RIVER Peer Grief Support Model: Overview and Rationale

The purpose of the RIVER Peer Grief Support Model¹ is to enable a person bereaved by the death of someone close to them² who has experienced significant healing on their grief journey to connect with and give support to other grievers. People bereaved by someone’s death are considered peers in relation to their grief. A bereaved person trained to deliver Peer Grief Support (PGS) using the RIVER model is called a Peer Grief Helper (PGH).

The elements of the RIVER model—Relate, Invite, Validate, Empower, Reassure—were created based on its developers' combined 60 years of experience in the emerging field of PGS focused on helping people cope with grief after someone close to them dies. Identifying these five elements involved a kind of reverse engineering framed by the question: “What do grieving people need from peer supporters that can be provided using well-known ideas about interpersonal support that are highly likely to help the bereaved cope with their grief?” The RIVER developers reflected on and analyzed their work over the years supporting bereaved people and training PGHs and concluded that relating to, inviting, validating, empowering, and reassuring grievers—if applied purposefully and systematically—has great potential to support people’s grief journey and help them with the ongoing process of grieving.

Even though the model describes how PGHs can purposefully and systematically apply the RIVER elements to support bereaved people, it should never be mistaken for describing a linear process. The motion of working with RIVER is not linear at all. The elements are interrelated and integral with each other. Several elements are often operating simultaneously in a single interchange with a griever. The dynamics of each element constantly affect the others as well as the system as a whole.

The five elements of the RIVER model are supported by fundamental principles and practices for helping others. RIVER is a structured approach that can be applied consistently and methodically at the same time it enables PGHs to use their personal experiences of grief as a foundation from which they can deliver flexible, responsive, individualized support to grieving people. The RIVER structure arranges the five elements (Relate, Invite, Validate, Empower, and Reassure) in four domains that guide PGHs’ preparations, decisions, and actions. The domains are Intention, Hope, Focus of the Action, and Concrete Actions, and each element is defined and described in relation to each domain. RIVER is illustrated below in a table, which can be assessed from the perspective of the four domains (horizontal view) and the perspective of the five elements (vertical view): considering it from both perspectives provides an understanding of how RIVER functions.

FOUR DOMAINS

The first two domains, intention and hope, refer to a PGH’s inner experience.

Intention: Even though having an intention is an inner experience, it is not passive, for a person must set an intention. RIVER asks a PGH to set an intention by declaring and defining it. When someone declares an intention—whether only silently to themselves or by actually sharing it with others—the intention becomes a potentially purposeful force. When a person defines an intention by saying what it means to them, the intention moves from being a concept to becoming a reality. 

Each element in RIVER is itself an intention. Viewed horizontally, across the table, here are the intentions and their definitions:³

• My intention is to relate to the grieving person, which means to support them in seeing that their grief matters.
• My intention is to invite the grieving person, which means to support them in saying what they need to about their grief. 
• My intention is to validate the grieving person, which means to support them in knowing that neither they nor their grief should be judged.
• My intention is to empower the grieving person, which means to support them as they navigate their own grief journey.
• My intention is to reassure the grieving person, which means to support them in discovering how grief is a part of their life. 
• My intention is to reassure the grieving person, which means to support them in discovering how grief is a part of their life.

Hope: As with intention, having a hope is an active experience. To hope requires PGHs to positively believe that it is possible for something to happen on behalf of grievers’ healing. RIVER asks PGHs to hope that bereaved people have a specific realization (that they “come to see” something) in relation to each of the five elements. These five hopes are not goals or expectations: they are based only on PGHs believing that it is possible for grieving people to have five key insights that could lead them toward healing.

Viewed horizontally, here are the RIVER hopes: I hope the person comes to see that they are not alone. I hope the person comes to see that their story is welcome. I hope the person comes to see that their reactions are understandable. I hope the person comes to see that they can find their way. I hope the person comes to see that their grief is a process.

The final two domains, focus of the PGHs’ action and concrete actions, refer to a PGH’s outward behavior.

Focus of the Action: There are 10 focuses of the action, two for each element. They relate to tried-and-true practices in peer support and grief support.⁴ The focuses of a PGH’s action in RIVER, listed below as they are arranged horizontally across the table, are supplemented with statements or observations about a number of fundamental principles and practices for helping others.

