William Worden.2009. Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner.New York: Springer.
Review by Stephen W. Hiemstra
The problem of unresolved grief could reasonably be described as posing a silent healthcare crisis. When I worked as a chaplain intern at Providence Hospital about half of the patients that I visited had presenting diagnoses brought about or complicated by resolved grief. This outcome is no doubt related to the unwillingness of American culture generally to respect the grieving process and of many people to participate in organized religion where they might better share their grief with a support group. Unresolved grief may lead to anxiety and depression or simply be confused with both.
In his book, Grief Counseling and Grief Therapy, William Worden writes:
“In this book I am using the term ‘mourning’ to indicate the process that occurs after a loss, while ‘grief’ refers to the personal experience of the loss.”(37)
He further explains:
“I make a distinction between grief counseling and grief therapy. Counseling involves helping people facilitate uncomplicated, or normal, grief to a healthy adaptation to the tasks of mourning within a reasonable time frame. I reserve the term, grief therapy, for those specialized techniques, described in chapter 6, that are used to help people with abnormal or complicated grief reactions.”(83)
Worden spends the first half of the book explaining the process of mourning and dealing with uncomplicated grief. The second half of the book focuses on complicated grief and special situations that arise.
The Mourning Process
Worden (39-50) divides the process of mourning into four tasks:
- Accepting the reality of the loss,
- Working through the pain,
- Adjusting to a world without the deceased, and
- Finding connection with the deceased while moving on.
The first task is to get beyond denial—a funeral with an open casket helps mourners get over the denial. The second task has to deal with the pain that may be accompanied by anxiety, anger, guilt, depression, and loneliness. The third task is to account for all the activities that the deceased shared with you and to find alternative arrangements. The fourth task is the re-evaluate your relationship with the deceased while moving on.
Challenging Grief Situations
Getting stuck in any one of these four tasks may flag a case of complicated grief. Generally, complicated grief is a consequence of having a complicated relationship with the deceased. Complications might include unfinished business, broken relationships, co-dependencies, or psychiatric issues. Factors inducing guilt or shame normally complicates the mourning process.
Special circumstances arise when the grieving person is prevented from participating the normal mourning process, such as suicide, physical absence, death from AIDS, or death of someone involved in an affair. Sudden death or multiple deaths pose other special circumstances.
Background and Organization
William Worden has most recently been a professor of Psychology, Rosemead Graduate School of Professional Psychology, California. He has taught and practiced psychiatrics at a number of institutions. His doctorate and final post-doctoral work were at Boston University. He also has a seminary degree.
Worden writes in ten chapters:
- Attachment, Loss, and the Experience of Grief
- Understanding the Mourning Process
- The Mourning Process: Mediators of Mourning
- Grief Counseling: Facilitating Uncomplicated Grief
- Abnormal Grief Reactions: Complicated Mourning
- Grief Therapy: Resolving Complicated Mourning
- Grieving Special Types of Losses
- Grief and Family Systems
- The Counselor’s Own Grief
- Training for Grief Counseling(ix-xi)
These chapters are proceeded by a preface and introduction and followed by an appendix, bibliography, and index. In view of the media handling of mass shootings and other disasters in recent years, I wish that Worden had also written a chapter on secondary trauma, a kind of vicarious loss.
William Worden’s Grief Counseling and Grief Therapyoffers a thorough understanding of mourning and complicated grief. Since 2011, Worden’s advice and counsel has informed my pastoral approach to grieving people and I frequently go back to refer to the chapters. Although Worden writes to professional counselors in an academic context, his writing is accessible and understandable.