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Archive for March 26th, 2012

“…when we finally know we are dying, and all other sentient beings are dying with us, we start to have a burning, almost heartbreaking sense of the fragility and preciousness of each moment and each being, and from this can grow a deep, clear, limitless compassion for all beings.”

~~ Sogyal Rinpoche

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William Worden’s Task Theory of Grief…

Dr. Worden‘s book

I remember Dr. Worden’s book when I first got to hospice.  And I appreciated it at the time.  It gave me, a new grief counselor, a framework to think about grief counseling… somewhere to start and ideas to get me going.

Now, I read the second edition of his book and the link above is to his fourth edition.  That’s important to know because since the first edition and the current edition, Dr. Worden has generously added in the ideas of other thanatologists to round out or support his task-based theory.

Overall, the theory stands that there are certain tasks that all of us must do in order to have successful grieving take place.  Mind you these are my words after reading the newest version of the book as well.

I will lay out the tasks and discuss them and then give my overall impression.  I have a great deal of respect for Dr. Worden as he is a senior member of the Association for Death Education and Counseling (ADEC), where I hold my certificate from and he has been in the field for decades doing therapy and doing research.  I’ve heard him speak at a few conferences and I continue to appreciate his work, especially his ideas about complicated bereavement.

So let’s look at the tasks…

1.  To accept the reality of the loss —  There is, for many, a span of time where we can hardly believe the words that we are hearing.  Someone has died.

Someone close to us, someone we care about.

We never think that day is going to come and for a lot, but not all, no matter how much we know and prepare, we are taken off-balance when those words come.

Surely the person delivering the news is wrong.  It was some sort of screw up.

But the fact is, hearing the words, seeing that person who has died makes it real for most of us and we know, there is no turning back.

But just because we know it, doesn’t mean that we don’t wish that was the case.

There are many reasons why this can be a difficult first step.  Think about all the shows you’ve seen like NCIS where military personnel go to the home of someone deployed in active duty… you know that there is a chance that someone will die… but the chance versus the reality are vastly different worlds.

And a military death is another good example of what can be difficult in grief… what if someone doesn’t come home, the family isn’t allowed an open casket, etc.  There is a lot of room for our brilliantly adaptive minds to create scenarios that sound like a tv show.

This task was probably very hard for the families who were affected with losses after 9/11 and Oklahoma City, where some people might not have ever been found.  Would you not, in your heart of hearts, pray to whatever kept the universe going, that everyone was wrong and that your loved one had been spared?  Why wouldn’t you want to believe in a miracle…

For Dr. Worden, this has to be the first thing that is done.. to come to terms with, to reconcile with the fact that the person is no longer physically present as we have known them and our relationship is forever altered.  The rest of the tasks (and therefore our grief) really can’t be completed without this first one.

Ÿ2.  To experience the pain or grief —  (In the fourth edition of the book, this is called To Process the Pain of Grief)

The next task is to confront the pain, be present to all of the emotions that come with grief.  In the field, it’s usually called the “grief work”… naming our feelings, allowing ourselves to feel them, working through them, talking about them, etc.  This is what most people think of as grief… the sadness, the anxiety, the dread, the longing, or the utter loneliness.

There is still so much to say about this task, but I would like to hold off until I write about the difference between intuitive and instrumental grievers… an idea from a colleague and friend of Dr. Worden’s, Dr. Kenneth Doka.  This will be addressed in an upcoming post and I will add a link here as well.

Suffice it to say, these are all the jumbled emotions and feelings that any of us go through… relief after someone has had a long struggle with illness, despair over the seemingly early death of a young child or adult, happiness if we believe that person has gone to some afterlife, anger when we felt that we have been left, etc.

Dr. Worden’s point it that we need to feel the feelings, work through them, and again, come to some reconciliation with those feelings.

Ÿ

3.  To adjust to an environment in which the deceased is missing — Before I get into task 3, I want to say that the tasks are not linear…

it’s not like the 12 Step‘s of AA/Al-non where you go through one step at a time…

it’s not like Maslow’s hierachy in that you have to have the bottom foundation before you can have a peak experiences or other transpersonal connection.

There is no reason why tasks 2 & 3 might not occur together…

Task 3 is about figuring out what life is going to be like without the person who died.  This is where secondary losses come up… (again, hold on, a graphic and a blog post will be coming up)…

Secondary losses are the things that you lose because someone died — for instance, if you parent dies, your family loses a second income, perhaps the primary one.  Maybe the family loses social status.  Maybe the person who died is the family problem fixer, vacation planner, glue-that-holds-the family together… all of that is lost and we have to figure out how to live without all of that.

Task 3, as Dr. Worden describes it, is in my mind of the biggest reasons why we just don’t “get over grief” right away… this doesn’t just unfold over night, it unfolds over our lifetime….. think about losing your husband and two years from now you get an invitation to a wedding…

Mrs. Jennifer Stevens and guest. . . the pain comes up, we are struck, possibly for the first time, possibly for another newer time, that the person who should be going with us, who rightfully belongs there, cannot be there and some level of grief, bittersweetness, pain, sadness, etc can ensue.

