A Thanatology Grieving Index - By Keith Torkelson MS, BS

 

Assessment List

• Houben Grieving Deficits 23 Items (LSF)
• Houben Grieving Strengths 27 Items (HSF)
• Generic Grieving Deficits 27 Items (LSF)
• Bargaining Grief Assessment 17 Items (HSF)
• Holistic Emotional Components (LSF)
• Holistic Cognitive Components (LSF)
• Holistic Social Components (LSF)
• Holistic Spiritual/Religious Components (LSF)
• Stiffled about the dead 10 Items (LSF)
• TRIG Grief Present Score 13 Items (LSF)
• Core Bereavement Scale 17 Items (LSF)
• Depressed 9 Items (LSF)
• CESD-R-20 Depression Score (LSF)

 

Results Up Front – Grieving Index

Subjects of Grieving = Joan NZ, Candace DB, Kevin GT, John B. Craig ET

Scored by and for = Keith “Buster” Torkelson MS, BS

HSF = High Scores are Favorable | LSF = Low Scores are Favorable

Topics (Rough Order)

 

Grief
Assessment
Quantified Results
Deficits
DABDA
LE – Lived Experience
Strengths
Types of Grief
Thanatology
Scales
Bereavement
Palliative Care
Grief Intensity
Holism
Prolonged Grief Disorder
The Dead
Older Adults
PTSD
Depression
Unique Journey

Assessment Evaluation of Your Loss (2017, Houben) - GRIEF and Loss

https://my.therapist.com/hubfs/therapist.com/Squeeze%20Page%20Assets/PUB084395%20Grief%20and%20Loss.pdf?hsLang=en

Copyright © 2017, Ligia M. Houben. Transforming Grief & Loss Workbook. All rights reserved. Assessment.

Deficits – Scored by and for Keith “Buster” Torkelson MS, BS

 

##	Statement	2026 0102 F-RT SW-Solo
01	I do not want to think about my loss.	0.00
02	I will never be happy again.	0.00
03	These misfortunes only happen to me.	0.00
04	Everyone else is happy.	0.00
05	I do not care about my health.	0.00
06	I do not believe in support groups.	0.00
07	I do not believe in God.	0.50
08	I do not believe in spiritual guides.	0.00
09	I feel a lot of anger.	0.00
10	I feel a lot of resentment.	0.25
11	I will never forgive those who caused this pain.	0.00
12	I do not want to talk about death.	0.00
13	Life is unfair.	0.50
14	If I get busy, I do not need to think about my loss.	0.50
15	I do not have to share my pain with anyone.	0.00
16	I need to be strong for others.	1.00
17	From now on, I will not show my feelings.	0.00
18	I do not think I will recover.	0.50
19	Nobody understands me.	0.25
20	I will never see my loved one again.	1.00
21	Religion does not help to heal a loss.	0.50
22	Why did this happen to me?	0.00
23	I am guilty of suffering this loss.	0.50
		=5.50/23
	Houben Grieving Deficits 23 Items (LSF)	23.9%

 

Assessment Evaluation of Your Loss (2017, Houben) - GRIEF and Loss

https://my.therapist.com/hubfs/therapist.com/Squeeze%20Page%20Assets/PUB084395%20Grief%20and%20Loss.pdf?hsLang=en

Copyright © 2017, Ligia M. Houben. Transforming Grief & Loss Workbook. All rights reserved. Assessment.

Strengths – Scored by and for Keith “Buster” Torkelson MS, BS

 

##	Statement	2026 0102 F-RT SW-Solo
24 (1)	Someday I will be happy.	1.00
25	I will learn to live with this loss.	1.00
26	I will get over this loss and transform my life.	1.00
27	I would rather be alone.	0.00
28	I do not want help.	1.00
29	I have processed my loss.	1.00
30	I will be happy again.	0.50
31	Losses are part of life.	1.00
32	Everybody faces tough times in life.	1.00
33	Support groups can provide help.	0.50
34	I believe in the possibility of something greater than myself.	1.00
35	At certain times we need spiritual guides.	1.00
36	Keeping grudges is not healthy for my soul.	1.00
37	I have managed to forgive.	0.50
38	It is necessary to talk about death.	1.00
39	Sometimes life is not easy, but I still go forward.	1.00
40	Although it is difficult, I need to process my loss.	0.50
41	It is important to show my true feelings.	1.00
42	There will be a time when I will have recovered.	0.50
43	There are people who understand my pain.	0.50
44	I always carry my loved one in my heart.	1.00
45	The spiritual dimension helps me to find meaning.	1.00
46	I am not the only person facing a loss.	1.00
47	I am not guilty of this loss.	1.00
48	I help others with their loss.	1.00
49	I can love, starting with myself.	0.50
50 (27)	By transforming my loss I can change my life.	1.00
	CALC	=22.5/27
	Houben Grieving Strengths 27 Items (HSF) =	83.3%

 

Newly bereaved: You will experience a wide and often frightening variety of emotions after this loss.  These feeling and experiences are natural and normal.  Here are some you may encounter.

