In every life, there will be times in which one must cope with grief and loss. Some recent conversations I have had with those who are grieving seemed to warrant a detour from the topic of marital relationships for a discussion of grief and mourning. There is a sense in which all of our work in therapy has an aspect of grief. It grieves us when life and relationships are not the way we would like them to be. However, for this post, I am primarily addressing the pain of loss through death.
Over the last 50 years, a number of therapists and researchers had attempted to define a framework to explain how one works through the process of grieving. Best known are the stages of mourning first described by Elisabeth Kubler-Ross (1969). Parkes (1972) and Sanders (1989) defined the process as a series of phases. When I worked as a hospice counselor, we worked with Worden’s (2009, pp. 39-53) tasks of mourning. Worden identified four tasks for the grieving process. Task 1: accept the reality of the loss. Task 2: process the pain of grief. Task 3: adjust to an environment without the person who died. Task 4: “find an enduring connection with the deceased in the midst of embarking on a new life” (p. 50). Worden’s conceptualization of the process captures the essence of the process.
Each of these tasks warrants further discussion and explanation (which I will address in future posts). For this post let me address Worden’s framework. The word “task” can imply that each of these is something on the to-do list for those who are mourning. The state of a task on one’s list is generally binary; it is either finished or it is not. One could also construe tasks to be sequential. However, it is useful to think of these four tasks as four simultaneous processes that the mourner is working through. One does not need to complete on task before beginning work on the next. As processes, the state of working through the grieving process is not binary. For example, it is not accurate to assert that one either has or has not accepted the reality of the loss. Accepting the reality of the loss is both a cognitive process and an emotional process. A grieving wife may understand the reality of the death of her husband very well, but still may have the sensation of expecting him to walk in the door at his usual time at the end of the day. Additionally, the process of working through these tasks is not linear. Some days are better than others. Holidays, birthdays, anniversaries, favorite songs, movies, places, and a myriad of other stimuli can cause grief to resurge. Paraphrasing one of my hospice colleagues, grief is like the waves on the ocean, if you turn your back on it, it can knock you down and pull you under (Ison, 2010).
Grief can be complicated by the circumstances surrounding the death, the nature of the relationship and secondary losses. Grief can also be mitigated by the strength of the support system surrounding the mourner. Self-care is critical at the time when grief feels the most overwhelming. As with other stressors in life, coping is substantially more difficult alone. Isolation is inherently traumatizing.
References
Ison, L. (2010). Personal communication.
Parkes, C. (1972). Bereavement: Studies of grief in adult life. New York: International United Press.
Sanders, C. (1989). Grief: The mourning after. New York: Wiley.
Worden, W. (2009). Grief counseling and grief therapy (4th ed.). New York: Springer Publishing Company.
“I work with individuals, couples, and families to help develop secure connections
and craft manageable solutions.”
More information is available on my website www.scottwoodtherapy.com. I am also available for speaking engagements, seminars, and retreats http://scottwoodtherapy.com/Page5.html.
Scott Wood is a registered marriage and family therapist intern (IMF67385) and is supervised by Dr. Melinda Reinicke, Psychologist (Psy11011).
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Posted on May 5, 2012
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