May 15, 2008 - Families Coping With Loss: Dr. J. William Worden

HEALING THE GRIEVING HEART
Families Coping with Loss
Hosts:  Dr. Gloria Horsley and Dr. Heidi Horsley
With guest:  Dr. J. William Worden
May 15, 2008
G: Hello, I’m Dr. Gloria Horsley with my co-host
H: Dr. Heidi Horsley.
G: Each week Heidi and I welcome you to Healing the Grieving Heart, a show of hope and conversation with those who’ve suffered the loss of a loved one and for healthcare professionals who work in this most difficult field.  As always the message is others have been there before you and made it.  You can too.  You need not walk alone.  If you’re listening to our Thursday live Internet show, please join Heidi, me, and our guest by calling our toll-free number, 1-866-472-5792, with questions or comments regarding the losses in your life.  These shows are archived on our blog, www.thegriefblog.com.  They can be downloaded on iTunes and transcripts can be accessed on www.thegriefblog.com.  Good morning, Heidi.
H: Good morning, mom.
G: It’s been a really busy week for us.
H: Yeah, it has.
G: I saw Heidi in Utah because Heidi and I spoke at the Caring Connections at the Utah School of Nursing.  Kathie Supiano invited us to come and speak there.  Wonderful program.  It’s so great to see a university outreaching into most of the state of Utah.  They’re running groups for people who’ve had any kind of loss and was kind of a twelve-part program.  It’s pretty amazing, isn’t it, Heidi?
H: It is and, you know, we spoke on Tuesday night and I love what they wanted us to speak on.  They wanted us to speak on continuing bonds after the loss of a family member and how do we continue those connections.
G: Yeah, there were just some great people and we got a couple of questions for our guest today, Bill Worden, which we’ll bring up a little later on.  And then Heidi had to take the red eye back to New York and tell our audience what you did back there.
H: I did.  So right after we did our presentation on Tuesday night, I jumped on a plane and flew to Manhattan back to JFK and last night I went to an event at the Museum of Natural History and it was put on by the American Foundation of Suicide Prevention.  It was to honor Eric Hipple, and he is one of the people that we’re writing a book with right now on men and depression, and he was given the “Survivor of Suicide Loss” award, and it was a really, really nice event, and it’s really to talk about the stigma of depression and suicide and get the word out there and be proactive in educating people about what are the signs of depression and suicide?
G: And if you remember, if you listened in on our show, Eric Hipple was a quarterback for the Detroit Lions for ten years and is now with the University of Michigan Depression Center, and our new book coming out – I think that we’ve got the name nailed down — it’s going to be Real Men Do Cry dealing with depression and suicide.  Tackling, it’s going to be, right?  Football analogy.
H: It’s Tackling Depression and Surviving Suicide, and if you haven’t heard Eric’s show, I would really recommend it because he relates in so many ways to males and men and gives voice to what they’re going through.  It’s a very good show and it’s very educational and he’s a great person.
G: Oh, he is, and you said he did a great job last night, too.
H: He’s so down to earth and he gets up there and he can just connect with everybody on many many levels and he’s just a really easy approachable person.
G: Yeah, and we want to congratulate Eric on that award.  A wonderful thing for the work he’s been doing.  Well, our poetry contest is over as you all know, and it’s just been so wonderful, and we have our first, second, and third place, and Heidi’s going to read the poetry from our third place, and I’ll have to tell you, we have been getting wonderful emails on the Internet about the contest and how much the poetry has meant to people, and we want to thank everybody and we’re definitely going to do it again next year.  It’s just been wonderful so start writing those poems and get ready to submit something for next year.  So, okay, Heidi, do you want to read our third place winner?
H: Sure.  Her name is Lana Golembeski and the name of her poem is “The Promise of Spring.” 
It is yet another cold blustery day in Minnesota.
As I look out onto the two feet of snow,
I wonder if spring will ever come.
In my eyes, it looks impossible.
How can spring come?
All I can see is snow
and all I can feel is the cold.
And yet, despite all of that,
I know that spring WILL come…
no matter how difficult it is to comprehend at the moment

Isn’t our search for hope and joy again
after losing our children much the same?
