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Cross-Modality Grief Therapy: Description and assessment of a new program
Abstract
A recently developed program for extensive inpatient grief therapy in groups, administered on a time-limited basis, is outlined, an illustrative case study is described, and empirical assessment of the program's efficacy is provided. During a 3-month stay in a Dutch Health Care Centre, a combined treatment program was offered that integrated behavior and art therapy [so-called Cross-Modality Grief Therapy, (CMGT)]. Assessment (levels of symptomatology on the General Health Questionnaire) was made at pretest, post-test, and follow-up and was compared with levels at comparable time points among participants in a more traditional program. Systematic advantages were found for CMGT. Discussion focuses on the identification of elements within CMGT that were responsible for its effectiveness.
... The mean number of participants was 42.35 with a range of 7 to 158 participants. Study participants were broken down into the following age groups: 12 studies were with children and/or adolescents (Chemtob, Singer, Lyshak-Stelzer, & Patricia, 2007;Chin, Chin, Palombo, Palombo, Bannasch, & Cross, 1980;Dolgin, Somer, Zaidel, & Zaizov, 1997;Epp, 2008;Omizo & Omizo, 1989;Pifalo, 2006;Rosal, 1993;Rosal, McCulloch-Vislisel, & Neece, 1997 Saunders & Saunders, 2000;Wallace-Di Garbo & Hill, 2006;Walsh & Hardin, 1994;White & Allen, 1971), 16 with adults (Brooke, 1995;Franks & Whitaker, 2007;Gantt & Tinnin, 2007;Gussak, 2004;Hughes & da Silva, 2011;Monti et al., 2006;Nainis et al., 2009;Oster et al., 2006;Puig, Lee, Goodwin, & Sherrard, 2006;Richardson, Jones, Evans, Stevens, & Rowes, 2007;Schut, de Keijser, van den Bout, & Stroebe, 1996;Svensk et al., 2009;Theorell et al., 1998;Thyme et al., 2007;Visser & Op' t Hoog, 2008;Walsh, Martin, & Schmidt, 2004) and one was with the aged (Doric-Henry, 1997). The mean duration of treatment was 14.5 sessions (median = 8.5) with a range of 1 to 90 sessions. ...
... Problem types represented were mental health (n = 10; Chemtob et al., 2007;Chin et al., 1980;Doric-Henry, 1997;Franks & Whitaker, 2007;Gantt & Tinnin, 2007;Omizo & Omizo, 1989;Richardson et al., 2007;Thyme et al., 2007;Walsh et al., 2004, White & Allen, 1971), social adjustment and behavioral problems (n = 8; Epp, 2008;Gussak, 2004;Rosal, 1993;Rosal et al., 1997;Saunders & Saunders, 2000;Schut et al., 1996;Wallace-DiGarbo & Hill, 2006;Walsh & Hardin, 1994), cancer (n=6;Dolgin et al., 1997;Monti et al., 2006;Oster et al., 2006;Puig et al., 2006;Svensk et al., 2009;Visser & Op' t Hoog, 2008), other physical health (n = 3; Hughes & da Silva, 2011;Nainis et al., 2009;Theorell et al., 1998), and sexual abuse (n = 2; Brooke, 1995;Pifalo, 2006). ...
... A number of studies have examined the efficacy of cognitive-behavioral intervention techniques for bereaved individuals. Malkinson's (2001) review of cognitive-behavioral therapy of grief shows that the outcome studies of grief cognitive-behavioral interventions are limited, but those carried out are cited as effective ones (Mawson et al., 1981;Ramsey, 1979;Schut, de Keijser, van den Bout, & Stroebe, 1996;Sireling et al., 1988), especially if the grief reactions are prolonged and distorted. Ramsey (1979) was one of the first who developed a behavioral treatment for CG. ...
... To date, the number of outcome studies evaluating cognitive-behavioral bereavement interventions is limited. Nevertheless, they are considered to be effective (Mawson et al., 1981;Schut, de Keijser, van den Bout, & Stroebe, 1996;Sireling et al. 1988), especially when grief reactions are prolonged and distorted. ...
Theoretischer Hintergrund: In den vergangenen Jahren wurde in einer Reihe von Studien nachgewiesen, dass Internet-basierte Psychotherapien eine wirksame Behandlungsmethode für psychischen Störungen sein können. Basierend auf dem kognitiv-verhaltenstherapeutischen Behandlungsmanual für posttraumatische Belastungsstörungen (Lange et al., 2000) wurde eine Internet-basierte Behandlung für komplizierte Trauer entwickelt und evaluiert. Untersuchung: Eine theoretische Einleitung gibt einen Überblick über komplizierte Trauer, Trauerinterventionen, und Internet-basierte Psychotherapie. Anhand einer Fallstudie wird im Folgenden der Behandlungsprozess demonstriert. Die Studie evaluierte die Wirksamkeit dieses drei- phasigen Behandlungsmodelles (Selbstkonfrontation, kognitive Umstrukturierung, soziale Unterstützung) im Bezug auf trauerbezogene Symptome, allgemeine Psychopathologie und salutogenetische Variablen. Des weiteren wurde die therapeutische Online-Beziehung als Prädiktor für die salutogenetischen Behandlungsergebnisse evaluiert. Methode: Patienten mit einer Diagnose von komplizierter Trauer (N = 50) wurden randomisiert entweder der Behandlungs- oder der Wartelistengruppe zugewiesen. Der Kontakt zwischen Therapeut und Patient fand ausschliesslich während der fünf-wöchigen Behandlungszeit über E-mail statt. Die Patienten schrieben in dieser Zeit 10 Essays zu festen Terminen. Skalen wurden zur Erhebung der komplizierten Trauer Symptomatik (IES), allgemeiner Psychopathologie (BSI), allgemeinem psychischer und physischem Gesundheitszustand (SF-12), persönliche Reifung (PTGI), Optimismus (LOT-R) und therapeutische Beziehung (WAI) eingesetzt. Ergebnis: Die Patienten der Behandlungsgruppe verbesserten sich signifikant gegenüber den Patienten der Wartelistengruppe in Bezug auf Trauersymptomatik, allgemeine Psychopathologie und persönliche Reifung. Insgesamt wurden grosse Behandlungseffekte gefunden: Vermeidung (d = 1.19), Intrusionen (d = 1.47) und Depression (d = .85). Ebenso zeigten sich signifikante Effekte für persönliche Reifung nach Abschluss der Behandlung. Kein Behandlungseffekt konnte für Optimismus gefunden werden und die therapeutische Beziehung beeinflusste nicht die persönliche Reifung. Schlussfolgerung: Die Ergebnisse demonstrieren, dass dieser neue Behandlungsansatz für komplizierte Trauer vielversprechend ist. Background: During the last years research has shown that Internet-based psychotherapeutic interventions are effective in a number of areas. Based on a cognitive-behavioral treatment protocol for posttraumatic stress disorder (Interapy, Lange et al., 2000), an