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Best Practices in Counseling Grief and Loss: Finding Benefit from TraumaAltmaier, Elizabeth MJournal of Mental Health Counseling; Jan 2011; 33, 1; ProQuest Psychology Journalspg. 33

Journal of Mental Health Counseling

Volume 33/Number 1/January 2011/Pages 33-xxx

Best Practices in Counseling Grief and Loss: Finding Benefit from Trauma

Elizabeth M. Altmaier

Grief may be a primary presenting concern of clients or may form a background to another presenting

concern. In either case, use of best practices in assessing and treating grief is essential. In this article I

review what best practices are in general and in assessment and treatment. I also evaluate ways lo mea­

sure grief and describe domains of the grief experience. The article also discusses controversies within

the literature on grief counseling, including the potential for deterioration after treatment. It concludes

with a view of counseling grief that promotes finding benefit from trauma.

This special section describes the devastating impact of loss on the life of a person. However common it may be, loss causes significant individual griev­ing, which in tum can impair emotional, cognitive, and behavioral functioning. Throughout this special section we have emphasized the difficulties caused by the crisis of loss and the experience of bereavement, such as the potential of complicated grief and the special case of parentally bereaved children. We have also noted the importance of culture-based counseling issues related to grief.

More important, however, is a larger perspective introduced by Harvey, who defined loss as a "fundamental human experience" (Harvey, 2002, p. 2) from which we can grow and learn to understand others, help others, and develop our own courage to live with pain. It is critical to keep this positive view of grief in mind when considering best practices in counseling those who are grieving because it treats counseling as facilitating growth rather than simply mending loss.

In this article I focus on the evidence that underlies assessment and treatment, and on practices that should be considered in counseling the grieving client. Thinking of grieving within the context of posttraumatic growth will define alternative counseling approaches.

Elizabeth M Altmaier is affiliated with The University of Iowa. Correspondence concerning this

article should be directed to Elizabeth M Altmaier, Department of Psychological and Quantitative

Foundations, The University of Iowa College of Education, 360 Lindquist Center, Iowa City, Iowa

52242-1529. E-mail: [email protected].

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34 JOURNAL OF MENTAL HEALTH COUNSELING

IMPLEMENTING BEST PRACTICES: FROM RESEARCH EVIDENCE TO

COUNSELING EACH CLIENT

What are best practices? Though the term has been adopted widely, its usage is not agreed upon-much like terminology related to grief. Concisely, best practices, a term borrowed from the business world, suggests that there is a par­ticular technique, approach, or method that when used with a particular target is more effective (reaches its goals) and efficient (uses fewer resources) than other techniques, approaches, or methods. It also suggests that there are data available to influence the decision to use this particular technique. Within the mental health field, other terms that denote a similar emphasis on using data to make decisions on assessment and treatment are evidence-based practice and empirically supported treatment.

One approach to understanding best practices is to focus on outcome data gathered in clinical trials of a particular treatment (empirically supported treat­ments). Many consider these studies to be the best basis upon which to select a treatment. Advocates of empirically supported treatment argue that although a treatment is only one of several influences on client outcome, it is the influence that a counselor in training can most readily learn and the influence that can be most easily studied scientifically (Norcross, Beutler, & Levant, 2005).

There are two other sources of data to inform treatment choice. One is clini­cal lore-the accumulated experience of many practitioners transmitted through personal testimony, continuing education, client reports, news cover­age, and so on. Unfortunately, clinical lore has the drawback of promoting treatments later shown to be ineffective or less effective than alternatives. Fad diets might be the health counterpart to selection of counseling approaches predicated on clinical lore.

Another data source is the counselor's own personal clinical experience. A seasoned counselor can recall similar clients, similar desired outcomes, similar contexts, and so on-memories that can inform a present treatment decision. Unfortunately, clinical experience can fall prey to the biases that influence human memory, such as confirmation bias, which emphasizes previous suc­cesses and overlooks previous failures. Another bias is the availability heuris­tic, where clients who are memorable for any reason are prominent images in the counselor's memory, while less memorable clients fade.

