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Last week, the Association for Death Education and Counseling (ADEC) held its 30th Annual Conference in Montreal, Canada. There were several important presentations, some of which I will be writing about later. However, today I want to concentrate on one session that is relevant to a topic that has been in the popular press and on the television show Boston Legal: Is “grief counseling” helpful or harmful to the bereaved?
After years of research, there is little reason to doubt that psychotherapy is an effective way to help most people who are experiencing distress. Both professional journals and the mass media have reported that despite the theoretical approach of the clinician or who is receiving the therapy - individuals, family, or groups - clients are in significantly better shape after therapy than those who do not take advantage of it.
For the subset of psychotherapy known as grief or bereavement counseling, however, the effectiveness of therapy is not as well established. There are three reasons for this lack of clarity:
- Contrary to other therapeutic areas which aim to treat and assuage preexisting, specific disorders and problems with living, bereavement counseling is most often practiced as a preventive treatment. Its goal is to diminish a client’s probability of suffering future psychological or physical problems. Unlike non-bereavement therapy, there are no easy means to examine the impact of treatment on a pre- and post-treatment basis.
- Most bereaved people have a tendency to improve in their adaptation to the loss without any professional assistance. Only 10-15% of those whose loved one has died experience suffering and grief so intense and for so long that they develop psychological and physical debilitation, sometimes to the point of being fatal.
- Many studies have failed to distinguish between the three broad categories of bereavement interventions as delineated by the Institute of Medicine (IOM): universal, selective, and indicated.
- Universal interventions are those that focus on anyone who is bereaved without considering individual death-related risk factors or preexisting functioning.
- Selective interventions are oriented to those whose loss has the potential for causing high distress such as those whose child died violently, suicide survivors, etc.
- The third category, indicated interventions, addresses those who present significant problems adapting to the death. These problems could include normally recognized psychological symptoms such as depression or other clinically important complications such as guilt, loss-related intrusions, rage, etc. It is also important to note that the complicated grief these mourners suffer will not diminish just because of the passage of time nor can it be simply reduced to common psychological disorders such as depression and PTSD.
Because of these variables, the reports of how helpful counseling is for the bereaved have ranged from favorable to neutral to harmful.
At the ADEC conference, Joseph Currier and Robert Neimeyer presented the findings of their analysis of the existing research and tried to make some sense out of the disparate results. They, along with Jeffrey Berman, conducted a comprehensive meta-analysis of 61 published, controlled research studies on the efficacy of bereavement counseling. Besides examining how effective counseling can be, the researchers also attempted to determine if timing for starting therapy; the method of recruitment; the mode of death; or the bereaved person’s sex, age, or relationship to the deceased had any bearing on the results.
Without going into the details of the study, let me summarize what they found. Their analysis showed that general bereavement counseling has a slightly helpful effect that continues for only a short time after the intervention ends. These findings are similar to those for generically applied trauma interventions. However, when Currier, Neimeyer, and Berman delved more deeply into the data, they made some interesting discoveries.
- Interventions that addressed the universal population did not produce any statistically better results than those that occur from the mere passage of time. Most people have the personal resiliency and available societal and familial support systems to help them adapt to the loss, whether they receive counseling or not.
- For those who qualify for selective interventions, counseling did provide more benefit, but it was short-lived and not statistically significant later.
- However, if the proper steps were undertaken to assess if the client was having specific problems in adapting to the loss and if any of these problems were subsequently addressed, i.e., indicated interventions, the effects of the counseling were the same as in other areas of psychotherapy.
It is also noteworthy that Currier, Neimeyer, and Berman found that except for the method of recruitment, no relationship existed between the other possible factors (the sex or age of the bereaved, timing of therapy, etc.) and successful therapy. The only effect that the method of recruitment had was with clients who were either self and/or clinically referred. Referred clients experienced better outcomes than those who entered therapy as the result of aggressive outreach programs.
So, the answer to the question “Is ‘grief counseling’ helpful or harmful to the bereaved?” is “It depends.” As Neimeyer said at the conference, counseling helps, unless it doesn’t. In other words, for those bereaved individuals needing indicated interventions, the higher the level of bereavement-related distress, the greater the benefit they will receive from bereavement therapy. To read the entire paper, click on The Effectiveness of Psychotherapeutic Interventions for the Bereaved: A Comprehensive Quantitative Review.
