This paper examines the effectiveness of bereavement counseling interventions for children and adolescents experiencing the loss of a loved one. The author argues that while bereavement counseling is crucial for developing healthy coping mechanisms, existing research shows mixed results regarding intervention efficacy. The proposed cross-sectional study will analyze grief counseling outcomes using the Inventory of Complicated Grief and Core Bereavement Items measures, comparing treatment techniques across age groups. By screening participants for genuine clinical need prior to treatment, the research aims to determine which intervention strategies—including art therapy, client-centered interviews, and group therapy—are most effective for specific age groups. The study addresses gaps in current literature by controlling for confounding variables and connecting individual-level grief work to larger-scale crisis response capacity.
The loss of a loved one is a traumatic event that can take months or even years to overcome fully (Tomita & Kitamura, 2002). Bereavement, however, is experienced especially acutely in children and adolescents who lack the psychological and social tools necessary to understand loss and move effectively forward with their lives. Bereavement counselors are crucial in helping develop healthy coping mechanisms for loss (Burnett et al., 1997). Strategies such as art therapy, client-centered therapy, self-assessment measures, and interviews are utilized to help these professionals gain immediate understanding of subjective individual grief and determine how best to address their clients' needs.
A 1999 U.S. census reported that more than 2% of children under age 18 had experienced the loss of at least one parent (U.S. Social Security Administration, 1999). It is further estimated that as many as 5% of children in the United States will experience the loss of a loved one before their fifteenth birthday (Currier, Holland, & Neimeyer, 2007). The time elapsed between these two data points indicates that childhood bereavement trauma is on the rise in the United States. This trend alone is reason enough to redouble efforts to effectively treat minors suffering the trauma of loss. It is essential that personnel in positions of counsel and support are trained in the most effective, efficient, and recent methods of helping bereaved children.
The experience of significant loss during an individual's lifetime is a statistical probability. It is rare that individuals experience their entire lifetime without losing a close friend, family member, or loved one. Unfortunately, given the current global political climate and state of environmental change, individuals will also likely experience massive loss of life resulting from natural disasters or war. The tools and skills developed by social aid workers and researchers that prove effective in individual family interventions will ultimately help ease the inevitable trauma of large-scale global events, such as natural disasters that leave thousands displaced or deceased.
While it is essential that children experiencing loss and grief be guided through the grieving process, there is controversy regarding the actual benefit of bereavement counseling. In a study conducted by Neimeyer in 2000, 38% of individuals who received treatment were likely to have been better in the long term had they not been counseled at all (Larson & Hoyt, 2007). Although the Neimeyer study was ultimately overturned because his conclusions were drawn from unpublished and untested data, such pessimism in the field of bereavement counseling is noteworthy. According to meta-analytic studies that adjusted for pre- and post-test data, many existing treatment strategies were so weakly effective that they provided little tangible relief (Larson & Hoyt, 2007). It is the duty of social aid workers and professional counselors to alleviate stress, not add to it by involving grieving individuals in therapy that proves ultimately unhelpful.
Abnormalities in the grieving process are positively correlated with increased vulnerability for psychological disturbances or disorders later in life (Currier et al., 2007). Even with evidentially supported successful techniques—strategies that aid significant numbers of participants to adjust normally—as many as 15% of children receiving bereavement counseling will still experience psychological, social, and behavioral problems two years after the loss (Currier et al., 2007). These problems have the potential to become lifelong disadvantages if appropriate measures are not taken immediately to effectively return the child to a normative state of behavior and psychological functioning.
The significance of continued research into, and adaptation of, bereavement counseling strategies for juveniles (individuals who experience significant loss before age 18) is multifaceted. If a child experiencing loss is successfully guided through the grieving process, they are likely to return to a normative level of psychosocial functioning within months of the loss, allowing them to move forward in their life and meet developmental goals without additional disruption (Gwynne, Blick, & Duffy, 2009). These children are unlikely to require further counseling as a result of that loss event, making resources available for other individuals in need. Successful grief counseling may also reduce the likelihood that the individual engages in self-harm or suicidal actions and ideations later in life, preventing the experience of crucial loss for their family members and saving their lives (Stroede, Schut, & Stroede, 2007). Finally, data collected through continued research and application in individual family contexts will be applicable to large-scale events, maximizing the efficacy of social aid workers in times of crisis.
