Observing a client's grieving process: bringing logical positivism into qualitative grief counselling research

This positional paper originates from our need as researcher/practitioners to establish a meaningful epistemological framework for research into bereaved people's journey through loss and grief over time. We describe how the field of grief research has a long and established biological basis, in keeping with a positivist epistemology. However, there has been a diminution of the influence of logical positivism in twenty-first-century counselling research. We argue that in grief counselling research, naturalistic observation of the grieving process within a logical positivist paradigm, remains a valid and valuable construct. We posit an observational protocol for the grief counselling process which minimises the intrusion of research method into the therapeutic process. We offer this as a means of conducting qualitative research within a bereavement counselling service. Further, we suggest that the development of an observational protocol for a client's grieving process has potential implications for developing good practice in grief work.     

Grief counselling in context: Multiple roles and professional compromise

The issues involved in the use of counselling skills and approaches by members of professions such as nursing and social work have received relatively little research attention. Grief counselling represents an appropriate area in which to explore these issues, since members of many diverse professional groups may be called on to work therapeutically or supportively with the bereaved. This paper explores the use of grief counselling in a variety of professional and voluntary contexts, through an analysis of the experience of students who had undertaken a bereavement counselling course. The aim of the study was to explore the level of awareness shown by employing organisations to the 'loss' element of client experience, and the implications of organisational context for the role of counsellor as a worker responding to client grief. A range of practice characteristics emerged. At one end of the spectrum was clearly focused and contracted grief counselling, usually within the context of specialist voluntary agencies. By contrast, there were practitioners whose counselling response to grief was concealed within a multi-professional perspective characterised by compromise, usually working in complex organisational contexts in the statutory sector. It is argued that the range of practitioner activity cannot be understood simply by describing some activities as counselling and others as the use of counselling skills; it seems that there is a real and sometimes subtle middle ground which lies between the two. This is territory which is determined by the context of practice and needs to be understood and defined as such     

Counselling on Death and Dying

The growing concern for improved quality of care for the dying and the bereaved is reviewed. The growth of the hospice movement, home-care teams and self-help groups are referred to, together with the attempts that have been made to evaluate the effectiveness of bereavement counselling. In the light of current work and formal psychological studies, an outline of the grief process is given. Reference is made to possible future developments in this field and to the importance of counselling skills being acquired by a wider range of people than at present.     

Evaluation eines präventiven Beratungskonzeptes für Kinder körperlich kranker Eltern

Children of parents suffering from a serious disease (e.g. cancer, multiple sclerosis, Aids) are at increased risk for mental health problems. Empirically based interventions for these children are missing. At the University Medical Centre Hamburg-Eppendorf, a preventive short-term counselling service has been existing since July 2000. Results from a 6-month evaluation (n=50) are presented. The evaluation encompasses a retrospective interrogation in a multiperspective und multidimensional approach. Most families experienced the intervention as helpful and supportive in coping with the multiple stressors of the situation. Out of a previously defined list of 12 intervention goals, enhancing anticipatory grief in children, their active coping behaviour as well as parents’ sense of their own parenting competence were identified as the most important foci of the counselling interventions, as reported by parents, children and therapists.     

Laying mother to rest: Working with grief-related nightmares through exposure therapy and imagery

Cognitive behavioural therapy of unresolved grief is usually presented as a fairly rapid approach for reducing psychological problems. The present case study shows how behavioural cognitive and symbolic approaches can be integrated to foster griefwork at several levels. The counselling adopted a behavioural exposure technique specifically for eliminating a significant anxiety-provoking obstacle to mourning, namely the experience of recurrent death-related nightmares that surfaced every time the bereavement was recalled in depth. The client was also encouraged to explore the symbolic meaning of the dream images and in drawings modified these images in ways that helped to alleviate her feelings of long-standing guilt. Drawing as well as verbal representation could also be regarded as an effective form of exposure therapy, helping the client to stay with the anxiety-provoking death-related images. The client once relatively free of nightmares could mourn the loss of the mother more deeply in subsequent less directive counselling sessions.     

