Staff Perspective: Musing About Grief
As we move through life, we accumulate experiences with death and grief, sometimes other’s grief and sometimes our own. In 2014, my twin boys died the day they were born. Their death propelled me into my own very personal experience of grief, but also heightened my awareness of other’s experiences with grief. As I began searching for topics for this blog entry I kept coming back to grief. Each time the topic entered my mind, I pushed it aside and tried to think of something more intellectual, more timely, more popular, more military, more… something. Grief is so common. No group of people (civilian vs. military, male vs. female, young vs. old, rich vs. poor) has a lock on grief – we all grieve. As a topic this seemed too ordinary or too common at first glance, but I couldn’t get it out of my head. I do not recall a single class in my graduate program that taught how to treat grief, and I have encountered few trainings on the topic throughout my years as a military psychologist. Usually, there have been one or two providers in a clinic that have some grief training, but there has not been a push to have most providers in the clinic trained to treat grief. I’m embarrassed to say I wasn’t even sure if there were empirically supported treatments for grief. After much mental debate about what I should write about this week, I gave in to the idea of writing about grief and turned to Currier, Neimeyer, and Berman’s 2008 article, “The Effectiveness of Psychotherapeutic Interventions on Bereaved Persons: A comprehensive Quantitative Review” to help inform my musings.
In 2008 Currier et. al. published a meta-analysis of the effectiveness of existing psychotherapeutic interventions for grief. In their review of 61 studies, they found that grief therapies did not significantly improve outcomes compared to no intervention. These were disappointing results given that the studies spanned three decades of research and efforts to help the bereaved. Currier et al. (2008) decided to take a closer look at the studies to see if there were potential moderators that might indicate differences in effectiveness across groups. By looking at the population targeted by the specific studies, they found that who received treatment was a critical factor in effectiveness of the treatments. Specifically, treatments that were applied to all individuals experiencing grief (Universal Grief Therapy) or individuals considered high-risk grievers such as those grieving violent deaths or the death of a child (Selective Grief Therapy) had very low or negative effect sizes at post-intervention or follow-up. In other words, these groups were doing no better than would be expected by the passage of time. However, the treatments that were delivered to individuals assessed the presence of complicated grief and difficulties coping with the loss (Indicated Grief Therapy) produced enduring improvements at post-intervention and follow-up. Furthermore, age did not matter as a factor, nor did gender or type of death (traumatic vs. expected) or relationship to the deceased.
These were interesting results to me, as I apply them to my own life and experiences with grief. In my own journey through grief, I found the pain and unhappiness to be extreme, but at no time did I feel that I was depressed or that life would not hold happiness and purpose in my future. I never felt my own self-worth or value in life waiver even as I felt overwhelmed, angry, and confused by my loss. In other words, I was not in need of therapy. I clearly remember wishing that I could jump forward in time – perhaps to where I am now – when the loss was not so fresh and I had been able to resume my regular life in whatever shape that was going to take without my twins. It turns out that meant returning to the Center for Deployment Psychology after leaving for a year, throwing myself into parenting my older son, traveling, and taking tango lessons with my husband.
But what about those who do struggle to move forward with their lives after a loss? For example, one of my close friends has lived in a world of grief that is difficult to imagine for the past seven years. Her relationship to grief started when her husband committed suicide. Her three children were relatively young at the time, the oldest only in junior high school. She managed to rebuild her life and provide a stable family life for her children in a remarkable show of strength and perseverance. Then her son was killed in an auto accident a year ago. Although, my friend has continued to amaze me with her resilience, her children have been a different story. Her oldest two really struggled with their father’s death, and after her brother died her oldest turned to therapy for help. During one of our early talks after her son died my friend asked me what I thought about her younger son going to therapy. She said she had been urged by people to take him even if he didn’t seem to be exhibiting problems. She wanted my opinion. At the time I realized I could not give her an answer informed by research and my opinion was probably no better than a guess. After reading Currier et al.’s 2008 article as well as Neimeyer and Currier’s 2009 follow up discussion of emerging directions in grief therapy I could now give my friend a much better answer, “only if he is beginning to exhibit symptoms of difficulty adjusting and moving forward with his life.” Furthermore, I could reassure my friend that there are actually evidenced based interventions for targeted grief, which I would recommend she pursue only if there was an indication of need for treatment.
References:
Currier, J. M., Neimeyer, R. A., & Berman, J. S. (2008). The Effectiveness of Psychotherapeutic Interventions for Bereaved Persons: A comprehensive Quantitative Review. Psychological Bulletin, 134(5), 648-661.
Neimeyer, R. A. & Currier, J. M. (2009). Grief Therapy Evidence of Efficacy and Emerging Directions. Current Directions in Psychological Science, 18(6), 352-356.