An alternate view of counseling effectiveness is the primacy of the counselor within the interpersonal relationship. In this view, treatments are essentially equal in their effectiveness, but it is whether the counselor is, for example, warm or rejecting, sensitive or insensitive, astute or ignorant that most influ­ences outcomes. When data are sought to support treatment decisions, the per­sonhood of the counselor is typically overlooked although it accounts for as

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Altmaier I BEST PRACTICES IN GRIEF 35

much of the outcome as treatment. Wampold (Norcross et al., 2005), for exam­ple, argues that overlooking the personhood of counselors in research on best practices, particularly research that focuses on the treatment as the sole or pri­mary influence on outcome, causes two types of misattribution: First, it inflates the effects attributed to treatment and thereby creates a false sense of confi­dence in a treatment when the counselor may be the agent for change. Second, a focus on treatment alone creates an impression that counseling is a package of techniques that can be delivered impersonally-a gross misunderstanding of the deeply human enterprise of counseling.

Alternatively, the counselor-client relationship may be the primary source of influence. Lambert (Norcross et al., 2005) notes that when clients are asked about their counseling experience in qualitative and retrospective studies, the relationship with the counselor is typically cited as the primary reason for change: clients feel understood, valued, appreciated, supported, and so on. Technique and theoretically based explanations of treatment outcome (e.g., change in dysfunctional cognitions) are almost never mentioned.

Last, the fact that clients are active agents in their own improvement and change cannot be overlooked. Rather than being a passive recipient of a treat­ment, the client elaborates on the insights of counseling outside the session, works the information and insights into her life, and through self-healing and self-determination mechanisms creates a medium for effective outcome.

In summary, the background of best practices is important in selecting coun­seling approaches for a grieving client, keeping in mind that there is contro­versy over whether grief counseling is appropriate for everyone, only for persons seeking treatment, or only for persons experiencing complicated grief. Moreover, though in general some counseling approaches may seem to be effective, research should not imply that the personhood of the counselor, the relationship of client and counselor, or the client's own self-healing processes are insignificant aspects of change.

BEST PRACTICES IN GRIEF ASSESSMENT

Although grief is a universal phenomenon, it has not been adequately con­ceptualized. As the accompanying articles note, the lack of consistency in defining grief has led to inconsistency in the development of grief measures. In what follows I describe the most prominent of these measures. They were cho­sen because they (a) are the most widely used; (b) focus on grief, rather than broad psychiatric symptoms; ( c) assess normal, not complicated, grief; and ( d) consider grief across all possible losses, rather than a specific loss, such as the loss of a child. (See Stroebe, Hansson, Schut, & Stroebe, 2008, for more com­plete coverage of conceptual issues in the measurement of grief.)

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36 JOURNAL OF MENTAL HEALTH COUNSELING

Grief Measures Texas Revised Inventory of Grief (TRIG; Faschingbauer, Zisook, & DeVaul,

1987). The TRIG, probably the most widely used measure of grief, is a brief measure with two subscales: Current Grief and Past Disruption. Items, created based on a review of the literature and the clinical experience of the authors, contain sentences of personal description to which the participant responds on a five-point scale (I =completely false to 5 =completely true). Because of the contrasting temporal nature of the two sections, the developers assert that the two scores can be used to assess progress in grieving.

Niemeyer and Hogan (2001) summarized the psychometric qualities of the scale. Internal consistency ranged from . 77 to .87 for the Current Grief subscale and .86 to .89 for Past Disruption. For the original Texas Inventory of Grief, Faschingbauer ( 1981) reported an exploratory factor analysis study in which items were retained with factor loadings greater than .40. Though there are few data on validity, the widespread usage of the scale provides considerable com­parative data for users.

From a construct validity perspective, there are several concerns about the TRIG. The Current Grief subscale contains three items related to crying (e.g., "I still cry when I think of the person who died"). There is considerable over­lap of this subscale with depression: items assess sadness, loss of interest in previously pleasurable activities, irritability, and sleep problems. Finally, the scale fails to incorporate constructs that have been both theoretically and empirically associated with grief (e.g., guilt, hearing the dead person's voice).

