Does grief counseling work?

Complicated Grief and the Quest for Meaning: A Constructivist Contribution

One of the more important results of the upwelling of research on bereavement in recent decades has been the development of criteria for complicated grief, a disorder whose coherence, correlates and consequences have been subjected to increasing scrutiny. In this article I argue that clinical, conceptual, and evidence-based considerations converge to support the further refinement of such criteria, with a special emphasis on their connection to the protracted and painful quest for meaning that characterizes a subset of the bereaved. As further research supports and extends these current efforts, there is reason to believe that an understanding of complicated grief can make a significant contribution to research, theory, and practice concerning adaptation in the wake of loss.

The Fundamental Paradox in the Grief Literature: A Critical Reflection

A key theme in the bereavement literature is the recognition that every grief experience is unique and dependent on many variables, such as the circumstances of the death, characteristics of the bereaved individual, their relationship with the deceased, the provision and availability of support, and a myriad of sociocultural factors. Concurrently, there are corresponding efforts to define “normal” grief and delineate it from “complicated” grief experiences. The discord between these two potentially opposing statements remains a paradox evident within the three major tensions within the thanatological literature—the dominance of grief theories, the medicalization of grief, and the efficacy of grief interventions. Three recommendations for moving beyond the paradox are discussed—the provision of improved grief education for service providers, the bereaved, and the wider community; the conduct of research that emphasizes the context of grief and is relevant to service provision; and the examination of current grief interventions.

Assessing Grief and Bereavement: Observations from the Field

The purpose of this article is to describe the evaluations involved in the Yale Bereavement Study (YBS), a three-year NIMH and NCI-funded longitudinal study conducted from January 2000 through May 2003. The quantitative and qualitative questions included in the YBS gave the respondents an opportunity to describe their most recent loss, rate and review their past losses, and assess all aspects of their current life situations. In this article, the first author describes, in a qualitative manner, the ways in which this assessment, per se, appeared helpful and not harmful to the respondents. Also, developed here is the implication for potential application of a modified version of the YBS which could be used in both research and clinical practice.

Mothers’ Grief, Forgiveness, and Posttraumatic Growth After the Loss of a Child

The aim of this study was to investigate maternal grief after losing a child in relation to forgiveness and posttraumatic growth. A sample of 60 grieving mothers from Slovakia completed the following battery: The Texas Revised Inventory of Grief, a modified version of the Enright Forgiveness Inventory, and the Posttraumatic Growth Inventory. The results showed a negative association between forgiveness and grief and a strong positive association between forgiveness and posttraumatic growth, which was not moderated by the time elapsed since the loss. Semistructured interviews were conducted with 12 mothers. The data were analyzed through Consensual Qualitative Research to gain deeper understanding of forgiveness and posttraumatic growth experiences after the loss of a child. Categories and subcategories are discussed.

Maladaptive coping in adults who have experienced early parental loss and grief counseling

This study compares maladaptive coping, measured as substance use, behavioral disengagement, self-blame, and emotional eating, among adults (>18 years) who have experienced early parental loss ( N = 1465 women, N = 331 men) with non-bereaved controls ( N = 515 women, N = 115 men). We also compared bereaved adults who received grief counseling ( N = 822 women, N = 190 men) with bereaved controls who had not ( N = 233 women, N = 66 men). Bereaved adults reported significantly more substance use, behavioral disengagement, and emotional eating than non-bereaved adults. Counseling participants reported significantly more substance use and self-blame than non-participants. Our results suggest that early loss may negatively impact the development of adulthood coping.

The Indirect Effect of Positive Parenting on the Relationship Between Parent and Sibling Bereavement Outcomes After the Death of a Child

CONTEXT

Families are referred to pediatric palliative care (PPC) programs when a child is diagnosed with a medical condition associated with less than a full life expectancy. When a child dies, PPC programs typically offer a range of bereavement interventions to these families, often focusing on parents. Currently, it is unclear which factors increase the likelihood that bereaved siblings will experience negative outcomes, limiting the development of empirically supported interventions that can be delivered in PPC programs.

