Wednesday, July 11, 2012

Advance Preparation for Loss

I am intrigued to listen to the ongoing shouting match in professional circles regarding the efficacy of grief counseling.  I know that my personal experience is of no use in this regard.  I have no idea whether grief counseling is effective in general, since I never really entertained the possibility for myself.  I wouldn't recommend my path to anyone else, although I found real avenues for personal growth by trying to build my own road forward.

It is clear that the Kubler-Ross five stage model has not received clinical validation.  It was derived from the experiences of people facing terminal diagnoses.  The model was then extended to all sorts of loss experiences--most of which have no similarity to facing a terminal diagnosis.  Now that model is part of the Culture of Bereavement Orthodoxy.  The five stage model has vociferous defenders in the community of practictioners.  It has few defenders left in the research community.

It is also clear that the Freudian notions of "grief work" and "cathexis" have no real basis in the research.  Nonetheless, these concepts are part, as well, of the Culture of Bereavement Orthodoxy.  In fact, a focus on getting out the feelings related to grief has been demonstrated to do more harm than good in many test cases.  This idea of "grief work" was at best a footnote in Freud's one article on grief--a footnote that was built into a whole discipline by a few of Freud's early followers.

It does not appear, on the other hand, that claims about the inefficacy and even damaging potential of grief counseling are based in real research either.  Several articles dispute what is becoming another piece of unproven orthodoxy in the psychology of grief community.  It does not appear that anyone has conclusively demonstrated that grief counseling is no better than a placebo and/or damaging in a number of cases.

Those assertions, however, have become the basis for a number of arguments against the use of grief counseling in all but the most complicated grief cases.  It is not clear that those arguments stand on solid research ground.

What is clear is that how we were wired before the loss is highly determinative of how we will respond to the loss in the longer term.  So, in fact, we might all be well-served to focus on our psychological hygiene in preparation for the losses we will experience in life.

Everyone loses loved ones at some point.  Everyone dies.  In other cultures and other times, people have spent important time and energy preparing for loss and death.  There is great wisdom in pursuing that personal discipline.

What are the traits that empower us to grief well?
--have I developed resilience in the face of adversity?
--can I choose optimism in the face of difficulty?
--do I know how to take care of myself physically when I am under stress?
--do I have good social support systems in place?
--have I developed a sense of myself that is not completely dependent on another person's existence?
--do I have a sense of humor?
--do I have a sense of perspective, the ability to step back and then move forward?

Perhaps the most effective response to loss would be the proactive one--working on one's personal psychological hygiene day in and day out.  We know that grieving will come, just as we know that cavities come if we don't brush our teeth.  Perhaps we need to apply the same energies to our psyches that we do to our gums.

So we might benefit from "grief guides"--those who have been there and learned the skills to survive.  Perhaps we need to teach these skills to our children in order to make their lives better now and to prepare them for the real losses of later life.

Perhaps we all need more training in choosing hope.

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