For the Newly Bereaved

 

Bereaved Parents of the USA

https://bereavedparentsusa.org/for-the-newly-bereaved/

Generic Grieving Deficits 27 Items

Scored by Keith “Buster” Torkelson MS, BS

 

##	Item	2026 0102 F-RT SW-Solo
01	Profound sadness.	0.00
02	Crying all the time or at unexpected times.	0.00
03	Extreme physical exhaustion, or a manic energy.	0.50
04	Difficulty sleeping, or sleeping all the time.	0.00
05	Lack of appetite, or over eating, often accompanied by weight loss or weight gain.	0.50
05	Anxiety, often manifested in overprotective behavior toward surviving family members.	0.00
06	Denial of the loss.	0.00
07	Inability to concentrate, frequently misplacing items and forgetting things.	0.50
08	A deep longing and emptiness, feeling that nothing has meaning.	0.00
10	Intense questioning: “Why??” “If only I had….?” “Why didn’t I…?”	0.00
11	Looking for blame, and blaming yourself or others.	0.50
12	Anger with yourself, family members, medical personnel, God, even the deceased.	0.00
13	Fearing that you are mentally ill or unstable.	0.50
14	Physical symptoms such as heaviness in your chest, difficulty breathing, tightness in your throat, yawning, sighing, gasping or even hyperventilating (do not hesitate to see a doctor for symptoms that concern you.	0.50
15	Inability to function at work.	0.50
16	Increased intensity of, or sudden loss of, religious faith.	0.00
17	Wanting to die (a feeling that usually subsides over time as you realize the value of staying present for other loved ones).	0.50
18	Needing to tell and retell the story of your loved one’s death.	0.50
19	Sensing the presence of your loved one in an odor or touch.	0.00
20	Difficulty in everyday tasks that remind you of your loved one, such as seeing his or her favorite foods on the shelves when grocery shopping.	0.00
21	Anger with yourself if you smile or laugh, and wondering how you can feel happy when your loved one is dead.	0.00
22	Feeling as though your spouse or other family members don’t understand your grief or are not grieving as you think they should.	0.50
23	Losing old friends who don’t seem to understand your pain and grief.	0.00
24	Making new connections with people who have also experienced the death of a child, sibling, or grandchild.	0.00
25	Feeling “stuck” in an aspect of grief such as denial or anger.	0.50
26	Feeling as though your work through grief is “one step forward, two steps back” or proceeding in a completely random way.	0.50
27	Frustration with others who expect you to be “over this” in a specific time frame – perhaps even frustration with yourself if you feel you should have “moved on.”	0.50
	CALC	=6.50/27
	Generic Grieving Deficits 27 Items (LSF) =	24.1%

 

DABDA

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

 

DABDA Scheme

DABDA is the acronym for Elisabeth Kübler-Ross's five stages of grief: Denial, Anger, Bargaining, Depression, and Acceptance, a framework for understanding emotional responses to loss, though not necessarily a linear process. People often experience these stages, or a mix of them, when facing major life changes or terminal illness, but not everyone goes through all stages or in the same order.

Denial

Denial is a psychological defense mechanism where people reject or ignore painful realities, truths, or feelings to protect themselves from anxiety, often seen in addiction, grief, or trauma, though it can be temporarily helpful but harmful long-term. It also means refusing to grant a request or contradicting a statement, like denying a charge.

 

Anger

Anger is a fundamental human emotion—a strong feeling of displeasure or antagonism due to perceived threat, injustice, or hurt, activating a physical and mental "fight" response (increased heart rate, adrenaline). Common triggers include frustration, perceived unfairness, betrayal, and unmet goals, manifesting as annoyance, rage, or resentment, and while normal, excessive anger can harm relationships and health, signaling a need for management skills or professional help.

 

Bargaining in Grieving

Bargaining in grief is the third stage (of the Kübler-Ross model) where you try to negotiate with a higher power, fate, or yourself to reverse or delay a loss, often using "what if" and "if only" statements to regain control or find meaning, serving as a defense mechanism to manage overwhelming pain before accepting reality. Examples include promising to change behaviors if a loved one returns or regretting past actions, with coping involving self-compassion, support, and shifting focus to the present. 

 

Depression in Grieving

Grief is a natural response to loss, involving waves of sadness often mixed with positive memories, while depression is a persistent, pervasive negative mood, often with feelings of worthlessness, impacting daily life significantly and lacking hope. Grief naturally fluctuates, but if intense sadness, inability to function, suicidal thoughts, or hopelessness become constant and disabling, it may indicate a shift to Major Depressive Disorder (MDD) or Complicated/Prolonged Grief, both requiring professional help, notes Harvard Health, Mayo Clinic, and Psychiatry.org.

 

Acceptance in Grieving

Grief acceptance, the final stage in the Kübler-Ross model, is when you come to terms with the reality of a loss, no longer denying or fighting it, but instead focusing energy on new routines, cherishing memories, and planning a future, which involves acknowledging pain, seeking support, maintaining self-care, and understanding your unique process. It's not about "being okay" but about integrating the loss into your life and finding ways to move forward with a sense of peace and purpose.