Bereavement anxieties and health amongst the Australian-Italian Catholic community

This article is based on survey of 269 households in the state of Victoria, Australia. It elicits some useful guidelines for professional caregivers in relation to eight cultural/religious groups including Australian-born Christians and Arab-born Muslims. The focus here is upon the relationships between the Australian Italian community and personal health outcomes during bereavement. The following sub-strata are examined: community differences in relation to grief and loss practices and traditions; the value of religious communal support and counseling; symptomatological differences from psychosocial and educational perspectives; psychopathological/psychiatric symptoms and beliefs and practice concerning the afterlife. Significant differences were revealed between the sexes on such matters as health problems, grief expressions, psychosomatic manifestations, communication with the dead, beliefs in the afterlife and interpretation of the meaning of loss. Differences in these findings will assist professional caregivers who deal with families experiencing personal death loss to broaden their own perspectives on bereavement, offering specific counselling strategies and care-giving interventions.     

Stillbirth, neonatal death and Sudden Infant Death (SIDS): parental reactions

The differences between parental grief reactions following different types of infant losses were investigated. A total of 117 parents (55 couples) from three groups of parents (stillbirth, neonatal death and Sudden Infant Death), 53% women and 47% men, answered a survey on different grief reactions one to four years following the death. Included in the survey were psychometric measures relating to anxiety, depression, impact of event, bodily discomfort, and general wellbeing. The results demonstrated that the three groups differed in their experience of various grief reactions. Sudden Infant Death Syndrome (SIDS) parents reported significantly more anxiety and intrusive thoughts than the other two groups in the early post-loss period, as well as significantly more anger, restlessness, and sleep disturbances than the neonatal group. The SIDS parents also scored significantly higher on some of the measures (experience of recovery, IES intrusion) relating to how they felt at the time of study. While the death being sudden did not show any correlation with the parents experience of recovery or the psychometric measures, the length of time the child had lived showed a strong relationship to these measures. It is emphasized that counselling to parents must be based on increased knowledge about parental reactions, tailored to the individual family's needs.     

Can parental responses to adult children with schizophrenia be conceptualized in terms of loss and grief? A case study analysis

It has been suggested that parental responses to adult children with schizophrenia may involve feelings of loss and grief, centred around loss of the pre-morbid version of their child. In this exploratory study, an in-depth case study analysis of four parental accounts of their responses was undertaken in order to obtain insights into whether these responses can be conceptualized in terms of loss and grief, with the aim of informing therapeutic practice with parents in this position. Information was also obtained on how parents coped with the reactions that their child's condition elicited in them. Data were analysed using Interpretative Phenomenological Analysis. In relation to the central research question, it was found that the perception of loss was not uniform amongst participants. Three acknowledged a sense of loss, at least to some extent, but one parent resisted such an interpretation because she perceived a continuity over time in her son's behaviour and she also challenged her son's diagnosis. One parent acknowledged a loss of his daughter's pre-morbid self but qualified this by pointing to her continued physical presence. The usefulness of existing models of grief is examined in light of the findings. The implications for the practice of counselling psychology are discussed.     

Simulation and counselling

Simulations are basically models of social and physical situations. Their educational value and the problems involved in using simulation techniques are analysed, and some possible applications of these techniques in counselling are outlined: these include applications in counsellor training, in one-to-one and three-person counselling situations, and in preparing pupils for such experiences as job interviews. But dangers of “faddishness” have to be avoided, and more rigorous research into the effectiveness of simulation techniques is still needed.     

