Grief theories provide a conceptual base for understanding grief and loss as a process involving many common characteristics and phases. A general understanding of these will help you understand and anticipate the process that people may go through. This will help you to identify and normalise reactions to loss, and to identify where further help may be needed.  
 

Stage and Phase-Based Models 

Many theories of grief, and particularly bereavement, suggests that people go through stages or phases in their grieving process. Whilst the stages and phases are slightly different in each theoretical model, they are similar in proposing that people need to move through these stages or phases in order to reach some kind of recovery. These models are prone to create problems when an individual’s experience does not match with the suggested stages or phases of a given theory, and there is limited evidence that the models describe what most, let alone all, bereaved people will go through.  

Attachment Theory and Grief 

Attachment theory explores the nature of the connection or attachment between humans, particularly between primary caregivers and infants, and the consequences of separation. Bowlby hypothesised that the grief process reflects the disruption of attachment bonds – resulting in similar distress behaviours displayed by infants when they are separated from their primary caregiver such as crying, clinging, and anger designed to regain the connection (Pomeroy & Garcia, 2009). Bowlby’s observations of mourning were then expanded by others into phases in grieving: numbness; yearning and searching; disorganisation and despair; and reorganisation (Harris & Winokuer, 2016). The idea that attachment has a significant influence on grief has also been adopted by many others (e.g., Worden, 2009), but there is a lack of empirical evidence to support the attachment-based stage model of grief (Machin, 2014). Some research has also questioned the tenet that attachment style predicts adult adjustment more broadly (Lewis, Feiring, & Rosenthal, 2000). 

Kübler-Ross’ Five Stages Model  

One of the most widely known models when talking about grief is the ‘five stages’ model developed by Elizabeth Kübler-Ross, the five stages being denial and isolation, anger, bargaining, depression, and acceptance (1969). Despite its wide application to grieving, Kübler-Ross’s model was not developed in relation to grief. It was based on her observations of patients as they died of terminal illnesses; while they might have been grieving, the focus of the model was not grief. So, contrary to popular belief, Kübler-Ross’s model actually isn’t a model of grief at all! 

In addition, Kübler-Ross’s observations were not systematic or supported by research, even among the population she was observing (i.e., people with terminal illnesses), let alone among people experiencing loss and grief (Harris & Winokuer, 2016). Nonetheless, the stages were adopted by many, including counsellors, and applied to work with grieving people. It is also concerning that the stages are often considered to be discrete and sequential – i.e., to be moved through one after another – despite Kübler-Ross herself stating that movement back and forwards between stages occurs, and that stages can overlap. 

Given its popularity, it is very likely that you will come across this model at some point in your counselling practice (some clients may even cite it). So it is important to be mindful that the model is not supported by evidence and does not necessarily provide helpful guidance regarding the experiences of grieving people. This also applies to other stage and phase models (such as Rando’s model, which we consider next). It is also important to keep in mind that believing that they ‘should’ progress through certain stages or ‘should’ feel something included in the model can cause additional difficulties for clients. Remember that clients may not experience the stages described in this model or progress through the described phases at all, so it can be useful to help clients come to understand that such models are not necessarily accurate.     

Task-Oriented Models of Grief 

Some more recent models of grief suggest that, rather than fixed stages, the grieving process presents people who experience loss with a series of tasks associated with ‘processing’ or ‘progressing through’ grief (McLeod & McLeod, 2011). Those who promote task models claim a distinction between them and stage models: namely that stage models describe grieving while task models describe processes in which bereaved people can actively engage. However, they share many of the characteristics (and criticisms) of stage models.  

Rando’s ‘Six Rs’ 

Rando’s model of bereavement, also known as the ‘six Rs’, proposes that bereaved people’s processing of grief involves six tasks: recognising the loss; reacting to the separation; recollecting and re-experiencing the deceased and the relationship; relinquishing old attachments to the deceased and assumptive world; readjusting with adaptive movement into the new world; and reinvesting (McCoyd & Walter, 2016). As with stage theories, there are significant criticisms of task theories, including this one. These criticisms are very similar to those of stage models, and include: that Rando claims her processes are universal (i.e., experienced by everyone who experiences loss and grief, regardless of individual and cultural circumstances); that Rando claims that bereaved people must move through these processes in order to heal; and that task models in general suffer from a lack of empirical support (i.e., they are not supported by research) (McCoyd & Walter, 2016; Ober, Granello, & Wheaton, 2012). 

Worden’s Model  

Worden (2009) identified four key tasks he believes to be required for a healthy grieving process: 

Task 1: Acknowledging the reality of the loss. The mourner needs to cease denying that the death has occurred and come to believe that the loved person is truly dead and cannot return to life. The mourner needs to examine and assess the true nature of the loss and neither minimise or exaggerate it. 

Task 2: Processing the pain of grief. Sadness, despondency, anger, fatigue and distress are all normal responses to the death of a loved person; people should be encouraged to experience these feelings in appropriate and supported ways, so that they do not carry them throughout their lives. 

Task 3: Adjusting to a world in which the deceased person is missing. A full awareness of the loss of all the roles performed by the deceased in the life of the mourner may take some time to realise. Challenges to grow are presented to the mourner as he or she assumes new roles and begins to redefine himself or herself, often by learning new coping skills or by refocusing attention on other people and activities.  

