Bereavement Therapy Research Articles

Exploring Attachment Incoherence in Bereaved Families’ Therapy Narratives: An Attachment Theory-Informed Thematic Analysis

Attachment theory predicts that family bereavement leads even securely attached individuals to experience temporary attachment insecurity. This paper explores how incoherence, a narrative marker of attachment insecurity, is displayed in the talk of families undergoing bereavement family therapy. This study uses the lens of attachment theory, and specifically the Adult Attachment Interview, to explore how members of five families talked about the loss of a close family member and how interactions between therapist and family members could hinder a coherent dialogue about the death. The families were recruited through Winston’s Wish, a UK-based family bereavement charity. The analysis centres on the “Telling the story” intervention, used at the start of therapy, in which family members together tell the story of the death. Families also re-told the story in an extra family session towards the end of the therapy for the purposes of this research. Transcripts of the therapy sessions were analysed using thematic analysis, with some codes developed directly from the unresolved loss codes of the AAI and other codes generated from analysing the transcripts through the lens of attachment theory. Through a micro focus on therapy process, the study provides tentative support for suppositions in attachment theory about the psychological importance of (fostering) coherent speech as well as information about potentially helpful versus unhelpful therapist actions in family bereavement therapy. The findings have relevance for bereavement therapy interventions, therapy training and research practice.

Mortality as Framed by Ongoingness in Digital Design

This article presents a number of perspectives on mortality in light of both Victorian mourning and memento mori jewelry and bereavement therapy and grieving. Both help to reveal valuable qualities for digital design. The article then illustrates how these qualities influenced the design of four digital lockets, examining how both Victorian and modern practices relate to mortality, mourning, grief, and death, and exploring possibilities for digital design. Finally, ongoingness—by reference to the work of artist Moira Ricci—is explained as both a theoretical construct and a resource for design practice. Central in the proposal is the notion that, rather than being distanced or detached from the deceased (as has been the predominant grieving therapy approach of modernity), the bereaved can continue to have an active and growing relationship with them.

PC-FACS

PC-FACS

Hospice Services for Complicated Grief and Depression: Results from a National Survey.

To describe the prevalence of screening for complicated grief (CG) and depression in hospice and access to bereavement therapy and to examine whether screening and access to therapy varied according to hospice organizational characteristics or staff training and involvement. Cross-sectional national survey conducted from 2008 to 2009. United States. Hospices (N = 591). Whether hospices screened for depression or CG at the time of death or provided access to bereavement therapy (individual or group). Organizational characteristics included region, chain status, ownership, and patient volume. Staffing-related variables included training length and meeting attendance requirements. Fifty-five percent of hospices provided screening for CG and depression and access to bereavement therapy, 13% provided screening but not access to bereavement therapy, 24% provided access to bereavement therapy but not screening, and 8% neither screened nor provided access to bereavement therapy. Hospices with 100 patients per day or more were significantly more likely to provide screening and access to bereavement therapy. Hospices appear to have high capacity to provide screening for CG and depression and to deliver group and individual therapy, but data are needed on whether screeners are evidence based and whether therapy addresses CG or depression specifically. Future work could build upon existing infrastructure to ensure use of well-validated screeners and evidence-based therapies.

Psychologists' and counsellors' perspectives on prolonged grief disorder and its inclusion in diagnostic manuals

Introduction: In this research, proposed criteria for what has been termed ‘Prolonged Grief Disorder’ (PGD) (more recently termed, ‘Persistent Complex Bereavement‐Related Disorder’ (PCB‐RD) in the proposed DSM‐V), were presented to psychologists and counsellors. Method: Participants were asked about their views on the ‘disorder’ and whether they considered its inclusion in diagnostic manuals was justified. A total of 185 participants, (147 psychologists, specialist and general, and 38 counsellors) responded to an online survey (part of a larger research project), concerning their attitudes, choices and activities regarding bereavement therapy. In this part of the research, therapists’ perspectives about pathological grief, the recognition of PGD and its inclusion in diagnostic manuals were explored. Fifty‐nine participants took the option of adding written remarks to the survey to expand on their opinions regarding PGD. Results/Conclusions: Tentative support for the inclusion of PGD in diagnostic manuals was given; however many therapists indicated considerable reservations about potential negative repercussions of using such a diagnosis. One‐way between‐groups analysis of variance was undertaken to determine whether participants' opinions varied according to main occupation or specialism; however, no significant difference was found. This research was conducted prior to the latest update to the proposed revision and diagnostic category concerning bereavement in the DSM‐5 of April 2012, but many observations and recommendations concerning PGD made by the therapists participating in this research can be seen to be applicable to PCB‐RD. Implications: The implications of this research for assessing and diagnosing grief, and ways of working with bereaved clients, are discussed.