 

Lister Lista – Sample of People That Died

Note - 50 Friends and Family who have died

Bargaining while Grieving – Context of Most Significant Other Ever

Bargaining in grief is the third stage (after denial and anger) where you try to…

Scored by Keith “Buster” Torkelson MS, BS – Strengths Assessment

Permanent Solution in Grieving

There's no single "permanent solution" to grief, as it's a lifelong process of learning to live with loss, but healing comes from integrating the absence into your life through self-care (healthy habits, exercise), social support (friends, groups, therapy), accepting emotions, and adapting routines. Strategies include professional help (grief counseling), support groups, new traditions for special dates, and gradually mastering new life tasks, all while being patient and kind to yourself as you find new ways to live with the enduring love and memory.

 

When does grieving end?

Grief doesn't truly "end," but its intense pain lessens and changes over time, often improving within 6 months to 2 years, though deep feelings can last longer, evolving from sharp pain to softer memories, with triggers like holidays sometimes bringing waves of sadness. There's no set timeline; it's a unique journey influenced by your relationship with the lost person, circumstances, and culture, with the goal being integration, not erasure, of the loss.

Simple Grief

"Simple grief," sometimes called uncomplicated or normal grief, is the natural emotional process of adjusting to a loss where painful experiences are interspersed with positive emotions like relief, joy, and peace. This process typically involves common grief reactions such as sadness, difficulty concentrating, and sleep disturbances, but these feelings are not debilitating or lasting. It is a personal journey with no set timeline, characterized by a gradual integration of the loss into one's life rather than an overwhelming or prolonged period of incapacitation.

 

Complicated Grief

Complicated grief is a prolonged and intense form of grief that can significantly interfere with a person's daily life. It is characterized by persistent and overwhelming sadness, longing, and preoccupation with the deceased.

 

Prolonged

Prolonged grief disorder, also known as complicated grief, traumatic grief, and persistent complex bereavement disorder, is a mental disorder consisting of a distinct set of symptoms following the death of a family member or close friend.

 

FYI - Thanatologist

https://coleimperi.com/about-1

Cole Imperi is a thanatologist, award-winning author, and researcher whose work focuses on the use of non-clinical tools in support of those experiencing loss and grief.

https://www.facebook.com/hellocoleimperi/

 

Non-clinical Tools in support of those grieving

Non-clinical tools in support of those grieving focus on community, self-care, creative expression, and practical support to help individuals process and integrate their loss into their lives.

 

Clinical Tools in support of those grieving

Clinical tools supporting the grieving involve both assessment measures (like PG-13, ICG) to gauge severity and therapeutic approaches, including CBT, narrative therapy, and Interpersonal Psychotherapy, alongside support systems (groups, peer support, hospice care) and self-help strategies (exercise, journaling, therapy models like PLISSIT) to help individuals process loss, adjust to life without the deceased, and maintain connection, with tailored tools for different ages like play therapy for children.

 

Moving ahead from grieving others to grieving self

Moving from grieving others to grieving yourself involves shifting from focusing outward on the loss of someone else to acknowledging how that loss, or past experiences, have changed you, requiring self-compassion, allowing new feelings to emerge (like grief for your past self), and gently rebuilding your identity as an evolved, resilient person, not just a survivor. It means becoming an ally to your past self, understanding you are still "you" but refined, using self-compassion to feel the grief for your own losses, and eventually finding new joys and goals, integrating the past into a future self.

 

Past Self

A "past self" refers to who you were previously—a collection of your past choices, beliefs, and experiences that still influence you, often seen as different versions of yourself as you've grown. Psychologically, it involves making peace with past actions, understanding patterns, and learning from them to improve your present and future.

 

Aside - Finding a Thanatologist

Although the search did not identify any practicing thanatologists specifically in Orange County, MD, there are several thanatology-related resources in Maryland. A thanatologist is an expert in the academic and clinical aspects of death, dying, and bereavement, and is often a resource for hospices, counselors, and educators.

 

Thanatology-related resources in Maryland

Center for Counseling and Applied Thanatology (CCAT): Located in Westminster, MD, CCAT offers a range of services for individuals and families facing grief, including counseling, death planning, and education. They use a sliding scale for counseling services based on a client's needs.

 

University of Maryland Baltimore

The School of Graduate Studies offers a program in Aging and Applied Thanatology. The curriculum is designed to help professionals become more comfortable and competent in addressing the issues of aging, dying, death, and grieving.

 

What to consider when seeking a thanatologist

 

Thanatologists vs. Grief Counselors

A thanatologist has specialized training in death and grief, but grief counseling may not be their exclusive practice. If you are seeking one-on-one counseling for grief, a certified grief counselor or licensed therapist may be a more direct option.

