Preparing to Work with Loss and Bereavement: Theories and Insights for Therapists

Preparing to Work with Loss and Bereavement
Learning Outcomes
Foundational Theories of Grief
Elisabeth Kübler-Ross: Five Stages of Grief
Attachment Theory: Parkes and Bowlby
William Worden's Four Tasks of Mourning
The Dual Process Model by Stroebe and Schut
Types of Loss: Expanding the Understanding of Grief
Preparing as a Therapist
Practical Considerations in Grief Therapy
Cultural Aspects of Grief
Frequently Asked Questions
Final Reflections
Further Reading and Resources

Grief and bereavement are universal experiences yet individual in their manifestations. For therapists working with clients facing loss, understanding grief’s complexities is vital. This post explores the foundations of grief theories and types of loss, offering practical insights for therapeutic settings.

Learning Outcomes

By exploring this material, you will gain:

An understanding of key grief theories, including critiques and alternative models.
Awareness of different grief types and their implications.
Enhanced skills to reflect on your experiences with loss to provide empathetic client support.

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Working with Loss and Bereavement Theories

Foundational Theories of Grief

Diagram illustrating the five stages of grief by Elisabeth Kübler-Ross: denial, anger, bargaining, depression and acceptance.

Elisabeth Kübler-Ross: Five Stages of Grief

Kübler-Ross introduced the widely recognised model of grief stages: Denial, Anger, Bargaining, Depression, and Acceptance (DABDA). While seminal, critiques highlight its simplicity, emphasising that grief does not follow a linear path. Therapists should use this model as a framework rather than a prescriptive guide.

Attachment Theory: Parkes and Bowlby

Parkes and Bowlby applied attachment theory to grief, proposing a sequence of Numbness, Yearning, Disorganisation and Despair, and Reorganisation. This model underscores grief’s physical and emotional impacts and its ties to attachment styles.

Diagram showing Parkes and Bowlby’s attachment theory of grief, including numbness, yearning, disorganisation and despair, and reorganisation.

William Worden’s Four Tasks of Mourning

Worden proposed a task-oriented approach:

Accept the reality of the loss.
Work through the pain of grief.
Adjust to an environment without the deceased.
Find an enduring connection with the deceased while moving forward.

This non-linear model emphasises client autonomy and the therapeutic process.

The Dual Process Model by Stroebe and Schut

The Dual Process Model addresses the oscillation between:

Loss-oriented processes (e.g. grief work, acknowledging the reality of loss).
Restoration-oriented activities (e.g. attending to new roles, creating a new normal).

This approach offers a flexible, client-centred perspective, balancing emotional processing with life adjustments.

Diagram of the dual process model of grief by Stroebe and Schut, showing oscillation between loss-oriented processes and restoration-oriented activities.

Understanding these models is just the beginning. Counsellors and psychotherapists must also recognise the somatic impacts of grief, where clients experience physical symptoms like headaches or stomach pains that mirror the experiences of the deceased. For example, clients grieving a loved one who passed from cancer may report similar sensations, an area requiring careful exploration. Moreover, the sociocultural context of grief cannot be ignored. Cultural norms shape grieving behaviours, and sensitivity to these differences is essential for establishing trust and rapport.

While early models like DABDA provide foundational insights, practitioners should approach them as adaptable frameworks. Professionals like Colin Murray Parkes’ critique of linear models reminds us that grief is highly individualised.

Instead of a fixed sequence, clients often experience emotions cyclically or simultaneously, requiring a more fluid therapeutic approach. Modern models, such as the Dual Process Model, account for this variability, emphasising the interplay between emotional and cognitive domains.

Types of Loss: Expanding the Understanding of Grief

Normal Grief: A gradual reduction in emotional intensity, allowing individuals to engage with daily life.
Anticipatory Grief: Experienced before an impending loss, such as a terminal illness or significant life change.
Complicated Grief: Marked by prolonged and intense yearning, denial, or psychotic states. Clients may resist acknowledging the loss.
Secondary Losses: Consequences of primary grief, such as losing financial stability, roles, or support systems.

