There are two research-based models that are especially helpful in understanding child bereavement. The first is J William Worden’s Tasks of Mourning JW Worden Grief Counselling and Grief Therapy, 4^th Edition 2009 Springer New York. (The other model is presented in Module 3.)

The bereavement model is offered to you in summary. The full text is easy to read and is recommended as further reading to inform your practice.

---

Professor William Worden stresses that mourning, which he defines as the emotional process that occurs after a loss, is an essential and necessarily painful healing process which is achieved through a series of tasks Worden 2009.

There are four tasks that are addressed over an extended period of time and not in any sequential order. In your dealings with parents they and you will be grappling with task 1 and task 2. Your interventions with parents will be theoretically underpinned by this researched evidence.

1. To accept the reality of the loss

Initially the bereaved person is likely to be in a state of shock and numbness, even when a death has been anticipated. This can be manifest as over-reaction, whereby the bereaved person feels faint, cries uncontrollably, becomes hysterical or collapses. However, often the antithesis is seen and the person may display no emotion at all, appearing very controlled, calm and detached. A person’s culture may also determine their response at this time.

This initial shock may last several days and usually allows the bereaved person to deal with all the necessary practicalities and cope with the funeral without losing control – a form of emotional protection.

It is important that the bereaved person gradually accepts the death of this significant person in their life, and the fact that they can never return, in order to allow them to begin the task of adjustment. Some people may not immediately be able to acknowledge what has happened and may cope by denying it or refusing to talk about it.

Being involved and consulted as much as possible before the death underlines the difficult reality and although honest conversations may be hard for you, research shows they are helpful. Maybe to see their dead baby or child, or to bath, dress and hold them for as long as they require, reinforces the reality. Being involved as much as possible in preparations for the funeral, and observing rituals and traditions, all assist people to face the reality of what has happened. 

Families from ethnic minorities will need acknowledgment of, and support for, the mourning rituals appropriate to their culture. If you are unsure, ask the parents what their cultural observances are.

2. To process the pain of grief

Your experience of the parents’ emotions may be limited due to the trauma and shock they are experiencing. Once the numbed feeling subsides (this may take a long time) and the full reality of what has happened is experienced, the bereaved person may have intensely painful feelings, which may last weeks or months or years.

Their grief may overwhelm them so that they are incapable of thinking about anything or anybody else but themselves and how they feel. It gets in the way of everything they think and do. They may over-react to other people’s comments and appear irritable. Susan Hill, a writer and a bereaved mother, eloquently described her extreme sensitivity as “having one skin less”.

As well as feelings of extreme sadness, the bereaved may have a whole mixture of intense emotions. Some people struggle with guilt about some aspect of their relationship with the dead person. Perhaps they had left unsaid their true feelings, or said things they didn’t really mean. Maybe they had not spent enough time with them or really listened.

Feelings of anger can be extremely powerful. The bereaved person may feel anger towards the dead person; anger for the loss of control that death brings; anger at their god for letting it happen. They may feel resentful towards a family member who they feel contributed in some way to the death.

Grief is not a mental illness, although sleeplessness, anxiety, fear, anger and a preoccupation with self can all add up to a feeling of ‘going mad’. These feelings are natural, and when experienced and expressed will become less frequent and begin to subside over time. Talking about them and bringing them into the open is helpful.

Expressing grief is cathartic and attempts to short-circuit these feelings rarely help in the long term. If grief is denied, deep-seated problems may occur in the years ahead and psychological help may be needed.

---

Tasks 3 and 4 are included in this module for your learning. They are not tasks that will be immediately attended to by parents at the time of the death of a child or baby.

3. To adjust to a world without the deceased

Facing the future without someone important in your life is a difficult and painful process. No one can fill the aching void the person has left and each day life brings constant reminders of their absence. The future seems uncertain, or even frightening, and a tremendous effort is required to get through every day. It may take many months before the bereaved person is able to dwell less upon the sad events surrounding the death and starts to function more as they did before the loss.

4. To find an enduring connection with the deceased in the midst of embarking on a new life

This involves moving forward with your changed life without the physical presence of the dead person, whilst holding onto the memories of them. It is a way of reinvesting in life again alongside the knowledge that the dead person will never be forgotten. This can often feel like a betrayal and is perhaps the most difficult task of all, but it has been recognised that it is important to maintain a relationship or ‘continuing bonds’ with the person who has died, albeit a very different relationship to when the person was alive Klass, Silverman & Nickman 1996.

There is a sense of looking to the future, while recalling times spent with the person who has died and finding comfort and pleasure in those memories. It is also a way of making life more meaningful and winning back control, so that the bereaved person is not continually ambushed by memories of the person who has died and trapped by painful feelings, but rather can choose when they want to reflect about their relationship with the dead person. It is normal at anniversaries for feelings of grief to be aroused again and to be as vivid as on the day the death occurred.