OBJECTIVES

The present study explored the relationship between parents' and surviving sibling's mental health symptoms (i.e., post-traumatic stress disorder [PTSD], prolonged grief disorder (PGD), and depression symptoms) after a child's death. Additionally, the extent to which parent functioning indirectly impacted sibling functioning through parenting behaviors (i.e., positive parenting and parent involvement) was also examined, with a specific focus on differences based on parent gender.

METHODS

Sixty bereaved parents and siblings (aged 8-18) who enrolled in a PPC program from 2008 to 2013 completed measures of PTSD, PGD, and depression related to the loss of a child/sibling. Siblings also completed a measure of general parenting behaviors.

RESULTS

Maternal, but not paternal, symptoms of PTSD and PGD were directly associated with sibling outcomes. Paternal symptoms were associated with sibling symptoms indirectly, through parenting behaviors (i.e., via decreasing positive parenting).

CONCLUSION

These results underscore the importance of examining both maternal and paternal influences after the death of a child, demonstrate differential impact of maternal vs. paternal symptoms on siblings, and stress the importance of addressing postloss symptoms from a family systems perspective.

From Body to Mind and Spirit: Qigong Exercise for Bereaved Persons with Chronic Fatigue Syndrome-Like Illness

Bereavement may bring negative impacts on the mind, body, and spiritual well-being of grieving persons. Some bereaved persons with chronic fatigue syndrome- (CFS-) illness experience a dual burden of distress. This study investigated the effects of bereavement on CFS-like illness by comparing bereaved and nonbereaved participants. It also adopted a random group design to investigate the effectiveness of Qigong on improving the well-being of bereaved participants. The Qigong intervention comprised 10 group sessions delivered twice a week for 5 weeks and home-practice for at least three times a week lasting 15–30 minutes each. The participants' fatigue, anxiety, and depression, quality of life (QoL), and spiritual well-being were measured at baseline and 3 months after treatment. The bereaved participants experienced significantly greater mental fatigue (16.09 versus 14.44, p = 0.017) and lower physical QoL (34.02 versus 37.17, p = 0.011) than their nonbereaved counterparts. After 3 months, the mental fatigue (−8 versus −4, p = 0.010) and physical fatigue (−10 versus −5, p = 0.007) experienced by intervention group had declined significantly, and improvements on their spirituality (14 versus −2, p = 0.013) and psychological QoL (8.91 versus 0.69, p = 0.002) scores exceeded those of the control group.

A Hospice-Based Bereavement Support Group Using Creative Arts

There is evidence of the value of individual creative arts (art, drama, music, etc.) in helping people to cope with bereavement. However, there is a gap in the research on the effectiveness of the intentional, combined use of creative arts activities in bereavement support group intervention for adults. This article describes an exploratory study which assessed the effectiveness of using creative arts activities in an eight session support group intervention. A waiting list, randomized control trial supplemented by limited qualitative data was used. Evidence was found that the intervention did help participants’ ability to move between loss and restoration coping when they attended at least six of the eight sessions. However, the use of creative arts activities appears to be more suitable for some people than for others.

Publication Trends in Thanatology: An Analysis of Leading Journals

To identify important trends in thanatology as a discipline, the authors analyzed over 1,500 articles that appeared in Death Studies and Omega over a 20-year period, coding the category of articles (e.g., theory, application, empirical research), their content focus (e.g., bereavement, death attitudes, end-of-life), and for empirical studies, their methodology (e.g., quantitative, qualitative). In general, empirical research predominates in both journals, with quantitative methods outnumbering qualitative procedures 2 to 1 across the period studied, despite an uptick in the latter methods in recent years. Purely theoretical articles, in contrast, decline in frequency. Research on grief and bereavement is the most commonly occurring (and increasing) content focus of this work, with a declining but still substantial body of basic research addressing death attitudes. Suicidology is also well represented in the corpus of articles analyzed. In contrast, publications on topics such as death education, medical ethics, and end-of-life issues occur with lower frequency, in the latter instances likely due to the submission of such work to more specialized medical journals. Differences in emphasis of Death Studies and Omega are noted, and the analysis of publication patterns is interpreted with respect to overall trends in the discipline and the culture, yielding a broad depiction of the field and some predictions regarding its possible future.

