4.4 Are there alternatives to medication?
Another response to bereavement has been to suggest that the bereaved person should go through some form of bereavement counselling. Cruse Bereavement Care is the largest bereavement counselling organisation in the UK.
There are contrasting opinions about the effectiveness of bereavement counselling (also called grief counselling). For many years it had been thought that there was no evidence for the effectiveness of grief counselling, and there was even an opinion that substantial numbers of people might be harmed by the experience. In 2003 a review in the US by John Jordan, a psychologist, and Robert Neimeyer, a professor of clinical psychotherapy, analysed the effectiveness of counselling intervention following bereavement and concluded:
grief counselling does not appear to be very effective, most probably because many of the people who receive it would do just as well (and perhaps in some cases better) without it. The assumption that grief counselling is ‘naturally’ beneficial for everyone fails to recognize the possibility of harmful effects of bereavement interventions for some individuals.
(Jordan and Neimeyer, 2003, p. 781)
Their research claimed that almost 50 per cent of ‘normal grievers’ might deteriorate as a result of the experience of bereavement counselling. At the time, this was a sensational conclusion.
Perhaps unsurprisingly, the foundations on which Jordan and Neimeyer built their claims were subsequently attacked and argued to be fundamentally flawed. Two American psychology professors in particular, Dale Larson and William Hoyt, went to great lengths to systematically dismantle the research methodology used by Jordan and Neimeyer (Larson and Hoyt, 2007). They found that the data on which the original research was based had never been published and that it had come from a single dissertation that, in turn, had not been peer reviewed. (Peer review means that a publication has been critically reviewed by an expert colleague in the field. It is largely used as a measure of quality.)
They further argued that Jordan and Neimeyer's research used an inappropriate statistical methodology. Larson and Holt concluded with a message that was much more hopeful for advocates of bereavement counselling:
There is no evidence that bereaved clients are harmed by counselling or that clients who are ‘normally’ bereaved are at special risk. There is not any strong evidence that grief counselling, as typically practiced, is less efficacious than other forms of counselling and psychotherapy.
(Larson and Hoyt, 2007, p. 354)
This debate is ongoing. Wolfgang Stroebe and colleagues (Stroebe et al., 2005) have reviewed the available evidence relating to the effectiveness, or lack of effectiveness, of bereavement work in general and counselling more specifically. Their review concludes with a number of significant findings:
Some of the previously held assumptions about the effectiveness of bereavement work and bereavement counselling should be challenged.
There is little evidence to support the notion that the disclosure of emotions positively assists in the recovery from bereavement.
Bereavement counselling is not effective for people who have been referred simply because they have been bereaved, but should instead be focused on people with significant problems or who have expressed a need.
Loneliness is a common feeling after bereavement, but one that only abates with time, not as a result of bereavement work.
Certain types of bereavement, such as sudden death, increase the likelihood of grief complications.