Grief Theories and the Thinking Behind Them

The key similarity of all of these grief theories is that they assume a linear and progressive timeline for grief, which views grief as work or tasks to be undertaken by the bereaved. 

William Worden’s tasks of mourning are: 1) to accept the reality of the loss, 2) to work through the pain of grief, 3) to adjust to an environment in which the deceased is missing, and 4) to find an enduring connection with the deceased while embarking on a new life. [6] In this sense, Worden’s theory of grief allows for an “enduring connection with the deceased,” but he still discusses mourning as though it should be something one “gets through,” or ”completes,” rather than grief that one learns to live with. Similar to Worden, clinical psychologist Therese Rando’s tasks of mourning view grief as a shift from loss recognition to a readjustment to a new world without the deceased. [7] The key similarity of all of these grief theories is that they assume a linear and progressive timeline for grief, which views grief as work or tasks to be undertaken by the bereaved. Members of our collective have found that any discussion of grief through a stage-based lens, or work is not helpful, and in fact, may impede the grieving process.

So, what does healthy grief look like, then? Grief impacts people psychologically/emotionally, behaviorally, cognitively, physically, and socially, impacting individuals, families, and society. Members of our collective utilize a variety of methods and approaches, from the Dual Process Model to Continuing Bonds Theory to Narrative Grief Therapy, but all these grief therapies encourage someone to learn how to live with the grief, to incorporate the grief into their daily life, and share that grief with others, knowing that the way this grief feels and looks will shift on a regular basis.

Stroebe and Schut’s dual-process model of grief suggests that the bereaved person oscillates between a loss orientation and a restoration oriented model of coping, [8] in which a person may feel the loss of their loved one keenly, followed by periods in which they feel okay again, but the process continually shifts, and sometimes one feels both ways at once. The dual process model recognizes the ongoing unpredictability of grief and acknowledges that the living may continue to have a relationship with the deceased.

Expanding on this idea, Klass, Silverman, and Nickman’s [9] theory of “continuing bonds” describes what many around the world consider to be caring for the dead, [10] and is a dominant grief paradigm in the non-western world. No longer viewed as part of a maladaptive grieving process, and re-evaluating the process of mourning in light of John Bowlby’s Attachment Theory, [11] Klass, Nickman, and Silverman view the ongoing attachment to the deceased as healthy and even expected. Continuing Bonds Theory argues that grief may in fact be a life-long process—one that may not ever be completed, or finished—and validates continuing a new version of the relationship with the deceased. Relationships with the dead are not static ones, but changing and valuable ones that will continue to develop as we move through life. In short, this “model of grieving …focuses on the complexity of human relationships and the ways in which people remain connected to each other in life and in death.” [12] While Continuing Bonds Theory has seen wide acceptance in the United Kingdom and in Europe, it has not yet been broadly promoted in the United States, even though in some ways, it is one of the more pluralistic and ecumenical grief theories in the toolbox.

These grieving theories all share the same characteristics: they encourage us to grieve, to express ourselves, whether through words, art or music, and they validate the constant shifting we may feel as mourners. 

Finally, Robert Neimeyer’s Narrative Grief Therapy [13] utilizes a variety of narrative and artistic tools to encourage grievers to reconstruct meaning in a world without their loved ones. Being able to name one’s feelings, find words to express our loss, and engage in artistic expression to convey our emptiness is no small thing in a world that has suddenly shifted, and in which the absence of another is a huge vacuum that others may not necessarily share. For Neimeyer, grieving “requires us to reconstruct a world that again 'makes sense,' that restores a semblance of meaning, direction, and interpretability to a life that is forever transformed.” Neimeyer’s meaning-making can take many forms in grief—whether ritual, narrative, art or community. The important part is that the world is built anew—with a recognition of loss and all the space that loss gives to create.

These grieving theories all share the same characteristics: they encourage us to grieve, to express ourselves, whether through words, art or music, and they validate the constant shifting we may feel as mourners. And they recognize that to live is to die, and to love is to grieve when that love is lost. While our collective consists of a variety of grief theory perspectives, we want you to know that grief is normal, and in fact, it is healthy, even if it is painful or seems unbearable. Finally, grief is a lifelong process that one learns to incorporate into one’s life. We hope you will find these many tools and resources valuable.

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Paper Editors: Candi K. Cann, Ph.D, Michael Hebb, Megan Devine, LCPC, Alica Forneret, Allison Gilbert, Lashanna Williams, Stephanie Gailing, Silvia Perez-Protto, M.D., Rana Adwish, M.D.

Footnotes:

[1] It is imperative to note that all of these psychologists and theorists were white, and live(d) in the United States, the United Kingdom, and/ or Europe. As a result, much of grief theory has been written as though it is universal, when in actuality it reflects the white experience. This gap in the literature has recently received some attention, but grief theory has far to go in order to reflect a diversity of experience.

[2] Elisabeth Kübler-Ross. Living with Death and Dying New York: Macmillan, 1981.

[3] Kübler-Ross’ stages—initially formulated as stages of the dying process—include the five stages of denial, anger, bargaining, depression and acceptance are supposed stages one passes through in grief. The problem here is that not only have these stages been mis-applied from dying to grief, but they are often interpreted as five steps that one must undertake to be considered a successful griever.

[4] See Erich Lindemann’s Beyond Grief : Studies in Crisis Intervention New York: Aronson, 1979.

[5] Worden, J. William. "Tasks and mediators of mourning: A guideline for the mental health practitioner." In Session: Psychotherapy in Practice: Psychotherapy in Practice 2, no. 4 (1996): 73-80.

[6] J. William (James William) Worden. Grief Counseling and Grief Therapy: a Handbook for the Mental Health Practitioner 4th ed. New York, NY: Springer Pub. Co., 2009.

[7] Therese Rando describes what she calls the 6 R’s of healthy grief: Recognize the loss, React to the loss, Recollect and Re-Experience the lost relationship, Relinquish, and put the loss behind you, Readjust, and Reinvest. Rando, Therese A. Grief, dying, and death: Clinical interventions for caregivers. Champaign, IL: Research Press Company, 1984.

[8] See Margaret Schut and Henk Stroebe’s original article. "The dual process model of coping with bereavement: Rationale and description." Death studies 23, no. 3 (1999): 197-224, and a ten year review was published in 2010 and is here: Stroebe, Margaret, and Henk Schut. "The dual process model of coping with bereavement: A decade on." OMEGA-Journal of Death and Dying 61, no. 4 (2010): 273-289.

[9] Dennis Klass, Phyllis R., Silverman, and Steven L. Nickman, Continuing Bonds : New Understandings of Grief. New York: Routledge, Taylor & Francis Group, 1996.

[10] I am indebted to Tony Walter for this distinction between Remembering and Caring for the dead.

[11] Bowlby, John. Attachment and loss: Vol. 3: Loss. Hogarth Press and the Institute of Psycho-Analysis, 1980.

[12] ibid. p. 22.

[13] Neimeyer, Robert A. "Narrative strategies in grief therapy." Journal of Constructivist Psychology 12, no. 1 (1999): 65-85, and Neimeyer, Robert A. "Reauthoring life narratives: Grief therapy as meaning reconstruction." The Israel journal of psychiatry and related sciences 38, no. 3/4 (2001): 171

Photo credit: Shin Roran