Grief Experience Inventory (GEi). The GEi was designed to be sensitive to the longitudinal process of grief (Sanders, Mauger, & Strong, 1985). Items derived from the literature are presented as self-descriptive sentences to which the participant responds true or false. Scoring is similar to that of the Minnesota Multiphasic Personality Inventory: there are three validity scales: Denial, Atypical Responses, and Social Desirability; nine clinical scales: Despair, Anger-Hostility, Guilt, Social Isolation, Loss of Control, Rumination, Depersonalization, Somatization, and Death Anxiety; and six "research" scales: Sleep Disturbance, Appetite, Loss of Vigor, Physical Symptoms, Optimism­Despair, and Dependency.

Niemeyer and Hogan (2001) summarized the psychometric properties of the scale. Internal consistency is rather poor, with six of the nine clinical scales having an alpha coefficient below .70. Sanders et al. (1985) present a factor analysis with three dominant factors that do not correspond to the scale's struc­ture-the largest factor seems to measure depression. Validity data (Sanders et al., 1985) reveal that the clinical scales differentiate between bereaved and non­bereaved persons and yield higher scores for persons who indicate they are having difficulty accepting the loss of the loved one.

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Altmaier I BEST PRACTICES IN GRIEF 37

Core Bereavement Items (CBI). Burnett, Middleton, Raphael, and Martinek (1997) describe their CBI as a "scale of core bereavement items that could be used to assess the intensities of the bereavement reaction in different commu­nity samples of bereaved subjects" (p. 51 ). Their items were formulated from focus interviews with recently bereaved adults and a review of the literature. After selecting 76 items, the authors used factor analysis to narrow the pool to seven subscales. Validity studies further reduced coverage to 17 items in three subscales: Images and Thoughts (e.g., "Do images of the lost person make you feel distressed?"); Acute Separation (e.g., "Do you find yourself missing the lost person?"); and Grief (e.g., "Do reminders of the lost person, such as pho­tos, situations, music, places, etc., cause you to feel a longing for him or her?"). Items are responded to on a four-point frequency scale with anchors indicating increasing frequency.

Niemeyer and Hogan (2001) report reliability and validity data for the CBI; coefficient alpha was estimated at .91 for the scale as a whole. Middleton et al. (1998) noted the following validity data: bereaved parents scored higher than bereaved spouses, who in turn scored higher than bereaved adult children. There are no factorial validity data.

Hogan Grief Reaction Checklist (HGRC). The most recent scale (Hogan, Greenfield, & Schmidt, 2001) was explicitly intended to "delineate normal grief' (p. 2) and in particular to avoid blurring grief with symptoms like depres­sion or anxiety. Hogan et al. also used an empirical method of scale develop­ment, obtaining and analyzing interview data from bereaved adults, to identify six categories: Despair, Panic Behavior, Blame/ Anger, Disorganization, Detachment, and Personal Growth. Initially focus groups analyzed items that were then given to a community sample of adults who had experienced the death of a family member. Factor analysis revealed six factors that corre­sponded to the initial categories; items with loadings of .40 or greater were retained.

Hogan et al. (2001) present alpha coefficients ranging from .79 to .90 for the subscales and .90 for the whole measure. They suggest using a total score for the 61 items. However, although this scale is presented as useful for general grief, the final set of instructions pertains to the death of a child for parents rather than as a general grief measure.

In assessing grief it is important to remember that no single measure captures all its manifestations. Counselors might well consider assessing domains of grief rather than the general concept of grief because clients will have differing experiences and may well be expressing their grief within different domains across time.

Schoulte and Altmaier (2008) analyzed grief measures to identify a consen­sus of domains that encompass the experience of grief. After a thorough review

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38 JOURNAL OF MENTAL HEALTH COUNSELING

of the literature that yielded all relevant inventories, superordinate grief domains and definitions were determined via qualitative content analysis of all items on these inventories (see Table 1 ).

