Rubin Two Track DS 99
Rubin Two Track DS 99
Rubin Two Track DS 99
Representative Research
KEY Footnotes
# Recently Bereaved 5 A 1 5 A vs. C are signi cantly diÚ erent
$ Non-Recently Bereaved 5 B 2 5 A vs. B 1 C are signi cantly diÚ erent
Ó No child loss 5 C 3 5 A vs. B are signi cantly diÚ erent
Mother : ‘‘I know this isn’t true, but my baby died because I did not love
him enough.’’
Another : ‘‘My baby died because my husband and I were ghting
during the pregnancy and that weakened the fetus’s development.’’
‘‘I’ll always wonder what I could have done,’’ was one mother’s parting
statement to the interviewing researcher.
It was 14 years ago. The city military officer came with my husband to tell
me my son had been killed. I couldn’t believe it when they told me. I didn’t
think I could handle it. . . . Our relationship had been so close I couldn’t
692 S. S. Rubin
nd anything negative to say about him. He had been so special. I lost the
thing that was most precious to me, the most precious thing of all.
[ Interviewer : What was the rst year of loss like ?] I kept on working. I
waited for him every Friday afternoon to come home and he didn’t. I had
dreams about him all the time. I would dream that he was alive and I
would tell myself in that dream that he really wasn’t. I missed him so much
on weekends and holidays. . . . I was jealous of his friends that were still
alive . . . I thought a lot about what to do given my situation, given the
other kids. [What do you mean ?] I thought a lot about whether to kill
myself.
[ And today ?] Well it is true, that time helps and my friends did too. Yet
I live with him all the time. He is with me always. I close my eyes and
travel with him on the bus. When I pass groups of soldiers I look for him. I
can’t do volunteer work with them because it is too powerful, the looking
for him.
[ What thoughts do you have ?] I think about him, about who he would
have been today. How he would be married, what his children would have
been like, my grandchildren. I think about this all the time. I miss that so
much, that he and his children would have come. Perhaps when I die, we
will meet again. I never used to think about that, but now I do.
Whereas theory and research lay the groundwork for the genesis
and clarity of the Two-Track Model of Bereavement, for many it is
in the clinical world that the model makes its contribution. Two
cases are used to illustrate clinical work. The rst vignette presents
the clinical assessment of a woman where the focus on functioning
is predominant. The second presents the treatment of a woman
where the relationship with the deceased was the prominent com-
ponent of the therapy.
Case 1: T anya 1
Tanya was a 44-year-old woman who came for therapeutic consul-
tation and entered therapy because of concerns that she was
unable to maintain her regular routine and level of activity. In the
initial intake meeting, she stressed her inability to function, which
had begun ‘‘without warning or cause’’ shortly after her return
from a vacation abroad. She was awakening at 3 :30 am and was
1
This case was not part of the original ADEC presentation but is included here for
purposes of clarifying the therapeutic applications of the Two-Track Model.
700 S. S. Rubin
afraid of what the day would bring. Afraid to use the term depres-
sion, Tanya recounted symptoms of anxiety, unhappiness, and her
concerns about ‘‘falling victim to mental illness’’ and needing hos-
pitalization. Sleep difficulties, abdominal upset, and periods of
weepiness all contributed to a picture of depression that she per-
ceived as having occurred totally without cause or reason.
A glance at the application form suggested she was no stranger
to loss and bereavement. Subsequent material in the interview soon
con rmed how central these features were to the onset of her diffi-
culties. The most recent of her losses was the death of her mother
several months prior. Her death had followed a debilitating bout
with cancer that had raged for a year. Tanya had sel essly nursed
her parent through the progressively worsening illness. She had left
no time for herself or her own pursuits as she was wife to her
husband, mother to her children, daughter to her own father and
nurse to her failing mother. These behaviors seemed self-evident to
her.
‘‘I am the only surviving child of my parents so of course the
burden falls on me. My sister died suddenly when I was 15, and it
was up to me to care for both of my parents and to ll the void left
in their lives. I have been similarly occupied for the past 30 years.’’
Prior to this crisis in her life, Tanya described herself as an
active and competent professional woman who worked in market-
ing with notable success. She and her husband entertained a great
deal and led an active life, all of which had totally stopped given
the changes in her emotional life and the ‘‘onset of the ‘d-word’
thing—I can’t even say the word.’’
As part of the initial intake sessions, Tanya was asked about the
relationship with her mother in the more distant past as well as
more recently. The questions seemed almost irrelevant to her. She
described a con ictual relationship with an opinionated woman
who typically got her way in the home by force of personality.
Whatever she conveyed, however, was overshadowed by the
impression that she did not like to talk about these things and that
they were not relevant. It also emerged that she had not grieved or
set aside time for mourning her mother—immersion in activity and
doing things having taken precedence over anything else. Tanya
described her relationship with her father as ‘‘not easy,’’ but she
attributed her parents’ strained relationship to patterns character-
T he T wo-T rack M odel of Bereavement 701
istic of ‘‘the older generation.’’ Tanya noted that her father had
generally done what his wife had wanted, and found it ‘‘surprising
that he does not feel free and liberated, but now complains to me
that he is alone and expects me to take care of him.’’
