Grief Therapy: Nature and application Essay

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Grief Therapy: Nature and application

Introduction

            Bereavement is viewed as a normal part of human experience and considered as well as a vital aspect to the human state. Many of those who experience the loss of a loved one receive support and care from significant others and friends. A marginal number of bereaved people face critical and at times lasting consequences while the rest of the majority manages to prevail over their grief in the course of time. Those who find this time of bereavement and mourning incapacitating therefore need professional therapeutic help (Corr, 1999).

A lot of those Psychotherapeutic interventions for bereavement differ extensively, and comprise individual and group techniques. Among the numerous intervention programs which were devised to diminish the anguish and distress connected with mourning is grief therapy and has been reviewed for its effectiveness. This paper outlines the use of grief therapy, the statistics surrounding its use, such as how prevalent grief therapy is, the populations which utilize it and to what degree it helps resolve issues and other relevant matters to grief therapy.

Discussion

            Who uses grief therapy? Social worker Dennis M. Reilly states, “We do not necessarily need a whole new profession of . . . bereavement counselors. We do need more thought, sensitivity, and activity concerning this issue on the part of the existing professional groups; that is, clergy, funeral directors, family therapists, nurses, social workers and physicians” (Worden 1991, p. 5). Trained therapists may be physicians, junior hospital or clinical medical students. Barclay et al (2003) were able to study general practitioners in Wales to ascertain how well prepared they are to care for the dying.   It is likely then that although there are several available professional therapists, with various support groups sprouting these days, help for the sufferer is no longer elusive. Where is grief therapy conducted and in what format?

Grief therapy by and large is carried out in a constrained area (usually an office setting). These areas may be located in hospitals (for both inpatients and their families and for outpatients), mental health clinics, churches, synagogues, chemical dependency inpatient and out-patient programs, schools, universities, funeral home aftercare programs, employee assistance programs, and programs that serve chronically ill or terminally ill persons. Additional sites might include adult or juvenile service locations for criminal offenders. Private practice (when a counselor or therapist works for herself) is another opportunity to provide direct client services (Barclay et al., 2003).

  When Is Grief Counseling or Therapy Needed? Based on studies by many experts, including John Jordan, grief counseling and grief therapy techniques are put to test and redesigned by new research. In their article published in the journal Death Studies, Selby Jacobs, Carolyn Mazure, and Holly Prigerson state, “The death of a family member or intimate exposes the afflicted person to a higher risk for several types of psychiatric disorders. These include major depressions, panic disorders, generalized anxiety disorders, posttraumatic stress disorders; and increased alcohol use and abuse” (Jacobs, Mazure, and Prigerson 2000, p. 185). They encourage the development of a new Diagnostic and Statistical Manual of Mental Disorders (DSM) category entitled “Traumatic Grief,” which would facilitate early detection and intervention for those bereaved persons affected by this disorder.

Researcher Phyllis Silverman is concerned that messages dealing with the resolution of grief, especially a new category entitled “Traumatic Grief,” may do more harm to the mourner. She states, “If this initiative succeeds (‘Traumatic Grief’), it will have serious repercussions for how we consider the bereaved—they become persons who are suffering from a psychiatric diagnose or a condition eligible for reimbursed services from mental health professionals” (Silverman 2001). She feels the new DSM category may help provide the availability of more services, but believes it is important to consider what it means when predictable, expected aspects of the life cycle experience are called “disorders” that require expert care.

When one thinks of grief counselors and grief therapists one is again reminded that grief and bereavement is a process, not an event. How do persons cope and adapt? Grief counseling or grief therapy intervention can be useful at any point in the grief process, before and/or after a death.   Grief counseling and therapy do not only begin after death. Then again, is this actually accurate? According to clinician, researcher and writer Therese Rando, Anticipatory grief is the phenomenon encompassing the process of mourning, coping, interaction, planning, and psychosocial reorganization that are stimulated and begun in part in response to the awareness of the impending loss of a loved one and the recognition of associated losses in the past, present, and future.

It is seldom explicitly recognized, but the truly therapeutic experience of anticipatory grief mandates a delicate balance among the mutually conflicting demands of simultaneously holding onto, letting go of, and drawing closer to the dying patient. (Rando 2000, p. 29) Based also on in-depth studies made by Schut and Stroebe, grief therapy, when applied soon after bereavement may not alleviate but instead render therapy ineffective or else even interfere with the “normal” grieving manner (p.141,2005).. These scholars further say “intervention is more effective for those with more complicated forms of grief.”

