Analysis of Worden’s Task Model and the Dual-Process Model as it relates to children and adults

Grief work is understood to refer to the cognitive process of confronting the reality of a loss through death, of going over events that occurred before and at the time of death, and of focusing on memories and working towards detachment from (or relocating) the deceased. (Stroebe & Schut, 2010, p. 3)

Untimely loss is an unperceivable and often unconsidered circumstance until the situation presents itself. Whether it be through terminal illness or sudden tragedy, the loss of a significant family figure impacts the individual continuously for the remainder of one’s life. For a parent, losing a child bears a complex identity shift, where the individual has essentially and perhaps literally lost a part of oneself, the past that existed with them and the future that was expected for them (Albuquerque et al., 2015; Bergstraesser et al., 2015; Donnelly et al, 2020; Jung & Lee, 2022). A child who loses a parent, specifically at a young age, goes through a similar dissociative experience. Having lost a primary attachment, the person who’s advocation is only for the betterment of them now ceases to exist, and now must depend on a mixture of substitute familial relationships to uphold this person’s role (Worden, 2018). With death comes a braided experience of grief and mourning, differentiated through the internal and external expression of oneself. Grief is the internal emotional experience, the involuntary reaction to the loss whereas mourning is an outward expression of this grief, the way the experience is processed so people can come to understand and find purpose in their experience (Fisk, 2022).

Theories have been developed to assist with the conceptualisation of death and works to provide a sense of meaning to one’s bereavement. The two models explored in this essay are Worden’s (1982; 1991; 2001; 2009) task model which is comprised of four active processes to work through the consequences of loss and Shroebe and Schut (1999; 2010) Dual Process Model which focuses on how one copes with bereavement. Both models explore the subjective actions a person performs after experiencing grief and assist with self-identification through grief and grief work. There is an unexpected confrontation that accompanies child loss and early loss of a parent. Using these models, these subgroups are permitted to navigate the bereavement with a sense of control and non-urgency. Where the Dual Process Model allows oscillation between loss- and restoration- oriented grief, Worden’s tasks provide a framework for managing the emotional processes associated with bereavement. Through the examination of these theories of grief and loss, it can be conceptualised as an experience of directional navigation, working through personal responsibilities and how they relate to oneself, the deceased, and their culture.

Worden’s (2009) task model of grief comprise of four “tasks” that are common to the process of mourning and as the lexicon of the word suggests, these tasks can be used to actively focus on metabolising grief through constructive and meaning practices. The tasks comprise of: (1) To accept the reality of the loss; (2) To process the pain of grief; (3) To adjust to a world without the person we’ve lost; and (4) To find an enduring connection as you move forward on your life journey (Worden, 2009). Expanding on these tasks it appears Worden is supporting the human desire to make meaning of one’s experience especially in times of hardship. The first task is similar to many other models of grief in that it asks the individual to integrate the experience of death beyond an intellectual acceptance of non-existence. The second task integrates the emotional, physical and psychological aspects of processing the loss. Denial or suppression through avoidance here will hinder the healing process (Worden, 2015). This task is also most associated with grief work through counselling. The third and fourth tasks are continually evolving and focus on forming a bond with the deceased through personalised adjustments to one’s internal and external environment such as continuing bonds (Klass, Silverman, & Nickman, 1996).

Unlike other models of grief which aim to explore bereavement through explaining the consequences of one’s experience, the Dual Process Model (Stroebe & Schut, 1999; 2010) is termed a coping process model. As Stroebe and Schut (2010) describe, coping is a process, whereas consequences are an outcome variable. This theory was developed as an alternative consideration of grief work in counselling based on non-Western cultural patterns of coping with grief and the Western assumptions of what may be considered maladaptive coping mechanisms. This model’s simplicity denotes that people will oscillate between two major perspectives: (1) loss-oriented; and (2) restoration-oriented (Stroebe & Schut, 2010).  The former refers to a person’s focus towards processing aspects of the loss and incorporating grief work whereas the latter refers to a focus on the secondary stressors that are a consequence of the loss, the necessary changes after loss and accepting one’s new role and identity. The regulatory process of oscillation suggests that over time there will be less attention to loss-oriented and more towards restoration-oriented tasks and works well to identify with as a long-term process of bereavement (Worden, 2018). Complex grief involving multi-layered emotional, physical, and psychological elements can be approached as they arrive without categorisation of adaptive versus maladaptive coping. However, those with a propensity towards loss-oriented grief may find this open-ended concept difficult to conceptualise.

