Grief and Bereavement Counseling

The unique pain of grief has been recognized and described poignantly in some of the most ancient texts and oral traditions of world cultures, but it is only in the past 50 years that formal organizations and professions have evolved to address the specific social, psychological, and spiritual needs of those persons who have lost loved ones. As the field of grief counseling has grown, it has also diversified, drawing inspiration from evolving theories of grieving while continuing to respond to the needs of various groups touched by often tragic loss. As it has done so, it has also begun to attract the attention of social scientists who have evaluated and sometimes criticized the field, raising questions about its basic assumptions, its social role, and its clinical efficacy. Although present evidence does not support the conclusion that formal bereavement services are of benefit to everybody, it seems clear that they are of considerable help to many, and especially those who stand in greatest need of assistance.

Models of Bereavement Intervention

Some observers distinguish between bereavement support, counseling, and therapy on the basis of [Page 543]who delivers the services and who receives them. Bereavement support most commonly describes informal mutual support groups for bereaved persons in the community, such as those offered by many churches or synagogues, as well as those affiliated with national or international organizations, such as AARP (formerly known as American Association of Retired Persons) Widowed Persons Services, Mothers Against Drunk Driving (MADD), or The Compassionate Friends groups for parents who have lost children. But this category can also include services coordinated by health or mental health professionals, such as hospice bereavement care or national networks of services like those provided by Cruse throughout the United Kingdom. In these models, support is commonly offered to all bereaved people, or all bereaved by a certain kind of loss (such as those who have lost children or who have lost a loved one to murder, suicide, or an impaired driver), irrespective of their level of demonstrated distress or psychological disorder. Support may take many forms, ranging from simple provision of psychoeducational material or lectures on grief and trauma, through annual rituals of remembrance, to home visits and support groups led by a veteran member of the group, typically without professional training. Such support services have the advantage of minimizing the stigma of bereavement and mobilizing community resources, especially in the form of the presence, understanding, and practical counsel of others who have “been there” (through having suffered a similar loss) and who are coping with their circumstance.

In contrast, grief counseling usually denotes services provided or facilitated by a trained professional, such as a nurse, social worker, counselor, or psychologist. Counseling is more often provided to individuals or families, though group counseling led by professionals is also common. Grief therapy shares these features but is usually distinguished by its assumption that the client or patient is struggling with a problematic reaction to the loss, such as a diagnosable case of depression or prolonged grief disorder. For this reason, programs that focus on prevention of future mental health problems, such as those for children who have lost a parent or sibling, might more appropriately be termed grief counseling rather than grief therapy, per se. Both forms of services are provided in a range of settings such as hospitals, clinics, and counseling centers, though they also are offered by therapists of several disciplines as part of their independent practice. Gradually there has been a move, especially in the United States, toward considering grief therapy a specialized form of practice beyond general counseling and therapy, supported by certification programs such as those organized by the Association for Death Education and Counseling. In practice, however, distinctions among most forms of bereavement interventions are inexact and overlapping, in part because many settings offer services in multiple formats (such as individual or group) by multiple volunteer or professional support personnel. Generally speaking, professionally conducted grief therapy is appropriate when community support services are inadequate to deal with bereaved people who are struggling intensely for prolonged periods because of personal vulnerabilities, such as a disposition to major depression or acute concerns about abandonment by another. It also can be indicated when the losses with which people must deal overwhelm both the bereaved and those who attempt to support them, such as the premature death of a young person or the murder of a loved one.

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