Robert A. Neimeyer

Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11

Holly Prigerson and colleagues tested the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and care of bereaved individuals at heightened risk of persistent distress and dysfunction.

Meaning reconstruction & the experience of loss.

Debunking the notion that an invariant sequence of stages of grief occurs among all who experience the death of a loved one, this groundbreaking volume clearly demonstrates that highly individual processes of meaning-making are at the heart of grief dynamics. Leading the reader through earlier conceptions of grief and mourning in which successful grieving is viewed as withdrawal of psychic energy from the deceased, the healthy role of continued symbolic bonds is stressed as well as appreciation of life-enhancing growth as one integrates the lessons of loss. A prominent theme in the volume is that symptoms in the bereaved have meaning-making significance, and that meaning reconstruction in response to loss is the central process in grieving. More scientifically oriented readers will find comprehensive discussions of research programmes supporting these tenets, particularly those linking grief with responses to loss involved in trauma. Practitioners will find clinically informed models and ample case descriptions to bridge concepts with the lived world of real people suffering real losses. All should find new paradigms for approaching loss and reconstruction of meaning in a respectful, revealing way that has significance both personally and professionally.

Psychotherapy for the Treatment of Depression: A Comprehensive Review of Controlled Outcome Research

Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychotherapy for depressed clients, (b) its effectiveness relative to pharmacotherapy, and (c) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. In view of these results, the focus of future research should be less on differentiating among psychotherapies for depression than on identifying the factors responsible for improvement.

Complicated grief and related bereavement issues for DSM‐5

Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over‐and under‐diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over‐diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders. Depression and Anxiety, 2011.

SEARCHING FOR THE MEANING OF MEANING: GRIEF THERAPY AND THE PROCESS OF RECONSTRUCTION

A comprehensive quantitative review of published randomized controlled outcome studies of grief counseling and therapy suggests that such interventions are typically ineffective, and perhaps even deleterious, at least for persons experiencing a normal bereavement. On the other hand, there is some evidence that grief therapy is more beneficial and safer for those who have been traumatically bereaved. Beginning with this sobering appraisal, this article considers the findings of C. G. Davis, C. B. Wortman, D. R. Lehman, and R. C. Silver (this issue) and their implications for a meaning reconstruction approach to grief therapy, arguing that an expanded conception of meaning is necessary to provide a stronger basis for clinical intervention.

Loss, Grief, and the Search for Significance: Toward a Model of Meaning Reconstruction in Bereavement

Constructivist theories recently have begun to inform understandings of grief, emphasizing the role of meaning making in adaptation to bereavement. In this article we review empirical studies using qualitative, quantitative, and mixed methods, investigating how three activities of meaning reconstruction are involved in the grieving process: sense making, benefit finding, and identity change. In particular, we consider how critical processes have been operationally defined and how study methods and designs have constrained what can be concluded from this burgeoning field of research. We conclude by positing an integrated model of meaning reconstruction pathways as a heuristic guide to further research and briefly note the implications of this model for clinical practice.

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.

Mourning and Meaning

Viewed in an expanded frame, the phenomena of grief and bereavement call for analysis in sociological, psychological, and psychiatric terms. In this article, the authors argue that a common theme in these accounts is that of the meaning of loss as expressed in both individual and collective attempts at adaptation. At a societal level, communal rituals, discursive practices, and local cultures provide resources for integrating the significance of loss for survivors and regulating the emotional chaos of bereavement. At an individual and interpersonal level, survivors struggle to assimilate the loss into their existing self-narratives, which are sometimes profoundly challenged by traumatic bereavement. Complicated grief can therefore be viewed as the inability to reconstruct a meaningful personal reality, an outcome to which individuals with insecure working models of self and relationships are especially vulnerable. Nonetheless, evidence suggests that grief can prompt personal growth as well as despair, augmenting rather than only reducing the survivors sense of meaning.

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.

DOES GRIEF COUNSELING WORK

Most bereavement caregivers accept as a truism that their interventions are helpful. However, an examination of the bereavement intervention literature suggests that the scientific basis for accepting the efficacy of grief counseling may be quite weak. This article summarizes the findings of four recent qualitative and quantitative reviews of the bereavement intervention literature. It then discusses three possible explanations for these surprising findings and concludes with recommendations for both researchers and clinicians in thanatology that could help to focus efforts to answer the questions of when and for whom grief counseling is helpful.