The parent-child bond is a creation of hopes and future expectations and when this relationship is interrupted by death, the bereaved parent may carry strong feelings of guilt over the perceived parental role of keeping the child safe. A child’s death is considered asynchronous with the natural order of life and thus bereaved parents may find feelings of guilt over the loss or the desire for someone to blame for their child’s death. In this case, counsellors work towards helping the person find an appropriate way to express their anger, blame or guilt, and not at the expense of others such as their partner (Buckle & Flemming, 2011; Albuquerque et al., 2015; Worden, 2015). The broad range of physical and emotional difficulties that arise through grief processing can be ameliorated by working with external help. When a child dies, there is a decoherence of identity, relationship expectation and interpersonal communication processes. Searching for meaning enables empathy and acceptance towards oneself and others and is an important aspect of the healing process (Albuquerque et al., 2017a). The parents’ belief system will conceptualise the grieving process and help to integrate the incomprehensible loss into the pre-loss structures that gave their life meaning.

Children who have lost parents make up only 4% of their demographic and is reported to be the most distressing form of trauma among youth, directly affecting their sense of security and cognitive processing (Edgar-Bailey & Kress, 2010; Ener & Ray, 2018; Pynoos et al., 2014; Alvis et al., 2023). Loss at a young age, especially of a primary caregiver can present as maladaptive behavioural and emotional struggles that affect the child’s capacity for form and maintain intimate relationships, to cope with stressful life events, and to fulfill developmental tasks (Cerniglia et al. 2014; Ener & Ray, 2018). However, most children will grieve adaptively and continue to function normally across other life domains (Webb, 2015; Thanasiu & Pizza, 2019; Alvis et al., 2023). The individualistic nature of grief delivers a variety of conceptualisations of death and is the essential factor to consider when examining a child’s reaction to the irreversible and finality of this loss. Children will experience painful and complicated emotions in the categories of separation distress, existential/identity distress, and circumstance-related distress. Feelings such as a loss of control, isolation, separation distress, guilt and shame, anger, and even conflicting feelings about the deceased will play a critical role in considering the way a child reacts to bereavement (Layne et al., 2017; Alvis et al., 2023). Working with children in a way to reduce avoidance and promote a connection with these feelings and build self-esteem and self-worth is essential to their healing. Morning rituals, socialisation, and emotional regulation will be impacted by death. The family’s culture will most often dictate the mourning process, and most likely the child’s understanding of death (Thanasiu & Pizza, 2019). Normative behaviours and practices are subsequently determined by the family’s culture and must be considered to enhance culturally sensitive counselling practice (Alvis et al., 2023). Working within a guided framework such as Worden’s four tasks of grief and the Dual Process Model and a strong adherence to alignment with cultural factors, can promote positive interpretations of healing from loss.

The two models indicated above relate not only to the specific loss, but also the circumstantial consequences of the loss such as adjusting to a world without the deceased and attending to lifestyle changes. Worden’s (2009) tasks allow the individual to move freely through the four elements without a perceivable timeline, similarly, the Dual Process Model’s permits a regulatory process of oscillation between stressors related to loss and restoration based activities. Being presented as ‘tasks’, Worden’s model insinuates those actions as being controlled by the individual, visited when capable. Both models are considerably active in nature, where the person is ‘dealing with’ the situation compared to some other models of grief which suggest bereavement is a passive experience which ‘happens to’ the person (Kubler-Ross & Kessler, 2005; Bowlby, 1980). Likewise, Stroebe and Schut (2010) consider oscillation as motivated action applied by the individual. This particular aspect of these models is a strength for transforming loss-oriented bereavement into accountability, the loss happened to them, but the way grief and bereavement is managed is within their control.

Worden’s first and second task could be likened to the loss-oriented aspect of the Dual Process Model and his third and fourth tasks could be likened to the restoration-oriented aspect of the Dual Process model. However, Stroebe and Schut (2010) specifically indicate that their model is inherently different from Worden’s tasks. Unlike Worden’s model which asks the individual to confront their grief in a dynamic manner, the Dual Process Model considers denial and avoidance as essential parts of adaptive coping. This is based on the premise that although persistent negative affect enhances grief, persistent positive states are also maladaptive and neglect necessary facets of grief such as rumination (Stroebe & Schut, 2010).