Traumatic Grief: Triggered by sudden, violent, or out-of-sequence losses, often necessitating trauma-focused interventions before grief therapy.
Collective Grief: Shared mourning, often seen after public tragedies. This grief can trigger personal loss reflections and provide community healing opportunities.
Collective grief frequently triggers unresolved personal grief. For example, public events like Princess Diana’s death or terrorist attacks create a shared space for mourning, allowing individuals to reflect on their losses. Therapists can help clients navigate these reflections, linking the collective experience to personal healing without minimising their journey.

Grief is not always rooted in death. You might frequently encounter grief related to role transitions, such as retirement or losing a parental role when children move away. These shifts can create a void in identity, requiring clients to redefine their sense of self.

Similarly, loss of material stability, such as through redundancy or financial crisis, can evoke profound grief, often overshadowed by logistical concerns. Therapists must attune themselves to these dynamics to fully address the multifaceted nature of grief.

Preparing as a Therapist

To support clients effectively, practitioners must first reflect on their relationship with loss:

Have you processed your grief?
Are you equipped with supervision and personal therapy to manage client interactions involving loss?
Can you hold space for cultural and individual differences in grieving?

These introspections are essential to maintaining therapeutic presence and intersubjective connection.

Counsellors and psychotherapists must also evaluate their supervisory relationships. Working with supervisors experienced in grief and loss is crucial, as their insights can support you in navigating complex client dynamics. Furthermore, acknowledging that grief is pervasive in most client presentations can prepare you to encounter it in unexpected contexts, such as relationship issues or career transitions.

Practical Considerations in Grief Therapy

Cultural Sensitivity: Acknowledge that societal and cultural norms shape grief expressions. Understanding these can enhance rapport and effectiveness.
Somatic Awareness: Recognise the body’s role in grief. Clients may report physical symptoms mirroring their loss. Clients may also exhibit physical symptoms mimicking those experienced by the deceased, such as headaches when mourning a loved one who had brain cancer. Recognising these somatic experiences can provide insight into the depth of a client’s emotional and psychological connection to their loss. Therapists can explore these sensations gently, linking them to the grieving process while addressing any underlying concerns about health anxiety.

Client Empowerment: Emphasise client agency in navigating grief. Models like Worden’s tasks and the Dual Process Model support autonomy and adaptation.
Address Secondary Losses: Explore how logistical and relational disruptions compound primary grief, helping clients address practical and emotional needs.
Practical Interventions for Traumatic Grief: Before exploring grief itself, clients experiencing traumatic grief may require practical support, such as securing housing or managing finances, to create stability.

Cultural Aspects of Grief

Cultural norms and practices deeply influence grief. For instance, some cultures emphasise collective mourning through rituals and ceremonies, while others focus on individual processing. Therapists must remain sensitive to these cultural frameworks, as they can shape how clients express grief and seek support.

For example, communal rituals like wakes or public memorials might serve as coping mechanisms, while their absence can exacerbate feelings of isolation. Understanding these nuances is essential for creating culturally competent interventions.

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Working with Loss and Bereavement Theories

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Frequently Asked Questions

What are the main grief theories counsellors use when working with clients experiencing loss and bereavement?

Counsellors often draw on several foundational grief theories to understand a client’s experience, including Kübler‑Ross’s five stages of grief, attachment‑based models by Parkes and Bowlby, Worden’s four tasks of mourning, and the Dual Process Model that highlights oscillation between loss‑oriented and restoration‑oriented coping.

How can a therapist prepare themselves before working with bereaved clients?

Therapists should reflect on their own experiences of loss, ensure they have appropriate supervision and personal therapy where needed, and build skills in cultural sensitivity, somatic awareness, and practical interventions to support clients through diverse and individual grief responses.

What types of loss might a counsellor encounter beyond the death of a loved one?

Loss can take many forms in counselling, including anticipatory loss before an expected death, complicated grief with prolonged distress, secondary losses like changes in roles or identity, and grief related to non‑death losses such as redundancy or relationship breakdowns.

Final Reflections

Grief therapy is not about “fixing” grief but holding space for clients to explore, process, and adapt. By integrating foundational theories, reflecting on personal experiences, and embracing cultural contexts, therapists can offer compassionate, informed support to those navigating loss.

By grounding your practice in these frameworks, you contribute meaningfully to your clients’ journeys of loss and healing.