Supportive care for women with recurrent miscarriage: a survey to quantify women's preferences

Supportive care is regularly offered to women with recurrent miscarriages (RMs). Their preferences for supportive care in their next pregnancy have been identified by qualitative research. The aim of this study was to quantify these supportive care preferences and identify women's characteristics that are associated with a higher or lower need for supportive care in women with RM. A questionnaire study was conducted in women with RMs (≥ 2 miscarriages) in three hospitals in the Netherlands. All women who received diagnostic work-up for RMs from January 2010 to December 2010 were sent a questionnaire. The questionnaire quantified supportive care options identified by a previous qualitative study. We next analysed associations between women's characteristics (age, ethnicity, education level, parity, pregnancy during questionnaire and time passed since last miscarriage) and their feelings about supportive care options to elucidate any differences between groups. Two hundred and sixty-six women were asked to participate in the study. In total, 174 women responded (response rate 65%) and 171 questionnaires were analysed. Women with RM preferred the following supportive care options for their next pregnancy: a plan with one doctor who shows understanding, takes them seriously, has knowledge of their obstetric history, listens to them, gives information about RM, shows empathy, informs on progress and enquires about emotional needs. Also, an ultrasound examination during symptoms, directly after a positive pregnancy test and every 2 weeks. Finally, if a miscarriage occurred, most women would prefer to talk to a medical or psychological professional afterwards. The majority of women expressed a low preference for admission to a hospital ward at the same gestational age as previous miscarriages and for bereavement therapy. The median preference, on a scale from 1 to 10, for supportive care was 8.0. Ethnicity, parity and pregnancy at the time of the survey were associated with different preferences, but female age, education level and time passed since the last miscarriage were not. Women with RM preferred a plan for the first trimester that involved one doctor, ultrasounds and the exercise of soft skills, like showing understanding, listening skills, awareness of obstetrical history and respect towards the patient and their miscarriage, by the health care professionals. In the event of a miscarriage, women prefer aftercare. Women from ethnic minorities and women who were not pregnant during the questionnaire investigation were the two patient groups who preferred the most supportive care options. Tailor-made supportive care can now be offered to women with RM.

Closed bereavement therapy group: a new way forward?

IntroductionThe End of Life Care Strategy recognises that care does not stop at the point of death but continues through to bereavement. A Closed Bereavement Therapy Group (CBTG) was developed...

Twenty-First-Century American Ghosts: The After-Death Communication—Therapy and Revelation from beyond the Grave

AbstractThis paper examines a recent arrival on the American pop cultural scene, a type of ghost encounter called After-Death Communications (ADCs). Delivered in dreams, visions, voices, odors, coincidences, etc., these cheerful greetings from deceased loved ones help bereaved survivors cope with their loss. Since the Enlightenment, spirits of the dead have become increasingly irrelevant to collective life. The new phantoms, however, are assigned roles in the family, health, and faith. How has this occurred? Strands of a complicated process are delineated, including medical origins in the bereavement hallucination, a designated symptom of grief. Cultural dynamics behind the current ADC phenomenon are contrasted with national trends that shaped the nineteenth-century spiritualist enthusiasm for ghosts. The literature, published since the 1990s, is reviewed in which the ADC has been formalized as a source of bereavement therapy and revelation. A tally of the peculiar features and functions of this twenty-first-century ghost experience links it to two American industries, psychotherapy and spiritual seeking.

Bereavement Therapy With Adolescents: Facilitating a Process of Spiritual Growth

Bereavement therapy as a catalyst for spiritual growth. This study aims to review the literature and reflect on the bereavement therapy undertaken with two adolescents who had been bereaved during childhood. Research articles and books identified through a combination of electronic and manual searches. It would appear that grief therapy could facilitate spiritual growth in such circumstances. Further in-depth studies are required to identify how typical or atypical this experience is, and to contribute to the evidence base for working with bereaved children and adolescents.

Good grief and not‐so‐good grief: Countertransference in bereavement therapy

This study examined the relationship between therapists' grief related to the death of a loved one and clients' perceptions of the process of bereavement therapy. Mail survey data were obtained from 69 client-therapist dyads. Results indicated that the extent to which therapists missed deceased loved ones was inversely related to client perceptions of therapist empathy, but not to client ratings of the alliance, session depth, or therapist credibility. Therapist acceptance of the death of a loved one was unrelated to any of the dependent measures. Results are discussed in terms of countertransference and its management.

