We at BereavementUK are privileged to share with you an interview with Dr Linda Machin. Linda is a pioneer in bereavement theory in the 21st century, having devised the Adult Attitude to Grief scale and the Range of Response to Loss model, which has helped countless health care professionals understand grief better, and countless bereaved people to feel better understood.
Read Tania’s interview with Linda here:
Linda, what initially inspired you to pursue a career in social work and later, to specialise in bereavement?
From an early age I was aware of health needs and health care through the eyes of my mother who had a disability. I think this influenced my aspiration for a hospital based career and ultimately the wish to become a Medical Social Work – the specialism which grew from the tradition of Hospital Almoners. In my work as a Medical Social Worker, which addressed the psychosocial needs of people dealing with illness and disability, I was involved with dying patients and their families on many occasions. My role seldom allowed follow-up of bereaved relatives and I was left wondering what had happened to those whom I had observed lacking the inner resourcefulness or social support to deal with the death of someone close. This was the seed of my interest in bereavement. With a subsequent social work appointment to the Diocese of Lichfield I pursued this interest further, recognising that churches are well placed to serve grieving people in their communities. I was given the opportunity to research the experience of bereaved people in five socially contrasting parishes. From this began the foundation of my specialism. I wrote training material for pastoral groups(later published for wider use by bereavement services) and set up a bereavement service in North Staffordshire in 1984. The organisation flourished (and continues to do so) as a resource seen by referring practitioners and clients alike as a gap in the provision for bereaved people. While I moved from being that organisation’s first director to an academic post at Keele university, teaching social work and counselling, my own research focus remained on bereavement. This included gaining first an MA and then a PhD.
You are well known for your development of the Range of Response to Loss model of grief and the Adult Attitude to Grief scale. For those out there that don’t know very much about this model and scale, would you mind outlining the concepts?
From my early research i.e. the experience of bereavement in five socially contrasting parishes (mentioned above) together with my own practice, I became aware of the many different ways people experience and express grief.
For some people the intense emotion which they feel is experienced as ‘overwhelming’ while for others retaining emotional ‘control’ is a dominant instinct and automatically restricts engagement with feelings of grief. The variability in unconscious reactions to bereavement/loss, is part of what is learned and absorbed within the varied and complex contexts of family, education and culture. I began to conceptualise these widely different reactions to loss as lying on a spectrum from overwhelmed to controlled.
In contrast, coping with the consequences of bereavement is a conscious response which seeks to reconcile the feelings of grief with the need to function in day to day life. For people whose bereavement is one of a number of other life troubles e.g. illness, unemployment, financial or relationship difficulties, and/or they have difficulty in coping with stress, grieving is likely to create a state of vulnerability. For people who have few other complicating factors in their life, who have some inner sense of strength and resourcefulness, and adequate social support, bereavement is likely to be met with resilience. That is not to say their grief is pain-free or easy but rather that the loss and its consequences can be accepted and managed. Reaching this point, even for people who are largely resilient takes time but will take longer for those who are vulnerable and in need of support in a number of aspects of their post-bereavement life. The spectrum from vulnerable to resilient coping responses interacting with the spectrum of overwhelmed to controlled reactions form a framework or model for understanding grief. I have called this The Range of Response to Loss model (RRL) (Machin 2001; 2014)
(co-existing stressful personal/ circumstantial / social factors make coping with grief difficult)
(personal resourcefulness, positive life perspective, social embeddeness make coping with
grief more possible)
The Adult Attitude to Grief scale is a measure which contains 3 statements for each of the overwhelmed, controlled and resilient categories in the RRL model. An indication of vulnerability can be calculated through the scoring system and by looking at the degree of agreement with the overwhelmed and controlled statements in the scale and the degree of disagreement with the resilient ones (Sim, Machin and Bartlam 2013).
Themes in the 9 items in the Adult Attitude to Grief scale
Overwhelmed Controlled Balanced/resilient
Robbing life of meaning
Denial of, or covering distress
Focus on day to day living
Courage in facing the loss
Sense of personal resourcefulness
Practitioners and bereaved clients have found the scale a useful means of exploring grief and finding a focus for addressing the things which are troubling or problematic (Machin and Spall 2004; Machin 2007; Machin 2014).
For more information and for copies of the scale contact: firstname.lastname@example.org
Linda you recently published a second edition of your book ‘Working with Loss and Grief’ ( Sage 2014) for practitioners. Can you tell us about the inspiration for this book and its message for those working in the field?
While theory and research always fascinate me, I am primarily concerned with how these perspectives relate to and enhance practice. It made sense, therefore, to write about the concepts making up the Range of Response to Loss model and the assessment function of the Adult Attitude to Grief scale, for practitioners. The first edition of ‘Working with Loss and Grief’ was well received and the publisher – Sage – invited me to do a second edition. This permitted the inclusion of evolving practice issues which had been generated by my on-going research, particularly into the identification of vulnerability in grief.
