Dale G. Larson

What has become of grief counseling? An evaluation of the empirical foundations of the new pessimism.

A pessimistic view of grief counseling has emerged over the last 7 years, exemplified by R. A. Neimeyers (2000) oft-cited claim that “such interventions are typically ineffective, and perhaps even deleterious, at least for persons experiencing a normal bereavement” (p. 541). This negative character

Roles for psychologists in end-of-life care: Emerging models of practice

Professional psychologists are increasingly likely to encounter opportunities to work with patients and families facing end-of-life issues. Psychologists can provide psychological assessment, intervention for patients andfamilies, consultation with and support of health care team members, grief therapy, and program development and evaluation. Psychological services are useful for healthy individuals who wish to make thoughtful plans about their own future care, patients with life-limiting illnesses, families stressed by providing end-of-life care, bereaved individuals, and health care providers who face issues of burnout and strain. Several challenges for psychologists working in end-of-life care are noted, including training, development of clear roles, and reimbursement.

Interdisciplinary Approaches to Assisting with End-of-life Care and Decision Making

The importance of interdisciplinary care for patients and families facing the end of life is examined. Descriptions of varying forms of team functioning are provided with an emphasis on the characteristics of high-functioning interdisciplinary teams. The value of empowering the patient and family to direct the care they receive from their team is emphasized. Interdisciplinary team interventions in end-of-life care focus on the biopsychosocial and spiritual dimensions of human experience and facilitate growth and development in the last phase of life. Despite its great promise for improving patient care, the interdisciplinary model is not—with the exception of hospice care—widely implemented in todays health care system. The contributions of interdisciplinary teams to end-of-life care can be enhanced through the development of interdisciplinary team training programs, the creation of payment structures that support the interdisciplinary team model, and continuing research assessing the dynamics of team functioning and the benefits that interdisciplinary team care provides to patients and families near the end of life.

A Cross-Cultural Investigation of Social Support and Burnout

A large number of studies have been published in recent years concerning social support, and a large number of studies have been published on burnout. Very few studies, however, have addressed the relationship between the two—and those that did reported conflicting results. The current exploratory study examines the different functions of social support (rather than the people who provide them) and their relationship to burnout among Israeli, Israeli Arab, Hungarian, and North American social science students (to assure subject homogeneity). Respondents were asked to rate the importance of six support functions and to indicate the extent to which they are available to them in their lives. Their responses were correlated with their burnout scores. Results showed both universal and culture-specific effects. While respondents in all four countries viewed the six support functions as very important, burnout was correlated more with the availability of support than with its importance. Different functions had ...

Grief counselling efficacy

Abstract The growing debate within the bereavement field about the efficacy of grief counselling offers two contrasting viewpoints. At one extreme is Neimeyers claim that ‘such interventions are typically ineffective, and perhaps even deleterious, at least for persons experiencing a normal bereavement’. At the other is the more cautiously optimistic position of Larson and Hoyt, who argue that studies of grief counselling as typically practised demonstrate levels of effectiveness similar to those found for traditional psychotherapy, and that there is no empirical evidence to support claims of harmful effects. This article summarises the key findings and claims in this debate, explores factors that might have contributed to an uncritical acceptance of the claim that grief counselling is harmful, and recapitulates the authors’ view that the empirical data on outcomes from grief counselling give cause for cautious optimism.

Self-concealment: implications for stress and empathy in oncology care

Oncology staff and patients, like all people faced with stressful situations, are confronted with the dilemma of whether to conceal or reveal the distress they are experiencing. For both staff and patients, self-concealment as a coping response increases stress and simultaneously diminishes the likelihood of helpful, empathic responses from others. This article explores these and other interactions between distress, empathy, and self-concealment in oncology work. The author concludes that oncology staff must find safe contexts and confidants for sharing their inevitable fears, self-doubts, and uncomfortable feelings and must help patients resolve the distress- disclosure dilemma that attends the cancer experience.

What have we learned from research on grief counselling

Abstract Dale Larson and William Hoyt respond to Robert Neimeyer and Henk Schuts articles in this issue. They argue that Neimeyer and Schuts more pessimistic conclusions about the effectiveness of bereavement counselling are drawn from large meta-analyses of many different approaches, with different populations, recruited in a range of different ways at different times following bereavement, and followed up over different periods of time. They restate their assertion that we should continue to be cautious about accepting unquestioningly such generalised findings based on broad-brush inclusion criteria as the research in fact provides more grounds for optimism than these meta-analyses suggest.

Helper secrets: invisible stressors in hospice work Staff support groups and networks are recommended antidotes

The demanding and emotionally complicated nature of hospice and oncology work can lead to self-doubts and other embarrassing and distressing thoughts and feelings about oneself as a helper. These troubling thoughts and feelingsfornithe core of helper secrets. This article presents an exploratory analysis of helper secrets gathered from 200 hospice workers. Factors contributing to the development, persistence, and stressful nature of helper secrets are discussed. Staff support groups and strengthened social support networks are recommendedas antidotes to these invisible stressors.

Becky's legacy: more lessons.

ABSTRACT In this commentary on Werths (this issue) article, the author attempts to continue the work of “meaning making” by describing 10 lessons that were evident to him, based on 25 years of experience as an end-of-life researcher and clinician. He highlights the impact of stress, the importance of communication, the idiosyncratic definition of a “good death,” the role of patient-centered care, the power of self-efficacy, the need to integrate theory and experience, the use of interdisciplinary teams, the impact of altruism and having a sense of purpose, the need to listen, and the healing effects of communicating about loss.

Taking Stock: Past Contributions and Current Thinking on Death, Dying, and Grief

Kenneth J. Doka is Professor of Gerontology at the College of New Rochelle. Along with Terry L. Martin he wrote Grieving beyond Gender: Understanding the Ways Men and Women Mourn (Routledge, 2010). Amy S. Tucci Vice President, Programs at Hospice Foundation of America, is the co-editor of Living with Grief (Hospice Foundation of America, 2007) and of End-of-Life Ethics: A Case Study Approach (Hospice Foundation of America, 2012). Dale G. Larson, Professor of Counseling Psychology at Santa Clara University, is a Fellow in the American Psychological Association, a clinician and researcher, and the author of The Helper’s Journey: Working with People Facing Grief, Loss and Life-Threatening Illness (Research Press, 1993) and with Daniel R. Tobin wrote ‘‘End-of-Life Conversations: Evolving Theory and Practice,’’ published in JAMA, 284(12), 1573–1578.