Insecure Attachment Styles and Complicated Grief Severity

A growing body of evidence supports links between attachment style, complicated grief (CG), and coping mechanisms in bereavement. In general, adults with insecure attachment styles are at an increased risk for developing CG when faced with the death of a loved one. However, much remains unknown regarding this complex interaction. This article provides a comprehensive synthesis of this literature base, offering future directions for attachment-informed CG research, clinical assessment, and treatment. The clear risk posed by an insecure attachment style on CG highlights the need for a proper and thorough assessment of attachment style as part of standard practice in grief-related treatment as well as the importance of meeting the unique clinical needs of the bereaved in consideration of one's attachment style. Further emphasis also should be placed on the mediating impacts of sociocultural variables, any of which could help to mitigate one's return to a level of preloss functioning.

The Possible Effects on Bereavement of Assisted After-Death Communication during Readings with Psychic Mediums: A Continuing Bonds Perspective

Unresolved, complicated, prolonged, or traumatic grief can have detrimental effects on mental and/or physical health. The effects of traditional grief counseling, with its focus on the client's acceptance of separation and integration of loss, are unclear. Within the model of continuing bonds, however, grief resolution includes an ongoing relationship between the living and the deceased. Spontaneous and induced experiences of after-death communication (ADC) have been shown to be beneficial in the resolution of grief by demonstrating these continued bonds. Presently, many bereaved individuals are experiencing assisted ADCs by receiving readings from psychic mediums and though little is known about the effects of this selfprescribed treatment option, anecdotal reports and exploratory data posit a positive outcome. This article aims to inform those who work with the bereaved about the relationships between grief, spontaneous, induced, and assisted ADC experiences, and the continuing bonds paradigm. Suggestions for future research are also included.

What is "normal" in grief?

Research conducted over the past two decades has revealed that grief, a common phenomenon experienced by many people following the loss of a loved one, is rarely experienced as a steady progression from high acuity (intensity) to eventual resolution. Instead of this single "traditional" path, four distinct trajectories are supported by empirical data: resilience, chronic grief, depressed-improved, and chronic depression. Furthermore, a small subset of individuals never fully integrate the loss into their life, and continue to experience severe disruption in daily life many years after the loss event, a phenomenon known as Complicated Grief (CG). Continued empirical research will help further our understanding of the normative grief process and CG as a disorder. This information is crucial for informing clinicians of best practices when attending to those suffering from loss.

Common therapeutic factors in bereavement groups

Group therapy remains a popular treatment format for individuals experiencing bereavement. Although many innovative group treatments for grief are being developed, common therapeutic factors can also contribute to outcomes. The author integrates research on group therapy processes and treatment for grief, and examines evidence regarding group therapeutic factors that may influence bereavement group outcomes. Specifically, research on therapeutic factors related to sharing and support, interpersonal learning, and meaning-making is highlighted where it has relevance to bereavement groups. Potential research examining the interactions of these processes, their effects on group functioning and outcomes, and the moderators of these effects are discussed.

Understanding the sociocultural context of coping for African American family members of homicide victims: a conceptual model

The disproportionate representation of African American survivors of homicide victims places them at greater risk for compromised mental health. However, an examination of factors that influence how this population copes with this traumatic event is absent from the literature. This article elucidates the importance of sociocultural factors that influence coping resources and strategies for African Americans surviving the homicide of a loved one. A socioculturally responsive model of coping is presented that can be utilized in furthering the development of research and practice that is culturally responsive to the needs of African American survivors of homicide victims.

Changes in parental self-identity following the death of a child to cancer

This study explored parental self-identity at 6, 12, and 18 months following the death of a child to cancer. Semi-structured interviews were analyzed using qualitative methodology. Two patterns of parental self-identity emerged: identity reintegration, characterized by 6 associated themes (e.g., positive reframing, focusing on surviving children); and identity disintegration, characterized by 7 associated themes (e.g., negative perceptions of social support, self-destructive thoughts and behaviors). Patterns were stable from 6 to 12 months, but a shift towards identity disintegration was observed at 18 months. These findings suggest a need to support bereaved parents' well-being beyond the first year post-death.

