Bereavement Counselling: Worden’s Four Tasks

This article looks at grief, particularly Worden’s model of bereavement counselling and his four tasks of mourning. The article may also inform you if bereavement counselling is suitable for you.

William Worden’s Four Tasks of Grief

Grief, the universal reaction to loss, affects everyone. Death being inevitable, the loss of significant people in our lives is bound to occur. The grieving process, therefore, is both a normal and natural one. Although painful, it is a necessary process, the intense emotions accompanying grief an unavoidable part of helping us heal.

old man mourning: bereavement

Grief, though it may be universal, is different for everybody. While most people experience a range of recognisable reactions and emotions, no two people grieve in exactly the same way. Whereas some people endure a period of sorrow and numbness, others may experience guilt or anger. Whatever grief brings, everyone copes with these emotions in their own way. There is no ‘normal’ or ‘right’ way to grieve; no standard timeframe for the process; no correct order in which to experience feelings; and the intensity of feelings varies from person to person.

One approach to processing grief is the Kübler-Ross 5 Stages of Grief Model; the stages being denial, anger, bargaining, depression, and acceptance. This model was thought to be linear; that is, each stage must be processed before moving on to the next. According to Kubler-Ross this was a misinterpretation of her theory. She stated before her own death that she no longer believed them to be linear. Instead, grief is chaotic, the stages scrambled, and it is rarely straightforward.

Complicated Grief

We all grieve in our own way, in our own time, and people find their own way of expressing grief. For some grieving may last months, for others years. Though grief may never disappear entirely, for most people the intensity of feeling subsides over time. However, while  grief is a normal—albeit difficult—transition, for some people there is a more complicated reaction. For some individuals there is, even after a significant amount of time has passed, no improvement at all. In these cases, feelings of loss prove debilitating. Over the long-term this can prove detrimental to both physical and mental well-being. One term for this phenomena  is ‘complicated grief’; that is, painful emotions so severe and long lasting that recovery seems impossible.

Though the causes of complicated grief are myriad, a typical underlying cause is the inability to process feelings.  Complications can arise from our immediate environment; for example, there may be children to look after, or a career to resume. In some cases attending to the practicalities of life doesn’t afford us the time to grieve. The processing of emotion requires space and so the too-busy-life can prove an external  obstacle. There can also be internal obstacles. Complicated grief can arise, for example, from overuse of drugs or alcohol which similarly impedes feeling. Again this delays the natural process.

Another cause of complicated grief may lie in the nature of the relationship between the bereaved and the deceased. This can happen when too intense a feeling – say anger – acts as an obstacle to the working-through of other feelings. Other complications include not having a sufficient support network; when the individual experiences ‘survivor guilt’; if they have an insecure attachment style; and so on.

 

Is there a time limit on grief?

mourning women: grief counsellingIn certain traditions, mourning rituals were more clearly defined and heavily codified. The Catholic Church, for example, still officially distinguishes between three types of mourning; heavy, half, and light mourning. Each category lasts for a prescribed length of time. It even includes a prescription for the correct type and colour of clothing for each stage. According to this model, the time limit for mourning has shortened. Heavy mourning, for example, was reduced from one year to three months. The total mourning period was reduced – first from six to two years – and then reduced again. It currently rests at one year; a reflection, perhaps, of the faster, more economically driven times we live in.

The medical model has also begun to prescribe time limits beyond which grief is thought to be complicated.  The psychiatric diagnostic manuals – the DSM-V and the ICD-11 – recently introduced categories for complicated grief. In 2013, the DSM introduced a diagnosis of Persistent Complex Bereavement Disorder; in 2018, the ICD introduced Prolonged Grief Disorder. The criteria is available by clicking the links.

One difference between the two is the duration after which continuing grief is considered a disorder. The DSM states symptoms must persist beyond 12 months, while the ICD opts for a mere six months. A diagnostic code is necessary in certain countries in order to receive medication or to qualify for insurance. From the perspective of this model, therefore, a time limit must be set somewhere.

I make no claim for the primacy of either the Church or medical model. Rather I use these examples to show the seeming arbitrariness of  time limits on grief

 

Bereavement counselling:

A different approach comes from the Centre for Complicated Grief which categorizes the typical trajectory of grief  as having two phases; acute and integrated.

Acute grief occurs in the early period after a loved one’s death.  This period includes the intense feelings we often associate with grieving; sadness, guilt, anger, or numbness. Grief dominates the life of the bereaved person during the acute phase. Activities tend to focus on doing or not doing things to try and deal with the loss. Also typical during this phase are insistent memories of the person who died; thoughts about them are never far from our minds.

The second phase is integrated grief. This is when thoughts, feelings and behaviours related to the loss are integrated into our ongoing functioning. There remains a place our life for  grief, but it no longer dominates. This integrated phase is longer-lasting form of grief in which the loss is acknowledged. It holds an appropriate space in our lives, but we are able to get on with other aspects of living.

According to the CGC model, if someone can’t work through these stages they may be suffering from complicated grief. The CGC definition of complicated grief is as follows; a persistent form of ‘intense grief in which maladaptive thoughts and dysfunctional behaviours are present.  [This includes] continued yearning, longing and sadness and/or preoccupation with thoughts and memories of the person who died. Grief continues to dominate life and the future seems bleak and empty’.

