- BIOETHICS FORUM ESSAY
Bereavement Counseling Gets High-Tech and Personal
There is a debate going on about the worth of bereavement counseling. In a study published seven years ago by R.A. Neimeyer, grief counseling was found to be not only unhelpful, but actually detrimental. The Neimeyer article has garnered lots of press, most recently in a June 18 article in Newsweek.
Now two highly regarded scholars, Dale Larson of Santa Clara University and William Hoyt of the University of Wisconsin at Madison, are about to publish a paper, “What Has Become of Grief Counseling? An Evaluation of the Empirical Foundations of the New Pessimism,” in Professional Psychology: Research and Practice, in which they argue the Neimeyer study was flawed. Larson and Hoyt discovered that the findings reported by Neimeyer had never been subjected to peer review, and their paper will reveal that a post hoc peer review conducted by the American Psychological Association conclusively discredits the Neimeyer article.
In the aftermath of September 11 and in the midst of the rising death toll in the wars in Afghanistan and Iraq, it seems surprising that people would feel better not talking about their grief. We are faced with loss on the national level every day. So the full story about how much help grief counseling provides may be just beginning to be told.
The bereavement counseling controversy claims more than academic interest for hospices that receive Medicare funds, and most do. Although Medicare does not reimburse for bereavement services, it requires hospices to provide them. For thirteen months after a patient’s death, hospice reaches out to the family and friends who were involved in caring for the patient. It offers periodic mailings and phone calls, workshops, support groups, memorial services, and, for those who wish to receive it, counseling. At Continuum Hospice in New York City, where I work, a bereavement staff of six counselors follows several thousand grieving people every year.
The requirement for hospices to provide bereavement is not altogether altruistic. At least some public health policy-makers evidently think that grieving people who receive structured support fare better emotionally. Insofar as emotions affect physical well-being, it will cost Medicare less to mandate the availability of bereavement services for the (often elderly) grieving than to have to pay for the stress-induced triple coronary bypasses.
The scope and volume of sponsored bereavement services make hospices the recognized provider of grief counseling in many communities, and most hospices offer their bereavement services to the general public, often at no cost.
The bereavement charts at Continuum hold volumes of anecdotal evidence from clients testifying to the benefits of short-term grief counseling. It was their reports that led to the conception and recent launch of what Continuum believes is the first web-based television channel that deals with loss. The site (www.grievingcenter.org) features more than an hour of video in segments averaging five minutes, plus artwork, music, articles, meditations, and the opportunity for users to ask questions, make comments, and blog their own stories. It features accounts of losing a loved one as told by people who have: the widow of a beloved New York physician who was killed on his bicycle, the actor who played Mr. Russell Huxtable on the Bill Cosby Show, a woman whose grief was unacknowledged because others considered her 102-year-old mother’s death routine, another woman whose brother was killed in gang warfare while her father, in hospice and near death, was asking why his son was not visiting. A music video from a hospice memorial service is so compelling that it’s gaining a following on YouTube (it can be seen here). What all the stories have in common is not just the human pathos but the shared insights about things men and women do to come to terms with loss. If receiving bereavement support is detrimental, nobody has told that to these folks.
The site has been averaging 3,800 hits per day, seeming to indicate not only the desire for bereavement support among the general public but also the effectiveness of using twenty-first century technology to provide it. The usage statistics also reveal that many people are logging on in the wee hours of the night. When loneliness is keenly felt and the Internet is an instant and intimate connection to people in a world filled with loss, there’s a place to visit and to connect, to see the various forms healing and hope can take.
William Purdy is an ordained Lutheran minister with a graduate degree in bioethics and vice president of provider relations at Continuum Hospice Care in New York.