Academic journal article Journal of Mental Health Counseling

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

Academic journal article Journal of Mental Health Counseling

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

Article excerpt

Grief moor 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 to measure 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.

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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 turn 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.

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. …

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