I sit here and wonder how I can ever find joy again in my life.
Everything and everyone I have ever loved
has been taken from me.
Just as it looks impossible for spring
to come back to Minnesota,
it looks like I will never have joy and hope again in my life.

But just as spring WILL come,
I must rest assured that joy and hope
will find me again some day.
I don’t know how or when it will happen.
But I hold on fast to my friends and my faith….
waiting for that day…
when joy will break through the broken surface of my heart
and it will spring anew.
That’s very very powerful.
G: Beautiful.  And thank you so much Lana for that poem and it’s just wonderful, and again, for all of you who submitted poems for our contest and hopefully when we get a collection of poems, we can come up with an anthology of this poetry because it’s really very touching.  Well, Heidi, we’ve got a wonderful guest today, and we were telling him before the show started that when I taught nursing at the University of Rochester Nursing School many years ago, I used William Worden’s book, and Heidi, you’re using it now, right?
H: I’m using it now to teach my graduate students at Columbia and I am so honored to have William Worden with us because he is definitely a leader in the field and I think he was a man that was way ahead of his time with his thoughts about grief and loss and what he said way back when still holds true today so I’m very excited to talk with him.
G: So why don’t you introduce him, Heidi.  Give us a little introduction for our audience.
H: Very good.  As I said, our guest today is Dr. William Worden and our topic is “Families Coping with Loss.”  Dr. J. William Worden is 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 today.  Welcome to the show, Dr. Worden.
B: Good morning.
G: Hi, Bill.  Welcome to the show.
B: Thank you very much.
G: It’s great having you on.  We have gotten some wonderful emails and questions that people have sent in and we’re very excited about this show.  I wanted to start out by asking you how you got in the field of grief and loss.
B: 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.
G: And there was nothing going on at that time, right?
B: There was nothing.  This was the very first effort.  We limited to a hundred people and they came for a couple days for continuing ed and then we did a combination of trying to help and explore their own losses and how that might impact on working with bereaved individuals but also then to do some skill building in small groups and so forth.  Very successful so we offered it once.  There were over a hundred so we limited to a hundred and then offered a second time that year and then for about the next five or six years, we offered it twice a year and because it was the only program of its kind at that time.
G: What made you connect with the idea of Kubler-Ross?  Did you have anything in your past life in your background?
B: I haven’t explored my past lifes yet.  I’m open to that.  I hear Oprah’s doing that kind of thing these days, but, no, I’m sorry.  No.  People have come up to me formally in terms of when I first was in the area wanting some kind of a loss history, but it really hasn’t been particularly and I’m not sure why but the area has certainly fit my personal interest as well as my professional interest, but no major losses in my early life.
H: And what did you think?  I know you were working with Kubler-Ross.  What did you think about the fact that her stage model which was meant for people that were terminally ill became a model that people were looking towards that were grieving?
B: Yeah, that’s kind of odd how that happened, but it did happen and what Weisman and I did at Mass General after her 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.
G: It’s incredible and it’s so fascinating to hear you say this because people really believe that.  I still hear them talking about it.  I hear professionals using it with bereaved people and then I hear the bereaved people saying, you know, I haven’t done anger yet.
B: 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.
H: Yeah, because it’s scary to think, okay, I’m in this stage of depression, and then all of a sudden you get angry and you think, oh, oh.  What’s happening?  Anger’s an earlier stage.  What’s wrong with me?  Whereas your model, like you said, it’s fluid.  You go back and forth between feelings, and it’s normal.
B: Yeah, I think so.  I tried to make it that way because that’s sort of the reality of my experience after a loss as well as the individuals and families that I would work with.  So it 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.
G: Can you give us a quick run down before we go to break of the tasks and then I’ve got some emails that I think are going to fit very well into this.