Positive and negative experiences from grief group participation: a qualitative study

This article presents qualitative interview data from the research project "Grief Support Groups in Norway" (2009-2011). The aim of this part of the study was to investigate grief group participant's experiences, benefits, and satisfaction with the grief group. Positive aspects were to meet with peers, share thoughts and feelings, normalization, exchange advice and information, and share hope. On the negative side were unfulfilled needs or expectations, additional personal stress, and unsatisfactory structure, organization, and leadership. Importantly, lack of screening caused bereaved with complicated grief to participate in groups that were non-therapeutic, leaving them with insufficient help. Also, group leaders were not always considered knowledgeable of group processes and impacts of different organizational and structural factors on groups. Conclusively, participants' needs and expectations should be considered when planning and organizing groups, in order to conduct helpful groups and increase the experience of a positive outcome.

Breaking bonds in male prairie vole: long-term effects on emotional and social behavior, physiology, and neurochemistry

Social relationships are essential for many fundamental aspects of life while bond disruption can be detrimental to mental and physical health. Male prairie voles form enduring social bonds with their female partners, allowing the evaluation of partner loss on behavior, physiology, and neurochemistry. Males were evaluated for partner preference formation induced by 24h of mating, and half were separated from their partner for 4 wk. In Experiment 1, partner loss significantly increased anxiety-like behaviors in the elevated plus maze and light-dark box tests and marginally increased depressive-like behaviors in the forced swim test. In addition, while intruder-directed aggression is common in pair bonded prairie voles, separated males were affiliative and lacked aggression toward an unfamiliar female and an intruding male conspecific. Partner loss increased the density of oxytocin-immunoreactivity (-ir), vasopressin-ir, and corticotrophin-releasing hormone-ir cells in the paraventricular nucleus of the hypothalamus and oxytocin-ir cells in the supraoptic nucleus. Tyrosine hydroxylase-ir was not affected. In Experiment 2, partner preference was observed after 2 wk of partner loss but eliminated after 4 wk partner loss. Body weight gain and plasma corticosterone concentrations were elevated throughout the 4 wk. No effects were observed for plasma oxytocin or vasopressin. Together, partner loss elicits anxiety-like and depression-like behaviors, disrupts bond-related behaviors, and alters neuropeptide systems that regulate such behaviors. Thus, partner loss in male prairie voles may provide a model to better understand the behavior, pathology, and neurobiology underlying partner loss and grief.

Group work with bereaved individuals: the power of mutual aid

Group work has been underused as an intervention with grieving clients. This is despite the fact that group membership offers bereaved individuals a number of unique advantages. In this article, the use of group work with bereaved individuals is examined, based on current theory and research. The role and skills of the group worker are identified and illustrated through the use of case examples. Challenges associated with working with groups for bereaved individuals also are discussed.

Coping processes among bereaved spouses

The authors investigated if an intervention based on the dual process model (vs. traditional bereavement support) enhanced oscillation between loss- (LO) and restoration-oriented (RO) coping of recently bereaved (2-6 months) spouses/partners. Participants were followed over 12 months. The authors found an increased emphasis over time on RO coping, particularly for women and those who were younger; however, no treatment effect was detected. Although patterns in the data are consistent with the model, the authors conclude that it is difficult for interventions to modify LO, RO, and oscillation unless there is sufficient intervention dosage and tailored to those exclusively engaged in one process.

Meaning-based group counseling for bereavement: bridging theory with emerging trends in intervention research

A growing body of scholarship has evaluated the usefulness of meaning-based theories in the context of bereavement counseling. Although scholars have discussed the application of meaning-based theories for individual practice, there is a lack of inquiry regarding its implications when conducting bereavement support groups. The objective of this article is to bridge meaning-based theories with bereavement group practice, leading to a novel intervention and laying the foundation for future efficacy studies. Building on recommendations specified in the literature, this article outlines the theoretical paradigms and structure of a short-term meaning-based group counseling intervention for uncomplicated bereavement.

