The death of a loved one is an event that we all go through at some point in life, which is associated with difficult affections and can mark a before and after. A new chapter. A new chapter.

The losses of our parents, grandparents or older siblings are part of a natural order dominated by time. Therefore, it is something we must assume and be prepared to experience. At other times, however, there are unforeseen, immeasurably painful losses (such as that of a child).

It is essential to consider that a passive attitude in the face of these circumstances usually leads nowhere, since there are a number of tasks that we must face in order to continue living and preserving the loving memory of the one who left.

In this article we will deal with the treatment of grief according to William Worden , a prestigious Doctor of Psychology whose contribution to this field has elevated him as an inescapable reference for the understanding of the process to which we allude: to transcend death (and life) while maintaining the capacity to be happy.

The treatment of grief according to William Worden

Many of the traditional descriptions of grief have understood the person who goes through it as a passive entity, subject to external forces that will trace a path along which he or she will simply wander without a compass or purpose. Such a way of perceiving this stage of life adds even more pain , since it adds a component of uncontrollability to a sometimes arid and barren landscape.

The truth is that it is a vital process that involves an enormous individuality, being difficult to distinguish a linear succession of universal stages that every survivor will necessarily go through. Thus, it is impossible to establish a time criterion from which the pain becomes clinically relevant . It is a complex experience, irreducible to objective terms that are applicable to everyone.

The treatment of grief according to William Worden aims, therefore, to be sensitive and aware of this reality . The author proposes a four-phase model in which extensive individuality is allowed, and in which the person must carry out a series of functions aimed at advancing on his or her path towards integrating the memory of the absent loved one on an emotional level. From this perspective, the person who survives a loss takes an active and proactive role, as opposed to the classic view.

The tasks to be fulfilled would be, concretely: to accept the loss, to protect the emotion experienced, to restore the balance by assigning roles and to integrate the memory of the loved one into one’s own life. Let’s see in detail the phases proposed by Worden , which constitute an approach often used in cases where the suffering becomes intense and prolonged.

1. Accepting the reality of loss

One of the first emotional reactions to learning about the loss of a loved one is shock. This is a response in which very intense emotions emerge, even compromising attention and/or memory for the episode (so the precise moment when the event was certain may not be remembered later). Although this state makes emotional processing difficult at the beginning, it allows for progressive assimilation of the situation as time goes by.

The moment a person starts to get his bearings, he usually remains in a position of denial or disbelief . This can go on for several days, when the person thinks, feels and acts as if the family member were present. All this is more likely in cases where death happens in a totally unexpected way, since when one has gone through a long-lasting illness one tends to observe an anticipated mourning (for which at least part of the way has already been travelled at the time of death).

The integration of the loss should be carried out on two levels, and in an always progressive manner: rational (assuming awareness of the facts as they happened, giving more precise coordinates to the situation and its consequences) and emotional (contacting the affects that follow as a result of what happened).

At this stage, there may be limited recognition of the intellectual , without the accompanying affections (feeling that the person would “still be there” if he or she were to visit his or her home). This situation often surprises the survivor, who does not understand why “he does not feel as bad as he expected”.

The practice of funeral rituals , which have existed since the dawn of humanity and depend on the cultural reality (or the beliefs of the deceased on a spiritual level), have a basic function in this whole process: they allow for the recording of what happened and facilitate the reunion of those who are suffering from a shared pain. This is one of the points where the first gestures of genuine grief (condolences, crying, etc.) are most often observed. This is the moment when a tangible and formal farewell is held.

In the days following this act, the mourning process can take many different forms . In some cases, the person needs to harbor within him the pain that accompanies him (which is why his appearance is taciturn and distant), while in others the desire to share feelings about the lost loved one is evident. The way of communicating is unique to each person, private and intimate. It is also the first stop on the way to overcoming grief.

2. Elaboration of the pain of grief

Dealing with the loss of a loved one is not a quick or easy process. Despite the fact that many weeks or months have passed, it is very possible that thoughts about it will generate intense pain and tremendously difficult to bear, so it is common for many people to try to distract themselves in order to avoid their suffering.

Thus, they can spend more time on their work or other activities, relegating what happens inside to a second order of importance .