B: Okay, sure.  Let me just do it really quickly.  It’s interesting, my daughter said to me the other day, I can’t remember the task.  You need a table, dad, in your new book.  Okay, so, I heard her anyway.  Yeah.  They’re just things that need to happen.  Sometimes it’s very easy depending on the death circumstances, and who died, and so forth, and other times much more difficult.  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, and a lot of my new grad students, they think, well, of course she knows he’s dead.  She went to the funeral and so forth, but it’s much much more subtle.  I have a woman in one of my bereavement groups who every morning she reaches over to her husband’s side of the bed.  He’s been dead about six months.  And to see if he’s there.  She knows he’s not going to be there but there’s that hope, you see.  So if I don’t change the clothes or empty my kids room or whatever it is, they may come back and they will need those toys or those clothes.
G: You know, Bill, this is so good.  We’re going to go to break now and then we’ll come back and do more with these tasks again, because I think that they’re extremely important and a lot of things are coming up for me when you’re talking about this.  So it’s time for a break now and we’re with William Worden, and we’re talking about dealing with the loss of a child or a family member, and you can reach us through our blog, www.thegriefblog.com, and also if you’d like to call in with some questions for Bill, our number is 1-866-472-5792, and you can also download these on mp3 files.  Also, if you want to email me, I’ve got my computer here and we can pick up the emails during the show.  Please stay tuned for more.
Well, Bill, when we went to break, we were talking about those tasks of mourning and we just got to the first one.  How many of them are there?
B: There are four and as I said before the break, I think the tasks are useful because they’re much more dynamic and fluid.
G: I want to say before we get into this, for people who have just tuned in, we were talking about the Kubler-Ross model, that anger, denial, depression, acceptance kind of thing, that really Bill’s done some studies on it, right?  And people really don’t move in that direction.
B: Not at Mass General, yeah, and we had a large grant from the National Institute of Mental Health back in the late 60s actually for 18 years and looking to see.  For example, denial, just to pick one of them, is an intermittent phenomenon.  Some people deny early.  Oh, they must have gotten the wrong x-ray.  It can’t be happening.  It isn’t me.  And others, there’s no early denial but it may be later that it comes in there.  And for some, there is none.  So it’s an individual kind of thing.
G: And so let’s go through the four tasks.
B: Okay.  The first one was to accept the reality of the loss, and it’s a subtle thing, as I said, to really wrap my mind around the fact that my loved one, my child, whoever is not coming back as they were and that takes a long time for people.  And one of my patients, her son flunked out of college just after her husband died, went to Europe, and came back from Europe after a year there, went over a cliff in a car and was killed with himself and another friend of his, and for eighteen months she went around not believing that he was dead but that he was still in Europe like he had been just preceding.
G: Now, did she see the body?
B: She didn’t.  This is an important piece.  She was advised not to see the body by a family friend who did identify the body of her 17-year-old son, and she said to me many many many many months later, I wished I had seen the body.
G: And I think there are other audience members who are feeling exactly that.  What would you say to her?  What did you say to her?  And what can you say to them?
B: At that point, there was nothing she could do, obviously.  But if I’m working in the emergency room and I have somebody come in and say their child is killed in a motorcycle crash.  This happened just two weeks ago.  And if I’m talking with them, working with them, I might ask them if they would like to see their son’s body – it’s often a male.  And there’s some hesitation and I leave the choice up to them, but I have found myself encouraging them saying, you know, I’ve had people come back to me later and wish they had done that.
G: Okay our audience are those people who wish they had seen it.  What do you have to say to them? 
B: Well, there’s just really nothing they can do at that point, but I think that one of the things that this whole area of memorialization of finding ways to remember – if it’s in the case of a child – remember my child as part of the grieving process.  But the point is that it’s very difficult if I don’t see the body and then there’s different religion and cultural traditions there but I’m very much positive for that.  Even if it’s a part of the body that’s tastefully displayed because sometimes somebody’s very very broken up from an accident, but if there can be a part that’s tastefully displayed for the family.
G: Yeah, and so what I want to say to our audience out there is what we’re saying is, it could be a little more difficult for you but recognize that.  Recognize maybe you’ll stay into that.  It’ll take you maybe a little longer than other people and be aware of that.
B: It could, yeah.
H: Maybe we can do rituals and memorials around the event somehow to honor the person that died because there’s also the idea that – I work with 9/11 families and a lot of them didn’t have any choices.  There was no body to see.  So there’s also that as well.  Some people don’t have that option.