Participants' Recommendations for the Ideal Grief Group: A Qualitative Study

Based on the results from the qualitative part of the study “Grief Groups in Norway” conducted in 2009–2011, this article focuses on grief group participants' recommendations for good or ideal grief groups. Participants have insightful observations about grief groups and how they can be improved, and taking their point of view seriously is one important way of ensuring that users of such group get an optimal experience from joining such groups. Using their experiences to adjust the structure and function of the groups, one can allow for practical solutions for organizations that have difficulties starting up grief support groups, for example, in areas where the population density is low. A major finding in this study was that grief group participants stressed the importance of thorough information before and at the start of grief groups. This concerned information about the aim, structure, organization, and possible effects and limitations of group participation.

The preparation of graduate health professionals for working with bereaved clients: an Australian perspective

Students enrolled in health profession courses require grief education so that, upon graduation, they are able to meet the needs of clients living with loss and grief. We investigated grief and loss education in six Australian university programs--medicine, nursing, counseling, psychology, social work, and occupational therapy--drawing from course documents and face-to-face interviews with key staff and final-year students. Only the counseling course included a dedicated grief and loss unit. The nursing, medicine, and occupational therapy courses emphasized end-of-life issues rather than a breadth of bereavement experiences. The social work course taught grief as a socially-constructed practice and the psychology course focused on grief and loss in addiction. Several factors influenced the delivery of grief education, including staffing, time, placement opportunities, student feedback, and needs of each profession. The study provides an indication as to how future health professionals are prepared for grief and loss issues in their practice.

Effectiveness of "primary bereavement care" for widows: a cluster randomized controlled trial involving family physicians

Thirty-one family physicians, from 19 primary care teams in Biscay (Spain), were randomly assigned to intervention or control group. The 75 intervention family physicians, after training in primary bereavement care, saw 43 widows for 7 sessions, from the 4th to 13th month after their loss. The 16 control family physicians, without primary bereavement care training, saw 44 widows for 7 ordinary appointments, with the same schedule. Outcome measures were collected at 4, 10, 16, and 24 months after the loss. A linear mixed model was used. No significant differences were found in favor of the intervention group on grief and indeed control group widows experienced more improvement in somatisation, general health, and general emotional outcomes.

Participants with Prolonged Grief—How Do They Benefit from Grief Group Participation?

Data analyzed in this article is part of a study conducted to explore grief support groups in Norway. Participants that fulfilled the criteria of Prolonged Grief Disorder (PGD) were compared with participants that did not in order to explore whether they differed on satisfaction and experiences with participation. To allow for comparison, a subsample of 22 participants that fulfilled the criteria of PGD were drawn from the total of 262 participants. Demographic and loss-related variables were analyzed to explore factors associated with PGD. Fulfillment of PGD was then analyzed to explore the group's effect on life quality and overall satisfaction. The main finding is that participants who fulfill the criteria of prolonged grief are in general less satisfied with the groups and report less positive effect on life quality. We also found age- and gender-differences regarding fulfillment of PGD, with older bereaved women especially at risk of developing symptoms of PGD.

Considerations for Grief Interventions: Eras of Witnessing with Families

This article describes research that was conducted to articulate interventions with families experiencing grief. Using an interpretive methodology framed by philosophical hermeneutics allowed for a depth of understanding of these therapeutic conversations. The research findings offer explanations of the role of time in relation to grief, particularly the timing of interventions, and describe the significance of working with multiple family members during therapeutic interventions. This research was unique in that it approached grief counseling with a family focus, the participants were interviewed for this study several years after the therapeutic encounter, and the underlying theoretical framework for the interventions focused on grief as a lifelong, life-changing experience, rather than a finite, pathology-laden event.

Caring for grieving family members: results from a national hospice survey

BACKGROUND

A founding principle of hospice is that the patient and family is the unit of care; however, we lack national information on services to family members. Although Medicare certification requires bereavement services be provided, reimbursement rates are not tied to the level or quality of care; therefore, limited financial incentives exist for hospice to provide more than a minimal benefit.

OBJECTIVES

To assess the scope and intensity of services provided to family members by hospice.

RESEARCH DESIGN

We fielded a national survey of hospices between September 2008 and November 2009.

PARTICIPANTS

A national sample of US hospices with an 84% response rate (N=591).

MEASURES

Bereavement services to the family, bereavement services to the community, labor-intensive family services, and comprehensive family services.

