Grief and Loss: Will Therapists Be Able to Help?

Coauthored by Kayvon Akbarian, MA

The United States continues to set records for COVID-19 cases and COVID-19 related deaths. At this point, the body count is well beyond the number who died in the entire Vietnam War. At the same time, we grapple with the killings of George Floyd, Breonna Taylor, Ahmaud Arbury, and so many more. With much that is still uncertain about the rest of 2020, one thing is clear: The next pandemic will be one of grief, and the field of mental health is not ready.

Source: Gary Ross/Pixabay

Grief is a painful but common life experience, and not all individuals who experience a loss will need mental health care to overcome it. Humans are resilient, and many of us are well-supported and possess the coping skills we need to overcome hardship without professional help. However, this is certainly not the case for everyone. The current pandemic complicates the grief of many individuals by adding layers of anxiety, trauma, survivor guilt, and more. In the coming months and years, more people than usual are likely to need extra help, and their journey may be harder than grieving in more normal times.

A recent study found that almost 46 percent of clients did not find their mental health professional helpful during their grief (Aoun et al., 2019). It’s no wonder; the field of mental health has neglected death and grief for far too long. Within programs that train therapists, the required coursework on these topics is paltry at best. Students frequently graduate having had only brief exposure to the topic and no formal training on effective clinical interventions. Some programs offer electives, but such courses rarely attract large audiences and at times are canceled due to low enrollment.

This is what training has looked like for decades, and it means that most therapists in practice today have sparse preparation to help the coming tidal wave of grieving clients. Therapists may rely on their transferrable skills of kindness and warmth and hope it is enough. They may attempt to apply what they already know to grief. They may throw some cognitive-behavioral therapy at it, or whatever their preferred approach to treatment may be.

Some clients may get lucky and be helped by this slapdash approach, but many will not. Those who are more symptomatic may even be harmed by underprepared clinicians. One study interviewed people who had received grief treatment and found many left feeling “frustrated, confused, abandoned, and overwhelmed at a particularly vulnerable time” (Valentine, McKell, and Ford, 2018, p. 301).

As well-intended as therapists typically are, without appropriate training they won’t know how to coach their clients through caring for dying loved ones, nor what to look out for should grief turn traumatic. They won’t likely understand the complicated role that culture and religion play in how people grieve. Worse, they may not see the ways their own cultural assumptions impact their work. They won’t likely know the research about what actually helps for different kinds of caregivers and grieving clients, let alone how to offer such treatments.

Therapists want clients to think we can help them because research has shown that positive expectancies can enhance the effectiveness of therapy (Constantino et al., 2018). Yet when grief and death are all around us and threaten our collective mental health, our lack of preparedness has to be named and has to be addressed. Effectiveness in treatment is directly tied to preparedness. Programs that train therapists must pay more attention to grief and death. Improvements will likely be slow, but any effort to push for more coverage of these topics can only help given the inadequacy of current standards.

In the short run, the sad reality is that those most impacted will be those most in need of help. They will assume therapists have the expertise needed to help them. If current practices persist, they will be largely mistaken. Members of the public in search of therapists will need to become educated consumers, to ask their therapists what specific training they have on the topics of death and grief and what treatments they will offer. Given how difficult it can be to find a therapist, many individuals will likely have to settle for providers with thin credentials. This unfortunate reality is only amplified for those from disadvantaged and marginalized backgrounds already disproportionately impacted by COVID-19 and a range of other injustices.

The US is known for having a culture of optimism that too often frames death as the ultimate failure. In such a context, death denial is pervasive. The hidden cost of this approach is gradually becoming apparent to those in need of mental health care, and the time to act has long since passed.