B: Yeah, and this is one of the things I just wrote about in the fourth edition of the book that’s going to be coming out this fall is that there are these losses which are ambiguous; that is, you don’t have a body.
G: And sometimes people don’t even know they’re missing for years.
B: Right, exactly.  We saw this so often during the Viet Nam era war where they thought they were dead but then on several occasions, people came back many years later.  But I think one of the pieces.  Let me just give you a quick footnote.  I was asked to work with some of the families after the Korean airliner was shot out of the sky a number of years ago and there were no bodies retrieved from that event and it is very difficult for some of the families, families I worked with to really believe.  They knew on one level the person was dead, but on the other hand, they didn’t.  And it was very helpful when the South Korean government put up a monument with the names of those people on there so that some of those families could go back and see that and they kind of crystallize it.  They knew they were dead on the one hand, but this sort of made it much more tangible and concrete.
G: So our acceptance is our first task.
B: Yeah, to believe that it happened and again sometimes many kinds of deaths are not difficult to believe, but some are, particularly these ambiguous losses that I mentioned.  And 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.
G: We’re getting an email here, it just came up, from somebody named Joan.  Thank you, Joan, for sending in an email, and she said my developmentally challenged daughter died last year of an infection.  People seem to think that she is better off in heaven.  It makes me angry.  She had the smile of an angel, and I wanted to ask Dr. Worden, how do I deal with my anger, and what are his thoughts on this?
B: Well, I think it’s helpful to some people to express that anger directly to the person.  I’m thinking about a patient of mine from Boston whose husband died suddenly, left her with five teenage boys, and she had to do stuff that he would always do, and she was very very angry, but she said to me, how can I be angry?  He didn’t want to die.  He just had cancer.  But the point is she was angry.  Do you see what I mean?  And she needed to be able to identify that anger and then to find an appropriate place to target it.  Sometimes kicking the cat can be helpful.
G: How about this idea that Joan put in that her daughter’s developmentally challenged.  I think people sometimes think, oh, you’re better off.
B: Oh, yeah, yeah.  Exactly.  And that’s obviously not so because Joan and her daughter had a really special relationship there.
G: And plus it’s a full-time job taking care of a developmentally challenged.  You’re out of a job, too.
B: Absolutely, 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.
G: I think that third task is so key because I think a lot of people don’t recognize it.  I think that third task of who am I now is really important because our parents tell us and people tell us, particularly parents say there was before and then there’s after and I’m not the same person any more, but then who am I?
B: Yes.  Exactly.  And so after you deal with the feelings – and that can take time – the feelings can come back.  We revisit it.  Anniversaries are particularly, as you all know, big times for feelings to come back in spades and need to be re-felt and so forth.  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. 
G: Give us our fourth task because we’re going to have to go to break and then we’ll come back to these when we come back from break.
B: Okay, the fourth one I have struggled with over the four editions of the book and here’s the latest way that I’ve written it.  Define an enduring connection with the deceased while embarking on a new life.
G: Right.  I like that.
B: I do, too, and maybe after the break we can talk about the idea of continuing bonds and how that came out of our Boston Harvard research that Silverman and I did.  Let’s think about that.
G: That’s great.  When we get back from break, we’ll revisit the four tasks and talk a little bit certainly about the final task.  And we’re talking to Dr. William Worden today.  You’re listening to Healing the Grieving Heart.  You can reach us through our blog, www.thegriefblog.com.  Remember that you can blog on about the things that are going on in your life and comment on the things that are going on with other people.  You can also download these shows on mp3 files.  We’ve got over a hundred shows archived on the website, and we hope that you will all tell your friends about it and listen in, and if you have a friend who doesn’t use a computer, you can download transcripts of these shows.  So we’re coming to break and please stay tuned for more.
When we went to break, we were going over the tasks of mourning and I’m going to just go through them for our audience.  Accept the reality of the situation, not the loss.  I think that idea of continuing awareness, too, of the thought of it.  And then process the pain of grief.  You make a point that grief is work, right?
B: Yes, exactly.
G: It’s not an easy thing.  And the question three is who am I now?