Internet-based treatment for complicated grief (CG) was developed and evaluated. Objective: A theoretical introduction of CG, bereavement interventions and psychotherapeutic Internet-based interventions is given. A case study illustrates the treatment procedure. The study evaluated the efficacy of this multiphasic treatment model (phases: self-confrontation, cognitive restructuring, social sharing) on grief-related symptoms, symptoms of general psychopathology and salutary outcome. Further, the online therapeutic alliance as a predictor of salutary treatment outcome was evaluated. Method: Bereaved individuals with a complicated grief diagnosis (N = 50) were randomly assigned to either the treatment group or a waiting list control condition. The contact between therapist and patient was exclusively via e-mail during the 5-week period of 10 writing-assignments. Pre-, post- and follow-up assessments were conducted. Results: Compared with the participants in the waiting control condition, the participants in the experimental group (n = 25) improved significantly on grief-related symptoms and general psychopathology. Overall, between-groups-effect sizes were large, with highest effects being found for avoidance (d = 1.19), intrusion (d = 1.47) and depression (d = .85). Significant Time x Condition effects indicated that personal growth increased during the treatment. However, there was no treatment effect found for optimism. The therapeutic relationship did not influence personal growth significantly over time. These results indicate that this new approach of treatment form for complicated grief is promising.
... Certainly, not talking about it must not be confused with not grieving. Combining therapy which promotes verbalisation with other forms of therapy, such as art therapy has been shown to be more beneficial than 'conventional' therapy alone in those with complicated grief (Schut et al 1996). ...
... O 'Connor et al (2003), Stroebe et al (2002), Tudiver (1992) 3 Range et al (2000), Schut et al (1996), Schut et al (1997) 3 ...
This paper reports on a systematic literature review of bereavement and bereavement care commissioned in Scotland to assist the development of policy and practice there. The review identified and appraised papers from a range of health and social care settings in which bereavement care b a feature, such as acute, hospice- and hospital-based care including neonatal and obstetric, community and primary care, mental health and learning disability services, and care of older people, families and children. Specific types of death were also reviewed, eg traumatic and from (tiseases such as HIV/AIDS. Key messages for each setting and type were identified and overall themes were drawn out which cut across at settings and types. These, it is proposed, represent important features of bereavement and bereavement care which, if acknowledged and addressed, could enhance services.
... Art therapy has been used with individuals, groups, and families as a primary or adjunctive therapy to address various issues including low self-esteem (Green, Wehling, & Talsky, 1987), physical and sexual trauma (Brooke, 1995), sexual abuse (Pifalo, 2002), depression (Ponteri, 2001), anxiety (Chambala, 2008), eating disorders (Rehavia-Hanauer, 2003), and grief (Schut, de Keijser, van den Bout, & Stroebe, 1996 ). Early reports documenting the benefits of art therapy were primarily subjective and descriptive case studies. ...
... ed patients already in individual psychotherapy (for self-improvement) with adjunct art/video group therapy for six weekly sessions. They found no change in psychiatric symptoms on the Minnesota Multiphasic Personality Inventory although patients reported improved states of self-actualization on the Personality Orientation Inventory (Shostrom, 1964). Schut et al. (1996 compared an integrated group behavior and art therapy approach versus regular group and individual therapy for grieving inpatients over the course of 3 months of weekly sessions using the General Health Questionnaire (Goldberg, 1978). The authors noted some non-significant advantage for the integrated group behavior and art therapy trea ...
This study evaluated the potential benefit of weekly group art therapy in groups of adult psychiatric outpatients at a university medical center. Eighteen patients participated in 4 successive 8-week groups of 6 to 8 patients each that met weekly and were led by 2 therapists (a board-certified art therapist and a psychiatry resident). The standardized Center for Epidemiological Studies Depression Scale (CES-D) was administered pre- and post-treatment. Ten patients who attended 4 or more sessions of group art therapy were included in the study. The mean group CES-D scores for the study patients decreased significantly from pre- to post-treatment. This is the first pilot study report of the efficacy of group art therapy using a standardized depressive measure in heterogeneous adult psychiatric outpatients.
... Certainly, not talking about it must not be confused with not grieving. Combining therapy which promotes verbalisation with other forms of therapy, such as art therapy has been shown to be more beneficial than 'conventional' therapy alone in those with complicated grief (Schut et al 1996). ...
... O 'Connor et al (2003), Stroebe et al (2002), Tudiver (1992) 3 Range et al (2000), Schut et al (1996), Schut et al (1997) 3 ...
This paper reports on a systematic literature review of bereavement and bereavement care commissioned in Scotland to assist the development of policy and practice there. The review identified and appraised papers from a range of health and social care settings in which bereavement care b a feature, such as acute, hospice- and hospital-based care including neonatal and obstetric, community and primary care, mental health and learning disability services, and care of older people, families and children. Specific types of death were also reviewed, eg traumatic and from (tiseases such as HIV/AIDS. Key messages for each setting and type were identified and overall themes were drawn out which cut across at settings and types. These, it is proposed, represent important features of bereavement and bereavement care which, if acknowledged and addressed, could enhance services.