 

Hospice care teams

If you are dealing with a terminal illness, hospice care providers often have bereavement specialists, social workers, and spiritual counselors on staff who can provide support. For example, BridgingLife (formerly Carroll Hospice) in Westminster Maryland provides 24/7 hospice services in the area.

https://www.lifebridgehealth.org/bridginglife-hospice-care-and-palliative-services

 

Grief support groups

Grief support groups provide a vital space to connect with others experiencing loss, reducing isolation through shared experiences, validation, and coping strategies, often led by peers or professionals like therapists, counselors, or those with thanatology training, with resources found via Psychology Today, local hospitals, or organizations like GriefShare and The Dougy Center. These groups offer hope and practical tools, with options ranging from peer-led, low-cost groups to professionally facilitated therapy sessions, and specialized groups for children, teens, and various types of loss.

Medical Doctor – Thanatologist

To find a medical doctor in Orange County, California, with expertise in thanatology (the study of death and dying), your search will be most effective by looking for specialists in related fields. A board-certified physician who focuses specifically on thanatology is not common. Instead, you should seek a doctor with training and experience in palliative medicine, hospice care, or geriatrics.

 

Medical doctors with thanatology-related expertise

Palliative care and hospice physicians

These medical doctors specialize in relieving suffering and improving the quality of life for people with serious illnesses, including at the end of life.

 

Providence Hospice Orange County

This organization provides end-of-life care with a family-centered approach. Their team includes physicians experienced in hospice and palliative medicine.  "Our mission is deeply rooted in our core values, established in 1930 by the Sisters of St. Joseph of Orange: Dignity, Service, Excellence and Justice.  We are committed to bringing these values to every aspect of care for patients living with life-limiting illnesses. We embrace a family-centered approach for the physical, emotional and spiritual care of patients. This special form of comfort care is provided to patients in their home, extended care or skilled nursing facility and, at times, in a hospital setting."

 

Silverado Hospice Orange County

The medical director at Silverado is a Doctor of Osteopathic Medicine (D.O.), with a philosophy of providing compassionate end-of-life care.

 

Hospice

Many people mistakenly believe that hospice speeds up the dying process. In truth, hospice neither extends life nor hastens death. Instead, it provides compassionate care that helps patients find comfort and meaning in their final days. Mar 19, 2025

 

UCI Health

The Palliative Care Services team at the University of California, Irvine, works to provide comfort and care for those with advanced illnesses.

Palliative Care | UCI Health | Orange County, CA

 

UCI Health

https://www.ucihealth.org/medical-services/programs/palliative-care

Palliative Care offers comfort and relief from pain as a result of a condition or chronic illness. To request palliative care services, call 714-456-8000.

 

Geriatric specialists

Geriatric medicine doctors specialize in the healthcare of elderly people. Their training includes understanding the medical and ethical issues surrounding end-of-life care. Healthgrades lists several geriatric specialists in the Orange area, some of whom may have particular experience with end-of-life issues.

 

Non-medical thanatology practitioners

For grief counseling and death education, professionals without an M.D. credential, such as licensed therapists, specialize in thanatology.

 

Death Education

Death education is a field of study, often within thanatology, that prepares individuals for death, dying, and grief by covering practical, emotional, and societal aspects, aiming to reduce fear, enhance coping skills, improve end-of-life planning (like advance directives), and foster open communication about the inevitable process of death to improve overall life appreciation and well-being. It addresses biological facts, grief management, cultural views, hospice/palliative care systems, and personal values, making a taboo subject more approachable.

 

Grief & Trauma Healing Network, LLC

Run by professional grief specialists, this organization in Orange offers counseling and support programs related to grief and loss.

 

Didi Hirsch Mental Health Services

This center in Santa Ana provides a range of mental health support services that include guidance for those experiencing loss.

 

How to find the right professional…

 

Contact hospices directly

Inquire with local hospice care providers about their medical staff. They can tell you about the physicians on their team who specialize in end-of-life care.

 

Use online databases

Search sites like Healthgrades and Psychology Today for specialists in palliative care, geriatrics, or grief counseling in Orange County.

 

Consult your primary care physician

Your doctor can provide referrals to medical specialists with a focus on end-of-life care and thanatology-related fields.

 

Thanatology, Grief, Loss Issues, Emotional Suffering

Thanatology is the scientific study of death, dying, and grief, providing frameworks (like Kübler-Ross's stages) to understand intense emotional suffering, loss, and bereavement, helping individuals and families cope through counseling, support, and education in areas like hospice and traumatic loss, addressing profound psychological impacts like depression, anxiety, and complicated grief to facilitate healing from significant life disruptions.

 

Thanatology, the study of death, dying, and bereavement.

Thanatology is the interdisciplinary study of death, dying, and bereavement, integrating scientific, psychological, social, cultural, and spiritual perspectives to understand and support the human experience of mortality, helping professionals and individuals navigate loss and improve end-of-life care through education, research, and compassionate practices in settings like hospice and healthcare.

 

Para-thanatology

Para-thanatology, often called Pastoral Thanatology, integrates spiritual, emotional, and practical care with the study of death (thanatology) to support the dying, the bereaved, and their families, focusing on the whole person, not just the medical event, and often involving chaplains, counselors, and other end-of-life professionals to provide holistic support through grief, loss, and end-of-life experiences.