Listening to her limited descriptions of her relationships with her
parents led to a comparison with other relationships. Although
generally not able to provide much detail of things in the past or of
her own emotional life, Tanya was a reliable informant when it
came to describing activities and her relationships with friends in
the present. In addition to her description of the present difficulties
and relationships with parents, family, and friends, it was impor-
tant to learn more about the earlier loss that gured so strongly in
her history. At this point in the assessment process, however,
Tanya’s ability to go into detail ( and emotional resonance) with
the story was very limited.
I did learn that Tanya’s sister had died suddenly in an automo-
bile accident, and as a result, life had totally changed for her. She
described the necessity of her ‘‘being strong’’ to take care of her
parents, and how proud she was that she did not cry at the funeral
but was on top of the situation. For the next several years, she was
the liaison with the outside world, as her mother did not leave
home to go out. Her father had been withdrawn as well.
It is hard to convey how difficult Tanya could be due to her
constant desire for reassurance and her inability to enter into much
detail of the past ; however getting the history proceeded tfully.
Tanya wished for reassurance and to be told many things. She
wished to be told that her condition was not unusual or serious;
that her husband would not have to put up with this for long ; that
she would become once again an adequate mother and pro-
fessional ; and that she was going to get over it soon. In addition to
questions about her general situation, Tanya wanted to know
about many other things. She wanted to know if she should stay in
bed when she had the urge or must ght to get up. Some of her
friends recommended the former and others the latter. What did I
the professional think ? What about the Xanax medication she was
taking—should she continue or not ? In consultation with a sleep
specialist, she described a new drug that was recommended to her
and wanted to know if I had experience with that drug too. The
questions were driven by her anxiety, and it was therapeutic as
702 S. S. Rubin
Case 2: N an
Nan was a 36-year-old woman who had been in therapy for a
year-and-a-half at the time this material was prepared. She was
born into a large Israeli Sephardic-Jewish working class family of
Middle Eastern origin. Both her parents were alive, but an older
brother 12 years her senior who had been her mentor and ‘‘surro-
gate father’’ had died when she was 13. Nan explained that she
was the youngest child of a large family and the only one that was
not married. At the time treatment started she had not established
a satisfying relationship with a male gure with whom she wished
to live, and because she did not wish to miss the experience of
having and raising a child, she was considering becoming a single
mother.
Treatment proceeded at a steady pace. In the early stages Nan
described tensions with her parents, in particular her difficulties
with her father. In dealing with the issue of her relationships with
men, the relationship with her father and her deceased brother
were relevant. Over the course of treatment Nan began to shift
from a Black–White contrast of her father ( the less savory gure) ,
who was the villain of the piece, and her older brother, who during
her youth had lled many of the nurturing roles and educational
roles that her father did not manage. At the time when her father
had been perceived as distant and unpredictable, the death of her
mentoring brother had been a devastating loss for her. A signi -
cant amount of the therapy discussions focused on these two
relationships with signi cant males in her early life.
To understand what was involved, Nan described her responses
when she was 13. Within the rst months of her brother’s death,
T he T wo-T rack M odel of Bereavement 705
may have in uenced her views of herself, her parents, and perhaps
her sensitivity to her later sibling loss of her older brother.
It is signi cant that at the time that the memories of her
younger sister and younger self were emerging, Nan responded
very poorly to a break initiated by her and by me. As we had
cancelled sessions before with no adverse consequences, I was less
than prepared for Nan’s response to treatment after a 2-week
hiatus. She opened our next session by suggesting that we consider
terminating treatment. She believed that therapy was not neces-
sary anymore, and besides, if she wanted to continue she might
prefer a woman or therapist who was more talkative in the therapy
session. My own reaction was one of surprise and dismay. Emo-
tionally, I responded with the feeling that I was about to be dis-
missed from the case ; I was going to be forgotten—to be replaced
by a new therapist, one who would listen and with whom Nan
would share her life and who would see her develop instead of me.
For the next two sessions, we explored the trigger and source for
her thoughts regarding the termination of therapy. Gradually, we
were able to comprehend together. It seemed that a portion of the
answer lay in the repetition of a con guration she had experienced
before. Facing her memories and feelings about her little sister had
increased her need to receive support from those around her. When
a short treatment hiatus occurred, this linked up to her own sense
of re-abandonment by the signi cant members of her family in
ways that echoed the response at the time of the loss of her sister
and the loss of her brother. While as a young child her option had
been withdrawal, as an adolescent she had left the family and gone
to boarding school. Similar impulses had seized her now—both to
withdraw and to go to a new place. Talking about these responses
in the context of her response to loss proved cathartic and allowed
her to continue in treatment. The issues of treatment continued but
there were no more crises. A mutually agreed satisfactory conclu-
sion to this stage of treatment and termination of treatment was
reached some 6 months later. The termination was marked by
greater comfort with her father, her increasingly complex view of
her deceased brother, and a sense of openness to all her siblings,
both living and dead.
In this case, the Two-Track Model focused us squarely on the
relational themes that were present here. It was the attempt to get
T he T wo-T rack M odel of Bereavement 709
Concluding Remarks
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