... Certainly, not talking about it must not be confused with not grieving. Combining therapy which promotes verbalisation with other forms of therapy, such as art therapy has been shown to be more beneficial than 'conventional' therapy alone in those with complicated grief (Schut et al 1996). ...
... O 'Connor et al (2003), Stroebe et al (2002), Tudiver (1992) 3 Range et al (2000), Schut et al (1996), Schut et al (1997) 3 ...
... Creative activities such as writing, drawing, painting, and sculpture are considered therapeutic for people who are dealing with loss. Generally grouped under the umbrella term Art Therapy, expressing feelings of loss in tangible formats sometimes helps the bereaved see their losses from a different perspective and come to terms with their separation (Simon, 1982;Lattanzi and Hale, 1984;Irwin, 1991;Schut et al., 1996;Turetksy and Hays, 2003). Saving Mr. Banks establishes the idea that P.L. Travers created her fictional character Mr. Banks based on her perception and experience of her father. ...
In its simplest form, this thesis is about cinematic representations of grief. However, it approaches and expands this subject area using a hybrid of psychoanalytic and Jungian concepts focusing on a specific type of grief: the aftermath of a traumatic bereavement. I use films and their narratives as case studies where I outline protagonists’ crypts using Nicolas Abraham and Maria Torok’s theory of the intrapsychic tomb. The way out of this trapped state is then investigated using the psychological framework of Carl Gustav Jung, which suggests that the psyche aims for an equilibrium, meaning a state of relief. After acknowledging the legacy of psychoanalytically fuelled film theory which grew with the works of Lacan, Metz, Baudry, Mulvey, and Miller, and explaining the reasons why I follow in the footsteps of Braswell, Fox, and Edwards, the investigation then pairs clinical theory with Jungian concepts and analyses seven films which not only depict traumatised states but also portray different paths out of these states. First, I use grief theory to explore the psychological problem, as my anchoring topic is traumatic loss. Second, I apply specific Jungian concepts such as shadow, symbols, archetypes, enantiodromia, amplification, and dreams to expand, explain, and illuminate particular narratives with their connections to these losses. Through using films as case studies, these new and creative applications of several Jungian concepts to cinematic narratives contribute to grief theory, film studies, psychoanalysis, and Jungian studies in a multi-layered, interconnected, and transdisciplinary way.
... The majority of studies were correlational with no control group (93%). Of the experimental designs, one study used a waitlist control group 71 and one used a treatment as usual control. 72 Approximately 19% of studies were cross-sectional, while 81% were longitudinal; 33% of studies included a follow-up session. ...
Bereaved individuals are increasingly considered at risk for negative psychological and physiological outcomes. Visual art modalities are often incorporated into grief therapy interventions, and clinical application of art therapy techniques with the bereaved has been widely documented. Although clinicians and recipients of these interventions advocate for their helpfulness in adapting to bereavement, research investigating the efficacy of visual art modalities has produced equivocal results and has not yet been synthesized to establish empirical support across settings. Accordingly, this review critically evaluates the existent literature on the effectiveness of visual art modalities with the bereaved and offers suggestions for future avenues of research. A total of 27 studies were included in the current review. Meta-analysis was not possible because of clinical heterogeneity and insufficient comparable data on outcome measures across studies. A narrative synthesis reports that therapeutic application of visual art modalities was associated with positive changes such as continuing bonds with the deceased and meaning making. Modest and conflicting preliminary evidence was found to support treatment effectiveness in alleviating negative grief symptoms such as general distress, functional impairment, and symptoms of depression and anxiety.
... In a longitudinal study of bereaved spouses conducted by Schut, van den Bout, de Keijser, and Stroebe (1996), the causal relation between the expression of emotions and health outcome (psychological/somatic symptomatology) was analyzed. The measure tapped emotional discharge as weIl as social sharing. ...
... Nuestra experiencia puntual ilustra un acompañamiento arteterapéutico en este ámbito (Collette, 2010), desde un modelo de psicoterapia integrativo-relacional (Payás, 2010). Si en el ámbito del duelo en general no son numerosos los estudios de investigación basada en la evidencia (Barreto &Soler, 2007), en el de su aplicación arteterapéutica escasean más todavía los estudios experimentales (Schut et al., 1996). ...
Art therapy allows a particularly valuable biographical creative approach at the end of life. The person concerned has multiple needs - physical, emotional, social and spiritual - that only a holistic attention may claim to embrace, as contemplated in the philosophy of palliative care. The art therapist is integrated into the interdisciplinary team to help to alleviate suffering and accompany the patient and his family. We present here the theoretical foundations and methodology of the intervention as well as the health framework in which it is included.
... The art therapy treatment approach can help individuals of all ages to create meaning and achieve insight, realise conflicts and problems, find relief from overwhelming emotions and trauma and acquire an increased sense of well-being (Malchiodi, 2012). Art therapists treat a wide variety of populations including substance abusers, psychiatric patients (Franks & Whitaker, 2007;Green, Wechling, & Talsky, 1987;Kymissis, Christenson, Swanson, & Orlowski, 1996;Richardson, Jones, Evans, Stevens, & Rowe, 2007), those suffering from posttraumatic stress disorder (Chapman, Knudson, Ladakakos, Morabito, & Schreier, 2001;Lyshak-Stelzer, Singer, St. John, & Chemtob, 2007), individuals who have been sexually abused (Brooke, 1995;Pifalo, 2002;Waller, 1992), bereaved adults and children (Gersh & Sao Joao Gonclaves, 2006;Schut, De Keijser, Van Den Bout, & Stroebe, 1996), children with learning disabilities (Silver & Lavin, 1977), Alzheimer's/dementia patients (Seifert & Baker, 2002), stroke patients (Sacchett, Byng, Marshall, & Pound, 2006) and cancer patients (Bar-Sela, Atid, Danos, Gabay, & Epelbaum, 2007;Favora-Scacco, Smirne, Schiliro, & Di Cataldo, 2001), among many others. The wide range of populations and ages of people who have accessed art therapy treatment demonstrates its versatility, as many approaches and modalities can be used within art therapy. ...
