Joseph M. Currier

Sense-Making, Grief, and the Experience of Violent Loss: Toward a Mediational Model

Bereavement following violent loss by accident, homicide or suicide increases the risk for complications in grieving. This is the first study to examine a constructivist model of grief that proposes that sense-making, or the capacity to construct an understanding of the loss experience, mediates the association between violent death and complicated grief symptomatology. An ethnically diverse sample of 1,056 recently bereaved college students completed the Inventory of Complicated Grief (ICG) and questions assessing the degree of sense-making and the circumstances surrounding their losses. Consistent with this studys primary hypothesis, sense-making emerged as an explanatory mechanism for the association between violent loss and complications in grieving. Specifically, the results revealed that sense-making explained this relation, even when the element of sudden bereavement was shared by all of the participants. Overall, this study provides initial support for a model of grief in which failure to find meaning in a loss is conceptualized as a crucial pathway to complicated grief symptomatology.

The Effectiveness of Psychotherapeutic Interventions for Bereaved Persons: A Comprehensive Quantitative Review.

Previous quantitative reviews of research on psychotherapeutic interventions for bereaved persons have yielded divergent findings and have not included many of the available controlled outcome studies. This meta-analysis summarizes results from 61 controlled studies to offer a more comprehensive integration of this literature. This review examined (a) the absolute effectiveness of bereavement interventions immediately following intervention and at follow-up assessments, (b) several of the clinically and theoretically relevant moderators of outcome, and (c) change over time among recipients of the interventions and individuals in no-intervention control groups. Overall, analyses showed that interventions had a small effect at posttreatment but no statistically significant benefit at follow-up. However, interventions that exclusively targeted grievers displaying marked difficulties adapting to loss had outcomes that compare favorably with psychotherapies for other difficulties. Other evidence suggested that the discouraging results for studies failing to screen for indications of distress could be attributed to a tendency among controls to improve naturally over time. The findings of the review underscore the importance of attending to the targeted population in the practice and study of psychotherapeutic interventions for bereaved persons.

Predictors of Grief Following the Death of One's Child: The Contribution of Finding Meaning

This study examined the relative contribution of objective risk factors and meaning-making to grief severity among 157 parents who had lost a child to death. Participants completed the Core Bereavement Items (CBI; Burnett, Middleton, Raphael, & Martinek, 1997), Inventory of Complicated Grief (ICG; Prigerson et al., 1995), questions assessing the process and degree of sense-making and benefit-finding, and the circumstances surrounding their losses. Results showed that the violence of the death, age of the child at death, and length of bereavement accounted for significant differences in normative grief symptoms (assessed by the CBI). Other results indicated that the cause of death was the only objective risk factor that significantly predicted the intensity of complicated grief (assessed by the ICG). Of the factors examined in this study, sense-making emerged as the most salient predictor of grief severity, with parents who reported having made little to no sense of their childs death being more likely to report greater intensity of grief. Implications for clinical work are discussed.

The Effectiveness of Bereavement Interventions With Children: A Meta-Analytic Review of Controlled Outcome Research

Grief therapies with children are becoming increasingly popular in the mental health community. Nonetheless, questions persist about how well these treatments actually help with childrens adjustment to the death of a loved one. This study used meta-analytic techniques to evaluate the general effectiveness of bereavement interventions with children. A thorough quantitative review of the existing controlled outcome literature (n = 13) yielded a conclusion akin to earlier reviews of grief therapy with adults, namely that the child grief interventions do not appear to generate the positive outcomes of other professional psychotherapeutic interventions. However, studies that intervened in a time-sensitive manner and those that implemented specific selection criteria produced better outcomes than investigations that did not attend to these factors.

Meaning Reconstruction in the First Two Years of Bereavement: The Role of Sense-Making and Benefit-Finding

Contemporary grief theories have highlighted the role of meaning-making in adaptation to bereavement, focusing on two major construals of meaning: making sense of the loss and finding benefit in the experience. The current investigation attempted a conceptual replication of the findings of Davis, Nolen-Hoeksema, and Larson (1998) that suggested that sense-making predicts adaptation to loss in the early period of bereavement, whereas benefit-finding primarily plays an ameliorative role as time progresses. To this end, an ethnically diverse sample of 1,022 recently bereaved college students completed the Inventory of Complicated Grief (ICG) as well as questions that assessed sense-making, benefit-finding, and the circumstances surrounding their losses. Results only partially replicated the findings of Davis and his colleagues, demonstrating that: 1) time since loss bore no relation to grief complications; 2) sense-making emerged as the most robust predictor of adjustment to bereavement; and 3) benefit finding interacted with sense making, with the fewest complications predicted when participants reported high sense, but low personal benefit, in the loss.