This is further confirmed from expert psychotherapist-researcher Worden who believes grief therapy is most proper in conditions that fall into three types: (1) The complicated grief reaction is manifested as prolonged grief; (2) the grief reaction manifests itself through some masked somatic or behavioral symptom; or (3) the reaction is manifested by an exaggerated grief response. People experiencing this kind of bereavement may not be that easy to recognize hence diagnostic techniques are crucial tools for the practitioner (Zisook, 2000). Grief therapy is not for everyone and is not a “cure” for the grieving process, Worden concludes.

  Recent investigations as to the efficacy of therapy or interventions were made in response to criticisms made a decade ago by Robak (p.701-702, 1999). He held that the bereavement research field failed to provide empirical studies on psychotherapy and counseling. According to Schut and Stroebe (p.142), researchers must determine that the psychological remedies or therapies for bereaved persons have been demonstrated to be successful in controlled research with a delineated population. However, in the area of grief counseling and therapy, “…well-established interventions (i.e. those well-described and transferable, with treatment manual, tested, replicated and found effective, and accompanied by indications and counter-indications) are not available.

This is largely based on stringent criteria adopted for efficacy studies (p.143). This implies that sources for the use of grief therapy, its efficacy and who practices this treatment program is therefore limited. As Schut and Stroebe (p.146) declare “ … although small steps in the right direction are now being taken, this fundamental message still holds; to create a body of sound scientific knowledge , the research agenda for the future must expand the number of well-designed and executed empirical studies on the efficacy of bereavement intervention.

Synthesis and Conclusion       

                                          There is a major new ”Report on Bereavement and Grief Research” made by the Center for the Advancement of Health which settled, ”A growing body of evidence indicates that interventions with adults who are not experiencing complicated grief cannot be regarded as beneficial in terms of diminishing grief-related symptoms.” The report indicated that there is very little support for the effectiveness of interventions like crisis teams that call on family members within hours of a loss, self-help groups that seek to foster friendships, efforts to show the bereaved ways to work through grief and a host of other therapeutic approaches believed to help the bereaved (The New York Times, Oct.9, 2006).

Counseling and therapy are opportunities for those who seek support to help move from only coping to being transformed by the loss—to find a new “normal” in their lives and to know that after a loved one dies one does not remove that person from his or her life, but rather learns to develop a new relationship with the person now that he or she has died. In A Time to Grieve: Mediations for Healing after the Death of a Loved One (1994) the writer Carol Crandall states, “You don’t heal from the loss of a loved one because time passes; you heal because of what you do with the time” (Staudacher 1994, p. 92). Even when bereavement therapy is needed, however, the benefit may depend on the approach used. For example, most bereavement groups focus on emotional issues.

These are most helpful to women. But men tend to grieve differently, and they are more likely to benefit from an approach that focuses on their processes of thinking. Caring friends and relatives often coax those who have just suffered the loss of a loved one to seek professional help, either by taking part in a bereavement group or through individual psychotherapy. But Dr. Robert A. Neimeyer, professor of psychology at the University of Memphis, editor of the scientific journal Death Studies and chairman of the committee that prepared the new report, said in an interview: ”Not everyone requires the same thing. Dealing with grief is not a ‘one size fits all’ proposition.”

Moreover, Dr. George Bonanno, psychologist at Columbia’s Teachers College, has found that the bereaved who naturally avoid emotions should not be forced to confront grief. Even three years later, such people show no traumatic consequences as a result of suppressing it, he reported. In more than half the cases, Dr. Neimeyer explained, far more useful than therapy to the bereaved are the empathy and emotional and physical support that friends, relatives and caring people in the neighborhood and at work can provide in the first weeks and months after a death.

Only when grieving is ”complicated” — intense and protracted, associated with deep unrelieved depression and interfering with normal enjoyments, life tasks or an ability to work — is there a clear-cut need for grief therapy, Dr. Neimeyer said. Dr. Hansson of Tulsa observes that many people who experience complicated grief have neither faced their losses nor allowed themselves to work through the emotions that naturally ensue. If, months down the road, a bereaved person is still grieving intensely, therapy should be sought, Dr. Neimeyer said. Among the hallmarks of complicated grief he listed are ”intrusive thoughts about the deceased, recurrent images of how the person died, a continual quest to reconnect with the deceased, corrosive loneliness, feeling purposeless and empty, difficulty believing the death ever happened and feeling that the world cannot be trusted.