Art therapists employ a variety of media, materials and processes during therapy sessions. The increase of technology among the general population and within counseling practice justifies interests in the use of digital media and software applications within art therapy. Technology can be added to expand upon current therapeutic interventions in art therapy, although the extent of its current use and acceptance in the field is not fully known. Specifically, digital collages may be used to increase the user's comfort and engagement with the collage process and decrease some logistical barriers that may exist. This article reviews the use of technology in art therapy, discusses the pros and cons of technology as applied to art therapy, addresses the role of the art therapist in technology-based interventions and presents software applications for creating digital collages that are available in today's market.
... All of these tasks lend themselves to the group setting. Several studies (Ferszt, Heineman, Ferszt, & Romano, 1998;Olsen & McEwen, 2004;Schut, de Keuser, Van den Bout, & Stroebe, 1996;Tonkins & Lambert, 1996) have investigated the effectiveness of grief counseling groups. These studies have included diverse populations and various types of grief. ...
This article provides a brief discussion of the various types of grief and posits that the many types, particularly disenfranchised, lend themselves to recovery through reconnection. Bereavement groups offer a particularly useful means of connection with a larger grieving community and allow validation from others along with personalization of loss. Additionally, the use of creativity creates deeper and more meaningful connections with self and others. Finally, the article ends with counseling considerations and two case examples.
... This study provides evidence of the treatment's efficacy in reducing distress symptoms, regardless of the theoretical framework, but no indication was provided on the degree of grief resolution achieved as a result of intervention. A study designed to assess the efficacy of an integrated behavior and art group-therapy program for individuals who suffered from complicated grief was conducted by Schut, de Keijser, van den Bout, and Stroebe (1996). The cross-modality grief therapy group comprised 52 individuals referred to a health care center, and the control group was made up of patients undergoing regular treatment provided by the center. ...
This article reviews outcome studies of grief therapy, with special attention to the cognitive perspective. Based on those studies, three observations on bereavement interventions are offered: (a) development of psychotherapy interventions has been strongly linked to theoretical conceptualizations and definitions of what constitutes normal, pathological, and chronic grief at different times after bereavement; (b) in most reported studies, generic non-bereavement scales were applied for measuring reduction of symptoms. By using such measures, a link between a decrease in symptoms and “recovery” following treatment may be suggested, while neglecting to assess the bereaved’s worldview using grief-specific measures; (c) in reviewed outcome studies, behavioral (desensitization, social reinforcement) and cognitive-behavioral (exposure, guided mourning) interventions are included among effective treatment modalities in cases of complicated grief. It is observed that although similar interventions have been applied, theoretical adherence has changed, implying a change not in the intervention itself but rather in the expected outcome.
... This study provides evidence of the treatment's efficacy in reducing distress symptoms, regardless of the theoretical framework, but no indication was provided on the degree of grief resolution achieved as a result of intervention. A study designed to assess the efficacy of an integrated behavior and art group-therapy program for individuals who suffered from complicated grief was conducted by Schut, de Keijser, van den Bout, and Stroebe (1996). The cross-modality grief therapy group comprised 52 individuals referred to a health care center, and the control group was made up of patients undergoing regular treatment provided by the center. ...
Objective: Fifteen treatment groups for men who abused intimate partners were evaluated. Method: 104 men took part, with a completion rate of 68.3%. Scores on social desirability were utilized to adjust totals on other self-report scales. Results: Group completers (n = 71) were no different from dropouts (n = 33) on the adjusted standardized measures or demographics. Group completion was associated with significant improvements on the adjusted variables of appraisal social support, self-esteem, perceived stress, attitudes toward marriage and the family, locus of control, and the marital relationship functions of roles, affective expression, and communication. Importantly, adjusted scores on both the Physical and Non-Physical Abuse subscales of the Index of Spouse Abuse were significantly reduced, the latter to below the clinical cutoff. No differences were found between court-mandated and non-court-mandated group completers. Conclusions: The utility of using social desirability to adjust scores is highlighted. The implications for group treatment are discussed.
... This study provides evidence of the treatment's efficacy in reducing distress symptoms, regardless of the theoretical framework, but no indication was provided on the degree of grief resolution achieved as a result of intervention. A study designed to assess the efficacy of an integrated behavior and art group-therapy program for individuals who suffered from complicated grief was conducted by Schut, de Keijser, van den Bout, and Stroebe (1996). The cross-modality grief therapy group comprised 52 individuals referred to a health care center, and the control group was made up of patients undergoing regular treatment provided by the center. ...
Objective: This study was intended to validate a Spanish adaptation of the Multi-Problem Screening Inventory (MPSI), which was developed by Hudson and McMurtry for assessment in social work practice. Method: Research was based on the cross-cultural equivalence model and included a content judgment study followed by a field test with a sample of 313 Puerto Rican university students. Results: Findings regarding internal consistency as well as item, factorial, discriminant, and convergent analyses of the Spanish MPSI were similar to those of the English version; items were found to be relevant for Puerto Ricans. Conclusions: Content, technical, and conceptual equivalence of the Spanish and English versions of the MPSI were supported, and thus its valid use in social work practice with the study population.
... To date, only a limited number of outcome studies have evaluated cognitive-behavioral bereavement interventions. Nevertheless, they are considered to be effective (Mawson et al., 1981;Schut, de Keijser, van den Bout, & Stroebe, 1996;Sireling et al., 1988), especially when grief reactions are prolonged and distorted. ...
