The treatment of grief according to William Worden

Key ideas applied to psychotherapy for people grieving the death of a loved one.

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

The loss of our parents, grandparents or older siblings is part of a natural order dominated by time. Therefore, it is something we must come to terms with 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 towards these circumstances usually leads nowhere, as there are a series of tasks that we must face in order to continue living and preserving the loving memory of the one who is gone.

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

William Worden's treatment of grief

Many of the traditional descriptions of grief have understood the bereaved as a passive entity, subject to external forces that will trace a path through 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, as it adds a component of uncontrollability.It adds a component of uncontrollability to a sometimes arid and barren landscape.

The truth is that it is a vital process that is highly individual, and it is difficult to distinguish a linear succession of universal stages that every survivor will necessarily go through. Thus, it is impossible to it is impossible to fix a time criterion from which Pain becomes of clinical relevance.. It is a complex experience, irreducible to objective terms applicable to all.

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

Specifically, the tasks to be fulfilled would be: accepting the loss, protecting the emotion experienced, restoring balance by assigning roles and integrating the memory of the loved one into one's own life. Let us look in detail at the phases proposed by Wordenwhich constitute a frequently used approach in cases where the suffering becomes intense and prolonged.

1. Accepting the reality of the loss

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

At the moment when the person begins to orient himself, is usually in a position of denial or disbelief.. This may last for several days, during which time he/she thinks, feels and acts as if the relative were present. All this is more likely in cases where the death occurs completely unexpectedly, because when one has gone through a lasting illness one tends to observe an anticipated mourning (for which at least part of the way has already been traveled at the time of death).

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

At this stage, there may be a limited recognition of intellectualwithout the accompanying affections (feeling that the person "would still be there" if he/she went home for a visit). This situation often surprises the survivor, who does not understand why he or she "does not feel as bad as expected".

The practice of funeral ritualswhich have existed since the dawn of humanity and depend on the cultural reality (or on the beliefs of the deceased on a spiritual level), have a basic function in this whole process: they allow a record to be made of what has happened and facilitate the reunion of those who suffer a shared grief. This is one of the points at which the first gestures of genuine grief (condolences, crying, etc.) are most frequently observed. This is the moment in which a tangible and formal farewell takes place.

In the days following this act, the mourning process can take many different forms. In some cases the person has a need to harbor the pain that accompanies him or her (which is why his or her 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 station in the journey towards overcoming grief.

2. Elaboration of the pain of grief

The elaboration of grief is not a quick or simple process. Although many weeks or months may have passed, it is very possible that thoughts about the loss of a loved one may still be present, it is very possible that the thoughts about it generate an intense pain and tremendously difficult to cope with. and tremendously difficult to cope with, so it is common that many people try to distract themselves in order to circumvent their suffering.

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

There are not infrequent cases of families who do everything possible to avoid anything that reminds them of the deceased (by removing photographs or building taboos about him) or in which the opposite happens (as if silence on the matter would banish him to cruel oblivion). All of 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 so, conflicts may sometimes arise from such discrepancies, which we must resolveWe will have to resolve them wisely to avoid additional discomfort.

The truth is that it is an emotional issue that sooner or later we will have to deal with. Facing it implies recognizing and assuming that we will go through disparate and confusing internal statessuch as anger, sadness or fear. All of them 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 necessary disposition 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, personally relevant levels of sadness and anxiety arise, and even some organic problem (such as headache, digestive disorders, etc.). Also It is also very common to have difficulty in sleeping and changes in appetite (ranging from (ranging from poor appetite to voracious hunger). For all these reasons, it is essential to ensure self-care and to take care of one's own health.

At this point in the process it is crucial to seek the support of people you trustWe need to understand that sometimes they too may feel frustrated when trying 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 suffering mental health problems associated with such a delicate moment.

Finally, it is necessary for the person to be aware of two situations that can aggravate his or her griefThe following situations should be taken into account: going to places where the person used to meet the deceased and when there are important dates (birthdays, Christmas, etc.). When the anniversary of the death arrives, there may also be a spontaneous intensification of grief. These are well known circumstances, for which one must be properly prepared.

3. Adapting 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 role but is interwoven in the group's activity. It could be said that its members have complementary roles with respect to each other, so that the dynamics that keep them togetherThe dynamics that hold them together are therefore 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 together.

Thus, the death of a loved one leaves not only an emotional void, but also extends to the acts and extends to the acts and customs of day-to-day life.. The responsibilities that were attributed to him/her are now left 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 person was a breadwinner or acted as a beacon guiding relational tensions to the placid shores of consensus.

Moreover, although it may be easy to redistribute the tasks among family members, feelings of anxiety or grief can sometimes arise as the tasks are carried out. This is because the action exacerbates the feeling of absence of the loved oneThis is because the action sharpens the sense of the loved one's absence, and at the same time shifts the contributions he or she made in life to a new dimension. This is why difficulties arise despite the availability of the skills or opportunity to successfully perform all the tasks.

This situation is usually experienced as a substantial adaptive challenge, although it also offers satisfactions and learning that contribute to improve the emotional state at a time of difficulty.

As one moves on to successive stages of grief, involvement in these new activities will no longer be perceived as a kind of substitution, involvement in these new activities will cease to be perceived as a kind of substitution, and the role of the deceased will be integrated into all the family dynamics that emerge from the shared adversity.The role of the deceased will be integrated into all the family dynamics that arise from the shared adversity.

4. Emotionally repositioning the deceased loved one

The death of a loved one implies 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 a grief process to be "overcome when the person is capable of attributing a harmonious meaning to the life of the person who is no longer with us.. For the truth is that the bonds between human beings are not diluted by death, but continue to be valid, transforming and acquiring new meanings.

The integration of the loved one into one's own life implies the reorganization of all that was shared with him/her in the bosom of our individuality; reconciling all the memories in the gentle flow of personal history. The anguishing emptiness of the first monthsexperienced as a rupture in the fabric of one's own existence, acquires a recognizable form and allows one to move forward. It is for this reason that in the last stage the person redirects his or her gaze "outwards", towards a life whose course never ceases.

And the fact is that forgetting what has been lost never comes. For when one life touches another life, it changes it forever. Even in spite of death.

Bibliographical 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.