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Family Grief Therapy Is Helpful Only for Some

Specific family characteristics may indicate whether grief therapy would be of benefit.

Grief counseling has weak effectiveness and, in fact, can often feel intrusive to many families with terminally ill relatives who are receiving palliative care. Approximately 15% to 20% of families of palliative-care recipients are dysfunctional; during early bereavement, this rate approaches 30%.

These investigators first identified 81 dysfunctional families who had relatives in palliative-care programs (mostly for cancer) and were at risk for morbid psychopathological outcomes, including clinical depression. The researchers then conducted a randomized controlled clinical trial of a structured treatment called family focused grief therapy (FFGT). Fifty-three families received FFGT; 28 received treatment as usual, which included therapy as needed (controls).

The researchers rated the families as dysfunctional — either "hostile" (high conflict, low expressiveness, low cohesion, help-rejecting) or "sullen" (moderate impairment in conflict, expressiveness, and cohesion; muted anger; desire for help) — or as intermediate between well-functioning and dysfunctional. Forty families completed FFGT, which consisted of four to eight 90-minute sessions over 9 to 18 months.

At follow-up (6 and 13 months after the patient died or the study was terminated), few changes were found in the FFGT group as a whole. Among the most distressed family members (the 10% of individuals with the "worst" test scores), those receiving FFGT had better global and depression-symptom outcomes than controls, but not improved social functioning. For "sullen" families, FFGT was associated with modestly better outcomes on global measures and depression ratings than the control condition. For "hostile" families, FFGT was associated with unchanged depression ratings and, actually, worse family functioning than the control condition. No differences were seen for the "intermediate" families.

Comment: The authors cautiously conclude, "When conflict seems inevitable, the benefits of bringing family members together for a meeting may be negligible." Despite good therapeutic intentions, counseling is not for everyone. Focusing therapeutic efforts on individuals who are particularly distressed, dysfunctional, and help-seeking may be beneficial.

— Joel Yager, MD

Published in Journal Watch Psychiatry August 7, 2006

Citation(s):

Kissane DW et al. Family focused grief therapy: A randomized, controlled trial in palliative care and bereavement. Am J Psychiatry 2006 Jul; 163:1208-18.

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