The most significant benefit of both Worden’s task model and the Dual Process Model is that they can be adapted to suit a variety of cultural subgroups. The generalised nature of these models allows for significant variability of interpretation, providing efficacious outcomes to a larger number of people. Parents who have lost a child are required to return to work, and possibly care for other children whilst coping with their grief. Being able to compartmentalise grief will work in their favour to be able to continue the necessary life tasks. Children who have lost a parent may be too young to understand the concept of loss and subconscious avoidance of the subject allows the child an opportunity to continue some degree of innocence until the necessary time arises to confront the event. Losing a parent as a child is an uncommon occurrence. It is a situation that is unrelatable to most children, causing a difficult duality in the affected child’s psychology. This is the greatest limitation for these cohorts. Since unanticipated loss is uncommon, it is unexpected. Unexpected situations shock the central nervous system. Models that focus on mediating the surrounding factors of loss permit the individual to conceptualise and work through their grief whilst breaking down the initial shock over time. The Dual Process Model does this more effectively than Worden’s task model in a non-confrontational manner, however, without perceived tasks, one might find it difficult to integrate their grief holistically.  

Lopez (2011) configured a practical guideline for practitioners to uphold cultural sensitivity when working with diverse clients in the space of grief and loss. Counsellors are recommended to understand their own culture, race and ethnicity by examining one’s experience of grief and how this influenced their reactions, responses and behaviours. The counsellor should become aware of personal biases related to diverse cultural groups and engage in self-exploration. Adults and children require different intervention methods of grief counselling. However, meaning making is an essential process of bereavement and is a large component of grief work with both populations (Neimeyer, 2016). In grief work, the counsellor’s role is to help the bereaved form a lasting healthy bond with the deceased and find a place for the deceased in their lives that allows them to live efficaciously in the world (Worden, 2015). Working with both parents it is important not to neglect parents who are not as expressive about their grief whilst also ensuring the lost child’s qualities are not projected onto surviving children. Teaching parents to acknowledge the loss of the child without the expectation that other children fill the empty space is an important part of the healing process (Rosetto, 2015). Integrating positive processes for coping with the loss such as the Dual Process Model, has found to be a flexible and complementary for partnerships grieving the loss of a child such as when the loss-oriented parent benefits from the proactive assistance of the other partner (Stroebe & Schut, 2015; Albuquerque et al., 2017; Albuquerque et al., 2017a). Worden’s four tasks of grief provide an intellectualised conceptualisation of how to manage bereavement though to a degree, fails to recognise the intricacies of grief and the cacophony of unexpected emotionally dysregulated behaviour.

Grief is a highly personal experience. The experience of grief is global, and this is why theories of grief and loss can be conceptualised into tasks, steps, needs, stages or processes. And though these theories contain the use of contextually linear diction, it is strongly advocated that this does not imply the linear progression of each task, step, need, stage or process. This must be a core understanding of grief counselling as without this knowledge, assumptions, preconceptions and ideations are projected and the healing process for the individual is stalled. These two processes, Worden’s tasks of grief (2015) and the Dual Process Model (Stroebe & Schut, 2010), are beneficial and applicable to culturally diverse populations and have only one hindrance, that a person must continue to find meaning in their loss and must find a place for the deceased in their life that is conducive to living in this world. Through the practice of self-awareness and by monitoring countertransference, counsellors are able to work competently and sensitively with an enhanced understanding of intrapersonal aspects of cultural to adequately support the healing process of culturally diverse clients utilising frameworks that align with the adopted healing process for each individual.

References

Albuquerque, S., Buyukan-Tetik, A., Stroebe, M., Schut, H. A. W., Narciso, I., Perira, M., & Finkenauer, C. (2017). Meaning and coping orientation of bereaved parents: Individual and dyadic processes. PLoS ONE, 12(6): e0178861. http://doi.org/10.1371/journal.pone.0178861

Albuquerque, S., Pereira, M., & Narciso, I. (2015). Couple’s relationship after the death of a child: A systematic review. Journal of Child and Family Studies, 25, 30-53. DOI: 10.1007/s10826-015-0219-2

Albuquerque, S., Ferreira, L. C., Narcisco, I., & Pereira, M. (2017a). Parents’ positive interpersonal coping after a child’s death. Journal of Child and Family Studies, 26, 1817-1830. DOI: 10.1007/s10826-017-0697-5.

Alvis, L., Zhang, N., Sandler, I. N., & Kaplow, J. B. (2023). Developmental manifestations of grief in children and adolescents: Caregiver and key grief facilitators. Journal of Child & Adolescent Trauma, 16, 447-457. https://doi.org/10.1007/s40653-021-00435-0

Bergstraesser, E., Inglin, S., Hornung, R., & Landolt, M. A. (2015). Dyadic coping of parents after the death of a child. Death Studies, 39, 129-138. DOI: 10.1080/074811.2014.920434

Bowlby, J. (1980). Attachment and loss: Loss, sadness, and depression (Vol. II). Basic Books

Buckle, J., & Flemming, S. (2011). Parenting after the death of a child: A practitioner’s guide. Routledge.