RESULTS

Most hospices provided bereavement services to the family (78%) and to the community (76%), but only a minority of hospices provided labor-intensive (23%) or comprehensive (27%) services to grieving family members. Larger hospice size was positively and significantly associated with each of the 4 measures of family services. We found no significant difference in provision of bereavement services to the family, labor-intensive services, or comprehensive services by ownership type; however, nonprofit hospices were more likely than for-profit hospices to provide bereavement services to the community.

CONCLUSIONS

Our results show substantial diversity in the scope and intensity of services provided to families of patients with terminal illnesses, suggesting a need for clearer guidance on what hospices should provide to exemplify best practices. Consensus within the field on more precise guidelines in this area is essential.

Helpful aspects of bereavement support for adults following an expected death: volunteers' and bereaved people's perspectives

Helpful and unhelpful aspects of bereavement support were investigated from the perspectives of 24 bereaved adults and their volunteer bereavement support workers. Most commonly reported themes were the provision of hope and reassurance, and the opportunity for continued sharing and support. Significantly more clients than volunteers reported provision of information, and talking to someone outside their social network as helpful, and both groups scored higher on helpfulness ratings than comparative groups of psychotherapists and clients. Clients' grieving styles and the quality of the helping relationship were also related to what was seen as helpful.

A pilot study of a weekend retreat intervention for family survivors of homicide

Homicide causes negative unintended consequences for family survivors. Family survivors face complicated grief and overwhelming loss with minimal support from others. The authors offered a retreat intervention as a way to ameliorate the effects of the homicidal death for family survivors of homicide. An exploratory longitudinal pilot study examined the feasibility and acceptability of the intervention and explored the impact of the TOZI© Healing intervention on participants' distress symptoms. Eight family members participated in the 2-day retreat and completed surveys at five time intervals over 30 months. Descriptive statistics and correlations were used to analyze the data. Although sample sizes were too small to achieve statistical significance, changes on selected holistic health outcomes, supported by overwhelmingly positive focus group responses to the intervention, affirm the need for further study.

Late-life bereavement and complicated grief: a proposed comprehensive framework

OBJECTIVES

The construct of complicated grief (CG) has garnered increased empirical attention since it has been proposed as a diagnostic category for the upcoming Diagnostic and Statistical Manual of Mental Disorders-V. The aim of this article is to critically examine construct validity in light of a proposed conceptual framework, with special emphasis on understanding late-life bereavement.

METHOD

This is a review article that critically examined current bereavement and grief models. We explored discriminant and convergent validity between CG and uncomplicated grief (UG) and other psychopathological constructs in terms of symptom intensity, symptom trajectories, bereavement outcomes, and treatment response.

RESULTS

The findings from this review show mixed support for differentiating CG from other outcomes of bereavement for the following reasons: (1) a clear boundary between CG and UG has not been adequately supported, (2) symptoms of CG and bereavement-related depression and anxiety overlap, although there is some evidence of incremental validity in that CG symptoms predict global functioning above and beyond symptoms of depression, and (3) the treatment literature demonstrated that general grief interventions and treatment targeted for improving depression are ineffective at treating symptoms of CG, whereas interventions specially tailored to treating CG have been moderately effective. The findings also emphasize the importance of considering pre-bereavement circumstances, such as preexisting depression, in the conceptualization of broader bereavement outcome.

CONCLUSION

There were mixed findings supporting the construct validation of CG. A comprehensive framework that emphasizes pre-bereavement circumstances was proposed in order to better predict various grief trajectories and outcomes of late-life loss.

Indicators of Family Resilience after the Death of a Child

The aim of this study was to identify and describe resilience qualities in families after losing a child. Questionnaires, including an open-ended question, were utilized to collect data independently from the parents and siblings of the deceased in 89 Belgian families. The results indicate that family strengths in general, and commitment to the family in particular, helped the families' adaptation after the loss. In addition, the adaptation process after the loss was aided if the family members viewed the crisis as a challenge. Both the siblings and the parents indicated that the extent to which a family experienced support from the community was directly related to family adaptation after the loss. Redefining the situation and utilizing social support from friends and family were underlined as effective family coping strategies. The findings could be used in interventions to promote family resilience, thereby affirming the reparative potential of families.

