July 29, 2007

Negative Views of Grief Counseling Are Not Substantiated by the Research, Experts Say

People suffering from grief can be helped; Flawed science led to unsupported negative reviews of grief counseling

WASHINGTON--Despite frequent claims to the contrary, there is no empirical or statistical evidence to suggest that grief counseling is harmful to clients, or that clients who are "normally" bereaved are at special risk if they receive grief counseling, according to a new look at the scientific literature on grief counseling.

A report published in 2000 claiming that 38 percent of clients (and close to 50 percent of so-called "normal" grievers) deteriorate as a result of grief counseling has been frequently cited in the scientific literature. The new review, by co-authors Dale G. Larson, PhD, of Santa Clara University and William T. Hoyt, PhD, of University of Wisconsin-Madison, found that the data on which these figures are based have never been published and came from a student dissertation that was never peer-reviewed, using a statistical technique attributed to another student's master's thesis, also never peer-reviewed.

The new findings are reported in the August issue of Professional Psychology: Research and Practice, published by the American Psychological Association (APA).

The belief that conventional grief interventions are potentially harmful has become common wisdom among bereavement researchers in the seven years since the published report, and has been featured in the national media. Larson and Hoyt reviewed published and unpublished meta-analyses of more than 50 outcome studies and solicited the assistance of the APA to conduct a peer review of the dissertation on which this claim was based. Reviewers were unanimous in their conclusion that the statistical analysis on which deterioration claims were based is fatally flawed.

Larson and Hoyt documented the spread of the deterioration claims from specialty journals to journals aimed at a wider audience of social psychologists and general psychologists, and note that authors of these articles cited the published summary rather than the student dissertation. This implied that authors citing the finding never examined the data on which it was based, they said. "It is no exaggeration to say that these deterioration claims have stimulated a revolution in our views about grief counseling, from cautiously optimistic to deeply pessimistic," said Hoyt. "It is disturbing that such radical claims, which contradict clinical experience and even common sense, could proliferate in journals, at conferences, and in national reports without anyone's ever acting on the basic scientific obligation to examine the data and analyses on which they were based."

A related claim from advocates of a pessimistic view of grief counseling has been that the average effectiveness of these interventions is small or nonexistent. According to Larson and Hoyt, the most rigorous peer-reviewed meta-analysis so far - Allumbaugh and Hoyt (1999) - found that the effects of grief counseling were positive, although somewhat smaller than those generally seen in other forms of counseling. However, they concluded that this difference may have been attributable to sampling procedures in the studies reviewed. Re-analysis of a subset of studies using self-referred clients showed strong positive effects, comparable to those observed in psychotherapy generally. "The studies showing weak or null effects are usually those using recruited clients, many of whom enter the study two or more years after the loss they are presumed to be grieving. It is not clear that we learn anything from this type of research about the benefits of grief treatment as it is actually conducted," said Larson

As a practicing grief counselor, Dr. Sean O'Riordan at Stanford University agreed that the negative view of grief counseling needs correcting. "I've been working with grieving clients for the past 20 years and they consistently report that our work together is enormously beneficial. It would be a tragedy not to offer counseling to these people in their time of need."

Article: "What Has Become of Grief Counseling? An Evaluation of the Empirical Foundations of the New Pessimism," Dale G. Larson, PhD, Santa Clara University; William T. Hoyt, PhD, University of Wisconsin-Madison; Professional Psychology: Research and Practice, Vol. 38, No. 4.

Dale G. Larson, PhD, can be reached by phone at (408) 554-4320 or by e-mail.

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.