Counselling strategies for bereaved people offered in primary care

The aim of this study was to identify strategies that general practice-based counsellors used when offering support to bereaved clients. Over the last decade, there has been a rapid growth in the provision of counselling services associated with British primary care services. A study was designed involving qualitative methods of data collection (semi-structured interviews) and analysis (a grounded theory approach). Counsellors were recruited from two cities in Southern Britain (Plymouth and Southampton). Twenty nine (76% response rate) counsellors agreed to participate (Southampton n = 15, Plymouth, n = 14). Semi-structured face-to-face audio-taped interviews elicited information about their perceptions of the appropriateness of general practitioner referrals, counselling strategies and models of bereavement. Analysis indicated that counsellors saw bereavement counselling within a broader agenda of work concerned with loss and relationship management. Many drew on eclectic approaches to bereavement counselling and specific strategies included: facilitating telling of the 'story' of the loss; engaging in active listening and valuing allowing people to talk; establishing a supportive relationship; and enabling the bereaved person to deal with unfinished business and to say 'goodbye'. Counsellors drew on implicit stage/phase models of grief that assumed levels of distress reduced over time. The value of these strategies requires more exploration.     

Impact of current grief on memory for past grief in spousal bereavement

This study examined the impact of changes in level of current grief over time on changes in memory for past grief. Following from previous work on the impact of current affective state on memory for past affectively salient events, bereaved individuals who underwent a greater reduction in grief over time were expected to show a similar pattern of changes in memory for past grief. A sample of conjugally bereaved participants completed measures of current grief and memory for past grief at the time of the loss of their spouse at each of the 2, 6, 13, and 30 month post-loss time periods. As predicted, those who reported greater reduction in grief over the course of the study were more likely to remember their past grief as progressively less severe relative to those who underwent less reduction in grief over time. A nonrecursive causal model analysis verified that changes in memory for past grief were explained by changes in current grief. These results were discussed in terms of contemporary reconstructive memory accounts of the effect of affective state on memory.     

Impact of current grief on memory for past grief in spousal bereavement

This study examined the impact of changes in level of current grief over time on changes in memory for past grief. Following from previous work on the impact of current affective state on memory for past affectively salient events, bereaved individuals who underwent a greater reduction in grief over time were expected to show a similar pattern of changes in memory for past grief. A sample of conjugally bereaved participants completed measures of current grief and memory for past grief at the time of the loss of their spouse at each of the 2, 6, 13, and 30 month post-loss time periods. As predicted, those who reported greater reduction in grief over the course of the study were more likely to remember their past grief as progressively less severe relative to those who underwent less reduction in grief over time. A nonrecursive causal model analysis verified that changes in memory for past grief were explained by changes in current grief. These results were discussed in terms of contemporary reconstructive memory accounts of the effect of affective state on memory.     

Development and validation of a Christian-based Grief Recovery Scale

The purpose of this study was to develop and validate a Christian-based Grief Recovery Scale (CGRS) which was used to measure Christians recovering from grief after a significant loss. Taiwanese Christian participants were recruited from churches and a comprehensive university in northern Taiwan. They were affected by both the Christian faith and Chinese cultural beliefs. The CGRS is developed through replicated factor analyses in three stages. The final version of the CGRS retains 35 Likert-type items and consists of six factors: spiritual well-being; recovering meaning and sense of control; ongoing physical and emotional responses; reassuring faith; strongly missing a deceased loved one; and life disturbance. The evidence for CGRS reliability and validity is highlighted. Implications for research and counselling practice are suggested.     

Towards a model of self-awareness development for counselling and psychotherapy training

Self-awareness has been considered to be a critical ingredient for effective counselling and psychotherapy. However, training models have failed to provide an integrated and explicit approach to self-awareness development. The authors therefore introduce and describe the integrated model of self-awareness development and discuss potential applications for counselling and psychotherapy training.     

