US researchers say they have found a better way to counsel people with a form of prolonged grief.
Bereavement counselling can help
Bereavement causes strong emotional, physical and spiritual reactions that can take years to work through.
Some develop a chronic, debilitating condition known as complicated grief that is more intense than normal grief and distinct from clinical depression.
A study in the Journal of the American Medical Association explains how 16 sessions of tailored therapy can help.
The technique used by the University of Pittsburgh team is called complicated grief treatment.
It used standard interpersonal psychotherapy, which involves helping the individual arrive at a more realistic assessment of the relationship with the deceased and encouraging the pursuit of satisfying relationships and activities.
But, in addition, complicated grief treatment employed other coping techniques.
These included getting the individual to tell the story of the death - a process called revisiting - and produce audio recordings of the exercise that they could listen to again. This was to help them put aside thoughts of the death and lessen the pain.
The therapist encouraged the bereaved to reminisce about the person they had lost to prompt them to speak openly about their feelings.
The individuals were also encouraged to make specific plans for pleasurable activities and engage in situations and relationships they had been avoiding since the death.
Compared with interpersonal psychotherapy (IPT) alone, complicated grief treatment (CGT) was much more effective, the researchers found.
Among 95 volunteers with complicated grief, 51% of those treated with 16 sessions of CGT reported a significant improvement in their lives compared with only 28% of those who received the same number of sessions of standard IPT.
Features of complicated grief
Prolonged disbelief, anger and bitterness regarding the death
Intense yearning and longing for the deceased
Avoidance of reminders of the deceased
Preoccupied thoughts of the loved one
If left untreated, can lead to negative health outcomes
The half who were treated with CGT also responded to the therapy much faster than the half treated with IPT.
Phillip Hodson, fellow of the British Association for Counselling and Psychotherapy, said the findings were interesting and important, but stressed that complicated grief was rare, affecting only about 10% of those grieving.
"Bereavement therapy does work and is generally of benefit.
"The retelling of the grief story is controversial. Some schools of thought say revisiting the past is irrelevant and even counterproductive.
"But others say telling the story of the past episode can help people to face and place it - to deal with the questions such as "How could this happen?" and "Why me" and so on.
"Our sense of what is right and wrong, fair and unfair is at real conflict with what happens in the real world. That is very difficult to reconcile ourselves to.
"Anything that can help with that struggle is to be welcomed.
"It's a question of finding which sort of therapy is good for which sort of problem and which type of individual. Most therapists use a range of techniques."