Four Tasks of Mourning
Worden offers a task-oriented framework of mourning at the individual and family
level (Worden, 1991). The combination of the timeline with the four basic
tasks provides a more comprehensive picture of the grief process. This enables
the therapist to design therapeutic interventions that are in sync with the
experience of the bereaved. Figure 2 illustrates the fit of the timeline
and task orientation.
The tasks are the challenges facing the bereaved during each phase. As an
example, accepting the reality of the loss is the challenge during the shock
phase. The second task of experiencing the pain is the work of the disorganization
phase. The adaptation to a new environment is the transition between the disorganization
and reorganization phases. Finally, the reinvesting of emotional energy and
the reorganization phase meld nicely.
The following information helps the therapist organize the approach of using
the timeline and task orientation to have an integrated view of the process.
First Task of Mourning
The first task of mourning is accepting the death and the loss (Worden, 1991).
This is a subtle process that is difficult to assess. The individual may
first talk about the deceased in first person. As the acceptance of the loss
begins, the past tense may be more frequently used. The family also develops
a shared acceptance of the reality of the loss. Family members slowly incorporate
the deceased in conversations. The deceased's possessions are a helpful barometer.
The individual may first link the loss to an object, then use the object
as a symbol of the loss or transitional object, and finally place the object
in a safe place as a treasured keepsake (Worden, 1991). For example, immediately
after a death the bereaved person may hold onto a possession of the deceased.
At first, he or she constantly carries this with them and is upset if it
is misplaced. As the grief progresses, the bereaved person is able to separate
from the object but knows where it is and how to gain access to it quickly.
Finally, the object is put away in a place for safe-keeping.
It is important to understand that the acceptance of the death is an ongoing
process, not an end point. The bereaved will experience the loss on some level
throughout his or her entire lifetime. Survivors of expected deaths may accept
the loss sooner than survivors of unexpected and sudden deaths (Parkes & Weiss,
Maintaining a focus on the context of death helps the therapist to join and
form a supportive relationship with the bereaved that reduces their isolation.
While individuals and organizations in their context either minimize or deny
the death and grief, the therapist adopts a position of acceptance and closeness.
Sophisticated interventions are not required, it requires that the therapist
be comfortable with the expression of denial and subsequent intense pain
by the bereaved. This relationship with the therapist needs to offer a safe
place to express this pain.
Bereavement therapy is demanding. The therapist must tolerate intense emotional
expression of family members' feelings of powerlessness when faced with unspeakable
tragedy and loss. The therapist can also experience this feeling of loss of
control. When this occurs, many therapeutic approaches direct the therapist
to reduce the intensity. While this familiar approach helps the therapist maintain
his or her own safety net, it can hinder the therapeutic encounter.
During these initial sessions, the therapist also supports and educates the
bereaved. The therapist educates the bereaved about the context of death and
the grief process. This is done because the bereaved person has most likely
had little education on the extent of the grief process. The key points are
to normalize the indicators of grief and give permission to grieve.
The picture session is an important systemic intervention (Hunsberger, 1984;
Lawrence, 1992). The deceased needs to be included in therapy. After allowance
of time for joining, each individual is requested to bring four to five pictures
to the session. Every picture tells a story and it is the therapist's task
to use these photographs as a tool to acquire information about the family.
It is a powerful event for a family member to bring personal photographs of
the deceased to a therapist. They often do not appreciate that they have completed
this assignment successfully. They have shared photographs of their loved ones
requested by a virtual stranger. A few weeks before they may not have been
able to talk about the deceased. This process is the first step to help the
bereaved gain a sense of mastery over death.
Clinical Case Examples
Ms. S is a 47-year-old office manager. Her husband of 8 years died while the
couple ate lunch in a restaurant. He was recovering from recent heart surgery
for a congenital heart condition. Three months into the grief process, Ms.
S came into therapy with their adopted seven-year-old daughter. Her daughter
had a history of behavior problems that they were working on in a previous
therapy. She presented with concerns regarding the grief process and how
she was feeling overwhelmed functioning as a single parent with this demanding
Identifying Ms. S's early position on the grief timeline, the
framework guided the therapist to develop the following interventions:
1. Provide a safe environment to talk about the depth of her feelings. She
felt pressure from relationships in her context to remain silent and there
was limited recognition of her grief.
2. Provide an outline of normal grief for her to compare her experience.
3. Give permission to grieve and acceptance of the range of feelings, and
to ask others to listen.
4. Reinforce the need for continued firm and consistent limits
for her daughter.
Second Task of Mourning
The second and most difficult task of mourning is to experience the pain (Worden,
1991). The individual has progressed Through the shock phase and they start
to accept that their loved one is not going to return. The bereaved is most
likely faced with expectations from others that they should be over it by
now. The fact is That they are now face-to-face with the most intense emotions
in the grief process. It is no coincidence that this task and phase occur
at the time when most people enter bereavement therapy.
It is crucial that the family share in the expression of pain to accomplish
this task. A family member may not participate in the shared expression of
pain through disallowing feelings and/or dysfunctional or unhealthy behavior.
This can disrupt the family process of experiencing the pain. Helping family
members accommodate to the differences in expression and timing of grief reactions
is key to the successful negotiation of this task.
In the disorganization phase, experiencing the pain is paramount. The therapist
attends to the individual and family levels. Continued contact throughout
the difficult and emotionally demanding disorganization phase is crucial.
The basic framework for guiding the contact is:
(a) reduce the isolation,
(b) provide an environment that allows expression of all emotions,
(c) promote the transition to the next stage of individual and family development,
(d) restore order in the family with developmentally appropriate, firm and
consistent limits with children.
At the individual level, the task of the therapist is to foster an environment
in which the bereaved can feel comfortable to express unspeakable feelings.
