8.6 Focus on Psychological Research – Effectiveness of Therapy for Grief
Can We Heal From Grief Following Significant Loss? Does Therapy Help?
Our society has gradually gotten better at acknowledging and discussing emotional and psychological distress, prioritizing mental health, and destigmatizing therapy. There is less of a taboo related to seeking therapy or counseling for different periods in our lives and although many people who could benefit from therapy still do not access it – whether intentionally or due to resource limitations – more people are benefitting from therapy than ever before. It may surprise readers to learn then that up until very recently, the prevailing consensus among the psychological research community was that although grief-focused counseling or therapy might “feel good” and be well-received, it generally did not work very well. Perhaps this makes some degree of sense. If someone becomes a widow or widower following several decades of a life intertwined with a spouse who is their best friend and most important relationship, isn’t enduring sadness and despondency to be expected? Can we possibly expect a few months of weekly, hour-long sessions to make a dent in the suffering? Maybe we should not be pathologizing what may well be the appropriate (if overwhelming) emotional reaction to such a severe, irreversible life experience. Maybe we cannot reasonably expect to treat something if the emotions are proportionate to the magnitude of the experience. Multiple research studies seemed to bear these possibilities out as the treatment-outcome literature for grief interventions were generally unimpressive.
A couple of researchers – Joseph Currier and Robert Neimeyer – wondered if perhaps these conclusions, intuitive though they may be, were premature. To echo an oft-repeated theme throughout this text: what we know depends very much on how we know it. They noticed that many, if not most, individuals gradually improve on their own over time even in the absence of therapy. What is the impact on comparisons between treatment and control groups if both groups have a large percentage of individuals who will get better no matter what? Both groups would look better from pre to post – but might it not be difficult to show statistically that a small subset of a much larger group actually did fare better if we lump everyone all together? These researchers also noted that some interventions seemed to be targeted towards bereaved individuals who were likely to have sustained and severe distress while many other studies did not intentionally select or focus on these “indicated” grievers. They suspected that interventions that focused only on those who were unlikely to get better on their own over time – those who had especially severe or pronounced grief reactions – might work reasonably well but that most other studies of grief treatment do not show a benefit of therapy because they include all types of grievers and most folks – treated or untreated – will get better regardless.
To test these ideas they conducted a meta-analysis (i.e., they combined results of lots of different studies) and analyzed the data to separate out “universal” treatment, from “selective” treatment, and “indicated” treatment (Neimeyer & Currier, 2009). Universal treatments were studies that focused on anyone who had experienced a loss without reference to complications or severity. Selective treatments focused on those whom we might suspect will be especially likely to have protracted grief (e.g., bereaved parents) – but here again, the focus was not based on individual symptom severity and complications. Only studies that were designed to treat individuals with particularly pronounced and severe grief presentations were considered “indicated” grief treatment. As can be seen in the figures linked below, this distinction matters. The first figure shows what the prevailing beliefs (and seeming research outcomes) used to be without making such distinctions. If we don’t focus on those most at risk for prolonged grief, it would appear that grief treatment doesn’t really work. But, taking the exact same studies, and sorting them into universal, selective, and indicated trials shows that this distinction matters quite a bit – as is clear in the second figure linked below. The individuals in the “indicated” group probably would not have gotten much better – on average – in the absence of treatment so those assigned to the control condition probably did not improve much relative to those who got active treatment. It was easier to show – relative to untreated controls – that therapy helped. In contrast, the other two types of studies (universal and selective), many individuals in the control group probably did get better on their own over time to some degree – which makes it harder statistically – to show pronounced benefits of treatment. In brief, we can take comfort in the knowledge that time does indeed heal many wounds (perhaps not all) and that even though we are likely to always be impacted by the deaths of important people in our lives, it does not mean that we will be forever despondent and nonfunctional. For those who do happen to have more severe and enduring reactions, there is good evidence that therapy can indeed help with healing and recovery to some degree.