Cerniglia, L., Cimino, S., Ballarotto, G., & MOnniello, G. (2014). Parental loss during childhood and outcomes on adolescents’ psychological profiles: A longitudinal study. Current Psychology, 33, 545-556. DOI: 10.1007/s12144-014-9228-3

Donnelly, R., Umberson, D., Hummer, R. A., & Garcia, M. A. (2020). Race, death of a child, and mortality risk among aging parents in the United States. Social Science & Medicine, 249, 112853. Doi: 10.1016/j.socscimed.2020.112853

Klass, D., silverman, P., & Nickman, S. (1996). Continuing bonds: New understandings of Grief (Eds.). Taylor & Fancis.

Ener, L., & Ray, D. C. (2018). Exploring characteristics of children presenting to counselling for grief and loss. Journal of Child and Family Studies, 27, 860-871. DOI: 10.1007/s10827-017-0939-6.

Fisk, G. (2022). The complexity and embeddedness of grief at work: A social-ecological model. Human Resource Management Review, 33, 1000929. https://doi.org/10.1016/j.hrmr.2022.100929

Jung, J. H., & Lee, H. J. (2022). Death of a child, religion, and mental health in later life. Aging & Mental Health, 26(3), 623-630. https://doi.org/10.1080/13607863.2021.1889968

Kubler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief through the five stages of loss. Scribner.

Layne, C. M., Kaplow, J. B., Ooosterhoff, B., Hill, R. M., & Pynoos, R. S. (2017). The interplay between posttraumatic stress and grief reactions in traumatically bereaved adolescents: When trauma, bereavement, and adolescence converge. Adolescent Psychiatry, 7(4), 266-285. https://doi.org/10.2174/2210676608666180306162544

Lopez, S. A. (2011). Culture as an influencing factor in adolescent grief and bereavement. The Prevention Researcher, 18(3), 10-13. Doi: 10.1037/e542572012-003

Neimyer, R. (2016). Techniques of grief therapy: Assessment and intervention. Routledge.

Pynoos, R., Steinberg, A., Laune, C., Liang, L. J., Vivrette, R., Briggs, E., Kisiel, C., Habib, M., Belin, T., & Fairbank, J. (2014). Modeling constellations of trauma exposure in the National Child Traumatic Stress Network Core Data Set. Psychological Trauma Theory Research Practice and Policy, 6(51)., S9-S17. https://doi.org/10.1037/a0037767

Silverman, P. R., NIckman, S., & Worden, J. W. (1992). Detachment revisited: The child’s reconstruction of a dead parent. American Journal of Orthopsychiatry, 62, 494-503. Doi: 10.1037/h0079366

Stroebe, M. S. & Schut, H. (1999). The Dual Process Model of coping with bereavement: Rationale and description. Death Studies, 23, 197-224.

Stroebe, M. S. & Schut, H. (2001). Meaning making in the Dual Process Model. In R. Neimeyer (Ed.), Meaning reconstruction and the experience of loss (pp. 55-73). American Psychological Association.

Stroebe, M. S., & Schut, H. (2008). The Dual Process Model of coping with bereavement: Overview and update. Grief Matters: The Australian Journal of Grief and Bereavement, 11, 1-4.

Stroebe, M. S., & Schut, H. (2010). The Dual Process Model of coping with bereavement: A decade on. Omega, 61(4), 273-289. DOI: 102190/OM.61.4.b

Thanasiu, P. L., & Pizza, N. (2019). Constructing culturally sensitive creative interventions for use with grieving children and adolescents. Journal of Creativity in Mental Health, 14(3), 270-279. https://doi.org/10.1080/15401383.2019.1589402

Webb, N. B. (2015). Family and community contexts of children and adolescents facing crisis or trauma. In N. B. Webb’s (Ed.) Play therapy with children and adolescents in crisis (4th ed.) (pp. 3-21). Guildford.

Worden, J. W. (1982). Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner (4th Ed.). Springer Publishing.

Worden, J. W. (1991). Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner (2nd Ed.). Springer Publishing.

Worden, J. W. (2001). Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner (3rd Ed.). Springer Publishing.

Worden, J. W. (2009). Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner (4th Ed.). Springer Publishing.

Worden, W. J. (2018). Grief counselling and grief therapy: A handbook for the mental health practitioner (5th ed.). Springer Publishing.