When I think of task 3, I think of the times I swore I saw my loved one out driving or in a crowded place.

I think of clients’ stories of seeing a funny email or comic and picking up the phone to share it, only to remember as they were dialing, that what was so common place, so instinctual before… to share something with someone we loved, can’t happen any more…. These are the thing we learn to adjust to.

Ÿ4.  To withdraw emotional energy and reinvest it in another relationship.* (This is how it was written in the 2nd edition) How Worden now writes it is:  To find an enduring connection with the deceased in the midst of embarking on a new life.

I have added both versions of how this task has been written because, well, as the phrase goes, we’ve come a long way baby!

For so long, the grief field had the thought, from Freudian thinking or psychoanalysis, that the only way to have effective finalization to grief was to no longer put energy into our relationship with the person who had died but rather to put them away on a shelf and to invest in a new relationship… find a substitution if you will.

This is where we get the whole idea of letting go… but as Dr. Robert Neimeyer once said in a conference I saw him at, no mother ever comes to counseling to say, hey, I’d like to let go of my child.. could you teach me how to do that so I can get on with life.

Thankfully we have a newer theory, that of continuing bonds (Klass & Silverman) that is gentler, kinder, and probably closer to what many of us do.  Now, maybe there were people out there that were able to section themselves off, stop loving the person who died and seek out someone new to be the object of their love.  If they did, then that was their path.  But for most of us, that is not what we do.

The last task is to try to figure out how we will continue to be in relationship with the person who has died given the new circumstances… that we have feelings, thoughts, memories, and attachments to the person and the person is no longer physically here.

How do we do that?  What role will that person play?  How will we relate to them?

I think of my friend and mentor Lois when I think of this task… I didn’t do my grief work and then go seek out a mentor and a friend to replace her… she was irreplaceable.  And I wouldn’t have thought to do that.

But I couldn’t call Lois up on the phone and be comforted by that southern voice that was filled with life until the very end.  I could hop a flight to Nashville and give her one of her famous hugs.  I could drive down the Natchez-Trace highway with her, eating tuna sandwiches, and watch dragonflies by the river.

What I could do is honor her as a earth-mother, elder, crone, and healer that she was and continues to be for me.  Lois lived her whole life trying to help others see the beauty in dying and in living.  The local tv station in Nashville even shot a documentary of her life for the last 18 months, including a shot of her in her last hours, tucked in bed with loved ones nearby.

Lois is with me, in my heart and head, wherever I go… sometimes its her words that come out of my mouth when I am being present to a grieving person… a turn of a phrase, like… take gentle care… is something that she said and meant and it meant something to me.  It’s now a part of me and I carry it with me and celebrate her every time I end an email or a conversation with it.

So, I am glad that we have moved beyond the psychoanalytic idea of decathexis… cutting those ties and replacing, letting go.  I think it’s more realistic.

I know many people, myself included, who still talk to the deceased.  We know they aren’t there.  We’re not crazy.  It’s comforting.

We don’t know if they are listening so why not.

So many people hold that in and feel pain from it.  When they can tell a grief counselor or group that they still talk to their loved one while doing the dishes (or whatever else) you can see the weight lifted off of them.  Not the weight of doing it, the weight of someone thinking that they were crazy or their grief was unresolved.

Overall, I think that Dr. Worden’s theory has merit as a schemata for understanding what people may go through on their healing journey.  I have a greater respect for it as I read edition 4 which really tried to incorporate some of the newer, postmodern ideas about grief — such as meaning making, continuing bonds, etc… and these are all theories that I will write about over time.

I don’t think that something so precious as love can be summarized and “a” way can be prescribed.  Worden offers us a very broad outline and there is a lot that we each fill in…

I disagree that we ever come to a final place with our grief… so it is hard for me to believe any theory that suggests that there is an end or that someone needs to be led through the process to completion.  I think more highly of our innate ability to heal than that.

Despite laying out a theory, Dr. Worden admits in his book that he has always liked Dr. Alan Wolfelt’s idea of the grief “companion” — that we honor the person who is grieving by being present and baring witness to whatever their process is.

I don’t even like the word.  I prefer grieving because to me, it is a process, an unfolding of events, meanings, love, and so much more throughout our lives.

We grieve differently at different developmental ages, as we will write about in a few weeks when we take a look at kids and grief with Elizabeth Hendrickson who has worked with and volunteered with kids who are grieving.

I think Dr. Worden is a good foundation for us to work from, to see things from… and as with any theory, I think we need to be cautious to not think that everything is cut and dry like 4 steps… we know better… we just sometimes forget what a big step even one foot in front of the other can be.

I hope that this helps you and gives you something to think about.  Thanks you so much for staying with me through this very long piece.

More to come soon…

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