 

20230328-TU: prep for 4/1/23 (SAT) – With Alan (Grief Coach)

Location – L24 Lot - Plan for Sushi Lunch

 

GEM-Grief Evaluation Measure

[NOTE RESEARCH GATE REQUIRES YOU COPY AND PASTE THE LINK IN]

https://www.researchgate.net/publication/7887708_The_Grief_Evaluation_Measure_GEM_An_initial_validation_study

 

GIS-Grief Intensity Scale

The Grief Intensity Scale (GIS) is a mental health tool used by clinicians and researchers to measure the severity of grief and its impact on daily functioning (biopsychosocial) after a loss, often helping to screen for potential prolonged grief disorder (PGD). It assesses symptoms through Likert-scale questions about frequency (e.g., never, daily) and evaluates impairment in areas like physical health, psychological coping, and social responsibilities, with higher scores indicating greater grief intensity.

 

FYI – Good Read - GIS - Grief Impairment Scale

https://pubmed.ncbi.nlm.nih.gov/36006100/

 

20230328-TU: Scored Grief Online about Craig Edward Torkelson (B. 1949 D. 1969). Your score is 18 out of a possible 50.

 

Your answers to the above questions indicate that you are not experiencing a clinically significant level of grief. This tool is not intended to be a substitute for a clinical diagnosis, however, so we encourage you to seek evaluation and support from a mental health professional.

 

20230328-TU: Transformation Scored

Interpretation

Assuming I suffered 100% grief I am (2026) 64% over my brother and I am not experiencing clinically significant level of grief.  I am ready to move ahead grieving Joan my most significant other ever (MSOE).  For the most part I am “Over” my sister (D. 2025) and my brother (D. 2024).  The following assessments address deficits as well as strengths.

Twilight of Life

"Twilight of life" (or "twilight years") is a metaphor for the final stage of a person's life, signifying old age, approaching the end, and a time of reflection, often marked by reduced physical strength but deep introspection, focusing on memories, family, and the meaning of one's existence. It's a period of transition, sometimes challenging but also rich with wisdom, love, and contemplation as individuals adjust to aging.

 

Full article - The Grief Evaluation Measure (GEM): An Initial Validation Study

John R. Jordan, John Baker, Margherite Matteis, Saul Rosenthal & Eugenia S. Ware

Pages 301-332

Received 17 Apr 2003: Accepted 25 Oct 2004: Published online: 16 Aug 2006

https://www.tandfonline.com/doi/full/10.1080/07481180590923706#:~:text=The%20GEM%20is%20a%20self,death%20of%20a%20loved%20one.

The GEM is a self-report instrument designed to assess the nature and severity of the grief reactions of persons 18 years of age or older following the death of a loved one

 

Abstract

This article describes the development of the Grief Evaluation Measure (GEM), a new instrument designed to screen for the development of a Complicated Mourning Response in a bereaved adult.

 

Complicated Mourning Response

A complicated mourning response (Complicated Grief or Prolonged Grief Disorder) is an intense, persistent, and disabling grief that lasts much longer than typical, where individuals are stuck in the pain, often feeling shock, intense longing, preoccupation with the deceased, inability to accept the death, avoidance of reminders, or feeling life has no meaning, preventing them from functioning in daily life. Effective responses involve specialized therapy (like CBT, Narrative Therapy), building support, and self-care to help process the loss and re-engage with life.

 

Bereaved Adult

A bereaved adult is someone experiencing intense sorrow and emotional disruption after the death of a loved one, facing unique challenges like navigating adult responsibilities, unresolved childhood issues, and a changing identity, often feeling isolated or misunderstood, but can find healing through community support, therapy, and adapting to life with the loss, with common signs including sleep/appetite changes, anxiety, guilt, and physical symptoms.

 

Bereaved Child

A bereaved child is a child who has lost someone important, grieving differently than adults through behaviors, play, or emotions like sadness, anger, or confusion, requiring honest, age-appropriate support, reassurance (especially that they're not to blame), routine, and patience to process the loss, which can manifest as sleep/eating changes, regression, or behavioral issues. Organizations like the National Alliance for Grieving Children (NACG) and Winston's Wish offer resources and support for these children and those who help them.

 

Aged ten (10) I needed help grieving my sibling’s pre-mature accidental death

Losing a sibling at age 10 to an accidental, premature death is profoundly traumatic, requiring gentle, patient support that validates your complex feelings (guilt, anger, sadness), normalizes your grief, offers creative outlets (memory books, planting), encourages talking to trusted adults or support groups like The Compassionate Friends, and helps you understand that feelings, not wishes, cause death. Professional grief counseling and peer support groups provide vital tools, while activities like creating memory projects or finding ways to honor your sibling offer healthy remembrance and healing

The GEM provides a quantitative and qualitative assessment of…

Mourners
Risk factors
Including the mourner's loss
Mourner’s medical history
Coping resources
Before the death
After the death, and…

 

…Circumstances Surrounding The Death

The circumstances of death refer to the specific conditions and events surrounding a person's death, categorized by the manner of death, which helps determine if it was Natural, Accident, Suicide, Homicide, or Undetermined, distinct from the specific cause of death (e.g., heart attack, gunshot). These details, including scene investigation and medical findings, are crucial for understanding how death occurred, informing death certificates, and often leading to legal investigations, distinguishing between a medical finding (cause) and a legal classification (manner).