The authors review current concepts of complicated grief and propose a new Internet-based cognitive-behavioral treatment program for complicated grief. They show how complicated grief is distinguished from disorders such as posttraumatic stress disorder, depression, and anxiety in the literature and explore the effectiveness of existing bereavement interventions. According to meta-analyses, conventional bereavement interventions show no overall benefit and may even have harmful effects if initiated too soon. For people with complicated grief symptoms or those affected by a death in traumatic circumstances, however, interventions have proved to reduce symptoms. Against this background, the authors introduce an Internet-based cognitive-behavioral treatment program for complicated grief that integrates established methods of psychotherapy with new technology. The intervention was conducted via e-mail and aimed exclusively at clients with complicated grief. The procedure and course of this new approach are illustrated in a case study. The treatment successfully reduced symptoms. Results and further implications of an Internet-based writing protocol are discussed.
... However, on the basis of the ways in which interventions for the bereaved are implemented, researchers and practitioners frequently rely on clinically significant indications of distress that do not necessarily align with or exceed a certain threshold for an established psychiatric disorder. In turn, such a procedure often makes indicated approaches to intervening with the bereaved indistinguishable from treatment or psychotherapy in general. 2 Because no-intervention controls were offered counseling in the studies that used a standard-of-care intervention for the comparison group (e.g., Kissane et al., 2006;Schut, de Keijser, van den Bout, & Stroebe, 1996;Sikkema et al., 2004), we excluded them from this review. ...
... On average, each additional session of therapy increased the expected effect size by approximately 0.07 units. Examination of the scatterplot indicated that one bivariate outlier had a strong influence on this estimate, however: Clients in one of the treatment conditions in Schut, de Keijser, Van den Bout, and Stroebe's (1996) study underwent 20 sessions of therapy (the longest treatment in the remaining studies was 14 sessions), with a large effect size of A = 2.20. When we excluded this study from the regression, the linear relation was no longer significant (B = 0.03, p > .10). ...
This meta-analysis addressed the question of how effective grief therapy is and for whom, using B. J. Becker's (1988) techniques for analyzing standardized mean-change scores. Analyses were based on 35 studies (
N = 2,284), with a weighted mean effect size (ES) of δ
+ = 0.43 (95% confidence interval = 0.33 to 0.52). Clients in no-treatment control groups showed little improvement (
d= = 0.06), possibly because of the relatively long delay between loss and treatment in most studies (mean delay = 27 months). Moderators of treatment efficacy included time since loss and relationship to the deceased. Client selection procedures, a methodological factor not originally coded in this meta-analysis, appeared to contribute strongly to variability in ESs: a small number of studies involving self-selected clients produced relatively large ESs, whereas the majority of studies involving clients recruited by the investigators produced ESs in the small to moderate range. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... In addition Grodner et al. (1982) have reported positive outcomes from a controlled trial of art/movement therapy with schizophrenics and depressives. Similarly Schut et al. (1996) obtained positive results on GHQ scores from a cross-modality grief therapy programme which included a significant art therapy component. ...
Background: There is no high quality controlled trial evidence for the effectiveness of art therapy in the adjunctive treatment of schizophrenia. Aims: To conduct the first exploratory RCT of group interactive art therapy (AT) as an adjunctive treatment in chronic schizophrenia Method: The outcomes of 43 patients randomized to 12 sessions of AT were compared with those of 47 who received standard psychiatric care. Patients were assessed on a range of measures of symptoms, social functioning and quality of life at pre- and post-treatment and six-month follow-up. Results: Art therapy produced a statistically significant positive effect on negative symptoms (assessed by Scale for the Assessment of Negative Symptoms) though had little and non-significant impact on other measures. Conclusions: Limitations of the study included insufficient statistical power and a sub-optimal level of treatment. Nevertheless, the results were sufficiently promising to justify further research along these lines. Declaration of interest: This research was funded by a grant from the London Region NHS Executive Research and Development Directorate.
... This study provides evidence of the treatment's efficacy in reducing distress symptoms, regardless of the theoretical framework, but no indication was provided on the degree of grief resolution achieved as a result of intervention. A study designed to assess the efficacy of an integrated behavior and art group-therapy program for individuals who suffered from complicated grief was conducted by Schut, de Keijser, van den Bout, and Stroebe (1996). The cross-modality grief therapy group comprised 52 individuals referred to a health care center, and the control group was made up of patients undergoing regular treatment provided by the center. ...
From a REBT perspective, loss through death is viewed as an intense negative and traumatic Activating event which effects the Belief system and related emotional and behavioral Consequences. Grief, then, is seen as a normal reaction and the process that follows is a necessary one characterized by the bereaved attempting to reorganize a shattered belief system. In the present paper a distinction between functional and dysfunctional grief is made. Based on Ellis' differentiation between iB's and RB's, typical irrational grief-related beliefs are identified (with specific focus on pain related ones). Various REBT interventions aimed at facilitating a more functional, healthier course of grief are suggested.
... In addition Grodner et al. (1982) have reported positive outcomes from a controlled trial of art/movement therapy with schizophrenics and depressives. Similarly Schut et al. (1996) obtained positive results on GHQ scores from a cross-modality grief therapy programme which included a significant art therapy component. ...
... The study examined the progression through Worden's tasks of grieving with inpatient, non-psychiatric (n = 52) clients participating in group therapy for a period of three months in a Dutch health care center. The 52 subjects within the treatment group were psychologically screened and participated in 12 two-hour behavior therapy sessions and 8 two-hour art therapy sessions over a three month time frame (Schut, et al., 1996). The control group consisted of 17 bereaved individuals that received and attended individual and group therapy grief counseling sessions focused on relaxation, social skills training, and grief topical discussions, without integrated behavior and art therapies. ...
Includes bibliographical references.
... Is intervention effective? Again, to address such matters, we conducted a comprehensive literature review (Schut, Stroebe, Van den Bout, & Terheggen, 2001; as well as our own empirical research (Schut, Van den Bout, De Keijser, & Stroebe, 1996;Schut, Stroebe, De Keijser, & Van den Bout,1997). For example, we have just completed an Internet study of the efficacy of cognitive behavioural writing tasks, conducted by Karolijne van der Houwen for her PhD (e.g. ...
