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The unique pain of grief has been recognized and described poignantly in some of
the most ancient texts and oral traditions of world cultures, but it is only in the last 50
years that formal organizations and professions have evolved to address the specific
social, psychological and spiritual needs of those persons who have lost loved ones. As
the field of grief counseling has grown it has also diversified, drawing inspiration from
evolving theories of grieving, while continuing to respond to the needs of various groups
touched by often tragic loss. As it has done so, it has also begun to attract the attention of
social scientists who have evaluated and sometimes criticized the field, raising questions
about its basic assumptions, its social role, and its clinical efficacy. Although present
evidence does not support the conclusion that formal bereavement services are of benefit
to everybody, it seems clear that they are of considerable help to many, and especially
on the basis of who delivers the services and who receives them. Bereavement support
most commonly describes informal mutual support groups for bereaved persons in the
groups for parents who have lost children. But this category can also include services
or national networks of services like those provided by Cruse throughout the United
Kingdom. In these models support is commonly offered to all bereaved people, or all
bereaved by a certain kind of loss (such as those who have lost children or who have lost
demonstrated distress or psychological disorder. Support may take many forms, ranging
through annual rituals of remembrance, to home visits and support groups led by a
veteran member of the group, typically without professional training. Such support
services have the advantage of minimizing the stigma of bereavement and mobilizing
community resources, especially in the form of the presence, understanding, and practical
counsel of others who have “been there” through having suffered a similar loss and who
led by professionals is also common. Grief therapy shares these features, but is usually
distinguished by its assumption that the client or patient is struggling with a problematic
reaction to the loss, such as a diagnosable case of depression or prolonged grief disorder.
For this reason, programs that focus on prevention of future mental health problems, such
as those for children who have lost a parent or sibling, might more appropriately be
termed grief counseling rather than grief therapy, per se. Both forms of services are
provided in a range of settings such as hospitals, clinics and counseling centers, though
Neimeyer 3
they also are offered by therapists of several disciplines as part of their independent
practice. Gradually there has been a move, especially in the United States, toward
considering grief therapy a specialized form of practice beyond general counseling and
for Death Education and Counseling. In practice, however, distinctions among most
forms of bereavement interventions are inexact and overlapping, in part because many
conducted grief therapy is appropriate when community support services are inadequate
to deal with bereaved people who are struggling intensely for prolonged periods because
about abandonment by another. It also can be indicated when the losses with which
people must deal overwhelm both the bereaved and those who attempt to support them,
such as the premature death of a young person or the murder of a loved one.
to say that most programs and services place emphasis on certain common factors,
sorrow words” in contexts that permit the expression of feelings related to the death of
the loved one and its aftermath. In keeping with the historical primacy of a
psychodynamic perspective with its focus on “working through” bonds with the deceased
in the service of “letting go,” and “moving on,” such therapy provides opportunities to
Neimeyer 4
review the relationship with the deceased and find symbolic ways to “say goodbye” with
grief can be shared and explored in media other than words, as through expressive arts
therapies that use drawing, painting, collage, mask work, sandtrays, music and more to
give symbolic form to emotions and meanings associated with the loss and, especially in
therapy, both individual and group services also have incorporated an emphasis on
education regarding basic grief and trauma reactions as well as practical coping skills,
approaches. For example, some group programs have been organized around the
presumed stages of grieving, with a series of weekly discussions of such topics as denial,
important tasks faced by the bereaved, such as acknowledging the reality of the loss,
confronting the pain of grief, and attempting to adjust to a world in which the deceased is
missing. Alternatively, some research based programs have drawn inspiration from
retelling of traumatic losses in order to better integrate them into one’s life story. Other
therapists help clients oscillate between the dual processes of loss-oriented coping (e.g.,
managing the intrusions of grief, seeking to relocate the relationship to the deceased) and
restoration-oriented coping (e.g., pursuing new activities and investments, taking on new
Neimeyer 5
cues of the loss, whether through concrete behaviors such as visiting the cemetery or
pain of the bereaved, and professional grief counseling has been given impetus by
cultural trends that view some form of therapy as a legitimate response to a wide range of
human suffering. Recently, these same interventions have attracted the attention of social
scientists who have attempted to understand processes of adaptation after profound loss
or trauma and how these can be facilitated by various programs and procedures.
