Grief treatment according to William Worden

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

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, immeasurably painful losses (such as that of a child).

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

In this article we will address Grief treatment according to William Worden, prestigious Doctor in Psychology whose contribution to this field has elevated him as an unavoidable reference for the understanding of the process to which we allude: transcending death (and life) while maintaining the capacity to be happy.

• Related article: "Grief: coping with the loss of a loved one"

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 you will simply wander without a compass or a 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 has enormous individuality, being difficult distinguish a linear succession of universal stages that every survivor will go through necessarily. So, it is impossible to establish a temporal criterion after which pain becomes clinically relevant. It is a complex experience, irreducible to objective terms that are applicable to all.

Grief treatment according to William Worden he claims, for all this, to be sensitive and aware of this reality. The author proposes a model of four phases in which there is room for extensive individuality, and in which the person must carry out a series of functions aimed at advancing on your path to emotionally integrate the memory of your loved one absent. From this perspective, whoever survives a loss adopts an active and proactive role, in opposition to the classical vision.

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

1. Accept the reality of the loss

One of the first emotional reactions that arise after learning of 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 that the precise moment in which the event was certain may not be remembered later). made). Although this state makes emotional processing difficult at first, it makes it possible to gradually assimilate the situation as time goes by.

At the moment in which the person begins to orient himself, the common thing is that they remain in a position of denial or disbelief. This can last for several days; in which he thinks, feels and acts as if the relative were present. All this is more probable in cases in which death occurs totally unexpectedly, because when you have gone through a long-term illness, there is a tendency to observe anticipated grief (for which at least part of the journey has already been traveled at the time of the death).

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

Limited recognition may be given at this stage to the intellectual, without accompanying affections (feeling that the person "would still be there" if they went to visit his home). This situation usually surprises the survivor, who does not understand why "it does not feel as bad as I expected".

The practice of funeral rituals, which have existed since the dawn of humanity and depend on cultural reality (or the beliefs of the deceased on a spiritual level), have a basic function in this whole process: they allow us to record what happened and facilitate the meeting of those who suffer from pain shared. This is one of the points where the first gestures of true regret are most frequently observed (condolences, tears, etc.). And it is that it is the moment in which a tangible and formal farewell is carried out.

In the days following this act, the grieving process can take many different forms. In some cases, the person needs to house the pain that accompanies them internally (for which reason their 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 journey towards overcoming grief.

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2. Elaboration of the pain of mourning

The elaboration of the pain for the loss of a loved one is not a quick or easy process. Despite many weeks or months having 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 overcome their suffering.

Thus, they can devote more time to 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 things that remind them of the deceased (removing photographs or building taboos on it) or in which the opposite occurs (as if silence on the matter banished him to the cruel forgot). All of this is natural in the context of efforts to put together a puzzle that is missing too many pieces, and in which each of the mourners has a unique way of approaching it. even with everything, conflicts can sometimes arise from such a discrepancy, which we must solve correctly to avoid additional discomfort.

The truth is that it is an emotional issue that sooner or later we will have to deal with. Facing him means recognizing and assuming that he will go through disparate and confusing internal states.; such as anger, sadness or fear. They are all legitimate affections that are part of the baggage we have to overcome adversity, so it is stopping 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 the greatest emotional effort, since during its development levels of personally relevant sadness and anxiety, and even some organic problem (such as headache, digestive disorders, etc.). Also it is very common for it to occur with 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 ensure that one's own health is maintained.

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 when trying to alleviate (unsuccessfully) the grief of someone they consider important.

We must establish links that allow us to communicate and organize our 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 grief: Go to places where you used to meet with the deceased person and that certain dates are fulfilled (birthdays, Christmas, etc.). When the anniversary of death arrives, a spontaneous flare-up of pain may also manifest. These are well-known circumstances, for which one must be duly prepared.

3. Adjusting to a new world without the loved one

All families work as a system, so that each of its gears fulfills a specific task but is embedded in the group's activity. arguably its members have complementary roles with respect to those of the others, so the dynamics that hold 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 together.

Thus, the death of a loved one not only leaves an emotional void, but also extends to the acts and customs of day to day. The responsibilities that were attributed to him are now neglected, and will have to be resolved by other elements of the family unit. This process is not at all simple, especially when the deceased person was in charge of the livelihood or acted as a beacon directing relational tensions toward the placid shores of the consensus.

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

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

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

4. Emotionally relocate the deceased loved one

The death of someone dear to us supposes 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 meaning to the life of someone who is no longer there. Well, the truth is that the bonds between human beings are not diluted with death, but continue in force, transforming 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 within our individuality; reconciling all the memories in the meek flow of personal history. The anguishing emptiness of the first months, experienced as a rupture in the fabric of one's existence, acquires a recognizable form and allows one to move on. That is why in the last stage the person redirects his gaze "outwards", towards a life whose course never ceases.

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

Bibliographic references:

• Drenth, C.M., Glaudina, A. and Strydon, 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.