There are important clinical implications if suicide bereavement requires a different set of clinical counseling approaches to that of other mourning. However, there are research studies that contend that differences between grieving states do not always occur, and that when they do they are only slight is only slight (Jordan, 2001).
A popular bereavement model utilised in counselling is the Kubler-Ross Model (1964) (as cited in Kelly, 1997). Kubler-Ross constructed an eight stage model during her work with dying patients, observing their different way of coping with their impending death. Her theory has been drawn on to provide a framework for interventions with people who are experiencing personal loss, such as through bereavement. The fist stage of the model is denial and isolation, and the bereaved make statements such as, "No, not me". The second stage is that of feeling s of anger, so that the bereaved accept that they are experiencing loss. At the third stage the bereaved try to bargain or postpone the full experience of grieving and mourning for their loss. Stage four, they let go of the anger only to feel an intense sense of loss that results in depression. Finally, during the fifth stage the bereaved accept their loss and the need to grieve, and come to feel at peace with the way things are.
In contrast, Kelly (1997) argues that a Kubler-Ross's theory assumes that a person will always experience shock and denial during bereavement, and that letting go and acceptance is necessary to be able to cope eventually following a meaningful loss. Also, he continues, her theory ignores the important contribution of the bereaved cognitive development stage. Instead, he suggests a Cognitive Equilibrium Model (CEM) for the grieving process, which has four phases. Phase one is when the bereaved awareness of loss changes their reality, and their attempts to deny their new reality place them in a sate of cognitive disequilibrium. In phase two, the bereaved may experience ambivalence about their change in reality, as they attempt to avoid accepting their new reality, and to remain in the past. During phase three a person lets go of the past and accepts their new reality, as well as the pain of loss, and begins the process of cognitive change (cognitive equilibrium). In the final phase, the bereaved renegotiates their attitude toward their loss, and relocates it within their life as they adapt on biosychosocial levels to their new reality.
Complicated grief has been found to occur following major personal loss, such as bereavement (Shear, Frank, Houck, & Reynolds, 2005). It can be characterized by a person's disbelief and denial; feelings of anger or bitterness; reoccurring painful emotions, with intense yearning; and preoccupied thoughts, which in the case of bereavement may include intrusive and distressing thoughts related to the death of the loved one (Shear et al., 2005). For those who are bereaved by suicide, the sense of shock and disbelief may be extremely intense. Feelings of anger are not uncommon as the bereaved may feel a sense of 'rejection' or 'abandonment' by their loved one's death (Knieper, 1999). They may have recurrent visions of how they might have