 

Worden’s Four Tasks

How then do we get beyond complicated grief? Of course, this depends on individual circumstances and the route to integration will be different for everyone. However, there is one model that provides a useful general approach; William Worden’s Four Tasks of Mourning model from his book Grief Counselling and Grief Therapy.

Worden suggests we must accomplish four tasks in order to complete the grieving and mourning processes . This bereavement counselling model is a flexible one, adaptable to any individual’s situation. Grief is not linear. There is  no specific order for completion, and it is possible to move backwards and forwards between the tasks. Nor does Worden posit any timeline for completion.  He goes as far as acknowledging it may be necessary to revisit specific tasks over the course of a lifetime.

Let’s take a look at each of the four tasks in detail.

 

Task 1: Accepting the reality of the loss

mourning statue: bereavement counsellingThe first task – both simple and complex – involves coming to terms with the end of the person’s life. It is not uncommon, following a loss, to experience shock or disbelief. In an attempt to avoid painful feelings we may pretend that the death hasn’t really happened. We might expect our loved one to walk through the door at any moment. When the phone rings we may expect them to be on the other end. The simplest ways of accepting the reality of the loss include going through the rituals of the funeral and mourning. Or speaking and thinking about the person in the past tense.

On a more complex level, there is an acceptance of the reality of the significance of the loss. Though we may have begun to speak about someone in the past tense, we might downplay the significance of our relationship with them. Doing so denies the impact the loss is having. We only accomplish this task when we accept the depth of the relationship,  confronting the full impact of the loss.

Another common struggle with this task is around acceptance of the mechanism of the death. If the death seems somehow unfair; for example, whether the deceased lived a full life or died young could complicate this task. Similarly, a death by suicide, overdose, or other stigmatised death can also present a challenge. If we are unable to accept the reality of how the person died, we may have difficulty accomplishing this task

Guilt can also get in the way of this task’s completion. To some people ‘acceptance’ implies agreement or approval, to others the severing of ties with the past; beliefs which complicate the task. Acceptance, however, doesn’t have to mean either of these things; instead, it can mark the moment when we are ready to begin the journey of healing.

 

Task 2: Working through pain and grief

Grief brings up with many emotions; from sadness to loneliness, despair to emptiness, anger or guilt; blame or shame; and countless others. Emotional turmoil is not a  one-size-fits-all model. Therefore Worden acknowledges that each loss means working through that range of emotions particular to the individual. The danger lies in disavowing our feelings, thereby avoiding them.

This can occur for many reasons.

Perhaps the feelings are so intense they have become intolerable. For some of us, it maybe the case that they’ve never learned to properly process our feelings. Society’s discomfort with the feelings accompanying grief can exacerbate this problem. Such discomfort can perhaps make us feel we shouldn’t acknowledge such emotions. Denying – or being denied – our feelings in this way means this task goes unfinished.

Whatever emotions may be present, it is important to acknowledge, talk about, and understand them. We must be patient, allowing ourselves to experience all of these feelings in order to properly process them. We should, Worden states, express – rather than avoid – these emotions. Being open about them, we will be better able to work them through.

 

Task 3: Adjusting to the new environment

The third task involves adjusting to a new environment, one from which the loved one is now missing. This task can mean different things to people depending on the relationship with the person who has died. It can depend also on the roles impacted by the loss. This readjustment happens over an extended period of time and may require several different types of adjustment; internal, external, and spiritual.

For example, a widow or widower may need to learn a new array of skills; ranging from bill paying, cooking, or taking care of the home. This aspect of the task takes into account barriers to grief that are tangible and not just emotional. This can include issues such as finances, companionship, or child care arrangements. There may be other external, environmental changes, such as living alone, or doing things alone. There may be internal changes; for example, the more difficult task of redefining our identity now that the other person absent.

This task can also mean adjusting to a spiritual environment altered by the experience of death. Adjustments may occur as we grapple with existential questions about purpose and meaning without the other person in our life.

 

Task 4: Finding a connection with the deceased while moving forward with life

This last task can take a long time and be one of the most difficult to accomplish. This task includes finding an ongoing and appropriate emotional connection with the person who has died. Doing so will allow us to move on with life. Again this task can mean different things to different people, Worden lays out a general template for its completion. We must allow space for memories of the deceased while at the same time engaging in  meaningful activities. This can include finding new activities that are enjoyable to us, or finding new relationships.

For Worden, not to accomplish this task is not to live. Life didn’t stop when the person died. Therefore it’s important we continue to live with a sense of purpose and meaning. Though the relationship with those we have lost evolves, by maintaining an emotional connection we invite them to remain a part of our lives.

Conclusion

We can’t change the fact that our loved ones have died. We do, however, have a choice in how we respond to their death. Initially it may seems appropriate to choose to stay wrapped up in sorrow. For a while this is often the strongest, most tangible connection we have to our loved one. By embracing the overwhelming pain we will eventually learn from it. Then, when we are ready,  we can find a new way forward whilst integrating the profound love we still feel. By maintaining an emotional connection with the past, yet grounding ourselves in the present, we can discover what matters most to us. By inviting more of this into our lives we can eventually find our way back to joy and happiness.

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If you wish to speak to Declan about bereavement counselling, don’t hesitate to get in touch.

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Posted in News on 19th September 2019
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