B: Well, the third one is adjusting to a world – let me just expand it a little bit here, Gloria – adjusting to a world without the deceased.  Now the external adjustments – getting used to sleeping in an empty bed or fixing meals for one or whatever it is, those are external adjustments.  Internal adjustments are who am I now?  That’s the part.  In other words, how has the death affected my sense of myself?
G: You know we have a person who is very much in touch with us on the blog and information.  Her name is Kim.  And Kim lost her only child two-and-a-half years old and she is so clear about struggling after two-and-a-half years.  Who am I now?  Who is a mommy without a child?
B: Yes, exactly.  Am I still a mother?  And that’s the kind of thing.  And then the third part of this third.  Not to get convoluted.  But the third part of adjusting to a world 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.  Not every death does that, you know.  When my mother died a few years ago at ninety-six, there was no challenge there.  She was an old lady.  She had a grateful life, and so there’s no spiritual challenge at that point.  But for some, especially when you lose a child or somebody suddenly, a death out of season, there’s a lot of spiritual meaning making challenges.
G: Of course, I think even if you lose an older mother or dad, who am I now without my parents?  I’m the next.  Because I’ve lost both my parents, too, and I think there is a challenge there, a question.  I don’t think you suffer like I did when I lost a child, but I did wonder, who am I now?
B: Exactly, and I mentioned at her funeral that we’re now orphans and it didn’t go over too big, but, you know, that’s how I was coping with my grief.  Kind of goofy.  The final one here is one that I think we need to share with the audience, and that 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.
H: What year was this, Bill?  I know the book that Silverman wrote was in ‘96, was that correct?
B: Yeah, but the impetus for a lot of that in the book.  Yeah, Silverman, Steve Nickman who was our psychiatrist on the project and so was Silverman, wrote this excellent book called Continuing Bonds, and it goes to show that the old Freudian notion of disengaging from the person who died so that one can move on with life is not a valid model to think about it.
H: I think it took awhile for people in the academic world to catch on to this concept because it wasn’t until 2007 that death studies devoted an entire journal to continuing bonds, and I’m one of the authors on one of the articles, and it was so exciting to know that the entire journal was going to be devoted to something that you had studied in ‘96 over ten years ago.
B: Well, things move slowly in academia.
G: But what I love right now is we are bringing this to the general public, and we are talking about these concepts that have been floating around in the grief world with the academics and we’re bringing it here.  Well, I wanted to cover a few emails here for our audience now that we’ve looked at these tasks.  One is from Ron, and Ron is age 55, and he says, my 30-year-old son died of cancer seven months ago.  He was married and had a family.  I keep thinking I’m recovering and then I just fall apart and slide back.  Is this normal?
B: Oh, I think so, yeah. 
G: I think it’s getting into this stage thing.  He thinks he’s going to progress.
B: Right, exactly, and 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.
G: You can have a smell or a sound.
B: Absolutely.  I was in Filene’s department store and heard music one time and just broke out in tears.  Why?  Because a friend of mine had died suddenly and that particular song I associated with this friend and it didn’t last a long time, but it was something I was not expecting going through Filene’s department store in Boston.
G: I think you just made a key point.  It didn’t last a long time.  I think that’s what happens.  You do go back.  It’s been my experience after Scott died that I did fly back but it didn’t last as long.
B: Yeah, and let me just give you a quick quote.  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.
G: Yeah, overwhelming and it could be frightening, and especially, I think, sometimes Heidi and I have talked about teenagers.  They’re sometimes afraid to express all that grief because they’re worried.  They’re afraid that they can’t get back.
H: And then parents get worried, Bill, that their teens aren’t grieving, and I was wondering what you’d say to them, because so many parents come to us and say we don’t think they’re grieving.  They’re not talking to us about what’s happening and we’re worried.
B: And one of the nice things about the Silverman Worden study that we did at Harvard is that we found that there’s a lot of room for individual differences.  I’m talking about adolescents particularly.  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.