Evaluating a bereavement follow-up intervention for grieving fathers and their experiences of support after the death of a child--a pilot study

This article describes a study designed to evaluate the effectiveness of an intervention program for bereaved fathers and their experiences of it in a sample of intervention (n = 62) and control (n = 41) fathers. Data were collected by 3 scales: the Hogan Grief Reactions Checklist, a scale for measuring received social support, and a scale for measuring fathers' experiences of the intervention program. Assessment at 6 months after leaving the hospital showed that intervention fathers reported lower grief reaction scores and stronger personal growth. Intervention fathers reported the most emotional support from both health care personnel and peer supporters. The support received was perceived as helpful in coping, and fathers rated the intervention favorably. The findings support the continuation of the intervention.

What Do We Know About Needs for Help After Suicide in Different Parts of the World?

Background: “A person’s death is not only an ending: it is also a beginning – for the survivors. Indeed, in the case of suicide, the largest public health problem is neither the prevention of suicide (...), nor the management of attempts (...), but the alleviation of the effects of stress in the survivor-victims of suicidal deaths, whose lives are forever changed and who, over a period of years, numbers in the millions ...” (Edwin S. Shneidman, 1973 ). Aims: As there is no doubt that suicide postvention should be given a more prominent position on the agenda than is presently the case, this paper explores what we now know about perceived needs for help on the part of suicide bereaved in different parts of the world. Methods: A search of related literature in the field was undertaken using the PubMed/PsychInfo databases. In addition, professionals throughout the world working in the field of suicide postvention were invited to submit reports about suicide postvention measures or literature. Results: Very little research was found that reflected the perceived needs for help on the part of the bereaved – and all the studies stemmed from countries in the Western world. However, the bereaved in these studies agreed about a common need for peer and social support, and that professional help must be adapted to and offered with respect for individual needs. Thus, it seems that in societies in which the stigma about suicide has diminished, the bereaved experience very similar needs for help, whereas in other societies it is difficult to talk about their need for help because of the sanctions and taboos connected to suicide. Conclusions: We need far more culturally sensitive research in order to explore and clarify how each community understands suicide and reacts to families who have lost someone by suicide.

Understanding bereavement: what every oncology practitioner should know

Death and dying are ever-present in the practice of oncology. Oncology clinic staff regularly encounter terminally ill patients and grieving family members and, therefore, are well positioned to identify and intervene on behalf of those at risk for extreme psychological distress. It is important for oncology providers to understand grief, the factors that heighten the risk for maladjustment to the loss, and how best to ease the emotional pain and suffering of bereaved family members. This article highlights models of grief that examine early relationships, relationships at the time of the loss, cognitive processes, and cultural practices. We also discuss special circumstances of grief such as the loss of a child or parent and grief in young adults. Risk factors for severe grief reactions, specifically prolonged grief disorder, are examined, as are the efficacy of various interventions, including staff support, psychodynamic therapy, cognitive-behavioral therapy, interpersonal therapy, group therapy, and Internet interventions. Overall, the literature on treatment for grief has demonstrated mixed results, but some therapies have shown promise in treating particularly distressed families and individuals. We discuss the clinical significance of grief and the importance of recognizing the unique factors which contribute to individuals' abilities to cope with loss.

Peer relationships of bereaved siblings and comparison classmates after a child's death from cancer

OBJECTIVES

To compare peer relationships among bereaved siblings and matched classmates, and to examine gender, grade level, and time since death as moderators.

METHODS

Families were recruited from cancer registries at four hospitals 3-12 months after a child's death. Measures of social behavior and peer acceptance were completed by children in the classrooms of 105 bereaved siblings (ages 8-17 years). Teachers also reported on children's social behavior. Three classmates were matched for gender, race, and age to each bereaved sibling to form a comparison group (n = 311).

RESULTS

Teachers reported bereaved siblings were more prosocial than comparison classmates. Peers perceived bereaved boys as more sensitive-isolated and victimized, while bereaved siblings in elementary grades were perceived by peers as less prosocial, more sensitive-isolated, less accepted, and as having fewer friends. Peers and teachers viewed bereaved siblings in middle/high school grades as higher on leadership-popularity.

