MAY 15, 2008 – FAMILIES COPING WITH LOSS: DR. J. WILLIAM WORDEN

MAY 15, 2008 – FAMILIES COPING WITH LOSS:  DR. J. WILLIAM WORDEN, a leader in the field of grief counseling and grief therapy. His research and clinical work span a period of over 40 years. He is affiliated with Harvard Medical School and Rosemead Graduate School of Psychology. He is also a co-Investigator of the Harvard Child Bereavement Study, based at Massachusetts General Hospital. He is the author of Personal Death Awareness; Children & Grief: When a Parent Dies, and is co-author of Helping Cancer Patients Cope. His book Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner is widely used around the world.

Bill Worden:  I was doing a workshop with Dr. Kubler-Ross at University of Chicago continuing education and Weisman and I had just begun the Omega Project at Mass General, which was a study of life-threatening illness and life-threatening behavior.  Anyway, we decided that in addition to having a workshop on how to work with terminally-ill patients and their families, it would be good to do something in grief so way back in the mid-70s we began these workshops to train social workers, nurses, physicians, psychologists and so forth on how to work with grief.

Bill Worden:  What Weisman and I did at Mass General after the Kubler-Ross book came out, I think in 1969-70, began to look to see whether people who were dying did go through the various stages that she’d outlined in her book and we did it very carefully and systematically on consecutive admissions to Mass General that were terminal and found that it just didn’t apply and yet it’s interesting to me because people don’t go in series through these stages as many people have talked about and written about, but it’s interesting how that particular model is still widely used. 

Bill Worden:  It’s taken so literally and it is of concern to me and that’s why when I wrote the book, Grief Counseling and Grief Therapy, which came out of those University of Chicago workshops, I approached the task of mourning because it seemed to me that paths that need to be worked through, accomplished, whatever, that was a much more dynamic and fluid kind of idea.

Bill Worden:  The reality of my experience after a loss is a very fluid kind of thing and a task can be accomplished at one level, at one point, and then later on go back and revisit it, rework and so forth, and I think that’s just sort of the way life is.

Bill Worden:  The first task is to accept the reality of the loss; that is, you first of all have got to believe that the person is gone and is not coming back, at least in the same way they were.

Bill Worden:  The second task is to process the pain of grief.  Now I wrote this very broadly – the pain of grief – because the pain from a grieving loss situation can be very very broad.  Most people think of sadness but it also includes things like anger and guilt and shame and loneliness and so my point is that these feelings need to be processed and if they’re not, two things can happen.  One, they can go underground and they can reappear in some later loss which I call a delayed grief reaction.  Or what is equally problematic is that they can develop a person’s pain, not experience, can then manifest itself as some kind of somatic bodily kind of manifestation.

Bill Worden:  I’ve seen this happen where say somebody’s had a child with leukemia or some other chronic, long-term caring disorder, and they spent more of their life and then the child dies and what do I do now?  And I have to re-define who I am which is part of that third task of mourning that we’re moving toward which is trying to find out who am I now without my dead child or my dead husband or whatever.

Bill Worden:  After you deal with the feelings – and that can take time – the feelings can come back.  We revisit it.  Anniversaries are particularly big times for feelings to come back in spades and need to be re-felt.  In the third task of mourning, I write it the following way.  To experience a world without the deceased, and there are three pieces to that.  One is to be able to experience the external adjustments.  For a widow, say living in an empty house.  Dealing as a single parent.  Those kinds of things.  I call those external adjustments.  The internal adjustments, the second part of this third task of mourning, has to do with how the person’s sense of self has changed.  Not just as a widow or a bereaved parent, but who am I now in terms of my self esteem?  In terms of my self-efficacy, the ability to make a difference in terms of what happens in my life.  And those are really some challenges.  But the third part is what I call spiritual adjustments.  That is, the whole meaning making process.  Why did this happen?  Why did this happen to me?  Where was God in this whole thing?  And so certain deaths can really affect a person’s sense of the predictability of the world and so on and so forth. 

Bill Worden:  The final one here is how do I find some kind of enduring connection with the loved one I lost while being able to embark on a new life for myself.  And this is the fourth task of mourning.  It’s important and necessary, and it’s a real struggle.  The idea of continuing bonds, as you mentioned early on this program, came out of our Harvard Child Bereavement Study.  Phyllis Silverman and I are studying 125 kids from 70 families over time after the death of a parent and one of the things we noticed was that these kids, a lot of them stayed connected to their dead parent through dreaming, feeling watched by them, thinking about them, keeping things that belonged to the dead person, and so forth.  So out of that observation, along with Denny Klass who is well known to your people from the Compassionate Friends group, we began to coin this term “continuing bonds,” and indeed a book came out.

Bill Worden:  It really is very cyclical.  There are times when I’m doing better.  There are times when I’m doing less well.  And one of the things about grief is that it can just hit you.  Blind-side you.  Even months and years afterwards.

Bill Worden:  Remember the woman that I mentioned whose son went over the cliff and she didn’t see the body and it took a long time for her to believe he was gone.  She had struggled because she lost both the husband and the son in a short period of time and she came to me once after a couple years and said something like, it doesn’t come back as frequently now as it did (meaning the pangs of grief) but when it does come back, she said to me – and here’s the point – I can remember the in-between times better.  And I thought that’s so profound, yeah, because she was still two years after the death, the second death, having these.  But she said when they came back, I can still remember the in-between times better, which she couldn’t do originally.  She was just overwhelmed by his death.

Bill Worden:  Some adolescents who didn’t seem to be grieving were, but they were very selective whom they were talking to about their dead parents.  In this case, they were all parents who died, and some of them were really doing it rather privately.  I remember one kid that used to stop by the cemetery where his dad was buried on his way home from school.  Now the family didn’t know about that.  He shared it with us as part of the interview.  So there’s a lot of room for individual differences.  However, we did find in the Harvard study that those families who could as a family talk about the dead person together did better over time.  That is, there is some value in terms of sharing the grief.

Bill Worden:  Grief therapy is good for people who are having some kind of complicated bereavement reaction.  Either the grief goes on and on for years and doesn’t seem to come to an end.  The person feels stuck.  Therapy’s good there.  Therapy’s good for somebody who has a delayed grief reaction.  They didn’t grieve enough early on and then later on they’re having an enormous response to some later loss.  It can be helpful there and it can also be helpful to somebody who develops anxiety disorders or major depressive disorder.  Whatever some kind of psychiatric problem.  Their therapy can be not only helpful but I think it’s the only kind of intervention.  If you have a major depression, I’m not sure that going through just a garden variety grief group is going to be the helpful kind of thing.