RELATE

• Affirming that each of us has experienced the death of someone close to us.
  • A great deal is known about people’s grief experience after someone dies, and there are a number of viable theories about grief that guide how grieving people are supported.⁵
• Affirming that each of us is having a unique grief experience.
  • Person-centered care is a well-established, broadly accepted best practice for delivering medical, psychiatric, and many other kinds of formal support.⁶

INVITE

• Creating a safe space for them to share their story.
  • Trauma-informed care is a firmly established best practice in helping professions.⁷
• Listening wholeheartedly.
  • Every interpersonal approach to helping someone—especially with psychological, emotional, or spiritual matters—is anchored by the helper listening carefully and nonjudgmentally to the person being helped.

VALIDATE

• Asserting that there is nothing wrong with how they feel.
  • The pain and emotions associated with grief are often unexpectedly complicated and intense,⁹ and bereaved people are often unfamiliar with them and resistant to them.
• Recognizing that grief is affecting how they act, think, feel, and believe.
  • Grief affects the whole person, every aspect of their nature and experience.¹⁰

EMPOWER

• Not knowing what the person needs or what they should do.
  • Peer support is by definition not expert assistance, and PGHs should avoid giving advice or being prescriptive. Not knowing is a key practice of PGHs.¹¹
• Honoring the person's decisions and being willing to help.
  • This is a central element of person-centered care⁶ and is foundational to a peer-to-peer relationship.

REASSURE

• Observing that grief is a lifelong journey.
  • Supporting people’s experience of grief across the lifespan is essential to applying a whole-person approach to PGS.
• Characterizing grief as a human experience, not as pathological.
  • Grief is a normal phenomenon, not an illness.

Concrete Actions: Each grieving person, each person who dies, and the relationship between a grieving person and their person who died are unique, so there is an infinite variety of concrete actions possible for every individual bereaved person. The specific concrete actions to use with a particular bereaved person are determined by a PGH interacting with a griever using the Key Practices for PGHs and Best Practices for Caregivers. The Key Practices for PGHs are bearing witness, not knowing, and compassionate action (deep listening and skillful speaking). The Best Practices for Caregivers are person-centered and trauma-informed care.¹¹

The view of RIVER from the perspective of the domains explains what a PGH does to support a grieving person. The PGH sets five intentions on behalf of a grieving person by declaring and defining each intention; embraces five hopes for the person by believing it is possible for them to “come to see” five healing realizations about their grief; focuses on 10 actions, two for each element, that are based on tried-and-true practices in peer support and grief support; and employs concrete actions on behalf of each griever that are in harmony with each corresponding intention, hope, and focus and are individualized for each person.

FIVE ELEMENTS

Considering each of the elements individually, by viewing them as they operate dynamically in each domain (vertically, from top to bottom on the table) shows how the RIVER structure, principles, and practices guide a PGH through a consistent, straightforward, reliable approach to helping a grieving person.

RELATE: My intention is to relate to the grieving person, which means to support them in seeing that their grief matters. I hope the person comes to see that they are not alone. I will support them by affirming that each of us has experienced the death of someone close to us and that each of us is having a unique grief experience. The specific actions I take will be in harmony with this intention, hope, and focus—and will be individualized for this person.

INVITE: My intention is to invite the grieving person, which means to support them in saying what they need to about their grief​. I hope the person comes to see that their story is welcome. I will support them by creating a safe space for them to share their story and listening wholeheartedly. The specific actions I take will be in harmony with this intention, hope, and focus—and will be individualized for this person.

VALIDATE: My intention is to validate the grieving person, which means to support them in knowing that neither they nor their grief should be judged. I hope the person comes to see that their reactions are understandable. I will support them by asserting that there is nothing wrong with how they feel and recognizing that grief is affecting how they act, think, feel, and believe. The specific actions I take will be in harmony with this intention, hope, and focus—and will be individualized for this person.

EMPOWER: My intention is to empower the grieving person, which means to support them as they navigate their own grief journey. I hope the person comes to see that they can find their way. I will support them by not knowing what the person needs or what they should do, honoring the person's decisions, and being willing to help. The specific actions I take will be in harmony with this intention, hope, and focus—and will be individualized for this person.

REASSURE:¹² My intention is to reassure the grieving person, which means to support them in discovering how grief is a part of their life. I hope the person comes to see that their grief is a process. I will support them by observing that grief is a lifelong journey and characterizing grief as a human experience, not as pathological. The specific actions I take will be in harmony with this intention, hope, and focus—and will be individualized for this person.