Table 1. Grief Domains and Definitions

Domain Physical symptoms

Cognitive difficulties

Uncertainty over future

Denial

Interpersonal interaction

Emotional response

Injustice of loss

Symbolic rituals

Continuing bonds

Benefit finding

Definition Somatic and physiological reactions

Difficulties remembering, learning, or thinking

Loss of meaning of life and pessimism about the future

Not accepting the loss, with responses including shock

and numbness

Changes in interpersonal reactions, needs, and

relationships

Range of internal feelings related to the loss

Frustration over the loss, feeling as though the loss was

not deserved, shattered assumptions of a "just world"

Behaviors with symbolic meaning an individual may

engage in during the grieving process

Continued emotional, cognitive, and behavioral links with

the deceased

Positive changes about the self as a result of the

experience of loss

One approach to grief assessment is for the counselor to assess each domain, either through clinical interviewing, published measures, or client self-reports. The use of diaries, journaling, and drawing can supplement the experience of a particular domain in addition to measures or conversation. In any assessment, client reactions should be normalized because there are socially perceived bar­riers to showing grief.

As Schoulte describes (above, pp. 11-20), cultural context is also necessary to assessment. Inquiring about social and cultural expectations is a fruitful way to transition to discussing the influence of family and culture. Questions as sim­ple as "What do you think your family's expectations are of you at this time?" can help a client explore what may be hidden influences on the grief experi­ence.

BEST PRACTICES IN THE TREATMENT OF GRIEF

Is grief counseling effective? Although intuitively it would seem that provid­ing a supportive environment in which to grieve-in the presence of an empathic counselor, with gentle encouragement to consider the role of the deceased in the client's life-would promote adjustment, there is controversy about how effective grief counseling is. Larson and Hoyt (2007) have summa­rized the empirical evidence for and against it. Two particular sources of

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Altmaier I BEST PRACTICES IN GRIEF 39

concern for them are the possibilities of a deterioration effect after treatment and of a minimal positive outcome.

Two researchers who conducted meta-analyses have argued that clients who received grief counseling may end up worse off than they began: Fortner ( 1999) cited a rate of 3 7% of clients deteriorating after treatment; Niemeyer (2000) found a similar rate, 38%. Larson and Hoyt (2007) studied the two meta­analyses in detail and concluded that the rates of deterioration found were based on a statistic that may have been defined erroneously. Specifically, Fortner (2008) notes that an error in his dissertation text may have led to confusion about the calculation of the deterioration rates he cited.

A second criticism is that the outcomes of grief counseling, expressed as an effect size, are not large enough to warrant confidence in such treatment. Reviews considered by Larson and Hoyt (2007) established an effect size (.11 to .43) lower than the .80 typically obtained in estimates of counseling outcome (see Wampold, 2001, for discussion). Schut, Stroebe, Van Den Bout, and Terheggen (2001) concluded that "based on the evidence to date, outreaching primary prevention intervention for bereaved people cannot be regarded as being beneficial in terms of diminishing grief-related symptoms, with a possi­ble exception for interventions being offered to bereaved children" (p. 731 ).

Taking this perspective, however, ignores the four views of the influence on counseling effectiveness previously discussed. The current controversy rests on

the treatment technique alone; what is not known are outcome effects attribut­able to the person of the counselor, the characteristics of the client, and their relationship. The widespread acceptance and promotion of groups such as Compassionate Friends (for suicide survivors) and online groups such as MyGriefSpace.net suggests that at least some grieving persons find support from compassionate others to be of help.

There is preliminary evidence that persons with complicated grief may achieve better outcomes than clients with normal grieving responses. Shear, Frank, Houck, and Reynolds (2005) compared two treatments for complicated grief, interpersonal therapy and a new treatment for complicated grief. This new treatment focused on ways in which to "retell" the stories associated with the loss so as to reduce distress and increase positive memories. Both treat­ments produced improvement in the target symptoms of complicated grief (assessed by an inventory of complicated grief), but the new treatment was found to be more effective.

