The bereavement model, stroke and rehabilitation: a critical analysis of the use of a psychological model in professional practice

Purpose: This pilot study aimed to explore with stroke survivors, carers and professionals, the impact of stroke and the process of recovery and rehabilitation. One theme that emerged in interviews with professionals was their use of the bereavement model in relation to recovery from stroke. The purpose of this paper is to explore the ways in which professionals use the bereavement model to explain and manage the rehabilitation of stroke survivors. Method: A person-centred study using qualitative research methods, semi structured interviews and self report diaries to explore with stroke survivors and carers the impact of stroke on their lives. Twenty-five interviews with stroke survivors, 23 individual or with carers and seven in two focus groups. Evidence from four self-report diaries provided more detailed examples of the everyday experiences of the survivors. A set of parallel interviews involving 17 professionals involved in the care and support of such individuals, nine individual and one group interview involving a community rehabilitation team. Results: The bereavement model can be identified in the literature aimed at professionals, and was evident in some professional accounts of stroke but was absent from survivors' and carers' accounts of stroke. In over half the interviews, professionals made reference to the bereavement model to explain a process of loss and readjustment. While survivors in their accounts of life after a stroke did acknowledge the ways in which stroke disrupted every-day life and resulted in losses and disabilities, their perception of such losses and disruption was shaped by the context of their every-day life. Most survivors sought to actively manage their recovery by setting goals. They wanted professional support in achieving their goals. The bereavement model appeared to be used by professionals in situations where there was a conflict over goals and professionals felt that survivors had become 'stuck' and their goals unrealistic. Conclusions: Following stroke, people try to make sense of what has happened and normalize their lives by setting themselves goals to progress towards recovery. It is important that professionals communicate effectively so that their interventions are grounded in and support the survivors' goals and strategies.