Grief counseling should be supported despite bad rap

Researcher says negative studies were bad science

It only took one research paper in 2000 to cast a negative view over grief counseling, but that single widely-repeated and reported study has had long-term and unjustified impact on the practice, an expert says.

Hospice professionals may have read in Newsweek and other major media outlets about how a study showed that one-third of grief counseling clients and 50 percent of "normal" grievers were worse off than a control group as a result of grief counseling treatment. This statistic has been reported in national magazines and newspapers, cited in professional journals, and used by the psychological, hospice, and counseling industries to promote a pessimistic view of grief counseling.1

The trouble is that the statistics are based on data in a dissertation that was not peer-reviewed or published and which experts say is bad science, says Dale G. Larson, PhD, a professor in the department of counseling psychology at Santa Clara University in Santa Clara, CA. Larson also is the interim dean of the School of Education, Counseling Psychology and Pastoral Ministries at Santa Clara University.

Larson was intrigued when he first saw the grief counseling statistic, so he ordered the original citation, a 28-page dissertation, which first had been cited in a 2000 Death Studies paper.2

The Death Studies paper has been widely cited as evidence of the negative effects of bereavement counseling, even though the original citation — the dissertation — had never been published or peer reviewed.

"It was cited by everyone else as evidence for harmful effects of grief counseling, but no one returned to the original research, which was under the radar and never critically evaluated," Larson says.

"So I studied that dissertation and immediately began to question the validity of the research because there were many problems with it," Larson says. "The statistics had never been vetted and were not approved by the methodological research community."

The study had analyzed data from a number of studies to determine what has become to be called "treatment-induced deterioration effects" (TIDE).

Larson consulted with statistical and methodology experts across the country to see if the research was valid.

"If the research was invalid, it was an extraordinary discovery because the study had shaped the entire way we were viewing bereavement in literature," Larson says. "In the seven years since the article, it had set the stage for the emergence of a pessimistic outlook on bereavement counseling."

The statistical experts confirmed that the dissertation's findings were invalid, Larson says.

So why did the media and research community pounce so easily on a flawed study to cast doubt on the positive impact of bereavement counseling?

Larson suspects it was a perfect storm of several things: "What happened is a number of people who are advancing counterintuitive positions overall, saying we don't need to talk about our loss experiences, found these dramatic counterintuitive findings to be very supportive of their positions, and so they championed them."

Since no one before Larson examined the original data, the findings were immune to critical review, he adds.

And since the media likes controversy and finds counterintuitive findings more interesting, the negative view of grief counseling has a longer-lasting public presence than it might have otherwise, he says.

"If you want to get into the New York Times, it's much easier to say you shouldn't talk about loss experiences, because to say you should talk about loss is not very interesting," Larson says.

In fact, Larson was interviewed this past summer by a reporter from Newsweek, who persisted in writing a story that is largely negative about grief counseling, despite his spending time explaining to her that this finding was based on bad science.

"I told her that every outside reviewer and methodologist has said the same thing, that the data is meaningless, and it's not just a judgment call," Larson says.

So a stigma about grief counseling persists, and it is hard to shake, he says.

"It's a psychological challenge to turn the field's view around," Larson says.

But hospices and bereavement counselors should take heart in the findings that have disproved the pessimism about grief counseling, he says.

"For bereavement workers who have felt self-doubting of the efficacy of their interventions, this should be very good news," Larson says. "This is about a scientific issue."

Larson has published a paper that disputes the pessimistic view in the August issue of Professional Psychology: Research and Practice, and he hopes hospices and other health care entities will use this study to shore up support for grief counseling.

"I've heard many times that the [earlier] negative findings have been used to critique funding for bereavement programs with people saying, 'Why should we support bereavement services if they're harmful?'" Larson says. "And now the hospice world has some real good argument in favor of bereavement services."

References

1. Larson DG, Hoyt WT. What has become of grief counseling? An evaluation of the empirical foundations of the new pessimism. Prof Psych: Res & Pract. 2007;38:347-355.

2. Neimeyer RA. Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Stud. 2000;24:541-558.