G: Okay, if you’re a family that is having difficulty sharing.  You’re out there.  You’re saying I’m going to a group.  I think we have an email here where a man is saying that his wife says that he needs to go to group.  She goes to group and talks about it.  She thinks he needs to go to group and talk about it but he thinks he’s doing fine.  So what about that?  You’re saying families who can talk about it do better.  So what if I’m out there and I want my family to talk about it but they don’t want to talk about it.
B: Well, it sounds like he doesn’t want to talk about it with a group and this is very common in my experience doing hospice groups with men.  Women are more likely to want emotional sharing kinds of groups.  Men are more skittish about that kind of thing, but I don’t think, even if he did go to the group, his talking about it at the group would be as healthy as if somehow this woman who wrote you could somehow facilitate a discussion about whoever it was that died in that family, including other family members.  I don’t know who died in that family.  Do you remember who it was?
G: It was actually a daughter killed by a drunk driver last year.
B: But there are other kids maybe do you think?
G: Yeah, she’s just going to a support group.  His wife thinks he should go.  She says I definitely need a support group in order to really grieve.  Is this true?
B: Yeah, and support groups are fine but maybe the support group can give her some clues as how to bring that back into the family.
G: How about therapy?  What’s your thought on that?  Grief therapy?
B: Well, I think grief therapy is good for people who are having some kind of complicated – what I’m calling in the book, 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.
H: Now, Bill, you said women like emotional sharing groups, which I agree with you.  What kind of groups work for men, for most men?
B: Well, let me tell you.  That’s interesting you should raise it.  We tried all kinds of things.  I fancy myself to be a little creative so we tried all kinds of butch activities for men, you know.  Monday Night Football to get them to come out, and none of them worked.  And one day, I’m standing in my office, which is right overlooking the Charles River in Boston, and I suddenly thought now this is just silly why I haven’t thought of this.  Men will come if we offer them something that has to do with problem solving and in the Harvard study, most of these men were not good single parents.  They didn’t have the training, the skills, and so forth.  So we started offering groups for men to teach them how to be better single parents and they came.  They didn’t want emotional support but they sure as heck wanted to know how to be a better single dad to their kids.
G: I like what you’re saying because I’m thinking of the women that are listening to this show right. now.  Bill’s saying, do it yourself and bring it to your family.  Don’t try to force people to go.
B: I think that’s better.  Yeah.  It’s just like couple’s therapy.  And if the husband comes in to couple’s therapy kicking and screaming, he may come one visit and I like to try to snooker him in from that point, but it doesn’t always work.  By snooker, I mean get him to see the value of working with the wife as a couple.  But I’m telling you, Monday Night Football didn’t do it.  As soon as we started offering those skill building, how to cook, how to manage this, that and the other thing.
G: Really practical things.
B: Very practical things because men – we took consecutive deaths from the Greater Boston Area, different communities, and so we had a really good sample, and what we found was that very few of these men could be a single parent.  They just didn’t know how to do it.  If a father dies, and the mother’s left, not a piece of cake, but really easier.  See what I mean?  Because meals can be on the table.  Bedtimes.  Homework assignments, and so forth.  Those keep consistent, which really amounts to the benefit of the children.  But when mom dies and dad’s left as a single parent, I’m telling you, you’re lucky to have meals on the table let alone on time.  One teen girl was going to bed about 11:00, 11:30.  Her dad said, oh, you’re going to bed so early.  Well, because he was lonely.  If mom had been there, she’d say homework’s not done.  10:00 o’clock.  Go to bed.  You get up early and finish the homework.
G: It’s time for us to go to break, but I think one of the things we’re hitting on right here now is having a person die in your family unit is a disruption and learning those new roles and taking on those new roles including kids, teens, everybody takes on these new roles and maybe that’s something we can talk with Bill Worden when we come back from break.  You’re listening to Healing the Grieving Heart and we want you to remember that all these shows are archived on our website, www.thegriefblog.com, and this show is brought to you by the Open to Hope Foundation.  Please stay tuned for more.  And this is our last break, by the way, and so we’re going to ask Dr. Worden if there’s anything he feels like we’ve missed when we come back so please stay tuned for more.
