Talk therapy is the best way to ease grief and depression following the death of a loved one, a new evidence review has concluded.
There’s solid evidence that psychotherapy can help people work through their grief, researchers reported today in the Annals of Internal Medicine.
Other common ways of confronting grief — support groups, spiritual counseling, peer counseling, antidepressants, self-help — had much less evidence supporting their effectiveness, researchers found.
“Although a range of effective interventions exist for practitioners to offer their grieving patients, more information is needed on how to effectively target these interventions to the specific circumstances of bereaved persons and patients experiencing prolonged grief disorder,” concluded the research team led by Susanne Hempel, director of the Southern California Evidence Review Center at the University of Southern California.
For the new review, researchers analyzed data from 169 previous clinical trials testing different means of helping people who are grappling with grief.
“Prolonged grief, which was previously also described in the literature as complicated grief, is characterized by intense, persistent and disabling grief that lasts longer than what is typically expected after bereavement,” researchers wrote.
Of the clinical trials reviewed, 76 evaluated whether psychotherapy could help people with their grief.
“Across studies, we found a positive effect of psychotherapy on grief disorder symptoms,” the review says.
Researchers also found some benefit from expert-facilitated support groups and enhanced contact from a person’s health care team, although the evidence there was not as strong.
“Evidence for other bereavement interventions, approaches for children, and outcomes beyond general grief or grieving, grief disorder, and depression symptoms is limited,” the team concluded.
The review is “an excellent summary of what works and doesn’t work for grief survivors,” said Sherry Cormier, an Annapolis, Maryland, psychologist and certified bereavement trauma specialist, who reviewed the findings. “It is a clarifying article that helps guide treatment decisions about what we know and, as important, what we still don’t know about bereavement treatment.”
For example, the review found that few studies have looked into how to best help grieving children and highlighted other surprising holes in the existing evidence regarding grief counseling.
“We could not determine the effect of spiritual counseling despite the fact that many people rely on spiritual support through local religious and community organizations to cope with loss and maintain emotional well-being,” the researchers wrote.
Cormier said data is scant.
“We still don’t have much data on how effective psychotherapy is for grieving children,” she said. “We also don’t know how effective psychotherapy is for culturally diverse bereaved clients. We need much more research that identifies components of effective psychotherapy for bereaved children as well as for culturally diverse grief survivors.”
This sort of research is crucial, said Cormier, author of "Sweet Sorrow: Finding Enduring Wholeness After Loss and Grief."
“Grief is very isolating,” Cormier said. “Grievers are mired in sorrow while the rest of world goes on. This disparity makes grievers feel more alone.”
But, she said, effective psychotherapy can address this.
“In effective psychotherapy, a grief survivor can experience compassion and validation from the therapist that addresses this isolation,” Cormier said. “Loss of a loved one also represents a major change in our attachments and our identity. Working through these vast life shifts in therapy helps heal disrupted attachment and loss of identity.”
She said bereaved people seeking therapy should trust their grief as a guide.
“You may need to weep and that will be all right. You may feel angry and that is also OK,” Cormier said. “Share what you need and what you are struggling with as you talk with your therapist," she advised. "The reliable presence and understanding of your trained therapist will help you navigate the immense changes you are experiencing from the loss of a beloved, one of the most profound life changes we encounter.”