Studying bereaved people over time—even those who have the intended benefit
of therapy—has made it clearer how difficult and extended the process of adapting to loss
can be for many. For example, children receiving family services after the death of a
parent are at risk of protracted disruptions of mood and behavior, especially when the
surviving parent has trouble maintaining open communication and effective structure and
discipline. Conversely, parents who have lost children to violent death from suicide,
homicide or accidents typically struggle with traumatic symptoms and grief for years or
even decades, and fathers in particular display little benefit from even systematic
therapies offering opportunities for sharing and discussion of coping strategies. Such
Neimeyer 6
results suggest that grief therapy is not a panacea for the pain of loss, and that some
people and families do not benefit greatly from the therapies that have been offered.
Studies comparing the progress of bereaved people who are randomly assigned to
most people who participate in grief counseling or therapy report high satisfaction with
services and also improve over time, it cannot be assumed that such improvement reflects
the effectiveness of therapy, as they might well have experienced a lessening of distress
as a function of natural processes of healing, their own efforts, or the social support
whether grief therapy can at times actually aggravate people’s distress, perhaps by
them with the negative emotions of others. However, most reviewers of the scientific
literature would agree that the evidence for the general effectiveness of grief therapy
offered to all bereaved people, regardless of whether or not they show serious signs of
depression, anxiety or disabling grief, those who receive treatment do no better than those
who do not. Although resolving the question of why this is so requires more research, it
seems probable that this largely reflects the resilience of the majority of bereaved
persons, whose grief is broadly in a normal range, and who ultimately will adapt well
In contrast, those studies that screen the bereaved for distress, that offer services
prolonged, or disordered forms of grieving, are far more consistent in supporting the
usefulness of grief therapy. For example, one important study compared a 16-week
therapy termed complicated grief treatment (CGT) against a more general interpersonal
psychotherapy (IPT) with a large group of bereaved people who met criteria for disabling
grief. Guided by the dual process model of bereavement, therapists in the CGT condition
promoted the dual goals of helping clients both process their loss and seek restoration in a
changed world that required the development of new life goals. Key interventions
included not only psychoeducation about oscillating attention to these two processes, but
also manual-guided therapeutic procedures delivered in three phases. The first of these
was termed Revisiting, in which the client was encouraged to tell and retell the story of
the loss with eyes closed, as the therapist prompted her or him to deeper emotional
engagement with the narrative. Clients were then instructed to listen to an audio
recording of the retelling between sessions to overcome tendencies to cope with the loss
through avoidance. In the next phase of Reconnecting, clients were encouraged to review
primarily positive but also negative memories of the loved one, as the therapist cultivated
which a renewed connection to the deceased was fostered through two-chair dialogue
with the lost loved one with the support of the therapist. Finally, in Restoration, clients
were encouraged to envision viable life goals for themselves if their grief were not so
intense, and then begin to work towards these. IPT followed its usual procedures by
linking symptoms of grief to interpersonal problems and working toward a realistic view
conditions showed improvement over time. Significantly, however, CGT was shown to
participants’ work and social adjustment, although the two treatments yielded comparable
outcomes on measures of depression and anxiety. Other studies also reinforce the
conclusion that specific treatments for complicated or prolonged grief can be effective
over a few months when they help clients think realistically and hopefully about their
situation, develop perspective on their loss, and orient to a changed future. Interestingly,
these therapies tend to share a focus on telling and exploring the story of the loss in
detail, whether in oral or written form, offering support for exposure to its most unsettling
features, and providing opportunities for reconstructing a life plan in the wake of
believe that bereavement interventions can play a valuable role in mobilizing support for
survivors, especially in circumstances of traumatic loss, and can mitigate the impact of
SEE ALSO Bereavement, Grief and Mourning; Homicide; Prolonged Grief Disorder;
FURTHER READINGS
outcome research. Journal of Clinical Child and Adolescent Psychology, 36, 253-
259.
Jordan, J. R., & Neimeyer, R. A. (2003). Does grief counseling work? Death Studies, 27,
765-786.
Shear, K., Frank, E., Houch, P. R., & Reynolds, C. F. (2005). Treatment of complicated
Stroebe, M., & Schut, H. (1999). The Dual Process Model of coping with bereavement:
Worden, J. W. (2002). Grief counseling and grief therapy. New York: Springer.