Does Grief Counseling Cause More Harm Than Good?

Is talking about loss always therapeutic?

Posted May 22, 2013

Dozens died in the tornado that barreled through Moore, Oklahoma. Nine of them were children. For those who witnessed the catastrophic events, the shock is deep; for those who lost loved ones, the grief is unimaginable. The mental health professionals in Moore are there to provide the bereaved with much-needed comfort, but also to encourage them to talk about what they experienced. The Salvation Army has also announced that they are dispatching counselors to the affected area as well.

There's no doubt that these practitioners have good intentions – but does grief counseling cause more harm than good? In recent years, the research has uncovered surprising results. Studies increasingly show that displaying little or no symptoms following a traumatic event may actually be a sign of health rather than a sign of problems. One study, for example, reported that grief therapy was harmful for people who showed no signs of problematic grieving.

Losing a loved one is without a doubt one of life's most painful experiences. Accordingly, clinicians were long trained to recommend "grief work" or "working through" the trauma, in keeping with Freud’s ideas. By talking about the loss, there would be a therapeutic catharsis, it was believed. Confronting the loss directly was considered the standard course of treatment for all individuals who experienced distress, in part to proactively fend off symptoms of trauma and depression. This typically involves talking about the loss, gaining insight into its meaning, and arriving at a sense of resolution. 

Although many clinicians still recommend grief counseling, there is actually a surprising lack of scientific evidence to demonstrate that it actually works. Research shows that it isn't as effective as conventional forms of talk therapy. So, why the confusion? The explanation may lie in the split within the academic community about the rates of Post-Traumatic Stress Disorder. Some studies report figures as low as four percent, and others as high as 60 percent. In other words, it’s difficult to gauge the need for this type of counseling.

And while there is understandable concern about chronic grief symptoms, only about 10 percent of bereaved people display chronically elevated grief symptoms — though the number increases when the loss is extreme or involves violence. Additionally, bereaved people tend to improve over time whether or not they receive treatment, calling the usefulness of grief counseling into question. In other words, people tend to be more resilient than is commonly thought.

Indeed, grief symptoms spike when people lose their loved ones under particularly violent or horrific circumstances. Yet at the same time studies demonstrate that deeply probing distressed individuals about their feelings of loss until they have a cathartic reaction can be harmful and even interfere with recovery. Many clinicians maintain that an essential stage in bereavement is to give the body a chance to calm down. Interrogating freshly traumatized individuals about their feelings can instead give rise to physical stress reactions, and consequently undermine this important step in the natural grieving process. 

The concerns about grief counseling have been ardent. "Most bereaved people do not need and will not benefit from clinical intervention," psychologists George Bonanno and Scott Lilienfeld wrote in a 2008 article for the journal Professional Psychology: Research and Practice. They even went as far as to state that equating grief counseling with conventional forms of therapy is "dangerous" and amounts to "unwarranted optimism" because they haven't been proven to be as effective.

Is there a time when grief counseling might be helpful? Like talk therapy in general, it seems to be most effective if the bereaved person seeks treatment by his/her own volition. It also seems that this form of counseling is most useful for those who had psychological distress before the loss, and which were exacerbated by grief. Moreover, the grieving process is different for everyone, and treatments should be tailored accordingly for those who want it. Finally, in the case of those coping with loss in Moore, one of the most helpful forms of therapy is the comfort they are drawing from the community in the face of this loss. While talking about their grief may or not be helpful, the support they receive from others is vital.

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More about the Blogger: Vinita Mehta, Ph.D. is a licensed Clinical Psychologist in Washington, DC, and an expert on relationships, managing anxiety and stress, and building health and resilience. Dr. Mehta provides speaking engagements for your organization and psychotherapy for adults.  She has successfully worked with individuals struggling with depression, anxiety, and life transitions, with a growing specialization in recovery from trauma and abuse

Dr. Mehta is also the author of the forthcoming book Paleo Love: How Our Stone Age Bodies Complicate Modern Relationships.

You can find Dr. Mehta's other Psychology Today posts here.

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