Grief Therapy Evidence of Efficacy and Emerging Directions

The loss of a loved one carries serious consequences for the physical and emotional well-being of many of the bereaved. It is therefore not surprising that to mitigate the impact of loss and promote successful adaptation, various forms of grief therapy have been proposed. However, controversies about the effectiveness of bereavement interventions have arisen, in part because previous reviews have relied on small samples of studies, which makes drawing inferences about the evidence base for bereavement interventions precarious at best. Drawing on a recent comprehensive analysis of over 60 controlled studies, we attempt to offer a more definitive view, and we discuss moderators associated with more effective bereavement interventions. Finally, we conclude by considering several theoretically informed approaches that hold promise for the further refinement of evidence-based therapies for bereavement complications, and we suggest some future directions for grief research and intervention.

Brief Report: Children's Response to Serious Illness: Perceptions of Benefit and Burden in a Pediatric Cancer Population

OBJECTIVE To examine a revised measure of benefit finding for children, in relation to perceptions of illness-related burden, and other measures of child psychological functioning. METHODS A sample of 78 children with cancer completed the newly revised Benefit/Burden Scale for Children (BBSC) and measures of optimism/pessimism, positive/negative affect, anxiety and defensiveness. RESULTS Factor analysis of the BBSC revealed a clear two-factor solution, with benefit finding and illness-related burden representing orthogonal factors. Both scales were internally consistent and demonstrated different patterns of correlation with the other measures assessed in the study. CONCLUSION The BBSC is internally reliable and preliminary data supports the validity of separate benefit and burden constructs. Children report positive and negative aspects of their illness simultaneously, and perceptions of benefit and burden function as independent constructs. The BBSC is a useful measure for pediatric cancer patients that could be applied to children experiencing other significant life events.

Parental depression and family environment predict distress in children before stem cell transplantation.

Objective: To examine parental symptoms of depression, family environment, and interaction of these parent and family factors in explaining severity of distress in children scheduled to undergo stem cell or bone marrow transplantation. Method: A self-report measure of illness-related distress, adjusted to reflect the experience of medical diagnosis and associated stressors was completed by 146 youth scheduled to undergo stem cell or bone marrow transplantation. Measures of parental depressive symptoms and family environment (cohesion, expressiveness, and conflict) were completed by the resident parent. Results: Parental symptoms of depression, family cohesion, and family expressiveness emerged as significant predictors of child-reported distress. Additionally, significant parental depression × family cohesion and parental depression × family expressiveness interactions emerged as predictors of the intensity of the childs distress. When parental depressive symptomatology was high, child distress was high regardless of family environment. However, when parental depressive symptomatology was low, family cohesion and expression served as protective factors against child distress. Conclusion: Parental depressive symptomatology and family functioning relate to child distress in an interactive manner. These findings inform future directions for research, including interventions for parents aimed at promoting child adjustment during the pediatric cancer experience.

Cause of Death and the Quest for Meaning After the Loss of a Child

This study examined patterns of making meaning among 155 parents whose children died from a variety of violent and non-violent causes. Findings indicated 53% of violent loss survivors could not make sense of their loss, as compared to 32% of non-violent loss survivors. Overall, there was overlap in sense-making strategies across different causes of death, with many parents invoking spiritual and religious meanings and the cultivation of empathy for the suffering of others. Nonetheless, violent loss survivors described the imperfection of the world and brevity of life more frequently in their narrative responses than parents who lost a child to natural causes, who in turn were more likely to find benefit in the loss in terms of personal growth. Violent loss survivors—and especially those losing a child to homicide—also reported enhanced appreciation of life more frequently than survivors of non-violent losses, and surviving a childs suicide was specifically associated with a change in priorities in the sample. Findings are discussed in terms of common and distinctive themes in meaning making that clinicians may encounter when working with parental bereavement, and the implications these carry for finding spiritual and secular significance in a traumatic loss.

Outcomes from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) program for bereaved caregivers.

Although preventive efforts for bereaved individuals have not been shown to be particularly effective in past studies, it has been suggested that intervention effects might be underestimated due to methodological issues such as short follow-up assessments. Thus, the present study aimed to assess the efficacy (as whole intervention packages and as component parts) of the Resources for Enhancing Alzheimers Caregiver Health (REACH) interventions in preventing complicated grief, normal grief, and depressive symptoms at a longer term follow-up assessment among bereaved caregivers (N = 224). On average, active interventions showed a statistically significant effect on normal grief symptoms (d = 0.28), exhibited a trend toward improvement on complicated grief symptoms (d = 0.25), and demonstrated little impact on depressive symptoms (d = 0.09). Interestingly, the examination of intervention components revealed differential effects, whereby cognitive and behavioral strategies were most effective at reducing levels of complicated grief, information and emotional support were most effective for addressing normal grief, and environmental modifications were most effective for ameliorating depressive symptoms. These findings suggest that different preloss interventions might be warranted depending on a caregivers unique clinical presentation and combination of risk factors.