Looking back through history, one finds frequent reference to the notion of “a broken heart”. In earlier times, grief was even recognized as a cause of death. In the 17th Century, “griefe” was actually listed in Dr. Heberden’s Bill, an early epidemiological classification of the causes of death in London for the year 1657 (Parkes, 1986). The “ broken heart” can either be understood in a broad metaphorical, or in a narrow medical sense. Metaphorically, it denotes extreme suffering and pain that is felt on the death of a loved one. There is historical record of this. In the 8th Century BC we find reference in the writings of the legendary epic poet Homer: “[It was not that I was] attacked by any of the malignant diseases that so often make the body waste away and die. No, it was my heartache for you, my glorious Odysseus, and for your wise and gentle ways that brought my life and all its sweetness to an end” (The Odyssey, Book XI, “ The Book of the Dead” ).
... However, on the basis of the ways in which interventions for the bereaved are implemented, researchers and practitioners frequently rely on clinically significant indications of distress that do not necessarily align with or exceed a certain threshold for an established psychiatric disorder. In turn, such a procedure often makes indicated approaches to intervening with the bereaved indistinguishable from treatment or psychotherapy in general. 2 Because no-intervention controls were offered counseling in the studies that used a standard-of-care intervention for the comparison group (e.g., Kissane et al., 2006; Schut, de Keijser, van den Bout, & Stroebe, 1996; Sikkema et al., 2004), we excluded them from this review. were excluded from this review (i.e., Cordsen, 1987; Lieberman & Videka-Sherman, 1986). ...
Previous quantitative reviews of research on psychotherapeutic interventions for bereaved persons have yielded divergent findings and have not included many of the available controlled outcome studies. This meta-analysis summarizes results from 61 controlled studies to offer a more comprehensive integration of this literature. This review examined (a) the absolute effectiveness of bereavement interventions immediately following intervention and at follow-up assessments, (b) several of the clinically and theoretically relevant moderators of outcome, and (c) change over time among recipients of the interventions and individuals in no-intervention control groups. Overall, analyses showed that interventions had a small effect at posttreatment but no statistically significant benefit at follow-up. However, interventions that exclusively targeted grievers displaying marked difficulties adapting to loss had outcomes that compare favorably with psychotherapies for other difficulties. Other evidence suggested that the discouraging results for studies failing to screen for indications of distress could be attributed to a tendency among controls to improve naturally over time. The findings of the review underscore the importance of attending to the targeted population in the practice and study of psychotherapeutic interventions for bereaved persons.
... This study provides evidence of the treatment's efficacy in reducing distress symptoms, regardless of the theoretical framework, but no indication was provided on the degree of grief resolution achieved as a result of intervention. A study designed to assess the efficacy of an integrated behavior and art group-therapy program for individuals who suffered from complicated grief was conducted by Schut, de Keijser, van den Bout, and Stroebe (1996). The cross-modality grief therapy group comprised 52 individuals referred to a health care center, and the control group was made up of patients undergoing regular treatment provided by the center. ...
This article focuses on long-term grief of older bereaved parents within the context of the Israeli society. The themes that emerged in a group discussion with 29 elderly bereaved parents whose sons were killed during military service support previous findings that the passage of time has no diminishing effect on parents' grief or on relinquishing attachment to the deceased. Aging appears to increase internalized involvement with the long-lost child, fears of fading memories, and the need to eternalize the deceased. In reviewing the past, parents reevaluate their coping with the loss and their relationship with the surviving children. The strong attachment seems to continue in external and inner representations of the lost child. In Israel, this preoccupation is enhanced due to society's attitude to dead soldiers, creating thereby an interface between society and bereaved families. The authors conclude that grief is a central theme in aging parents, and the term "aging of grief" is suggested to describe the course that grief and its many aspects may take with the passage of time.
This study examined the effects of online group art therapy on adults who lost family members using three instruments to measure depression, grief, and quality of life in a randomized controlled trial. Of the thirty-six participants who experienced the death of a family member, 20 were assigned to the experimental group which participate in online group art therapy over eight sessions of 1 hour once a week, and 16 were assigned to the control group with no intervention. In the experimental group, online group art therapy reduced depression and grief while improving the quality of life. The findings show the promise of online group art therapy in helping adults who have lost family members by relieving psychological distress and enhancing their quality of life.
This book explores traumatic loss, grief, and recovery through the thoughtful combination of Abraham & Torok’s ‘crypt’ theory, Jungian thought, and film theory to guide readers through the darkest places of the human psyche.
Focusing on both the destructive and reconstructive choices people can make, the book explores prolonged grief disorder, complicated mourning, post-traumatic stress disorder, embitterment, disenfranchised grief, trauma-related rumination as well as mental, emotional and physical pain. Presented with real life examples and fictional ones, the book connects the psychoanalytic concepts of intrapsychic tomb and theoretra with Jungian concepts such as teleological model of the psyche, dreams, alchemical operations, shadow, archetypes, enantiodromia, symbols, and compensation on the canvas of modern grief theory.
Traumatic Loss and Recovery in Jungian Studies and Cinema is important reading for psychoanalysts, Jungian analysts, and psychotherapists with an interest in popular culture, as well as cinema students, scholars, and general readers interested in psychology, counselling, mental health and media studies.