Overall, the best conclusion regarding the efficacy and effectiveness research on grief counseling is that the matter is still unresolved. Considering solely the treatment, which is the basis of outcome research in this area, yields a conclu­sion that counselors should continue to strive to provide counseling to persons in need while gathering data on effectiveness and efficacy. The Association of Death Education and Counseling has posted a statement on research efficacy

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40 JOURNAL OF MENTAL HEALTH COUNSELING

and the findings related to deterioration that promotes this balanced approach (ADEC, 2008).

INTERVENTION STRATEGIES

One way for counselors to begin thinking of grief counseling strategies is to utilize the perspective described above on the domains of influence on client outcome. Because of the importance of the personhood of the counselor, in this section I consider first qualities that ensure that a counselor will be an effective helper for grieving persons. (Here I rely heavily on the thoughtful writings of the director of the Center for Loss and Life Transition, Alan Wolfelt [ 1998].) A framework for those qualities consists of empathic presence, gentle conversa­tion, available space, and engaging trust. Within empathic presence are quali­

ties of listening, silence, and support. Many grieving persons will need to tell and retell stories associated with the loss. Empathic listening, accepting and encouraging the expression of feelings, and allowing pain to be expressed freely are critical.

Gentle conversation avoids cliches and easy answers. Telling grieving clients that they will "get over it," "better days will come," or "the darkest hours are just before dawn" is demeaning. The best response may be "I am sorry. Tell me more about it." A gentle conversation allows opportunities for remembering. Memories can be encouraged through pictures, drawing, and other expressive modalities.

Counselors should strive to provide available space for the client. Helping the client find support and encouragement from other sources as well as coun­seling is also critical. Time itself is important. Because grieving does not fol­low a predictable trajectory, counselors will need to be patient.

Last, engaging trust communicates to the client that she has the ability to recover and grow. Grieving clients may not see a future without the loved one, may not have confidence that they will ever be free of their feelings, or may feel overwhelmed by the demands of everyday life. Communicating a trust that continues to engage the client in the tasks of grief is essential. Using books that allow clients to have their own journey through grief may be helpful; Wolfelt (1997) is an example.

Most writers about grief counseling do not propose techniques per se. Rather, the best technique or treatment may be a different view of the relationship between counselor and client. Wolfelt ( 1998) argues that certain treatment goals are misguided, among them treating grief as a syndrome to be eliminated, pro­moting the client disengaging from the deceased and terminating the relation­ship, having the client finish a series of tasks, using a recovery or resolution model to suggest a return to the pre-loss state, considering grief as a life crisis where balance can be re-achieved, and failing to attend to the spiritual aspects

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Altmaier I BEST PRACTICES IN GRIEF 41

of grief. Companioning for these goals involves several tenets, Wolfelt says, including learning from the client, discovering the gift of silence, and listening with the heart (Wolfelt, 2007).

Using this perspective focuses the counselor on facilitating client grieving needs (Wolfelt, 1997). These needs form a structure for the relationship, but meeting them is not a linear or "led" process. Rather, within the relationship with the counselor, maintaining a companioning model helps the client to meet the needs of "acknowledging the reality of the death, embracing the pain of the loss, remembering the person who died, developing a new self-identity, search­ing for meaning, and receiving ongoing support from others" (p. 2). Meeting these human needs will lead to healing and reconciliation, what Wolfelt describes as "the new reality of moving forward in life without the physical presence of the person who died" (p. 135).

CAN GRIEF COUNSELING PROMOTE GROWTH?

In their research on trauma and growth, Tedeschi and Calhoun ( 1995) described characteristics that make an event traumatic: being sudden, unex­pected, and uncontrollable; and producing continuing, sometimes lifelong, effects. A recent interest in psychology has been to examine the positive rather than the pathological aspects of human functioning. Research suggests that through times of hardship, stemming from stressful life events or trauma, indi­viduals have experienced "benefits" or have grown. Posttraumatic growth

(Tedeschi & Calhoun, 1995) has been defined as experiencing positive growth following traumatic life events.

