Grief Treatment According to William Worden

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

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

It is essential to consider that a passive attitude in the face of these circumstances does not usually lead anywhere, since there are a series of tasks that we must face in order to continue living and preserving the loving memory of who left.

In this article we will address the treatment of mourning according to William Worden , a prestigious Doctor of Psychology whose contribution to this field has made him an inescapable reference for understanding the process we are talking about: transcending death (and life) while maintaining the ability to be happy.

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Grief Treatment According to William Worden

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

The truth is that it is a vital process that has enormous individuality, making it difficult to distinguish a linear succession of universal stages that every survivor will necessarily go through. Thus, it is impossible to establish a temporal criterion from which the pain becomes of clinical relevance . It is a complex experience, irreducible to objective terms that are applicable to all.

The treatment of mourning according to William Worden aims, therefore, to be sensitive and aware of this reality . The author proposes a four-phase model in which an extensive individuality is accommodated, and in which the person must carry out a series of functions aimed at moving forward on their journey to emotionally integrate the memory of the absent loved one . From this perspective, whoever survives a loss takes an active and proactive role, as opposed to the classical view.

The tasks to be fulfilled would be, specifically: accept the loss, protect the emotion that is experienced, restore balance by assigning roles and integrate the memory of the loved one in one’s life. Let’s look in detail at the phases Worden proposed , which are an approach frequently used in cases where suffering becomes intense and prolonged.

1. Accept the reality of loss

One of the first emotional reactions that comes after learning about the loss of a loved one is shock. It is a response in which very intense emotions emerge, which even compromise attention and / or memory for the episode (so the precise moment in which the event was certain may not be recalled later). Although this state makes it difficult to emotionally process at the beginning, it allows to assimilate the situation progressively as time goes by.

The moment the person begins to orient himself, it is common for him to remain in a position of denial or disbelief . This can last for several days; in which he thinks, feels and acts as if the family member were present. All this is more likely in cases in which death happens in a totally unexpected way, because when you have gone through a lasting illness you tend to observe an anticipated grief (for which you have already traveled at least part of the way in the moment of death).

The integration of the loss must be carried out on two levels, and in an always progressive way: rational (assume awareness of the events as they happened, giving more precise coordinates to the situation and its consequences) and emotional (contact the affects that occur as a result of what happened).

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

The practice of funeral rituals , which exist from 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 all this process: they allow us to record what happened and facilitate the gathering of those suffering from shared pain. This is one of the points in which the first gestures of real regret (condolences, cries, etc.) are most frequently observed. And it is the moment in which a tangible and formal farewell takes place.

In the days following this act, the grieving process can take many different forms . In some cases the person needs to harbor the pain that accompanies him (so 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 for each one, private and intimate. It is also the first station on the way to overcome the duel.

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2. Elaboration of grief pain

Crafting grief over 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 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 dedicate more time to their work or other activities, relegating what happens inside them to a second order of importance .

It is not uncommon for families to do everything possible to avoid what reminds them of the deceased (removing photographs or building taboos on him) or where the opposite occurs (as if silence on the matter 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 approaching it. Even with all this, sometimes conflicts can arise due to such discrepancy , which we will have to resolve correctly to avoid additional discomfort.

The truth is that it is an emotional matter that sooner or later we will have to deal with. Facing him means acknowledging and assuming that he will go through disparate and confusing internal states ; like anger, sadness, or fear. They are all legitimate affections that are part of the baggage we have to overcome adversity, so it is key to stop to listen to them from a position of acceptance and with the necessary disposition to tolerate their presence.

This part of the process is the one that requires the investment of greater emotional effort, since during its development personally relevant levels of sadness and anxiety arise, and even some organic problem (such as headaches, digestive disorders, etc.). It is also very common to have difficulty sleeping and changes in appetite (ranging from appetite to voracious hunger). For all these reasons, it is essential to guarantee self-care and ensure that you maintain your own health.

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

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

Finally, it is necessary for the person to be aware of two situations that can exacerbate their regret : going to places where they used to meet with the deceased person and that certain dates are met (birthdays, Christmas, etc.). When the anniversary of death arrives, a spontaneous flare-up of pain may also appear. These are well-known circumstances, for which one must be properly prepared.

3. Adapt to a new world without the loved one

All families function as a system, in such a way that each one of its gears fulfills a specific task but embedded in 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 also extends to the actions and customs of everyday life . The responsibilities attributed to it are now neglected, and will have to be resolved by other elements of the family unit. This process is not at all easy, especially when the deceased person was in charge of economic support or acted as a beacon that directed relational tensions towards the placid shores of consensus.

Also, even though it is easy to redistribute tasks among family members, feelings of anxiety or grief can sometimes arise as they are carried out. This is because the action sharpens the feeling of absence of the loved one , and at the same time displaces the contributions he made in life to a new dimension. That is why difficulties arise despite having the skills or the opportunity to successfully carry out all the tasks.

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

As one progresses towards successive stages of mourning, 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. Emotionally relocate the deceased loved one

The death of someone loved is a break in the line of continuity on which we wrote the book of our existence, making it difficult to integrate into the narrative that one makes of their own history.

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

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

And is that forgetting the lost never comes. For when a life touches another life, it changes it forever. Even despite death.


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