Existing data supports the increasingly popular hypothesis that current methods of bereavement counseling are statistically ineffective (Larson & Hoyt, 2007). Furthermore, psychotherapeutic techniques appear more effective than those specifically designed for grief counseling (Larson & Hoyt, 2007). While it may be feasible to employ psychotherapeutic techniques in individual familial settings, it would be impossible to employ those techniques on a larger scale during a crisis. Though the ultimate goal of counseling is helping an individual return to normative psychosocial function and participate more fully in their life and work, it is important to establish effective, efficient, and reliable treatment protocols that can be standardized and used across a variety of scenarios.
One important area of bereavement counseling research is the standardization of inclusion criteria for bereavement counseling programs. While all children should have guidance and a safe space to express their feelings about their subjective experience of loss, not all children who experience loss require counseling. The inclusion of study results from children who displayed no clinically relevant symptoms prior to counseling presents a significant confound for the collection of useful data. If prior to treatment they experienced no negative psychological symptoms, afterward they should exhibit no significant change. There is also the possibility that counseling itself may result in negative behavioral and psychological outcomes due to having to relive and reiterate a traumatic experience such as the loss of a loved one (Forte et al., 2004).
Types of bereavement interventions can be divided into three categories: primary, secondary, and tertiary interventions (Stroebe, Stroebe, & Schut, 2007). Primary interventions are made available to all individuals who experience loss irrespective of their specific need for intervention. For example, following a death in a hospital setting, the grief counselor may approach the family, offer their availability, and provide helpful suggestions to begin the healing process. These interventions are the least invasive in that they are available if necessary yet no one is compelled to attend (Forte et al., 2004).
Secondary interventions are more intensive and targeted specifically at individuals who present non-normative responses to their grief. Offered in the immediate aftermath of a loss, individuals are generally referred to this type of counseling through their primary intervention provider or as a result of apparent need for further assistance. In the case of children and adolescents, they would likely acquire this aid through parent or guardian intervention rather than seeking it independently (Forte et al., 2004).
Tertiary intervention occurs more than three to six months after the loss event and is primarily focused intensive therapy intended to treat post-traumatic stress or depression resulting from bereavement (Forte et al., 2004). While primary interventions generally continue for only one to five sessions and secondary interventions last perhaps two months, tertiary interventions can potentially last for years depending on symptom severity. Particularly with children, the long-term effects of grief, if not properly assessed and treated, may result in or increase vulnerability to negative mental health outcomes (Forte et al., 2004).
Techniques commonly employed in primary interventions include art therapy, interviews, and psychodynamic counseling. These techniques enable counselors to assess an individual's current mental state and dynamically alter treatment in accordance with how their patient responds.
Art therapy is particularly useful with younger children. Children under age eight may have difficulty grasping the concept of death and expressing their feelings about the loss of a loved one (Shaw, 2000). Through drawing or painting, a counselor may gain better understanding of their patient's subjective experience of the loss as well as any unresolved emotions or unanswered questions. Art therapy is also an effective means of determining the relative normality of a child's cognitive function following a traumatic event (Shaw, 2000).
Older children respond more effectively to client-centered interviews (Shaw, 2000). A client-centered interview is a psychoanalytic approach that encourages the patient to talk extensively with minimal guidance from the therapist. This approach may allow, through extensive vocalization of formally internalized feelings, thoughts, and questions, identification of the root of any unresolved issues associated with the loss that may have proven detrimental to the client's successful psychological functioning (Shaw, 2000).
Secondary intervention techniques are more intensive as behavioral and psychological problems associated with bereavement are apparently persisting to a degree that disrupts the individual's daily functioning (Gwynne, Blick, & Duffy, 2009). These techniques include weekend retreats and referral to group therapy sessions or support groups. While spending significant time processing a significant life event such as loss can be useful, in children it may ultimately prove more harmful than helpful (Larson & Hoyt, 2007). Perpetually reliving a traumatic event may actually reverse the healing and acceptance process, especially with younger adolescents, effectively trapping them in that stressful time. Participation in group therapy and support groups allows individuals, particularly adolescents, to gain a sense of camaraderie, which can be important during grief. However, these groups may foster malingering or even psychological dependence on the sympathy and attention garnered at such sessions (Larson & Hoyt, 2007).