An increasing number of studies have begun to examine positive psycholog­

ical outcomes of trauma. Linley and Joseph (2004) found that posttraumatic growth has been documented in a wide variety of human events: cancer, the Oklahoma City bombing, sexual assault, plane crash, and combat. Of particu­lar interest is a study by Davis, Nolen-Hoeksema, and Larson (1998) in which persons who lost a family member to death were interviewed before and after the loss. The authors considered two ways participants thought about the event: making sense of the loss (e.g., the participant accepted the death as fate or God's will) and finding something positive in the experience (e.g., improved family relationships). Those participants who either found benefit or made sense of the loss were less distressed six months after the death and experienced better adjustment.

Coping strategies may influence which individuals adjust better during and after trauma. Psychosocial coping resources may protect against depressive symptoms, and social support (perceived or actual) is thought to enhance psy­chological well-being by fulfilling the need for a sense of coherence and belonging, thus counteracting feelings of loneliness (Bisschop, Kriegsman,

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42 JOURNAL OF MENTAL HEALTH COUNSELING

Beedman, & Deeg 2004). Relationships between coping and posttraumatic growth have been reported. In Tedeschi and Calhoun's posttraumatic growth model ( 1995, 2004), coping plays an important role in the ability of individu­als to adjust after a traumatic event and ultimately experience and perceive growth. In a review of coping and posttraumatic growth among cancer patients, Stanton, Bower, and Low (2006) identified eight studies that used multiple cop­ing strategies. They found that posttraumatic growth was more commonly asso­

ciated with approach-oriented coping strategies (e.g., active acceptance) than

avoidance strategies. Spirituality and religion also play major roles in how individuals cope with

trauma and adversity. Both have been linked to a range of positive health out­

comes, including reduced depression and lower risk of substance abuse (Larson & Larson, 2003). Pargament, Koenig, and Perez (2000) found that individuals cope differently depending on their perception of God, other spiritual beings, or religion. The trend toward understanding spirituality and religiosity as a resource in traumatic situations has prompted the need for further research on

how religiosity impacts such phenomena as coping and posttraumatic growth. The spirituality of individuals experiencing traumatic events has been found

to change as a result of the events (Tedeschi & Calhoun, 1995, 1996; Tallman, Altmaier, & Garcia, 2007). Such spiritual or religious changes are thought to be a major component in changes in the life perspectives/philosophies growth domain. In a study of women who survived sexual assault, individuals reported becoming more spiritual (Kennedy, Davis, & Taylor, 1998), and increased spir­ituality was related to increased well-being after the assault. Tedeschi and Calhoun (1995) state that "the degree to which religious beliefs can help sur­vivors assimilate traumatic events and grow from their difficulties seems a promising area for investigation" (p. 117).

Finding benefit is a significant outcome for grieving clients. Whether indi­viduals are assisted in finding benefit through expressive approaches (King &

Miner, 2000; Smyth & Pennebaker, 2008), where participants write about their trauma or their emotions; "benefit reminding" approaches (Tennen & Affleck, 2002); or enhancement of active coping (Antoni et al., 2001) may not be as important as simply having the client participate in a process where meaning found through grieving is articulated and integrated into her overall view of the loss.

CONCLUSION

This article and others in this section have had as the overall goal the descrip­

tion of ways counselors can effectively conceptualize, empathize with, respond to, and assist a grieving client-much-needed but very difficult work. Indeed,

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Altmaier I BEST PRACTICES IN GRIEF 43

counselors who work regularly with grieving clients can suffer from compas­sion fatigue or even secondary traumatization. However, the promise of coun­seling with grieving clients is the possibility of impacting a person in both the present andthe future, and perhaps also improving the health and well-being of the client's children and other family members. It is not a task to be taken lightly. In her memoir of the year after her husband's death, Joan Didion (2006) writes of her ambivalence over her recovery from grief:

I did not want to finish the year because I know that as the days pass, as January becomes

February and February becomes summer, certain things will happen. My image of John at the

instant of his death will become less immediate, less raw. It will become something that hap­

pened in another year .... I know why we try to keep the dead alive: we try to keep them alive in

order to keep them with us. I also know that if we are to live ourselves there comes a point at

which we must relinquish the dead, let them go, keep them dead. Let them become the photo­

graph on the table. (pp. 225-226)

REFERENCES

Antoni, M. H., Lehman, J.M., Kilbourn, K. M., Boyers, A. E., Culver, J. L., Alferi, S. M., et al.