 
Well, Bill, this is our last segment.  It’s just amazing having you on the show.  You are a total fountain of knowledge both academic and in your own practice.  We could go on for five more shows or whatever talking about all this information we brought up.  But I just wanted to recap a few things before we end the show.  I want to talk about the idea for our audience that it isn’t – hope you’ve gotten the idea from this – that it’s not the stages of grief.  You don’t move through the denial and anger and you’re supposed to keep consecutively going through because we really wanted to point that out to you because I know people are very concerned about backsliding and that kind of thing.  And also that there are tasks that you can go through, but those tasks aren’t consecutive, are they, Bill?
B: No.  They can be reworked and several tasks can be worked on at the same time.
G: And also kids with their different age groups – a 7-year old is going to deal with it differently.  I was just talking to a woman a few minutes ago who was telling me that her daughter who was 4 when her sister died is now 8 and she’s reprocessing it, and she’s also concerned that her mother’s going to die.
B: Yes, and this is an interesting thing because in the Harvard study, and we followed these 125 kids along with 125 who aren’t bereaved, and we found that one year after the death of a parent 50% of these kids still were frightened and anxious about the safety of the surviving parent.  It was a much larger figure than it was four months after the parent died, and I think the reason is that as they go through that first year of grieving, they realize, I’ve only got one parent.
G: Then, of course, there’s the idea that as you get older, you understand reversibility and that people die and what death means.
B: Yes, exactly.  And you need, as you indicate, a certain cognitive and emotional level of development to really understand.
G: And when we went to break, we were talking about the family shake up.  I almost think of it like I used to put chicken in a bag with flour and salt and shake it up, and then you cook it, and boy, you’ve got the family in there.  You’re shaking ‘em up.
B: Yeah, and there needs to be the reallocation of roles and sometimes this is easy and people pick up the slack but other times it isn’t, and one of the things that we found in the Harvard study was it is so unhelpful to have a – like say, dad dies, and have an uncle say to the oldest male in the family, the oldest boy, now you’ve got to be the head of the family.  Dad’s gone and you’re the oldest.  This can be a horrible horrible legacy to leave with a young man, but also we found others in the study who took on that ascription themselves.  They said now dad is gone, I’ve got to do it.  So the helpful thing is to be able to talk about that so that mother can say no, we don’t expect that you’re going to take care of your little brothers.
G: Yeah, because people have a lot of ideas that if not expressed, they have these rituals and do these certain things.  Well, it’s almost time to close and I wanted to ask you do you have any special comments – you or Heidi?
B: Yeah, we talked about the four tasks of mourning which is really tough for a lot of people and especially tough for parents who’ve lost children, and how do I find an enduring connection with my dead child while somehow enabling me to go on and live my life.  And this is a woman who had a real struggle with this task and she wrote the following, which I thought was so poignant.  It’s just a couple of sentences.  She said, only recently have I begun to take notice of things in life that are still open to me.  You know, things that can bring me pleasure.  I know that I will continue to grieve for Robbie for the rest of my life and that I will keep his loving memory alive, but life goes on and like it or not, I’m a part of it.  Lately there have been times when I notice how well I seem to be doing on some project at home or even taking part in some activity with friends.  So this is a woman who’s just emerging from that struggle of I want to keep my child’s memory with me but also they’re gone and I’m alive and how do I then move forward.  Not an easy task and it’s one that sometimes comes many years later as you indicated.
G: Well, thank you so much for being on the show.  It’s been a great show.
B: Well, my pleasure.  Thanks for the invitation.
G: We’ve been talking with William Worden on “Families Coping with Loss,” and it’s time to close our show, and please stay tuned again next week when our guest will be Clara Hinton and her topic is “Finding Your Way After Sibling and Child Loss.”  Clara’s the author of Silent Grief: Miscarriage-Child Loss: Finding your Way through the Darkness.  She also has a wonderful website.  This show is archived on our blog, www.thegriefblog.com, as well as www.thecompassionatefriends.org website.  So please stay tuned again next Thursday at 9:00 Pacific Standard, 12:00 Eastern, for more of Healing the Grieving Heart, a show of hope, renewal, and support.  Remember, others have been there before you and made it.  You can, too.  You need not walk alone.  Thanks for listening.  I’m Dr. Gloria Horsley.