For those working in the field, the book gives a wide theoretical context to my own model (RRL) and a therapeutic exploration of the AAG scale in practice, using many case examples. Understanding the widely variable experiences and expressions of grief is vital to determining and providing appropriate and effective care. This is a key challenge for practice.
As a respected experienced professional in grief, have you seen many changes in the way society manages loss, and how we deal with it, during the years you have been working in the field?
In the last two decades, increasing knowledge and expertise in the fields of palliative and bereavement care have contributed to increased public discussion about death and dying. Wider debate has also been generated by the ethical issues which have come from expansion in medical knowledge, advances in medical intervention and the policy challenges of an aging population. However, the wider political focus has not always countered the limited understanding of grief at a personal level, where loss is frequently seen as a universal process of clearly defined stages and phases. These ideas have often been applied simplistically to all bereaved people, misunderstanding the complexity of individual grief. Perhaps as a casualty of austerity, increased insight into the needs of bereaved people has not been matched by resources being invested in research or care provision.
In services providing bereavement care, in common with health and social care generally, there has been a rapid growth of counselling as a talking therapy. Training and qualification in counselling has provided a new level of expertise for those needing support in their bereavement. While it has helped give increased professional status to this field of work there has sometimes been an inclination to see traditional support-giving by volunteers as less effective and/or appropriate. However, it is through recognition that the experience of grief is very variable and that only 10%-15% of people need therapeutic intervention rather than more informal types of support, that a mixed economy of care is beginning to be applied systematically on the basis of assessed need.
If someone is reading this who has just experienced a personal loss, and is looking for support, what message would you give to them?
Support comes in many forms and finding the appropriate one for you is important.
If your relative or friend has died in a hospice or hospital you will probably have been given a leaflet about practical things which need to be dealt with after a death and also the kind of feelings and thoughts you will have as a consequence of losing someone important in your life. (You can also access this kind of information on-line or at the library). This will help you understand that even some of the disturbing or upsetting thoughts and feelings are a normal part of grief. Accepting this can help you live with even the uncomfortable aspects of bereavement.
Specialist organisations can be an important source of information and support where they relate to the particular loss you have suffered e.g. death of a child, a suicide, a road traffic accident etc.
Alongside knowledge about the nature of grief, family and friends, for most people, will be a primary source of support, offering comfort for sorrow and help in establishing life changes after a loss.
If you continue to be troubled by aspects of the dying, death or the relationship with the deceased, it may help you to seek the support of a bereavement organisation e.g. Cruse Bereavement Care or a service you already have contact with such as a hospice. An opportunity to talk about your worries with an individual or in a small group may fairly quickly give you the relief you need.
Where your grief is proving especially difficult counselling may provide you with more in depth support in working through the issues which are impeding adjustment to your loss. This level of support may be found through a bereavement service or through other organisations such as a chaplaincy service.
Linda, you have dedicated much of your life’s work to supporting others and your research. What are you working on at the moment, and what are your plans for the future?
At the moment I am actively engaged in four areas of work:
1. I continue to offer training in use of the AAG across many practice groupings/teams in health and social care.
2. As an Honorary Research Fellow at Keele university, I am pursuing a number of research projects which make use of the concepts in the RRL and use the AAG to explore varied experiences of loss. This is likely to be extended into a range of research areas, such as loneliness. I am also interested in validating the AAG for use pre-bereavement with patients and their carers.
3. I am currently working on a number of writing projects including book chapters focusing on use of the AAG in psychotherapy and palliative care.
4. With the development of standards across the bereavement care sector greater attention is being given to assessment, and ensuring appropriate and effective intervention is linked to client need. I have helped establish a national Bereavement Assessment and Evaluation Task Group (BAETG) which is taking initiatives in these areas alongside leading practitioners, researchers and academics by looking at the implementation of standardised good practice. With the support of a well-respected and field-leading national organisation CORE (Clinical Outcomes in Routine Evaluation) we are currently piloting an IT system which will allow for the tracking of practice interventions using the AAG. This will enable practitioners to have a clear sense of the effectiveness of their intervention. The BAETG is also looking at training needs in bereavement services.
Machin, L. (2001) Exploring a framework for understanding the range of response to loss; a study of clients receiving bereavement counselling. Unpublished PhD thesis: Keele University, UK.
Machin, L. and Spall, R. (2004) Mapping Grief: a study in practice using a quantitative and qualitative approach to exploring and addressing the range of response to loss. Counselling and Psychotherapy Research. Vol 4 No 1, 9-17.
Machin, L. (2007) The Adult Attitude to Grief Scale as a Tool of Practice for Counsellors Working with Bereaved people. A study report sponsored by Age Concern, Tameside and Keele University.
Machin, L. (2009; 2014) Working with Loss and Grief. London: Sage.
Sim, J., Machin, L. and Bartlam, B. (2013) ‘Identifying vulnerability in grief: psychometric properties of the Adult Attitude to Grief scale’, Quality of Life Research.
Linda- thank you so much, on behalf of all us practitioners, and those bereaved, that have benefitted from your time, care, research, and expertise.