Cross-Lagged Analyses of Prolonged Grief and Depression Symptoms With Insomnia Symptoms

Prolonged grief disorder, characterized by severe, persistent and disabling grief, has recently been added to the DSM-5-TR and ICD-11. Treatment for prolonged grief symptoms shows limited effectiveness. It has been suggested that prolonged grief symptoms exacerbate insomnia symptoms, whereas insomnia symptoms, in turn, may fuel prolonged grief symptoms. To help clarify if treating sleep disturbances may be a viable treatment option for prolonged grief disorder, we examined the proposed reciprocal relationship between symptoms of prolonged grief and insomnia. On three time points across 6-month intervals, 343 bereaved adults (88% female) completed questionnaires to assess prolonged grief, depression, and insomnia symptoms. We applied random intercept cross-lagged panel models (RICLPMs) to assess reciprocal within-person effects between prolonged grief and insomnia symptoms and, as a secondary aim, between depression and insomnia symptoms. Changes in insomnia symptoms predicted changes in prolonged grief symptoms but not vice versa. Additionally, changes in depression and insomnia symptoms showed a reciprocal relationship. Our results suggest that targeting insomnia symptoms after bereavement is a viable option for improving current treatments for prolonged grief disorder.     

Religion and emotional compensation: results from a prospective study of widowhood

Based on recent applications of attachment theory to religion, the authors predicted that the loss of a spouse would cause widowed individuals to increase the importance of their religious/spiritual beliefs. This hypothesis was examined using the Changing Lives of Older Couples sample from which preloss measures of religiosity were available for widowed individuals and matched controls. A total of 103 widowed individuals provided follow-up data, including reports of religious beliefs and grief, at 6 months, 24 months, and 48 months after the loss. Results indicated that widowed individuals were more likely than controls to increase their religious/spiritual beliefs. This increase was associated with decreased grief but did not influence other indicators of adjustment such as depression. Finally, insecure individuals were most likely to benefit from increasing the importance of their beliefs. Results are discussed in terms of the potential value of applying psychological theory to the study of religion.     

Traumatische Trauer – ein eigenständiges Krankheitsbild?

Grief is a highly individualized process influenced by intrapsychic, interpersonal and social factors. The definition of normal and pathological grief is complicated by the variety of grief reactions. Empirical research indicates that pathological grief may be concerned considered as a separate entity. Two research groups developed empirically validated criteria with a special focus on the traumatic aspect of grief. The current state of research allows, however, in our opinion not the conclusion, that the proposed diagnostic criteria for complicated (Horowitz et al. 1997) or traumatic grief (Prigerson et al. 1999b) do not enclose all types of grief. Further empirical research on representative samples is necessary to validate previous findings and to differentiate specific subgroups of pathological grief.     

Parental grief following the death of an infant—a follow-up over one year

The course of parental bereavement during the first year following an infant's death was investigated. Also, the differences in mothers' and fathers' reactions, the differences according to the mothers' occupational role, and the similarities in couples' reactions were studied. From a total sample of 59 families, 13 families answered their questionnaires at all three time points (1, 6 and 13 months), 22 families responded at two time points, and 37 families responded at some point following the loss. Measures relating to anxiety, depression, bodily discomfort, general well being and impact of event were used at the three time points. The results showed that grief, as measured by the different inventories, decreased over time. The decrease was most evident from 6 to 13 months, and most prominent in women. A considerable number of the parents were still actively dealing with the loss all through the first year of bereavement. In most couples the mother reported most distress. Mothers were significantly more depressed than fathers at all time points, and mothers also had significantly higher anxiety and lower general health at 1 and 13 months, and intrusive scores of 1 and 6 months. Women at home evidenced more grief at all three time points than women employed outside the home. A high or low score in one spouse was more strongly correlated with a similar score in the other at 1 and 13 months, than at 6 months. The implications for counselling of parents, with special emphasis on the employment situation of the mother, is emphasized.     

Common Grief,Complex Grieving

In this article, the author reflects on the changes during the last 25 years in our understanding of grief and on the emerging new issues in the field of loss and grief studies. He identifies several significant issues, including the implications of violent death for public and private grief, the increased attention upon the family as a mourner, and new ritual patterns emerging out of changes in funeral practices in recent years. The essay concludes by briefly considering a number of issues shaping grief and our care for those who mourn.