Task 4: Finding an enduring connection with the deceased in the midst of embarking on a new life. It is important for the bereaved individual to find an appropriate place for the deceased person to occupy in a spiritual or nontangible sense. This task involves creating and sustaining an appropriate relationship with the deceased based on an ongoing emotional connection and memory, so that person will never by wholly lost to them. 

(Adapted from Harris & Winokuer, 2016, p. 34) 

A strength of Worden’s approach is that it is an active model which encourages responding to each client’s individual presentation and can assist clients in identifying their own needs and goals, which is critical to providing support in the context of grief (Harris & Winokuer, 2016). Despite the tasks being numbered, Worden (2009) has stated that they should not be viewed as fixed or prescriptive, but that “tasks can be revisited and worked through again and again over time. Various tasks can also be worked on at the same time” (Worden, 2009, p. 53).  

Nonetheless, it is problematic and potentially harmful to insist that a task must be undertaken; you may have noticed in the extract above that the tasks specify things that Worden believes ‘need’ to be done. It is also perfectly understandable that people would assume that a numbered series of tasks, such as Worden’s, indicates that the tasks are discrete and sequential (with all the problems this entails). It is also problematic to assume that aspects of grieving are universal and, as mentioned in regard to Rando’s model, there is a general lack of research evidence to suggest that task models are accurate in their ideas about grief and how it should be addressed.  

Contemporary Approaches to Loss and Grief 

More recent approaches to loss and grief focus more on adjustment to and integrating of loss, rather than on ‘recovery’ or ‘resolution’. There is the acknowledgement that, while grief may diminish over time, it may continue to have a presence in a person’s life, with the potential for reactivation at certain times (e.g., anniversaries, milestones) (Winokuer & Harris, 2012).  

The Dual Process Model 

Developed from a cognitive stress perspective, the dual process model of grief describes the grief experience as a process of oscillation (i.e., movement) between two modes of functioning: loss orientation and restoration orientation. 

In the loss-orientation, people may be immersed in the pain of separation, missing what has been lost, and coming to terms with the loss. At other times, in the restoration-orientation mode, the person engages in day-to-day activities, general life tasks, the things that need to be done in the aftermath of the loss, problem-solving, making appropriate adjustments, and focusing on other aspects of life (Hall, 2011).  

The adaptive, regulatory function of oscillation in the model is important to note. The ‘break’ from the distressing, sometime overwhelming nature of loss-orientation is important for mental and physical health, and necessary for “optimal adjustment over time” (Stroebe & Schut, 1999, p. 216). Worden (2009) uses the notion of ‘dosing’ to describe how bereaved people may expose themselves to the amount of the pain they are able to cope with before switching to restoration-orientation coping strategies. 

The model suggests that the focus of coping with grief may “differ from one moment to another, from one individual to another, and from one cultural group to another” (Hall, 2001). The dual process model uses these differences in coping to account for the diversity in the grief experience across individuals.  

Continuing Bonds 

While classical grief theory based on psychodynamic principles suggested that ‘recovery’ from bereavement involved disengaging from or ‘letting go’ of a deceased individual, more recent theory and practice focuses on maintaining a sense of continuity. This may be through memory and a “revised inner representation of the deceased (or person or thing which has been lost)” (Machin, 2009, p. 5). Many non-Western cultures show the significance of continued bonds through religious beliefs and rituals. For example, in Japanese culture, the maintenance of ties with the deceased is accepted and sustained by religious rituals. 

This has implications for counsellors, who are being encouraged to shift their focus from promoting ‘closure’ and sharing ideas about continuing bonds with clients when appropriate. For example, counsellors may support bereaved clients to explore the idea of continuing bonds and find healthy ways that they could maintain bonds with the deceased, if that is what the client would like to do.  

Meaning Making 

Significant loss, and particularly bereavement, can challenge our assumptions and beliefs about the world. Through loss, we may learn that not everyone is trustworthy – that some people harm others; that the world is not always a safe or predictable place; and that we have little ability to prevent many ‘bad things’ from happening to us (Winokuer & Harris, 2012). The reconstruction of one’s assumptive world, therefore, can be a central task for those who experience bereavement and other significant losses. It involves ‘relearning’ aspects of the self and the world (Attig, 1996). Such adjustments can include attempts to integrate the loss into the griever’s ‘personal narrative’, where the loss fits into “a meaningful plot structure” (Neimeyer, Prigerson & Davis, 2002, p.239).  

Meaning making can involve talking or not talking – it doesn’t have to be about storytelling, although that can be how it appears. People might make meaning out of creating art works, committing to a particular practice or enacting a particular value, or working to support a particular cause, to take just a few examples of the many ways that meaning making can be done. 

As you can see, approaches to grief have started to move away from stage, phase, task-based models to focusing on helping people integrate their memories and the importance of what has been lost into their present and future lives.  

There are various factors that help account for this diversity in how people grieve, from individual differences to the type of loss, to the family and cultural environment the person is in. Having an appreciation and understanding of the impact and influence of these factors will help you to respond to specific client needs based on their individual situation.