Models of grief currently used in bereavement counselling
Models of grief are not about ‘fitting’ people to theory, but a way of helping us understand and support bereaved people at such a traumatic time. They also offer a framework to guide anyone suffering a loss in their grief work.
Worden’s Four Tasks of Mourning
In his book Grief counselling and Grief Therapy (1983), J William Worden identifies four main tasks which, if worked through, will help bereaved people on the road to recovery.
Tasks of Mourning
- To accept the reality of the loss
- To work through the pain of grief - by identifying and talking about feelings
- To adjust to a world where the person who has died is missing
- To emotionally re-locate the dead person and move on with life
Worden’s four tasks recognise that grief is a natural human condition and the price we pay for loving another person. He suggests that grief is an ordered process with clearly defined stages. It’s probably more helpful to think of the stages as a ‘guide’ or a ‘map’ to recovery. Grief does involve a process but rarely is the path a straight forward one with landmarks to be passed and checked off along the way. Many people do cover the same ground, but some will pass every landmark whilst others will revisit a landmark several times or approach in a different order or maybe not at all.
Stroebe and Schut’s Dual Process Model
More recently (1999) Margaret Stroebe and Henk Schut carried out research into the experience of bereaved people and how they cope with the death of someone close to them. They developed the idea of the Dual Process Model which has become a widely respected and realistic way of looking at the journey through grief.
Bereaved people often feel as if ‘they are going mad’ or ‘not coping’ as they struggle with a myriad of incredibly intense and often overwhelming feelings, both physical and emotional. It is an enormously stressful time and as they carry on and pick up the pieces of their shattered lives, the stress of it all can often weaken their immune systems. As a result, it’s not uncommon for bereaved people to fall ill; as if their load wasn’t already hard enough to carry.
The Dual Process model explains how people make the transition from living with a relationship to living without it. It divides all the feelings and all the activities that can follow bereavement into two separate dimensions: loss and restoration. The model describes how it is healthy and natural for people to move back and forth between the two dimensions, as they are both equally important and valuable ways of coping with a loss.
The Loss Dimension
When someone close to us dies, many people feel an overwhelming sense of loss and pain. Night and day, they can do little more than mourn, talk or cry, often with an incredible urge to keep going over all the details and circumstances of the death. Grieving is hard work and can be incredibly exhausting and draining.
The early part of grief is often marked by a sense of shock and disbelief which stops us accepting what we know to be true. Many people talk about feeling ‘numb’ – the body’s way of protecting us and a natural defence mechanism against the enormity of the experience. People talk of finding it hard to believe that their loved one ‘isn’t going to walk in through the door’ or thinking that ‘they’ll wake up and find it was all a terrible nightmare.’
These kinds of thoughts and feelings fit Worden’s first task of mourning – ‘To accept the reality of the loss.’ Shock and disbelief can last for weeks or even months and can depend on the nature and circumstances of the death and whether it was expected or sudden and traumatic. Gradually however, like the thawing of ice, the reality of what has happened begins to sink in.
In the ‘loss dimension’ bereaved people are totally absorbed by looking backwards, their whole being focused on the past and the person and the way of life that’s been lost.
The Restoration Dimension
With their world turned upside down, many people experience a natural pull, an instinct, to get back to some kind of ‘normality’. ‘Restoration’ describes the things they do to start putting their lives back together again and to regain some control in a world which feels totally out of control and sometimes even unsafe. It is the beginning of looking forward.
They return to work, perhaps try and build a new social life or new relationships, or take up old interests which have been neglected (the carer who put their own life on hold to look after a loved one). They learn new skills (the widow whose husband did the driving and has to learn to drive or face isolation.) They take on practical ‘jobs’ previously done by their loved one - doing the cooking, handling the finances or putting out the rubbish bins for collection.
And shaken to their very core, many bereaved people have to adapt to a new identity: ‘widow’, ‘widower’, no longer a ‘parent’, a ‘brother’ or a ‘grandparent’. The loss of ‘who they are’ and all the things they did as part of that role (the Dad who loved to turn out every weekend to watch his son play football) can shake their confidence and self-esteem. It takes time and great effort to re – build that sense of self. This is the ‘adjustment’ phase of Worden’s tasks.
Moving Between The Two Dimensions
It can’t be emphasised enough. There is no right or wrong way to grieve. Both dimensions are ways people cope with loss and most people naturally move between the two dimensions right from the very beginning.
It’s difficult working in both areas simultaneously and focusing in one dimension does provide distraction and relief from the other. Sometimes, going to work allows a bereaved person a few hours welcome relief from their pain and grief while they hold everything together to do their job. However, suppressing their pain might result in a strong need to cry, grieve and let out painful emotions as soon as they get home, so entering loss mode again.
When expressing painful grief becomes exhausting, emotionally and physically, it can be helpful for a grieving person to distract themselves and get into restoration mode again – to find some company, do some gardening, get some fresh air or go to the cinema or whatever it takes – to get respite.
Whichever dimension the grieving person finds themselves in, there will inevitably be reminders of the other dimension - like enjoying a concert but bursting into tears when music is played that suddenly brings back memories of a loved one. It’s almost as if people are like a pendulum swinging back and forth between the two dimensions.
Explaining the varied ways that people grieve across different cultures, ages and genders.
The Dual Process Model also helps explain the varied ways that people grieve across different cultures, ages and genders. Some people find that the pain of loss is the earlier experience of their grief with the restoration work coming later as they gradually work through painful feelings.
However others, perhaps the parent of young children, find that sorting out the practicalities of their new situation, together with dealing with the children’s pain, is a priority which demands all their time and energy. They may even fear that if they give in to their own grief, they will be overwhelmed and never cope with managing life on their own. Subconsciously, they seem to put their own grief ‘on hold’ as they deal with the necessities of the ‘restoration’ dimension. They only face the ‘loss’ dimension when they are either no longer able to suppress their grief or have more time and space to focus on their own needs.
Sometimes, suppressing one dimension all together (for whatever reason) can lead to unresolved or complicated grief and problems with depression, ill health or being ‘stuck’ and unable to engage meaningfully with life again.
In western culture some men have been brought up to believe it’s a sign of weakness to show emotion or cry and are not comfortable talking about their feelings. When faced with bereavement they may try to avoid their grief and all the difficult feelings that go with it and focus mainly on restoration work, perhaps seeking a new partner or burying themselves in work.
Some people think that their loved one wouldn’t want them to be sad, so put on a brave face and immerse themselves in social activities, the gym, holidays, re-decorating the house or anything just to keep busy and avoid their grief. They can end up running themselves into the ground, physically and emotionally.
For others they become so engulfed by their loss and grief that they are never able to move forward and as a consequence neglect other relationships; like the mother who by keeping her teenager’s possessions and bedroom just as it was, builds a shrine to her dead child but fails to connect with her other living children.
Ultimately the Dual Process Model gives permission for a bereaved person to grieve in a way that is right for them. It gives them permission to laugh and talk about a new future in the early weeks of a bereavement and yet break down a year or two later after appearing to have ‘coped really well’ with all the practical demands that a death brings.
Other losses – Divorce, Illness, Injury and Redundancy
Both Worden’s and Stroebe and Schut’s work deal with loss so are equally helpful in helping people come to terms with other losses in their lives like divorce, illness, injury and redundancy.