It has become the received wisdom in psychological circles that bereavement counselling is at best ineffective and at worst harmful, especially when offered to people experiencing ‘normal’ grief (see here for a recent example; p61).
Why the dire reputation? According to counselling psychologists Dale Larson and William Hoyt, it’s thanks largely to inappropriate reporting of an unpublished student dissertation by Barry Fortner, in which it was claimed 38 per cent of bereaved clients would have fared better if, instead of receiving counselling, they had been in the no-treatment control group.
The trouble, Larson and Hoyt argue, is that Fortner’s 1999 dissertation has only been cited once, by his colleague Robert Neimeyer in 2000. Since then, over 14 studies have reported the 38 per cent figure, but each time they have cited Neimeyer’s published paper (a summary of past research), not Fortner, thus giving the misleading impression that the result came from a piece of quality, peer-reviewed empirical research.
Worse still, like a game of Chinese Whispers (or Telephone if you’re American), recent papers discussing the 38 per cent figure have cited not only Neimeyer, but also subsequent papers citing Neimeyer, thus giving the impression that the 38 per cent figure has been corroborated by later investigations!
But now Larson and Hoyt have hit back. In a journal article and technical analysis (the latter freely available on-line), they claim Fortner’s methodology that led to the 38 per cent figure is flawed. Moreover, they asked the APA Publisher Gary VandenBos to submit Fortner’s dissertation to a post hoc peer review. And according to Larson and Hoyt, “The experts conclusively agreed that [Fortner’s methodology] is seriously flawed and that there is no valid basis for the claim that 38 per cent of grief counselling clients suffered deterioration.”
Apart from Fortner’s 38 per cent statistic, the reputation of bereavement counselling has also suffered from the reported outcomes of three key meta-analyses (where the outcome data from lots of studies is lumped together), one of which is in Fortner’s dissertation.
For example, the most extensive of the meta-analyses, published by Allumbaugh and Hoyt in 1999, is often reported as having found poor efficacy for bereavement counselling. But according to Larson and Hoyt, the efficacy rates in the 35 assessed studies varied hugely, due mainly to differences in whether clients had referred themselves and how long they had been bereaved. If the analysis was confined to the recently bereaved, and to those who had chosen to receive counselling, then compared to no-treatment control, counselling showed the kind of benefits typically found for other types of psychological therapy for other conditions.
Larson and Hoyt acknowledge the need for more research and conclude: “…findings to date indicate that cautious optimism, rather than the recently fashionable dire pessimism, is the attitude most congruent with empirical findings on grief counselling outcomes.”
Larson, D.G. & Hoyt, W.T. (2007). What has become of grief counselling? An evaluation of the empirical foundations of the new pessimism. Professional Psychology: Research and Practice, 38, 347-355.
Image credit: Wellcome Library, London. A woman whose face expresses sadness. Etching in the crayon manner by W. Hebert, c. 1770, after C. Le Brun.