Creative Counselling

Bereavement Counselling

One of the early works that has influenced bereavement counselling was On Death and Dying by Elisabeth Kubler-Ross. In the past, many counsellors have taken this work to be definitive. Perhaps the most well known aspect of Kubler-Ross' theory was the idea that bereaved people go through 'stages', starting with denial, then moving through anger and bargaining with God to acceptance. I have never found this a particularly helpful idea, as it is so alien to my own experience and to that of the clients that I have seen. It is based on a wide experience of dying patients but not on work with the bereaved. And it has a very religious context which may not be appropriate to the majority of clients today.

A much more helpful way of looking at bereavement was provided by J. William Worden in Grief Counselling and Grief Therapy in which he sets out the 'four tasks of mourning'. The four basic tasks are to accept the reality of the loss, to work through the emotions associated with the loss, to learn how to cope with practical tasks of living without the support of the deceased, and to find a new place in one's emotional life for one's relationship with the deceased. These tasks relate to the ideas of denial, anger and grief, learning to cope and 'moving on'.

However, there are differences. Worden's emphasis is less passive than that of Kubler-Ross. The bereaved person does not pass through stages but undertakes tasks. This helps us to understand why some clients recover more quickly from a bereavement than others: one factor is the way in which the client is able to address these tasks. And it gives us a framework to support our work with clients: we can help the client to negotiate whichever of the tasks she or he is struggling with.

Nor does Worden use the concept 'moving on'. Instead, he writes about 'relocating the deceased in your mental and emotional life'. This is not only much closer to the real life experience of many people but it is also a much easier concept for many bereaved people to accept. For example, many parents who have lost a child in childhood continue to mark birthdays and to think of the child as part of the family. Worden's approach enables us to depathologise this way of coping as the family can be seen as finding a place in their lives for the memory of their child.

Bereaved Children

The Grief Encounters website offers helpful advice for people working with bereaved children. The most important element of their work, for me, is the idea of a spiral of grief, where the same thoughts and feelings get revisited but as time goes by their intensity lessens, like going round in an upward spiral.

This fits with the observation that children who are bereaved may grieve appropriately for their age and complete the 'tasks of mourning' at that stage of development. Then they may need at a later developmental stage to revisit the bereavement to deal with some of the tasks at their new developmental level. It is useful to be aware of this, so that childhood grief that is revisited in later childhood or adulthood is not unnecessarily pathologised.