 

Settings

The GEM is designed to provide an in-depth evaluation of the bereaved adult's subjective grief experience and associated symptoms. Reliability and validity studies were conducted with two samples of bereaved adults (n = 23 and n = 92, respectively) from various clinical and support settings.

 

Consistency and Reliability

Data on the two central sections of the GEM that assess the mourner's grief response and the level of symptomatology are described. Results indicate that the GEM's internal consistency and test–retest reliability are high. The GEM demonstrates good concurrent validity for established measures.

 

• Bereavement
• Trauma
• Physical symptoms
• Psychiatric symptoms

 

Good Predictive Validity for Mourner Adjustment

The Grief Evaluation Measure (GEM) has demonstrated good predictive validity for mourner adjustment one year after initial assessment. Several other factors and measures also show good predictive validity for identifying individuals at risk of developing complicated or prolonged grief disorder (PGD).

 

Assessment Frequency

>If you are not satisfied with your scores re-assess once per year after initial assessment.

 

Plans for future development and an invitation for other researchers to collaborate with research on the GEM are also discussed.  Grief Evaluation Measure (GEM).

 

FYI - Grieve Well

You Can Measure Grief and Here’s How

https://grievewellblog.wordpress.com/2017/09/16/yes-you-can-measure-grief-and-heres-how/

Date: September 16, 2017 - Author: Mark Henricks

Evidence-Based Bereavement Grief Coping Strategies.

Scientific research has identified many behaviors and attitudes that can potentially help reduce the severity and duration of grieving symptoms. Evidence-based bereavement coping strategies focus on active engagement with grief while rebuilding a meaningful life, reducing symptom severity through Cognitive Behavioral Therapy (CBT), Complicated Grief Therapy (CGT), and self-care techniques like mindfulness and social connection. Effective approaches also include maintaining healthy routines, accessing support groups, and using ritualistic expression to process the loss.

 

Subjective self-reports

Subjective self-reports are not considered the best way to measure anything, but it’s hard to measure psychological qualities any other way. Subjective self-reports (questionnaires, interviews) are vital for measuring internal psychological states, such as emotions, attitudes, and personality, because they allow direct access to personal experiences. While prone to biases (social desirability, memory, response styles), they are often unmatched in efficiency, despite the need to complement them with behavioral data to improve validity.

 

Grief Intensity Scale

In the world of grief assessments, the Grief Intensity Scale is about as quick and easy as it gets. In not much more time than it would take you to walk to the bathroom and step on the scale, you could complete this assessment and get an idea of what your grief level is today.

 

Links to end-of-life

Grief Intensity Scale PDF (See below – Prolonged Grief Disorder)

A Grief Intensity Scale PDF often refers to various self-report questionnaires used to measure the severity of grief, such as the Brief Grief Questionnaire (BGQ) for complicated grief (VA.gov), the Inventory of Complicated Grief (ICG) (Cornell), or general tools like the Holistic Grief Scale (griefcounselor.org) or Grief Impairment Scale (GIS) (Google Sites). These PDFs, available from health sites or research institutions, help identify if grief is overwhelming, signaling a need for professional help, by assessing emotional, cognitive, and behavioral impacts after a loss.

 

Assessments and Tools

 

FYI - Center for Research on End-of-Life Care – Prolonged Grief Disorder

https://endoflife.weill.cornell.edu/research/assessments_and_tools

An interactive pdf for PG-13 self-report assessment. Grief Intensity Scale. Weill Cornell Medicine Center for Research on End-of-Life.

 

Palliative Care

BCGuidelines.ca: Palliative Care for the Patient with Incurable Cancer or Advanced Disease

https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/palliative3_appendix_a.pdf

 

Grief Intensity Scale

[NOT AVAILABLE ANYMORE]

http://endoflife.weill.cornell.edu/research/grief-intensity-scale

FYI – Content - Grief Intensity

This Grief Intensity Scale assesses common thoughts, feelings, and behaviors of people who have lost someone important to them. The scale is meant to capture the grieving respondent’s intensity of his or her reaction to the loss.  A Grief Intensity Scale measures the severity of a person's emotional, cognitive, and behavioral reactions after losing someone important, helping clinicians understand the depth of their grief, with examples including assessing feelings like disbelief or anger, symptoms like functional impairment, and distinguishing normal grief from complicated grief, often using tools like the Inventory of Complicated Grief (ICG).