Treating people with these symptoms is important because their unresolved grief can have serious, even life-threatening health consequences, including high blood pressure, stroke, heart attack, substance abuse and suicide. ”Such people can literally die of a broken heart,” Dr. Neimeyer said.

   Perhaps the most revealing study of the varying courses of bereavement was undertaken by Dr. Bonanno, Dr. Camille B. Wortman, a psychologist at the State University of New York at Stony Brook, and six co-authors. They evaluated 1,532 people (all married, with at least one partner of each couple over age 65), then followed them for up to eight years. When a spouse died, they assessed the bereavement experiences of the widow or widower over time. This is what they found: 1) Forty-six percent of the survivors were ”resilient.” They experienced transitory distress, but scored low in depression both before the death and at 6 and 18 months after losing their spouses. 2) Eleven percent followed a common grief course, with rather severe depression at 6 months that had largely disappeared by 18 months. 3) Sixteen percent, who were not initially depressed, nonetheless were devastated afterward, experiencing prolonged depression.

4) Eight percent were chronically depressed beforehand, with the depression worsened by the death. 5)But 10 percent who had been depressed before the death did very well afterward, perhaps because they had been in bad marriages or were relieved from the burdens of taking care of ill spouses. 6) The remaining 9 percent did not fit into any category. , people may require very different therapy or no therapy at all.”  The available evidence therefore, points out that interventions for individuals at risk for complications of bereavement may result in some benefit for a short while.

However, the findings are inconsistent and they vary based on the factors such as the gender of participants and whether they were first screened before participating in the studies, which appears to increase the likelihood that the interventions would be successful (e.g. Schut et al., 2001). The concepts of complicated grief are fairly recent in bereavement research and this is the reason that no controlled studies exist that pertains directly to its treatment (Jacobs & Prigerson, 2000, p.479).

References

  1. Casarett D, Kutner JS, Abrahm J, et al: Life after death: a practical approach togrief and bereavement. Ann Intern Med 134 (3): 208-15, 2001.
  2. Corr, Charles A. “Children, Adolescents, and Death: Myths, Realities and Challenges.” Death Studies 23 (1999): 443–463.
  3. Bonano GA, Boerner C, Wortman B.: resilient or at Risk? A 4-year study of Older Adults Who initially Showed High or Low Distress following Conjugal Loss. J. Gerontol B. Psychol.Sci.Soc. Sci, March 1, 2005; 60(2):p67-p73.
  4. Hansson R., Stroebe M: Grief, Older Adulthood. In: Gullota T, bloom M (eds): Encyclopedia of Primary Prevention & health promotion. New York: Plenum, 2003, pp.515-521.
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  6. Jacobs, Shelby, Carolyn Mazure, and Holly Prigerson. “Diagnostic Criteria for Traumatic Grief.” Death Studies 24 (2000):185–199.
  7. Neimeyer R. (2000).Searching for the meaning of meanings: grief therapy and the process of reconstruction. Death Studies,24:531-558.
  8. Neimeyer, Robert. Lessons of Loss: A Guide to Coping. New York: McGraw-Hill, 1998.
  9. Rando, Therese A. Clinical Dimensions of Anticipatory Mourning. Champaign, IL: Research Press, 2000.
  10. Rando TA: Treatment of Complicated Mourning. Champaign: Research Press, 1993.
  11. Schut H, Stroebe M, van den Bout J, & Terheggen M, (2001). The efficacy of bereavement interventions: Determining who benefits. In Stroebe, M et al.eds., Handbook of bereavement: consequences, coping, and care. Washington, D.C.: American Psychological Association, pp. 705-737.
  12. Schucter SR, Zisook S: Treatment of spousal bereavement: a multidimensional approach. Psychiatr Ann 16 (5): 295-306, 1986.
  13. Staudacher, Carol. A Time to Grieve: Mediations for Healing after the Death of a Loved One. San Francisco: Harper San Francisco, 1994.
  14. Stroebe, Margaret, and Henk Schut. “The Dual Process Model of Coping with Bereavement: Rationale and Description.” Death Studies 23 (1999):197–224.
  15. Worden JW: Grief Counseling and Grief Therapy. New York: Springer Publishing Company, 1991.
  16. The New York Times, Oct.9,2006
  17. Zisook S & Schuchter S. (2001). Treatment of the depressions of bereavement. American Behavioral Scientist, 44(5);782-797.
  18. Zisook S: Understanding and managing bereavement in palliative care. In: Chochinov HM, Breitbart W, eds: Handbook of Psychiatry in Palliative Medicine. Oxford: Oxford University Press, 2000, pp 321-34.

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