(2001 ). Cognitive-behavioral stress management intervention decreases the prevalence of

depression and enhances benefit finding among women under treatment for early-stage breast

cancer. Health Psychology, 20, 20-32.

Association for Death Education and Counseling. (2008). Researching efficacy and finding deteri­

oration. Downloaded from http://www.adec.org/documents/Grief _Counseling_ Helpful_ or_

Harmful_Revision.pdfon July 7, 2008.

Burnett, P., Middleton, W., Raphael, B., & Martinek, N. ( 1997). Measuring core bereavement phe­

nomena. Psychological Medicine, 27, 49-57.

Bisschop, M. !., Kriegsman, D. M. W., Beedman, A. T. F., & Deeg, D. J. H. (2004). Chronic dis­

eases and depression: The modifying role of psychosocial resources. Social Science and

Medicine, 59, 721-733.

Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from

the experience: Two construals of meaning. Journal of Personality and Social Psychology, 75, 561-574.

Didion, J. (2006). The year of magical thinking. New York: Random House.

Faschingbauer, T. R. ( 1981 ). Texas Revised Inventory of Grief Manual. Houston, TX: Honeycomb.

Faschingbauer, T. R., Zisook, S., & DeVaul, R. (1987). The Texas Revised Inventory of Grief .

In S. Zisook (Ed.), Biopsychosocial aspects of bereavement (pp. 111-124). Washington, DC:

American Psychiatric Press.

Fortner, B. V. (1999). The effectiveness of grief counseling and therapy: A quantitative review.

Unpublished doctoral dissertation, University of Memphis, Memphis, TN. Fortner, B. V. (2008). Stemming the TIDE: A correction of Fortner ( 1999) and a clarification of

Larson and Hoyt (2007). Professional Psychology: Research and Practice, 39, 379-380.

Harvey, J. (2002). Perspective on loss and trauma: Assaults on the self. Thousand Oaks, CA: Sage.

Hogan, N. S., Greenfield, D. B., & Schmidt, L. A. (2001). Development and validation of the

Hogan Grief Reaction Checklist. Death Studies, 25, 1-32.

Kennedy, J. E., Davis, R. C., & Taylor, B. G. (1998). Changes in spirituality and well-being among

victims of sexual assault. Journal of Scientific Study of Religion, 3 7, 322-328.

user
user
Page 12: Altmaier, E.M. - Best Practices in Counseling Grief and Loss - Finding Benefit From Trauma

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

44 JOURNAL OF MENTAL HEALTH COUNSELING

King, L. A., & Miner. K. N. (2000). Writing about the perceived benefits of traumatic events:

Implications for physical health. Personality and Social Psychology Bulletin, 26, 220-230.

Larson, D., & Hoyt, W. (2007). What has become of grief counseling? An evaluation of the empir­

ical foundations of the new pessimism. Professional Psychology: Research and Practice, 38, 347-355.

Larson, D. B., & Larson, S.S. (2003). Spirituality's potential relevance to physical and emotional

health: A briefreview of quantitative research. Journal of Psychology and Theology, 31, 37-5 I. Lazarus, R. S., & Folkman, S. (I 984 ). Stress, appraisal, and coping, New York: Springer.

Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A review.

Journal of Traumatic Stress, 17, 11-2 l .

Middleton, W., Raphael, B., Burnett, P., & Martinek, N . (1998). A longitudinal study comparing

bereavement phenomena in recently bereaved spouses, adult children and parents. Australian

and New Zealand Journal of Psychiatry, 32, 235-241.

Niemeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of

reconstruction. Death Studies, 24, 541-558.

Neimeyer, R. A., & Hogan, N. S. (2001). Quantitative or qualitative? Measurement issues in the

study of grief. In M. S. Stroebe, R. 0. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of

bereavement research: Consequences, coping, and care (pp. 89-118). Washington, DC:

American Psychological Association.

Norcross, J., Beutler, L., & Levant, R., (Eds.) (2005). Evidence-based practices in mental health:

Debate and dialogue on the fandamental questions. Washington, DC: American Psychological

Association.

Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping:

Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56, 519-543.

Sanders, C. M., Mauger, P. A., & Strong, P. N. ( 1985). A manual for the Grief Experience Inventory.

Palo Alto, CA: Consulting Psychologists Press.

Schoulte, J.C., & Altmaier, E.M. (2008, August). Do grief measures rea/�y measure grief! Paper

presented at the American Psychological Association, Boston.

Schut, H., Stroebe, M. S., van den Bout, J., & Terheggen. M. (2001). The efficacy of bereavement

interventions: Determining who benefits. In M. S. Stroebe, R. 0. Hansson, W. Stroebe, & H.

Schut (Eds.), Handbook of bereavement research: Consequences. coping, and care (pp.

705-737). Washington, DC: American Psychological Association.

Shear, K., Frank, E., Houck, P.R., & Reynolds, C. F. (2005). Treatment of complicated grief: A ran­

domized controlled trial. Journal of the American Medical Association, 293, 2601-2608.

Smyth, J. M., & Pennebaker, J. W. (2008). Exploring the boundary conditions of expressive writ­

ing: In search of the right recipe. British Journal o.fHealth Psychology, 13, 1-7.

Stanton, A. L., Bower, J. E . ., & Low, C. A. (2006). Posttraumatic growth after cancer. In L. G.

Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth (pp. 138-175). Mahwah,

NJ: Erlbaum.

Stroebe, M. S., Hansson, R. 0., Schut, H., & Stroebe, W. (Eds.) (2008). Handbook of bereavement

research and practice: Advances in theory and intervention. Washington, DC: American

Psychological Association.

Tallman, B. A., Altmaier, E., & Garcia, C. (2007). Finding benefit from cancer. Journal of

Counseling Psychology, 54 , 481-487.

Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath

of suffering. Thousand Oaks, CA: Sage.

Tedeschi, R. G., & Calhoun, L. G. ( 1996). Posttraumatic growth inventory: Measuring the positive

legacy of trauma. Journal of Traumatic Stress, 9, 455-471.

Page 13: Altmaier, E.M. - Best Practices in Counseling Grief and Loss - Finding Benefit From Trauma

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Altmaier I BEST PRACTICES IN GRIEF 45

Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and

empirical evidence. Psychology Jnquily, I, l-18.

Tennen, H., & Aftlect, G. (2002). Benefit-finding and benefit-reminding. In C. R. Snyder & S. J. Lopez, (Eds.), Handbook of positive psychology (pp. 584-597). New York: Oxford.

Wampold, B. (200 I ). Outcomes of individual counseling and psychotherapy: Empirical evidence

addressing two fundamental questions. In S. D. Brown & R. W. Lent (Eds.), Handbook of coun­

seling psychology (3rd ed) (pp. 711-739). New York: Wiley.

Wolfelt, A. D. ( 1997). The journey through grief Reflections on healing. Fort Collins, CO:

Companion Press.

Wolfe It, A. D. (1998, March). "Companioning" versus treating: Beyond the medical model of

bereavement caregiving. Paper presented at the Association of Death Education and

Counseling, Indianapolis. Downloaded from http://www.griefwords.com/index.cgi?action=

page&page=articles%2Fbeyond.html&site_id=2 on June 16, 2009.

Wolfelt, A.O. (2009). The handbook/or companioning the mourner. Fort Collins, CO: Companion

Press.