expressive movement, psychodrama).

Provide group support for clients and their significant others who are experiencing grief

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and bereavement.

Acknowledge deaths with memorial services, flowers, photographs, and participation in

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commemorative projects such as The NAMES Project Foundation's AIDS Memorial

Quilt, which attempts to include the names of everyone who has died of AIDS.

Kubler-Ross bereavement and loss model

One of the best and most often referred to models of bereavement and loss comes from physician

and psychiatrist Elisabeth K_bler-Ross. In her book, On Death and Dying, she provides a five-

stage theory that has become common language when dealing with death and dying. Her model

of bereavement is essentially a series of defense mechanisms, or coping strategies, that are used

by an individual confronted by death. These stages can also be observed as individuals are

confronted with other traumatic circumstances or information, such as a positive HIV test, an

HIV/AIDS diagnosis, or the death of a friend or peer. The five stages are denial, anger,

bargaining, depression, and acceptance.

Individual interpretations of and responses to death and dying vary greatly, not only between

people, but between cultures and religions. Yet, as this model eloquently describes, adjusting to

death is a process, not an event that occurs seamlessly and in a logical sequential order.

The coping strategies and stages described below are not a recipe for health. Acceptance may not

be the goal for everyone. Emotional processing is made more challenging when survival needs

such as shelter, food, and medical care are not being met. Many clients are used to surviving with

"street smarts" and not by psychoanalytical parameters and discussions about childhood. This

model is included merely to help providers understand and relate to their experiences and their

clients' experiences.

Denial

This is a time of terror management, an effort to psychologically buy some time while adjusting

to the information or situation. It is here that people can feel the most isolated and the most

suspicious and doubtful of the information that they are receiving. Denial is a natural and healthy

response. It is not necessarily something that counselors must feel compelled to confront and rid

clients of at the earliest possible moment. Allowing clients to have denial can be challenging,

and for the caregivers and support staff it can be anxiety producing, but it is important to

remember that above all else, this is the client's experience. Denial is not always negative. The

times that denial must be confronted are when it causes a danger to self or others.

Anger

This stage emerges as the person accepts the diagnosis and begins to strike out. The most

common targets for this anger are the people closest and safest to him, especially caregivers and

service providers. Anger can also be a test. The person facing death may want to know who can