 

The Center’s Holistic Grief Scale - Nov 7, 2017

https://www.griefcounselor.org/2017/11/07/the-centers-new-holistic-grief-scale/

By, David Fireman, LCSW (33 Items)

 

The 5 Components of a Holistic Grief Scale

Scored by Keith “Buster” Torkelson MS, BS

Addresses Grieving our family and John Baer

Prolonged Grief Disorder

This diagnostic tool helps assess a person’s risk of developing prolonged grief disorder (PGD) following the death of a loved one. There are particular symptoms that must be elevated at 6 months in order to meet criteria for PGD. If a respondent meets criteria, he or she should seek out more thorough evaluation from a mental health professional. We have this scale available in a variety of languages.

Common Causes of death

Globally and in the U.S., the leading causes of death are primarily chronic, non-communicable diseases, with heart disease and cancer ranking highest. Major drivers of mortality also include stroke, respiratory infections, and unintentional injuries.

Stiffled about the dead =

Information about the deceased

Scored by Keith “Buster” Torkelson MS, BS

Stiffled about the dead 10 Items (LSF)

For each item below, please indicate how you currently feel?

Scored by and for Keith “Buster” Torkelson MS, BS

Pertains to Craig Edward

 

Since the death or as a result of the death?

Q14. Have the symptoms above caused significant impairment in social, occupational, or other important areas of functioning? Yes or SoSo or No

 

14-Item Grief Intensity Scale

20230328-TU: Scored Online about Craig Edward Torkelson (B. 1948 D. 1969)

Your score is (=0.36*50) 18 out of a possible 50.

Interpretation

Your answers to the above questions indicate that you are not experiencing a clinically significant level of grief. This tool is not intended to be a substitute for a clinical diagnosis, however, so we encourage you to seek evaluation and support from a mental health professional.

 

Aside - Perinatal Loss

A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions - Published online by Cambridge University Press:  01 September 2020

https://www.cambridge.org/core/journals/palliative-and-supportive-care/article/systematic-review-of-instruments-measuring-grief-after-perinatal-loss-and-factors-associated-with-grief-reactions/307A3B7BFAFEA8FF746B67BA3F950681#:~:text=This%20scale%20was%20developed%20by,measure%20grief%20intensity%20after%20miscarriages.

 

20230106-F: Moved to standalone >

10_BMB_Assess_ Brief_Grief_Questionnaire_23010601_Tool

 

Inventory of Complicated Grief PDF (3 Pages)

https://www.carepatron.com/files/inventory-of-complicated-grief.pdf

 

FYI - The Texas Revised Inventory of Grief (TRIG)

Core Bereavement Items and the Impact of Events Scale-Revised

 

There are also assessments for other feelings and symptoms that often go along with bereavement grief. For depression, the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) is considered a good one for self-assessment.

 

Depression

https://www.ismanet.org/doctoryourspirit/pdfs/Beck-Depression-Inventory-BDI.pdf

>The widely used Beck Depression Inventory. Aside - The Beck Anxiety Inventory is a quick and easy way to evaluate your level of anxiety.

 

FYI - Inventory of Complicated Grief PDF (12 Pages)

https://endoflife.weill.cornell.edu/sites/default/files/icg-r_ybs.pdf

 

Grief

Texas Revised Inventory of Grief (TRIG)

http://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/texas-grief.aspx

 

Construct - Grief symptoms

Description of Measure: The Texas Inventory of Grief – Revised or TRIG (Faschingbauer, 1981) assesses “normal” versus pathological grief symptoms (see ICG). It includes a “Present Feelings” index consisting of 13 first-person statements. Each item regards the client’s responses about various aspects of grief-related depression, such as acceptance of loss, crying and intrusive thoughts, and is scored on a 5-point scale. Possible responses are “Completely False”, “Mostly False”, “True and False”, “Mostly True”, and “Completely True.”

 

Texas Revised Inventory of Grief TRIG PDF

The Texas Revised Inventory of Grief (TRIG)

 

American Psychological Association (APA)

https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/texas-grief

>The TRIG assesses normal versus pathological grief symptoms, including depression, acceptance of loss, crying and intrusive thoughts.

 

Normal versus pathological grief

Normal grief is a temporary, natural process where feelings like sadness and anger gradually lessen, allowing a person to adapt and find new meaning, while pathological grief (Prolonged Grief Disorder/Complicated Grief) involves persistent, intense symptoms (like longing, disbelief, avoidance, or identity issues) that significantly impair daily functioning and don't improve, often lasting over a year, hindering healing. The key difference lies in duration, intensity, and functional impact, with normal grief fading and pathological grief intensifying or persisting, preventing integration of the loss.

 

How do you measure improvements with grief?

Measuring improvements in grief involves tracking a reduction in the intensity, frequency, and duration of painful emotions and behavioral avoidance over time. Key indicators include improved daily functioning, the ability to engage with memories without overwhelming distress, establishing new routines, and setting small, gentle goals. Improvements can be tracked via self-reflection, journaling, or clinical assessments.