Grief and Intellectual Disability

People with intellectual disabilities are living longer, which in turn leads to a higher probability that they will experience significant loss due to the death of someone they know. This paper describes a systemic therapeutic model, ROC, which combines bereavement therapy with training and support for staff. On reporting the effects of the ROC model, it is noted that changes over time in the type and nature of referrals has shown the ther apeutic value of the program. The author makes a case that the best way to detect and possibly prevent serious emotional problems in this population is to provide training and support in dealing with death and related issues for the service network surrounding these individuals.

Working with Dreams in a Bereavement Therapy Group

There is ample theory and research about group therapy, dream work, and bereavement as separate subjects. However, there is little written specifically about utilizing dream work in bereavement therapy groups. Using the Foulksian group analytic model, dreams in one particular bereavement group (for parents of children killed in a terrorist action) were interpreted in such a way as to help members access deep unconscious feelings. This helped facilitate a fuller and more complete mourning process. The analytic, dream interpretive activity also helped overcome resistance in the group-as-a-whole and thereby facilitated movement through group development phases.

Outcome Evaluation of Bereavement Groups for Adults with Intellectual Disabilities

Background Individuals with intellectual disabilities respond to loss in similar ways to other individuals. Bereavement interventions, whether provided individually or in a group, need to be planned according to the person's understanding, presenting symptoms, psychological functioning and support system. Measuring the effectiveness of such interventions is critical in order to increase our knowledge of useful interventions for this population. The present authors discuss individual and group bereavement therapy, and outline the goals and approaches used in their bereavement groups for adults with intellectual disabilities.Methods Individuals referred for bereavement group therapy were interviewed and assessed prior to their participation in the group. Measures of depression, anxiety, and knowledge of death and bereavement issues were administered before and after group participation.Results Scores for depression were significantly lower following group participation. However, scores for anxiety were mild and not significantly reduced. The participants' understanding and knowledge of the bereavement process did not improve significantly. When those with single and dual diagnosis were considered separately, those with a dual diagnosis experienced a significant decrease in depression, while those with a single diagnosis did not. Furthermore, depression scores for those with a dual diagnosis were generally higher.Conclusions The present preliminary investigation of therapeutic outcomes for bereavement group intervention suggests little change in anxiety and knowledge of death/bereavement issues, but significant improvement in symptoms of depression for participants, particularly those with a dual diagnosis. The weaknesses of the present study are discussed along with possible improvements for future studies.

Practitioners' accounts of religious and spiritual dimensions in bereavement therapy

This study explores religious and spiritual dimensions in bereavement therapy through in-depth qualitative interviews with 12 therapists for whom bereavement work constituted a major part of their therapeutic role. Information was gathered on the conceptualization of religious and spiritual issues, the perceived influence of therapists' beliefs on their practice and the therapeutic processes that occur in work with religious and spiritual issues. Interpretative Phenomenological Analysis was used to analyse the data, examining associations between these areas as well as highlighting the diversity of experiences and viewpoints. The multi-dimensional role of the therapeutic relationship was highlighted by participants as well as the perceived limitations of many theoretical models of therapy and bereavement in working with religious or spiritual issues. Some therapeutic processes were described in terms of the exploration of belief systems that have been challenged by bereavement and the re-creation of personal meaning. Implications for therapeutic practice and further research are discussed.

Practitioners' accounts of religious and spiritual dimensions in bereavement therapy

This study explores religious and spiritual dimensions in bereavement therapy through in-depth qualitative interviews with 12 therapists for whom bereavement work constituted a major part of their therapeutic role. Information was gathered on the conceptualization of religious and spiritual issues, the perceived influence of therapists' beliefs on their practice and the therapeutic processes that occur in work with religious and spiritual issues. Interpretative Phenomenological Analysis was used to analyse the data, examining associations between these areas as well as highlighting the diversity of experiences and viewpoints. The multi-dimensional role of the therapeutic relationship was highlighted by participants as well as the perceived limitations of many theoretical models of therapy and bereavement in working with religious or spiritual issues. Some therapeutic processes were described in terms of the exploration of belief systems that have been challenged by bereavement and the re-creation of personal meaning. Implications for therapeutic practice and further research are discussed.

No Longer an Outsider

At age 78, I lost my husband of 50 years to cancer. Overcome with grief but accustomed to being a therapist, I was suddenly thrust into the client role. My training and clinical experience gave me a special perspective on bereavement therapy. This article describes my experiences and observations of group process in a bereavement group for older women.

Training bereavement therapists

Abstract Curriculum and field experiences have been devised at the University of Missouri-Kansas City for preparation of professionals and advanced graduate students in bereavement therapy (lamentology). Assumptions behind the course and goals associated with it are described, as are the methods employed for selection of participants, course content, and the nature of related field activities. Observations are offered from the author's experience as a counselor educator and practicing psychologist.