The GRIEF Model: A Recognition-Based Framework for Spiritual Assessment in Contexts of Ongoing Loss

Healthcare chaplains, alongside those serving in palliative, dementia-care, displacement, and correctional settings, increasingly accompany people whose losses occur while the person still lives—losses that progressively strip away autonomy, agency, identity, and coherent life narrative without offering the closure that bereavement following death affords. Standard spiritual assessment frameworks (FICA, HOPE, SPIRIT, and Spiritual AIM) were designed for broad clinical application rather than for grief as the organizing assessment principle in ongoing loss contexts, and they do not explicitly assess the oscillatory, anticipatory, and ambiguous dimensions that define such situations. This conceptual paper introduces the GRIEF Model, a five-domain spiritual assessment framework for ongoing loss intended for use with both patients and family caregivers. The model integrates five complementary sources: the DNA Model’s dimensional content framework, the Dual Process Model’s oscillatory coping mechanism, the construct of liminal competence, participatory sense-making, and a Lacanian account of structural unresolvability. The five domains—Grief Landscape, Resources and Resilience, Identity and Meaning, Existential Concerns, and Family and Connection—reorient assessment from identifying problems requiring resolution toward recognizing capacities patients already demonstrate, while surfacing where chaplaincy support might enable more sustainable threshold-dwelling. The paper details each domain’s grounding, clinical application, and documentation priorities; translates domain findings into care planning; and specifies referral indicators distinguishing proportionate sustained grief from presentations requiring psychiatric evaluation. The GRIEF Model contributes to sociological and applied scholarship on chronic illness, biographical disruption, and the social organization of grief by offering a clinically operational alternative to resolution-paradigm assessment tools.