Dr. Elizabeth Parins, Psy.D. is a project developer and trainer in military and civilian programs with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
As we move through life, we accumulate experiences with death and grief, sometimes other’s grief and sometimes our own. In 2014, my twin boys died the day they were born. Their death propelled me into my own very personal experience of grief, but also heightened my awareness of other’s experiences with grief. As I began searching for topics for this blog entry I kept coming back to grief. Each time the topic entered my mind, I pushed it aside and tried to think of something more intellectual, more timely, more popular, more military, more… something. Grief is so common. No group of people (civilian vs. military, male vs. female, young vs. old, rich vs. poor) has a lock on grief – we all grieve. As a topic this seemed too ordinary or too common at first glance, but I couldn’t get it out of my head. I do not recall a single class in my graduate program that taught how to treat grief, and I have encountered few trainings on the topic throughout my years as a military psychologist. Usually, there have been one or two providers in a clinic that have some grief training, but there has not been a push to have most providers in the clinic trained to treat grief. I’m embarrassed to say I wasn’t even sure if there were empirically supported treatments for grief. After much mental debate about what I should write about this week, I gave in to the idea of writing about grief and turned to Currier, Neimeyer, and Berman’s 2008 article, “The Effectiveness of Psychotherapeutic Interventions on Bereaved Persons: A comprehensive Quantitative Review” to help inform my musings.
In 2008 Currier et. al. published a meta-analysis of the effectiveness of existing psychotherapeutic interventions for grief. In their review of 61 studies, they found that grief therapies did not significantly improve outcomes compared to no intervention. These were disappointing results given that the studies spanned three decades of research and efforts to help the bereaved. Currier et al. (2008) decided to take a closer look at the studies to see if there were potential moderators that might indicate differences in effectiveness across groups. By looking at the population targeted by the specific studies, they found that who received treatment was a critical factor in effectiveness of the treatments. Specifically, treatments that were applied to all individuals experiencing grief (Universal Grief Therapy) or individuals considered high-risk grievers such as those grieving violent deaths or the death of a child (Selective Grief Therapy) had very low or negative effect sizes at post-intervention or follow-up. In other words, these groups were doing no better than would be expected by the passage of time. However, the treatments that were delivered to individuals assessed the presence of complicated grief and difficulties coping with the loss (Indicated Grief Therapy) produced enduring improvements at post-intervention and follow-up. Furthermore, age did not matter as a factor, nor did gender or type of death (traumatic vs. expected) or relationship to the deceased.
These were interesting results to me, as I apply them to my own life and experiences with grief. In my own journey through grief, I found the pain and unhappiness to be extreme, but at no time did I feel that I was depressed or that life would not hold happiness and purpose in my future. I never felt my own self-worth or value in life waiver even as I felt overwhelmed, angry, and confused by my loss. In other words, I was not in need of therapy. I clearly remember wishing that I could jump forward in time – perhaps to where I am now – when the loss was not so fresh and I had been able to resume my regular life in whatever shape that was going to take without my twins. It turns out that meant returning to the Center for Deployment Psychology after leaving for a year, throwing myself into parenting my older son, traveling, and taking tango lessons with my husband.
But what about those who do struggle to move forward with their lives after a loss? For example, one of my close friends has lived in a world of grief that is difficult to imagine for the past seven years. Her relationship to grief started when her husband committed suicide. Her three children were relatively young at the time, the oldest only in junior high school. She managed to rebuild her life and provide a stable family life for her children in a remarkable show of strength and perseverance. Then her son was killed in an auto accident a year ago. Although, my friend has continued to amaze me with her resilience, her children have been a different story. Her oldest two really struggled with their father’s death, and after her brother died her oldest turned to therapy for help. During one of our early talks after her son died my friend asked me what I thought about her younger son going to therapy. She said she had been urged by people to take him even if he didn’t seem to be exhibiting problems. She wanted my opinion. At the time I realized I could not give her an answer informed by research and my opinion was probably no better than a guess. After reading Currier et al.’s 2008 article as well as Neimeyer and Currier’s 2009 follow up discussion of emerging directions in grief therapy I could now give my friend a much better answer, “only if he is beginning to exhibit symptoms of difficulty adjusting and moving forward with his life.” Furthermore, I could reassure my friend that there are actually evidenced based interventions for targeted grief, which I would recommend she pursue only if there was an indication of need for treatment.
References:
Currier, J. M., Neimeyer, R. A., & Berman, J. S. (2008). The Effectiveness of Psychotherapeutic Interventions for Bereaved Persons: A comprehensive Quantitative Review. Psychological Bulletin, 134(5), 648-661.
Neimeyer, R. A. & Currier, J. M. (2009). Grief Therapy Evidence of Efficacy and Emerging Directions. Current Directions in Psychological Science, 18(6), 352-356.
Dr. Elizabeth Parins, Psy.D. is a project developer and trainer in military and civilian programs with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.