CONCLUSIONS

Bereaved siblings who were male and in elementary grades were more vulnerable to social difficulties, while those in middle/high school may exhibit some strengths. Ongoing research to inform the development of interventions for bereaved siblings is warranted.

Behavioral activation and therapeutic exposure for bereavement in older adults

The development and clinical trial of a 5-session behavioral intervention for complicated bereavement (CB) is presented. We conceptualized CB in terms of Major Depression (MDD) and Post-traumatic Stress Disorder (PTSD) and consequently applied treatment components of Behavioral Activation and Therapeutic Exposure (BA-TE). In order to assure standardization of treatment, control costs, and engage patients, a multi-media, multi-context format was adopted to address avoidance and withdrawal behaviors conceptualized as central pathogenic responses in CB. Participants (N = 26) were assessed before and after BA-TE treatment via structured clinical interview and standardized questionnaires in terms of PTSD, MDD, CB, and health concerns. The number of days since the death of the loved one was widely variable and served as a covariate for all outcome analyses. ANCOVAS revealed statistically significant improvement, irrespective of how many days since death had elapsed prior to initiation of intervention, on structured interviews and self-report measures for most outcome variables.

Grief among family members of nursing home residents with advanced dementia

OBJECTIVES

To describe preloss and postloss grief symptoms among family members of nursing home (NH) residents with advanced dementia, and to identify predictors of greater postloss grief symptoms.

DESIGN

Prospective cohort study.

SETTING

22 NHs in the greater Boston area.

PARTICIPANTS

123 family members of NH residents who died with advanced dementia.

MEASUREMENTS

Preloss grief was measured at baseline, and postloss grief was measured 2 and 7 months postloss using the Prolonged Grief Disorder Scale. Independent variables included resident and family member sociodemographic characteristics, resident comfort, acute illness, acute care prior to death, family member depression, and family member understanding of dementia and of resident's prognosis.

RESULTS

Levels of preloss and postloss grief were relatively stable from baseline to 7 months postloss. Feelings of separation and yearning were the most prominent grief symptoms. After multivariable adjustment, greater preloss grief and the family member having lived with the resident prior to NH admission were the only factors independently associated with greater postloss grief 7 months after resident death.

CONCLUSIONS

The pattern of grieving for some family members of NH residents with advanced dementia is prolonged and begins before resident death. Identification of family members at risk for postloss grief during the preloss period may help guide interventions aimed at lessening postloss grief.

Complicated grief symptoms in caregivers of persons with lung cancer: the role of family conflict, intrapsychic strains, and hospice utilization

Guided by a stress process conceptual model, this study examines social and psychological determinants of complicated grief symptoms focusing on family conflict, intrapsychic strains, and the potential moderating effect of care quality and hospice utilization. Relying on data from 152 spouse and adult child lung cancer caregiver survey respondents, drawn from an ancillary study of the Assessment of Cancer CarE and SatiSfaction (ACCESS) in Wisconsin, hierarchical multiple regression analysis was used to examine determinants of complicated grief. After controlling for contextual factors and time since death, complicated grief symptoms were higher among caregivers with less education, among families with lower prior conflict but higher conflict at the end-of-life, who had family members who had difficulty accepting the illness, and who were caring for patients with greater fear of death. Additionally, hospice utilization moderated the effect of fear of death on complicated grief. Findings suggest that family conflict, intrapsychic strains, and hospice utilization may help to explain the variability found in complicated grief symptoms among bereaved caregivers. Implications for enhancing complicated grief assessment tools and preventative interventions across the continuum of cancer care are highlighted.

Professionals' experiences of grief counseling: implications for bridging the gap between research and practice

Despite the escalating interest in grief interventions, there is a clear misalignment between contemporary grief research and grief counseling practices, and this disparity may limit intervention effectiveness. Semi-structured interviews with 19 grief counselors revealed their current practices of grief counseling. The counselors' descriptions of grief and their grief counseling practices were diverse and many were influenced by classic grief theories and the grief work hypothesis. The grief counselors described negotiating several issues and dilemmas in their work and provided recommendations for achieving greater exchange between research and practice. The findings have the potential to inform the delivery, efficacy, and relevance of grief counseling in Western Australia.