Talking Therapy Episode 27: Diagnosing and Treating Complicated Grief

Hosts:

Producer:

Alan Kian, MA, York University
---------------------------------------------------------------------------------------------------------------------------

Marvin Goldfried is a distinguished professor of psychology at Stony Brook University, where he helped to develop the graduate program in clinical psychology—he is the cofounder of the Society for the Exploration of Psychotherapy Integration. Allen Frances is a professor of psychiatry and chair emeritus at Duke, and was chair of the DSM-IV task force.

Marvin describes the evolution of his psychotherapy orientation as psychodynamic, behavioral, CBT, and eventually integrative. He practices, teaches, and supervises what works clinically using direct and indirect evidence base.

Allen describes his approach to psychotherapy as “whatever works” or “no one size fits all”. He was trained and taught at the Columbia University Psychoanalytic Center, but remains equally interested in brief, supportive, cognitive, behavioral, interpersonal, and family therapies.

Please enjoy this week’s episode!

[ginalibrizzi]

Thank you both for sharing this conversation. I found it very helpful.

[emmanuellezech]

Thank you very much for this conversation about grief and the importance of not categorizing bereaved people as having pathological (complicated) grief. There is now research on the stigmatisation of bereaved people who are labelled as having Prolonged Grief Disorder (see the works by Maarten Eisma in the Netherlands). As a grief researcher and clinician since more than 20 years, I've never seen the ads of diagnosing bereaved people for their grief reactions/"symptoms": neither for them (although recognizing, acknowledging and unconditionnally accepting their suffering is, and this means that we, as therapists, can bear and regulate our own emotions with regard to death, separation and loss), nor for a differential choice in the treatment principles/strategies that I "use". While William (Bill) Worden's work on the four tasks (not stages!) of grief is essential reading, I also found the work of Margaret Stroebe and Henk Schut on the Dual Process Model of Coping Bereavement (1999, 2010) a well empirically-supported framework that is very inspiring for my clinical work. It stresses, among other ideas, the importance of not addressing only grief work (for those who might be "stuck"), but also the benefits of avoidance, even denial, but also distraction, respite, oscillating between loss- and restoration- (i.e., secundary to the loss) stressors. One size doen't fit all. This is specially true for helping and accompanying bereaved/grieving individuals. The psychotherapeutic relationship that involves a secure presence (base), that entails congruence, empathic understanding, unconditional positive regard (right rythm, neither too quick, nor too slow; intensity, neither too much, nor too few; timing, neither too early, nor too late; attunement, neither too close, nor too distant) to each client's idiosyncratic responses and (cultural, individual, interpersonal) frame of reference will be the most effective.

[kyliejones]

Interesting conversation. I'm a previously practising psychologist and a bereaved mom. Marvin's story about the lady who felt better after allowing herself to grieve makes sense from an Acceptance and Commitment Therapy (and its philosophical underpinnings) perspective. I utilised ACT at work and later, it helped me grieve the loss of my son. It's all about facing head on the loss, guilt, missing, anger and any other emotion that shows itself.

[garyrubadou]

If I could give this discussion five thumbs up, I would ! Thank You

[bananacake]

What is DSM please!??? TIA from Uk 🇬🇧🙋‍♀️

[erindabney]

Being pathologized and medicalized into a diagnosis following a non-fatal life-quake… well, now I’m making the final preparations to end my life.

I needed time and support to grieve and I never got it. No one needs me now, so F staying alive.