Tertiary intervention techniques are long-term therapeutic treatment plans including behavior modification, drug regimens, and standing appointments with therapists for treatment of pronounced disorders resulting from bereavement. The function of primary and secondary intervention strategies is to prevent the majority of individuals in need of some bereavement intervention from reaching this final and most severe treatment stage (Burnett et al., 1997). To qualify for a tertiary intervention, an individual must display a pervasive and fundamentally disruptive pattern of behaviors stemming from the loss event and preventing their successful reintegration with society (Tomita & Kitamura, 2002). In the case of children, the need for a tertiary intervention is especially concerning because it will inevitably impact the rest of their lives.
Given the generally pessimistic review of bereavement intervention techniques shared by most researchers, it would be valuable to determine whether the results of these trials are replicable in practice. Rather than including all data, it would be useful to screen participants prior to inclusion of their treatment objectives and outcomes in the data collected. If treatment is provided efficiently and immediately only to those individuals actually in need of counseling, intervention techniques would likely produce statistically significant results in lessening the amount of time necessary for participants to return to normal functioning following a significant loss.
This study will employ a cross-sectional design. A local hospital will be chosen based on proximity to the researcher and willingness to participate. The grief counseling department will provide redacted records of applicable participants. No personally identifying information will be included about participants, nor will the researcher have any direct interaction with them. The grief counseling center will provide participants with the Inventory of Complicated Grief before and after therapy as well as the Core Bereavement Items measure. The inventories, general nature of the therapeutic intervention (including who initiated therapy, duration, and clinician's opinion of efficacy), and case file summaries will be provided to the researcher upon conclusion of the study period. All participants will receive a briefing form prior to completing the inventory. Participation will be entirely voluntary and informed consent will be required for inclusion.
Ideally, the sample would include an ethnically, economically, and age-diverse group of participants. However, because this study utilizes convenience sampling, such normative distribution is unlikely to occur naturally. Therefore, multiple local hospitals should be included in the study. Participants will be included only if they score greater than 25 on the ICG and greater than 17 on the CBI. This ensures that only individuals presenting with a genuine need for therapeutic intervention will be included in the data analysis. Limiting the sample to those genuinely in need ensures that observed effects are actually a result of therapeutic intervention.
The two measures proposed are the Core Bereavement Inventory (CBI) and the Inventory of Complicated Grief (ICG). The CBI is a 35-item self-assessment scale that measures the subjective experience of loss. Composed of three internal subscales assessing thoughts, separation, and grief, this scale is easy to administer yet highly informative in assessing an individual's relative psychological functioning. The scale has a Cronbach's alpha of .85, indicating reasonable internal reliability. This scale is attractive because it can be used with children and adolescents.
The ICG is a 19-item scale that assesses the physical components of grief and the degree to which they disrupt an individual's life. This scale specifically measures symptoms of grief distinct from unrelated depression or anxiety. A cluster of seven symptoms assessed by this measure are indicative of long-term dysfunction. The Cronbach's alpha for this scale is .94, indicating an extremely high degree of internal reliability.
The final item used in data collection is the redacted case file of participants. Specific information regarding the nature of the loss and personally identifying information will be removed prior to review. The relevant factors are participant age, nature of loss (general descriptor such as mother or father), who initiated treatment, length of treatment, techniques employed, reason for terminating treatment, and success of treatment. These items are non-invasive yet, in combination with the pre-post test design, will yield information regarding which techniques are most successful for distinct age groups.
This study will employ a cross-sectional pre-post test design. The relative success of each participant's intervention will be determined through the two grief measures taken before and after treatment. These results will then be correlated with the various intervention techniques to determine which are, on average, most successful. Participants will be grouped by age and ethnicity when sufficient data is available.
"Research implications and challenges in data collection and generalization"
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