Öznel bir yapıya sahip olan yas sürecini her birey farklı şekilde tamamlamakta ancak bazı bireyler bu süreçte yas danışmanlığı ve yas terapisi gibi profesyonel desteğe gereksinim duymaktadır. Bu araştırmanın amacı yas sürecinde uygulanan psikolojik yardım müdahalelerinde hangi yaklaşımların/modellerin referans alındığını; müdahale edilen yaş gruplarının nasıl bir dağılım gösterdiğini ve müdahalelerin etkili olup olmadığını incelemektir. Araştırmada nitel veri toplama yöntemi olan doküman analizinden yararlanılmıştır. Araştırmanın dokümanları 2001-2021 yılları arasında yayımlanmış, İngilizce dilinde yazılmış, deneysel çalışma içeriğine sahip makale ve tezlerdir. Bu kapsamda Science Direct, ERIC, Proquest veri tabanlarında, “grief counseling” ve “grief therapy" anahtar kelimeleri ile tarama yapılmış ve araştırmaya dâhil edilme kriterlerini karşılayan 41 yayına ulaşılmıştır. Araştırmada ulaşılan makale ve tezlerde yas sürecinde Bilişsel Davranışçı Terapi ve Grupla Psikolojik Danışma müdahale yaklaşımlarının/modellerinin ön planda olduğu, ayrıca çocuklar, ergenler, gençler ve yetişkinlerden oluşan örneklem grupları ile çalışıldığı ancak yaşlılardan oluşan örneklem grupları ile yapılan araştırmaların sınırlı olduğu tespit edilmiştir. Araştırma sonucunda, yas sürecinde uygulanan müdahale yaklaşımlarının/modellerinin çoğunlukla etkili olduğu ve grupla yapılan müdahalelerin daha fazla tercih edildiği görülmüş ve bu sonuçlar alanyazın ışığında tartışılmıştır. Ayrıca gelecekte yapılacak çalışmalar için araştırmacılara çeşitli öneriler sunulmuştur.
Using Art Media in Psychotherapy makes a thoughtful and contextual argument for using graphic art materials in psychotherapy, providing historical context for art materials and their uses and incorporating them with contemporary practices and theories. Written with an analytic focus, many of the psychological references nod to Jung and post-Jungian thought with keen attention to image and to symbolic function. This book jettisons the idea of reductionist, cookbook approaches and instead provides an integrated and contextual understanding of the origins of each art form as well as an insightful use for each in its application in mental health healing practices. Using Art Media in Psychotherapy gives clinicians and students alike the tools they need to offer psychologically minded and clinically astute choices that honor their clients.
First, we review the global effectiveness of group versus individual psychotherapies, then we compare the outcome of short term vs long term group psychotherapy, and finally, we analyze the relative value of the psychodynamic, cognitive-behavioral and psychoeductative approaches, both in general and as applied to patients of different diagnostic cathegories. Among the comparative studies reviewed, there is evidence to support almost any form of group psychotherapy, whereas some other reviews conclude that no modality offers real advantages over the others. Some meta-analytic studies show a "size effect", like the one described in psychopharmachological studies. We discuss the relative degree of objectivity of the different field studies and the adequacy of the measurement instruments applied, and we conclude describing our evaluation battery, termed "Bel-Air", from the name of the main Hospital of the Department of Psychiatry of the University of Geneva. The Battery is formed by six instruments, the Brief Symptoms Inventory, BSI, the Global Behaviour Scale, GBS, the Coping Index of K. Sherrer and U. Scherrer, our adaptation of the Group Questionnaire of McKezie, the relationships questionnaire, ERA, of Fredenrich & Zinetti, and the Questionnaire of Social Functioning QFS, also developed by our group. The application of our battery, which takes a short time, allows for the measurement of common characteristics in a wide variety of groups. Of course, more specific instruments may be added for the measurement of specific variables in different diagnostic cathegories.
Loving and grieving are two sides of the same coin: we cannot have one without risking the other. Only by understanding the nature and pattern of loving can we begin to understand the problems of grieving. Conversely, the loss of a loved person can teach us much about the nature of love.
There is a long history of academic and evaluation research into health and the arts and culture, both within the UK and in other countries (Fraser and al Sayah, 2011). This evidence includes individual impacts, covering therapeutic and clinical outcomes for patients, and broader community impacts (e.g. reduced health care needs) in both clinical and non-clinical populations.
Within the body of research on arts and healthcare, there have been attempts at measuring and valuing the effects of the arts on clinical outcomes, although often this is context specific (e.g. for specific amenities or initiatives/programmes in specific locations) and lacking a policy purpose. This project was an extensive review of the literature on the use of arts in therapy. In this paper the use of 'AT' refers to a range of arts applications in therapy. This report focuses on the quantitative components of this literature.
A substantial body of empirical research has shown that mind-body practices, including Yoga and meditation, can decrease symptoms of depression, anxiety, negative mood, and fatigue. Given Yoga's adaptability to various human conditions, it can improve the physical and psychological health of our elders. When blended with clinical therapies, Yoga practices can gently ease the distress that arises from aging, natural decline, physical trauma, and loss. This article describes core practices of Transpersonal Integrative Therapy, a Yoga-based mind-body approach that has shown significant improvements in vitality and positive states, and improved satisfaction with life for those experiencing grief and mourning.
Clinicians and researchers have increasingly embraced cognitive and cognitive-behavioral therapies (CBT) for treating psychological difficulties following bereavement. The present review summarizes the existing empirical literature on CBT-based interventions for bereaved persons and the extent to which these therapies alleviated distress compared to non-CBT approaches and no-treatment control groups. Initial results for the 11 studies included in the review showed CBT-based interventions were more effective than other commonly practiced therapies (post-test d = 0.27; follow-up d = 0.25) and the relative efficacy of CBT did not vary across different bereavement-related distress symptoms. However, after accounting for the influence of researcher allegiance, differences between therapies were reduced in size and no longer statistically significant (posttest d = 0.12; follow-up d = 0.19). Compared to no-treatment control groups, CBT-based interventions were beneficial immediately after intervention (d = 0.38) but did not yield statistically significant overall effects at follow-up (d = 0.18). Findings of the review provide preliminary evidence for the helpfulness of CBT-based interventions with bereaved persons but also highlight the importance of studying the relative efficacy of different cognitive-behavioral change strategies as well as those from other theoretical orientations.
