Adapting the Transtheoretical Model of Change to the Bereavement Process (Report‪)‬

Debates continue in the thanatology literature about the bereavement process and appropriate wording to describe this process. For example, there is both support for and dispute regarding use of the terms "resilience" and "recovery" (Balk, 2004, 2008; Paletti, 2008;Tedeschi & Calhoun, 2008). Suggested alternatives include "adaptation," "reintegration," "management," "deal with," "adjust," and "cope" (Balk, 2004, 2008). More recently, the conceptualization of the bereavement process has shifted to a focus on "growth" and "development" (Balk, 2004, 2008; Davis, Wohl, & Verberg, 2007; Dutton & Zisook, 2005; Shapiro, 2008). Part of this debate on terminology is spurred by disagreement about the expected outcome, or aim, of bereavement. Only recently has there been wide acceptance that bereaved people typically undergo fundamental changes as they redefine themselves and explore a new identity (Davis et al., 2007; Dutton & Zisook, 2005; Sandler, Wolchik, & Ayers, 2008). Although, in Western society, we expect that within a few days or weeks the bereaved person should" get back into the swing of things" (Monk, Houck, & Shear, 2006), typically a long process of change lies ahead. Even though one may appear to have returned to a previous state," what looks like recovery to an observer might not feel like recovery to a bereaved person" (Rosenblatt, 2008, p. 9). The last decade has seen an increase in studies exploring the factors that facilitate coping with the death of a loved one (Keesee, Currier, & Neimeyer, 2008) and studies about the effectiveness of psychotherapeutic interventions for bereaved people (Currier, Neimeyer, & Berman, 2008); however, there remains little consensus regarding the process of "change" that bereaved people experience. By presenting an adaptation of Prochaska and DiClemente's (1992) transtheoretical model of change (TTM), this article begins the task of applying the model to the bereavement process. The first section critiques Western society's most common understanding of the stages one passes through during the bereavement process. The second section describes an adaptation of the TTM as it may be applied to the bereavement process. To address a common downfall in the literature (Balk, 2008; Bridging Work Group, 2005), the article strives to bridge theory and practice in a third section, which describes how this model can be used by clinicians. The implications for use of TTM, a critique of the model, and future directions are then discussed.