This requires a safe place and permission to express all of their feelings.
It is imperative to continue to discuss details of the death, funeral, and
relationship with the deceased. When working at the individual level, patience
is required because the bereaved may repeatedly review difficult aspects of
the death and/or their relationship.
Each person's grief happens in a family context. It is important for the therapist
to take an active leadership role in helping the parent(s) to promote shifts
in hierarchy and flexible boundaries. This unremitting attention to grief in
context creates room for the individual grief while attending to the survival
of the family. The importance of roles is highlighted. Extended family or community
relationships play an important role in supporting the grief process.
As the individual and family progress, the therapist needs to support and
validate their looking toward the future. Family members may often feel uncomfortable
with feeling better. The therapist helps place this transition in context as
a normal phase of the grief process.
A person experiencing a tragic, unexpected death including suicide or violent
death, may take a longer time to enter this phase. When this occurs, the Bereaved
receives pressure from their context and themselves to get over the death.
This can create a high level of anxiety at a time when the bereaved expects
and is expected to move on with their lives. The bereaved should have the opportunity
to work as long as they need to progress through the grief process.
Ms. D is a 67-year-old grandmother whose 40-year-old daughter died of a heart
attack during her second ER visit in one evening. She was sent home after
the first visit with the diagnosis of GI distress. She returned later in
cardiac arrest and died within 1 hour after being admitted. Ms. D entered
treatment 8 months after the death due to her own unstable emotional state
and her concern about her two grandchildren, Kelsy 15, and Kevin, 12. Kelsy
exhibited several concerning symptoms, including withdrawal, and isolating
herself in her room and refusal to wear any clothes that were not at least
two sizes too large. The latter was later connected to the fact that her
mother was a buxom woman who often wore tight fitting clothes.
Ms. D herself was angry, scared, and she felt overwhelmed by the prospect
of having to raise the children of her divorced daughter by herself. Ms. D
was seen alone to process her grief experience and to plan strategies to support
the granddaughter in her difficult grief reaction. Fortunately, her daughter
was a very effective parent and she had few behavior problems with the children.
However, due to Ms. D's emotional state she felt unable to provide the structure
and to set limits for the children. The disorganization of the family was the
first area for intervention. The therapist supported her in setting clear limits
and to provide the opportunity to include the death in their daily conversations.
The children were assured that Ms. D could handle their input about their mother
and to share their grief, a process that occurred slowly over a period of several
Third Task of Mourning
The third task of mourning is adapting to the environment where the deceased
is missing (Worden, 1991). The adaptation to the loss starts at the time
of death. This task serves as the transition from the disorganization phase
to the reorganization phase. The progression from shock to confusion now
emerges into a realization of what changes the death has created for the
individual and family. The loss is highlighted by the changes in the practical,
everyday routines. This adaptation process requires new individual and interpersonal
patterns to be established. This means new responsibilities and changes in
lifestyle while grieving the loss. The family must be able to cope with disorganization
while working to realign relationships and delegate new family roles.
The therapist now shifts to actively challenging the bereaved to organize new
behavioral patterns. This is accomplished by helping the bereaved assume
responsibilities, take risks into new areas and activities, and to become
aware of how the practical aspect of day-to-day living mirrors their grief
process. The family simultaneously experiences the grief and begins to more
effectively adapt to the changes. The family defines the new roles and responsibilities
and a shift in boundaries helps begin to promote adaptation.
During a support group for survivors of recent deaths, Ms. V, whose husband
died over a year ago, spoke about a recent night out with her friends. This
was her first venture out of the house since her husband's death. She returned
home late in the evening and was struck with the fact that the house was
dark. Her husband would have been driving her and he also always left the
lights on for their return. This new and unfamiliar event provided her with
the realization that the loss of her spouse of 35 years meant she had to
adapt her environment in a practical manner.
Fourth Task of Mourning
The final task of mourning is the reinvestment of emotional energy in relationships
with the living (Worden, 1991). The individual turns their attention to reestablishing
intimate relationships. The bereaved still has room for the deceased in their
everyday experience but their focus is now expanding the other facets of
At the family level, the deceased is included in family life. This process
is particular to each family based on the role of the deceased and type of
death. The family assigns the deceased a place in their world. The loss has
less of an impact on the daily functioning of the family.
The therapist's work centers on continued coping with the loss and promoting
an expanded social network. The direction is to help the bereaved to reestablish
the relationship with the decreased in a form That allows new relationships
to be established. The therapist also focuses on the guilt feelings of the
bereaved for moving on without the deceased. The bereaved finds a unique
way to include the deceased in their daily life while building other relationships.
Mr. R's 31-year-old wife, while driving home after leaving their 4-year-old
son at daycare was hit broadside by a teenager drag racing. Her 5-month-old
son was uninjured, but she died instantly. The family entered treatment 9
months after the accident. At 18 months after the death, the father was utilizing
occasional sessions for support. The last sessions revolved around the father's
new relationship. He met a divorced woman with two children and it quickly
became a serious relationship.
The therapist punctuated the father's shift from his relationship with his
deceased wife to his new partner. This included dealing with the feelings of
disloyalty contrasting with the need for a new relationship for himself and
a mother figure for his three children. This complex process included the blending
of the families leaving a respected position for the surviving children's mother
while creating a new family structure.
- McBride, Joseph & Steven Simms, Death in the Family: Adapting a Family
Systems Framework to the Grief Process, American Journal of Family Therapy,
Jan/Feb 2001, Vol. 29, Issue 1.
The article above contains foundational information. Articles below contain optional updates.
Reflection Exercise #11
The preceding section contained information
about the four tasks of mourning. Write
three case study examples regarding how you might use the content of this section
in your practice.
Online Continuing Education QUESTION
What are four tasks of mourning? Record the letter of the correct answer