial in validating the significance of the RRL within the field of grief support. It provides an example of the importance of integrating research and practice.