 

Factorial Validity of the Texas Revised Inventory of Grief-Present Scale among Bereaved Older Adults (TRIG 13 Items)

Andrew Futterman, Et.al.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4336468/

 

Pertains to Joan Buster’s most significant other ever (MSOE)

Scored by for Keith “Buster” Torkelson MS, BS

Approximately 10 years of grieving losing touch with her

Measuring Core Bereavement Phenomena

February 1997 Psychological Medicine 27(1):49-57

[With Researchgate - NEED TO COPY AND PASTE LINK INTO BROWSER]

https://www.researchgate.net/publication/14096634_Measuring_Core_Bereavement_Phenomena

 

As part of a longitudinal study of bereavement phenomena in three groups, bereaved spouses, bereaved adult children and bereaved parents, scale development was carried out using a pool of bereavement phenomenology questions administered prospectively. The items were derived from the literature, in particular studies dealing with the measurement of grief/bereavement, as well as from clinical experience. Factor analysis of theoretically grouped items produced seven subscales, three of which tapped frequently experienced phenomena in the bereaved. These three subscales formed the basis of a single measure, labelled the Core Bereavement Items (CBI), which demonstrated high reliability and sound face and discriminant validity. Preliminary analysis suggested that the CBI will prove to be a reliable and valid instrument with respect to the measure of core bereavement phenomena in commonly bereaved groups in Western society.

 

Core Bereavement Items (CBI) PDF (17 Items)

https://warwickmiddleton.com/wp-content/uploads/2018/08/Core-Bereavement-Items-CB117.pdf

Scored by and for Keith “Buster” Torkelson MS, BS

FYI - PTSD = Post Traumatic Stress Syndrome

Impact of Event Scale - Revised (IES-R) for DSM-IV

https://www.ptsd.va.gov/professional/assessment/adult-sr/ies-r.asp

Weiss, & Marmar, 1996

 

FYI - NOTE: This measure was based on DSM-III (IES) and DSM-IV (IES-R) criteria for PTSD. See a list of all measures (link below), including those updated to DSM-5.  The IES-R is a 22-item self-report measure (for DSM-IV) that assesses subjective distress caused by traumatic events. It is a revised version of the older version, the 15-item IES (Horowitz, Wilner, & Alvarez, 1979). The IES-R contains 7 additional items related to the hyperarousal symptoms of PTSD, which were not included in the original IES. Items correspond directly to 14 of the 17 DSM-IV symptoms of PTSD. The IES-R has not been updated to match the DSM-5, so it does not include items to full assess negative alterations in cognition and mood, for instance. Respondents are asked to identify a specific stressful life event and then indicate how much they were distressed or bothered during the past seven days by each "difficulty" listed.

 

FYI - See a list of all PTSD related measures (Some odd 70 measures)

https://www.ptsd.va.gov/PTSD/professional/assessment/list_measures.asp

Depression

http://cesd-r.com/

Online Assessment

The CESD-R is a screening test for depression and depressive disorder. The CESD-R measures symptoms defined by the American Psychiatric Association' Diagnostic and Statistical Manual (DSM-V) for a major depressive episode.  At the top of each of the following screens, you will see a statement. For each statement, please indicate how often you have felt this way recently by selecting the option you most agree with.  The 20 items in CESDR scale measure symptoms of depression in nine different groups as defined by the American Psychiatric Association Diagnostic and Statistical Manual, fifth edition. These symptom groups are shown below.

 

Measure Availability

We provide information on a variety of measures assessing trauma and PTSD. These measures are intended for use by qualified mental health professionals and researchers. Measures authored by National Center staff are available as direct downloads or by request. Measures developed outside of the National Center can be requested via contact information available on the information page for the specific measure.

 

20260102-F: Results – Web utility would not deliver our results

 

 

Center for Epidemiologic Studies Depression Scale Revised (CESD-R-20)

https://www.brandeis.edu/roybal/docs/CESD-R_Website_PDF.pdf

A deficits scale – Context of General

Scored by Keith “Buster” Torkelson MS, BS

CESD = Center for Epidemiologic Studies Depression

Alternate Assessment > Burns’ Depression Checklist (BDC)

For a longitudinal study about Buster’s depression we reference our Burn’s Depression Checklist material.

 

“Talk by Coldplay” (2005)

Oh, brother, I can't, I can't get through
I've been trying hard to reach you 'cause I don't know what to do
Oh, brother, I can't believe it's true
I'm so scared about the future
And I wanna talk to you
Oh, I wanna talk to you

 

Depression Screener – Deficits Assessment

20251229-M > PCP puts us down as depressed

LSF = Low Scores are Favorable

Score for Keith “Buster” Torkelson MS

20260103-SA-Grief Group

Takeaway - Everyone’s Grief Is Different

Why is grief so different for everyone?

Grief is highly individualistic, resembling a "fingerprint" because it is shaped by unique personalities, personal histories, and the specific nature of the relationship with the deceased. It differs based on coping mechanisms, culture, and the intense, varied emotional connection between people, making everyone’s journey unique, even within the same family. We deal with grief differently for the same reason that we have different personalities, borne of different life experiences and environment. The differences may be due to degree of love and connection between a departed one and a person. Jan 17, 2020