Grief Theories & Models

In the years since Kubler-Ross produced her seminal work, numerous psychologists and psychiatrists have developed new theories about how people move through grief. Although there are far too many to mention them all here, some of the most widely accepted include:

• The Dual Process Model
• Worden’s Four Tasks of Grieving
• Rando’s Six “R” Processes of Mourning
• Bonanno’s Theory of Psychological Resilience 
• Wolfelt’s Six Needs of Mourning

Below is a brief explanation of each.

The Dual Process Model 

Developed by Margaret Stroebe and Henk Schut during the mid-1990s, the Dual Process Model of Coping with Bereavement theorizes that grief is a dynamic process involving two competing needs: the need to confront the stressors associated with the loss (loss-oriented stressors) and the need to restore some semblance of order to a disrupted life (restoration-oriented stressors.) Examples of loss-oriented stressors include reminiscing, yearning, and imagining the person who died. Restoration-oriented stressors are circumstances that are secondary to the loss: for example, if the person who died paid the bills or did all the cooking, the bereaved person needs to find ways to accomplish those tasks

Central to the Dual Process model is the idea that people oscillate between coping with each of these competing needs as they seek to restore a sense of equilibrium to their lives.

Worden’s Four Tasks of Grieving

In 2008, psychologist William Worden published the 4th edition of his handbook “Grief Counseling and Grief Therapy” in which he outlined a task-oriented approach to healthy grieving. In this model, Worden proposed that mourners who actively engage in four specific tasks will adapt more quickly and more effectively after a loss. 

The four tasks are:

• Accept the reality of the loss
• Experience the pain of grief 
• Adjust to the “new normal” of life without the person who died
• Find an enduring connection with the person who died while still moving forward in new ways

As in the Dual Process model, people are expected to move back and forth between the four tasks as they mourn rather than march through them in an orderly progression. How long it takes any one individual to move through the tasks depends on many variables, including their degree of attachment to the person who died,  the manner of death, concurrent stressors (for example, financial woes after the primary wage-earner in a household dies, or raising children alone) and the psychological makeup of the griever. 

Add this chart? Source: https://whatsyourgrief.com/wp-content/uploads/2013/06/worden-tasks-of-mourning-1.jpg

Rando’s Six “R” Processes of Mourning

Dr. Therea Rando is a world renowned expert in the field of loss and grief, with a particular emphasis on traumatic grief. The Clinical Director of the Institute for the Study and Treatment of Loss, Dr. Rando has worked in the field of thanatology and grief since the early 1970s. Her research has spanned decades, and, in 1993, resulted in her proposing a theory she calls the Six “R” Processes of Mourning. 

Similar to Worden’s four tasks of mourning, Rando’s model proposes that mourning is an active process that progresses in a series of phases, each of which requires the mourner to engage in certain tasks (each of which begins with an “R”). In her model, the phases of mourning are:

• The Avoidance Phase: There is only one task in this phase — to recognize the loss. According to Rando, the grieving person cannot move on to the other phases of mourning until they have accepted that the loss occurred. 

• The Confrontation Phase during which the grieving person must accomplish three processes or tasks:
  • React to the separation, both the loss itself and secondary losses, such as loss of a sense of security and identity. Rando says this is the process through which the mourner seeks to “feel, identify, accept, and give some form of expression to all the psychological reactions to the loss.” 
  • Recollect and re-experience the relationship with the person who died. During this process, the mourner thinks about the loved one who died, remembers their relationship and re-experiences emotions they felt when the loved one was alive. 
  • Relinquish old attachments and begin to accommodate the “new normal” of life without the person who died. This is the longest and often the most difficult of the processes in the Confrontation Phase. 
• The Accomodation Phase during which the mourner begins to integrate the loss into their life and worldview. This phase has two tasks:
  • Readjust to the new reality and accept new roles and responsibilities while staying aware of life as it was before the loss. This is also the process during which the mourner begins to define a new relationship to the person who died. 
  • Reinvest emotional energy and learn to live again. This is the final phase of mourning, during which the person can begin to find pleasure in new things. This is also the phase when many people find a way to give meaning to the loss, such as starting a foundation or a self-help group, 

Rando emphasized that these processes are not necessarily linear, and that people may oscillate back and forth between the Confrontation and Accommodation phases for some time. 

Wolfelt’s Six Needs of Mourning

Alan Wolfelt is a noted psychologist who founded the Center for Loss and Life Transition in 1984. Similar to the grief experts mentioned above, Wolfelt believes that grievers must move through a process of mourning before they can integrate and ultimately move forward from a significant loss. This process includes six tasks that grievers “need” to complete, which include:

• Accepting the reality that the loss occurred
• Embracing the pain of the loss
• Remembering the person who died
• Developing a new sense of self 
• Finding meaning in the loss
• Seeking and accepting support

Wolfelt theorizes that it is impossible to truly reconcile a death until one moves through a process of openly acknowledging and expressing the pain of grief. However, this conflicts with numerous studies that show most people are able to adapt to and move past traumatic events, including bereavement, without doing so. 