It is not uncommon for families to do everything possible to avoid what reminds them of the deceased (by removing photographs or building taboos about him) or where the opposite occurs (as if silence on the subject banished him to cruel oblivion). All this is natural in the context of efforts to put together a puzzle for which too many pieces are missing, and in which each of the mourners has a unique way of dealing with it. Even so, conflicts can sometimes arise from such a discrepancy , which we will have to resolve correctly to avoid further discomfort.

The truth is, it’s an emotional issue that we’ll have to deal with sooner or later. Facing it means recognizing and assuming that we will go through different and confusing internal states ; such as anger, sadness or fear. All are legitimate affections that are part of the baggage we have to overcome adversity, so it is key to stop and listen to them from a position of acceptance and with the willingness to tolerate their presence.

This part of the process is the one that requires the investment of the greatest emotional effort, since during its development levels of sadness and anxiety arise that are personally relevant, and even some organic problem (such as headache, digestive disorders, etc.). Also it is very common for him to have difficulty sleeping and changes in appetite (ranging from lack of appetite to voracious hunger). For all these reasons, it is essential to guarantee self-care and to ensure that one’s health is maintained.

At this point in the process, it is crucial to seek the support of people you trust , and to understand that sometimes they too can feel frustrated in trying to alleviate (unsuccessfully) the grief of someone they consider important.

We must establish links that allow us to communicate and organize our interior life, which is possible when the interlocutor maintains an active and patient listening. This help reduces the risk of suffering mental health problems associated with such a delicate moment.

Finally, it is necessary for the person to be aware of two situations that may intensify his or her grief : going to places where he or she used to meet the deceased person and meeting dates (birthdays, Christmas, etc.). When the anniversary of the death arrives, a spontaneous intensification of grief can also be observed. These are well known circumstances, for which one must be properly prepared.

3. Adapting to a New World Without Your Loved One

All the families work as a system, so that each of their gears fulfils a specific task but is interwoven with the group’s activity. It could be said that its members have complementary roles with respect to the others , so the dynamics that keep them together are subject to a balance or “social homeostasis”. When one of the pieces is missing, it is necessary to make adjustments aimed at enabling the continuity of life in common.

Thus, the death of the loved one not only leaves an emotional void, but extends to the acts and customs of everyday life . The responsibilities that were attributed to him now remain unattended, and will have to be resolved by other elements of the family unit. This process is by no means simple, especially when the deceased was responsible for the economic support or acted as a beacon that directed the relational tensions towards the placid shores of consensus.

In addition, while it is easy to redistribute tasks among family members, feelings of anxiety or grief may sometimes arise while performing them. This is because the action sharpens the feeling of absence of the loved one , and at the same time displaces the contributions he or she made in life to a new dimension. This is why difficulties arise even when the skills or opportunity to successfully perform all tasks are available.

This situation is usually experienced as a substantial adaptive challenge, although it also offers satisfactions and learning that contribute to improve the emotional state in a difficult moment.

As we move towards successive stages of grief, the involvement in these new activities will no longer be perceived as a kind of substitution , integrating the role of the deceased in all the family dynamics that arise from shared adversity.

4. Emotional relocation of the deceased loved one

The death of someone we love represents a break in the line of continuity on which we write the book of our existence, which makes it difficult to integrate it into the narrative that one makes of one’s own history.

That is why we understand as “overcome” a mourning process when the person is able to attribute a harmonious sense to the life of the one who is no longer there . For the truth is that the bonds between human beings are not diluted with death, but continue to exist, transforming themselves and acquiring new meanings.

The integration of the loved one in one’s own life implies the reorganization of everything that was shared with him or her within our individuality; reconciling all memories in the meek flow of personal history. The distressing emptiness of the first months , experienced as a rupture in the fabric of one’s existence, takes on a recognizable form and allows one to move forward. That is why in the last stage the person redirects his gaze “outwards”, towards a life whose course never stops.

And that’s because forgetting what’s lost never comes. For when a life touches another life, it changes it forever. Even in spite of death.

Bibliographic references:

  • Drenth, C.M., Glaudina, A. and Strydom, H. (2010). A Complicated Grief Intervention Model. Health SA Gesondheid, 15(1), 1-8.
  • Simon, N.M. (2013). Treating Complicated Grief. Journal of the American Journal Association, 310(4), 416-423.