Summary

In Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (4^th ed.), J. William Worden provides an introduction to bereavement/loss, grief, mourning, and providing grief counseling or therapy. Worden defines grief to be the experience one goes through during a loss (and specifically for the purpose of this book, the loss of a loved one due to death). Mourning indicates the process one undergoes as he or she endeavors to adapt to a loss. And bereavement may be understood as referring to the specific loss to which the mourning individual is trying to adapt.[1]

Worden begins by addressing the concept of attachment. According to Worden, grief is rather incomprehensible or unexplainable a part from attachment. Attachment—“the tendency in human beings to create strong affectional bonds”— to someone (or something) is what makes the loss of that something (or someone) something that needs to be grieved.[2]

Worden distinguishes between normal (or uncomplicated) and abnormal (or complicated) grief. Normal grief may entail or be accompanied by a large variety of emotions, thoughts, and behaviors such as sadness, anger, guilt, depression-like symptoms, shock, preoccupation, various somatic sensations and distresses, insomnia, etc.[3] Worden stresses the importance of recognizing this broad range of experiences (including those that may seem rather odd or abnormal according to everyday experience) “so that they [counselors] do not pathologize behavior that should be recognized as normal.”[4] What makes abnormal grief abnormal, according to Worden, is not the presence of experiences that may seem bizarre compared to regular functional existence, but the intensity and duration of otherwise normal grief-reactions.[5] Thus, abnormal grief includes the following expressions: chronic grief—grief that is excessive in length or lacks resolution; delayed grief—postponed, inhibited, or suppressed grief reactions; exaggerated grief, which involves excessive intensification of the grief experience resulting in maladaptive behavior or feelings of being overwhelmed; and masked grief, where grief reactions are expressed in covert forms.

In contrast to viewing the process of mourning as occurring in stages or phases, Worden prefers a task-model. The benefit of framing the mourning process as comprised of tasks is that it presents the grieving individual as an active, rather than passive, agent. Mourning is not just something that happens; it is something that is accomplished. Nonetheless, Worden cautions against seeing the tasks as occurring in a strict chronological and logical order.[6] He identifies four tasks in the mourning process: (1) accepting the reality of the loss; (2) processing the pain of grief; (3) adjusting externally, internally, and spiritually (or religiously) to a world without the deceased; and (4) moving forward in life while retaining a meaningful bond with the deceased.[7]

A constant emphasis throughout the book is the need to recognize the complexity and uniqueness of each individual’s grief experience and the mourning process. As Worden states, “Even though the morning tasks apply to all death losses, how a person approaches and adapts to these tasks can be quite varied.”[8] A variety of complex and interrelated factors impact how grief and the mourning process are experienced. These factors include things such as one’s relationship to the deceased, the nature of the attachment to the deceased, the circumstances of the death, the expectedness of the death, cultural expectations for normal grieving, the griever’s age, gender, coping style, personality, worldview, social support, family network, etc. These, and many other factors, are what Worden calls “mediators” of the mourning process.[9] Similar social, relational, circumstantial, historical, and personality factors explain why some experience complicated (abnormal) grief.[10]

Finally, at various portions throughout the book Worden presents material related to helping those experiencing grief. This involves extra attention given to special types of loss such as loss as the result of suicide, sudden infant death syndrome, miscarriage, stillborn birth, abortion, AIDS, etc. Important to note is Worden’s distiction between grief counseling, which he defines as “helping people facilitate uncomplicated, or normal, grief to the tasks of mourning within a healthy time frame,” and grief therapy—the use of specialized techniques by trained professionals for helping those with complicated grief.[11]

Review

Worden’s work is commendable. Worden shows scholarly excellence in his field. He interacts with past theories and contemporary research. His writing style is clear and simple. Frequent use of illustrations helps make otherwise abstract concepts more tangible. His material is very well organized. As such, this book would function well as a handbook or quick reference tool for practitioners.

His work is relatively comprehensive in that it does not leave any seemingly significant stones unturned. He does well to uncover and address a full range of factors involved in whatever subject matter is at hand. For example, I appreciate his emphasis on the complexity and uniqueness of each individual’s grief and mourning experience. Rather than concede an overly simplistic sketch of the mourning process, Worden exercises diligence and excellence as a practitioner by exposing and examining a variety of factors that make each griever’s experience complexly unique.

Two further features of Worden’s work stand out to me as particularly helpful. First, in contrast to other (potentially overly simplistic) approaches to the mourning process that view the stages of mourning as sequential, Worden advocates for the “sequential flexibility” of the mourning tasks, i.e., the four tasks are not intended to communicate a strict sequential order; the griever may move back and forth between the mourning tasks. Second, Worden’s attention to the practitioner’s condition is needful. For example, a practitioner’s personal experience with grief may encumber his or her ability to provide counsel as successfully as otherwise possible. Recognition of the importance of such factors requires that practitioners maintain a level of self-awareness and perception of their limitations.

By way of critique, I will conclude this review by identifying a distinctively Christian concern that demands attention. Throughout the book, Worden is sensitive to spiritual and religious dimensions in the grieving and mourning process. Specifically, in task 3 of the mourning process, he addresses meaning-making—identifying (or attributing) meaning to a loss—and adjusting spiritually or religiously to a loss. On the one hand, Worden recognizes that religious commitments help many clients find (or see) meaning in a loss; and thus Worden understands that an individual’s religious framework shapes his or her interpretation of a loss-experience. However, his view of spiritual adjustment in task 3 of the mourning process seems to involve, on the other hand, the idea that the mourner’s experience shapes his or her religious worldview.[12] My concern is, as evangelicals who do not have the “convenience” of fickly adjusting our Biblical commitments when faced with a loss, how will we handle the potentially religiously disconcerting nature of some losses? To provide an example, for evangelicals committed to the doctrine of hell, what will healthy and Biblical grief (or grief counseling) for the loss someone who is unsaved look like? This matter is clearly beyond Worden’s interests; but it ought not be beyond the concern of committed, pastorally-minded Christians living in this death-ridden world.

Notes:

[1] J. William Worden, Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner, 4 edition. (New York, NY: Springer Publishing Company, 2009), 17.

[2] Ibid., 13; see also 13-16.

[3] Ibid., see 17–31.

[4] Ibid., 31.

[5] Ibid., 134.

[6] Ibid., 37-39.

[7] Ibid., 39–53.

[8] Ibid., 8.

[9] Ibid., 57–75.

[10] Ibid., 127–133.

[11] Ibid., 83.

[12] For example, Worden states, “Death can shake the foundations of one’s assumptive world. Loss through death can challenge one’s fundamental life values and philosophical beliefs–beliefs that are influenced by . . . religion. . . . (Grief Counseling and Grief Therapy, 48-49).