Bonanno’s Theory of Psychological Resilience

As the head of the Loss, Trauma and Emotions Lab at the Department of Counseling and Clinical Psychology at Columbia University, George Bonanno has led a team of researchers in exploring  the effects of grief and trauma for almost 30 years. His approach to grief is considered somewhat controversial, in that he believes that people exhibit a great deal of psychological resilience in the face of traumatic, even horrifying events. Nonetheless, decades of research support this theory, which is based on the concept that loss engenders deep feelings of sadness, regret, yearning, and psychological pain, yet the quality of human reliance allows most individuals to return to their normal state of psychological equilibrium relatively easily. Bonanno does not believe that grief must progress through stages or tasks, or that the bereaved need to “work through’ their pain. Rather, he holds that the majority of people who experience the death of a loved one or other trauma oscillate between periods of anguish and positivity and will gradually heal with the passage of time. 

In a 2016 interview, Bonanno explained it this way:

“People who are not showing grief symptoms, don’t do anything — they’re fine. In fact, they can be harmed by intruding on their lives. They don’t need to talk about it. But I think in this culture we have this sense that people need to talk about it — if they don’t talk about it, something is wrong — no, leave those people alone. In people who are showing moderate levels of grief symptoms, it is sometimes a matter of getting used to the pain, which passes with time.”

Again, these are not all or even most of the grief theories that have been put forth over the last 50 years. But they are a good representation of what the world of psychiatry and psychology believes about grief today. 

Sources

“The dual process model of coping with bereavement: rationale and description”. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/10848151/ 

“Worden’s Four Tasks of Grieving”. Therapy Changes. https://therapychanges.com/blog/2015/05/review-wordens-four-tasks-of-grieving/ 

“Grief and Mourning Basics”. Center for Loss and Life Transition. https://www.centerforloss.com/grief/grief-mourning-basics/ 

“Rethinking Trauma: George Bonanno on Resilience”. Cornell University. https://evidencebasedliving.human.cornell.edu/blog/rethinking-trauma-george-bonanno-on-resilience/ 
“Loss, Trauma, and Emotion Lab”. Columbia University. https://www.tc.columbia.edu/ltelab/

Continuing bonds theory refers to an adapted connection or relationship that individuals maintain with their loved one who has died. The theory was introduced in 1996 by Dennis Klass, Phyllis Silverman, and Steven Nickman in a book entitled “Continuing Bonds: New Understandings of Grief”, which encouraged readers to re-evaluate and question the traditional perspective that individuals should move on and let go of the cherished relationships they’ve had with their loved ones who have died. The alternative proposed by the authors suggested that continuing bonds with these loved ones could be achieved by actively integrating them into ongoing memories, reflections, rituals, discussions, and more. Through maintaining and nurturing these connections, improved healing and emotional well-being can be achieved. 

The absence of a loved one after death is life-changing. Death creates a substantial separation between every individual and their loved one who has died. What death does not change is the amount of love a person feels for these individuals. In this regard, continuing bonds allow people to continue actively expressing their love for the person who died while also helping them to navigate the experience of life without that loved one. This creates the possibility that continuing bonds may aid individuals in processing their grief in a way that’s comfortable for them and feel authentic to their relationship with the person who died. However, critics have suggested that continuing bonds may also have the potential to cause disordered grieving such as complicated grief, and may require additional support from a mental health professional to achieve healing.

Individuals may participate and emphasize continuing bonds in different ways based on their preferences and lifestyle. Some individuals like to incorporate their relationship with their loved one into their daily routine, which can involve keeping pictures of them around and actively mentioning them in discussions with friends and family. Writing is another option that many individuals use to maintain their connection. This can involve writing in a journal on a consistent basis or participating in grief writing, which shares the narrative of the loss and explains it in the context of the significance it has had in that individual’s life. Other methods to continue bonds can include maintaining activities or habits that were meaningful when a loved one was alive or openly talking with a loved one who has died.

Continuing bonds help to normalize the emotional connection that remains after a loved one has died. There are many individuals who continue bonds with a loved one after death without even being aware of the theory. Actions as simple as keeping an item that reminds them of a loved one or maintaining their legacy in some way can help individuals maintain the bond they shared with the person who died. These actions illustrate that the efforts to maintain these connections are ultimately part of the natural response to loss. 

Sources

“Continuing Bonds: Your Evolving Relationship with Someone Who Died”. Grief Compass. https://griefcompass.com/continuing-bonds 

“The Beauty of Continuing Bonds: Remembering Through Journaling”. Heather Stang. https://heatherstang.com/continuing-bonds-journaling/#