Beyond the broken heart: Mental and physical health consequences of losing a loved one
Is there such a phenomenon as ‘the broken heart’: Can those who have lost a loved one really die as a consequence of their bereavement? This question provides the starting point for a review of our scientific research program, which has focused on this stressful life event, placing this within the framework of general scientific knowledge about grief and grieving. Following discussion of research on the mortality of bereavement (in which the broken heart phenomenon is indeed confirmed) both mental and physical health consequences of losing a loved one are described, and attention is given to factors which increase the risk of such effects for some bereaved people. Effectiveness of psychotherapeutic intervention is evaluated, with the conclusion that professional help is not needed by all those who suffer a bereavement. Instead, it should be tailored toward those at high risk or with complications in their grieving. (Non)adaptive ways of coping are outlined through a comparatively new model, the Dual Process Model of Coping with Loss (Stroebe & Schut, 1999). Finally, cognitive processes underlying (mal)adaptation are described in the context of directions for future research in this field. Description of the above research covers (1) theoretical contributions, (2) reviews of the state of knowledge in the bereavement field, both generally and on specific topics, (3) empirical research on loss of a partner, child or other significant person, and (4) applied practice-directed research on a variety of issues.
The somatic connection between mind and body well-being based on the anthroposophical medical model of a human being is outlined from the perspectives of Steiner (199434.
Steiner , R . 1994. A psychology of body, soul and spirit, New York: Anthroposophical Press. View all references) and Pierrakos (198723.
Pierrakos , J . 1987. Core energetic, California: Life rhythm. View all references), arguing that the body becomes a map of mind experiences as they are inextricably linked. The expressive artistic therapies, particularly gesture, sound, and colour, are presented as the mediators of mind–body experience because they provide languages to communicate this experience. These artistic therapies are also seen as providing the means to reconnect body–mind experience in therapy in a way that can provide for interventions that transform difficult mind–body energetic patterns into patterns that create mental and physical well-being. This is illustrated with detailed interventions for transforming grief and loss and working with shock and betrayal.
This study investigated locus of control (LC) and hopelessness (H) among 25 pairs of bereaved parents, who lost their children in the Arab-Israeli conflict, and 25 pairs of demographically matched non-bereaved parents (mean age 53). Four of the 5 hypotheses were supported by results. LC was significantly more external and H was significantly lower among bereaved parents than among the control group. In both groups, mothers demonstrated significantly more external LC and higher H than did fathers. The bereaved mothers were significantly more externally controlled and hopeless than any other subgroup. No significant correlation was found between LC and H, either in the sample as a whole or in its subgroups, contrary to the hypothesized relation. The different effects of reaction to bereavement on men and women, as emerging from the results, are discussed in the light of gender-role socialization.
The article challenges the longstanding belief in the importance of “grief work” for adjustment to bereavement (the grief work hypothesis). It examines claims made in theoretical formulations and principles of grief counseling and therapy concerning the necessity of working through loss. Empirical evidence is reviewed, and cross-cultural findings are described to document alternative patterns of coping with grief. It is argued that there are grounds for questioning the hypothesis: 1) existing definitions and operationalizations are problematic; 2) the few empirical studies that have examined the impact of grief work have yielded equivocal results; 3) grief work is not a universal concept. Limitations of the grief work hypothesis as an explanation of coping with bereavement are identified and a differential approach is suggested. Implications for counseling and therapy are discussed.
Clients' drawings can serve four basic junctions in bereavement counseling. They may provide a channel for cathartic release of grief, a focus for clients' reflections on the dimensions of their losses, a means of identifying unexpressed conflicts associated with the losses, and possibly a source of information with diagnostic value. The potential benefits and limitations of bereavement-art therapy are surveyed and the suggestion made that these techniques could well have a place in the repertoire of skills of the eclectic bereavement counselor.
Assumptions about coping with bereavement were called into question some years ago by Wortman and Silver, who argued that many beliefs have been adhered to by researchers and theoreticians in the area, sometimes contrary to empirical evidence [1]. Their paper has been widely cited, and their conclusions taken as representative of the current state of knowledge. The purpose of this article is to encourage discussion of Wortman and Silver's conclusions, to examine empirical evidence and the claims of other researchers. Our conclusions contrast with many of those of the previous review. Certain so-called assumptions have not been generally made by researchers. For other assumptions, evidence has sometimes been misinterpreted. Finally, some beliefs are indeed the subject of continuing controversy. Thus, Wortman and Silver themselves seem to create myths about coping that they set out to criticize. Implications for the scientific study of the phenomena of bereavement are considered.
This case study examines a body of art work produced by Emma, a geriatric client admitted to a psychiatric ward for what appeared to be symptoms of Alzheimer's disease. On the ward, Emma attended art therapy groups, where she spontaneously created metaphors of loss. Her art work showed many similarities to art work produced by cancer patients. After a three-month stay on the psychiatric ward, Emma was diagnosed with cancer of the liver. She was transferred to a medical unit where she died three weeks later. Emma produced all her art work before she was diagnosed with cancer. This article presents evidence that Emma unconsciously knew she was dying, and independently worked on issues of her own death through her art work.
SYNOPSIS
This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.
1. Among 3,245 patients admitted to a psychiatric unit during 1949-51 there were at least 94 (2.9 per cent.) whose presenting illness had come on within six months of the death of a parent, spouse, sibling or child.
2. The number of patients whose illness followed the loss of a spouse was six times greater than expected and suggests that the bereavement was a causative factor in the development of the illness. The relationship between mental illness and the loss of other kin was not established.
3. Among the bereaved patients there was a preponderance of women over 40. Whilst the age distribution could be explained in terms of the population at risk the sex distribution could not; it seems that women are more inclined than men to develop mental illnesses following bereavement.
4. The incidence of affective disorders, and particularly reactive and neurotic depressions, was significantly greater among bereaved than non-bereaved patients. Nevertheless only 28 per cent. of bereaved patients were diagnosed "Neurotic or Reactive Depression" and further investigation is required to determine the specificity of the reaction to bereavement.
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Handbook of bereavement: Theory, research and intervention
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Omgaan met de dood van de partner: effecten op gezondheid en effecten van rouwtherapie [Coping with conjugal bereavement: Effects on psychological functioning and effects of grief counselling]
- H. A. W. Schut