Journal of Consulting and Clinical Psychology 1991, Vol. 59, No. 3, 479-482
Copyright 1991 b> the American Psychological Association, Inc. D022-006X/91/S3.00
Does "Grief Work" Work?
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Margaret Stroebe and Wolfgang Stroebe University of Tubingen Tubingen, Federal Republic of Germany
This article challenges the long-standing belief in the necessity of "grief work" for adjustment to bereavement. Evidence is offered from a prospective study of 30 widows and 30 widowers that indicates that grief work is not always as essential for adjustment to bereavement as theorists and clinicians have claimed. Widows who avoided confronting their loss did not differ in their depression scores from widows who worked through their grief. However, for widowers, performance of grief work was associated with better adjustment over an 18-month period. The implications of these findings for the grief work hypothesis are considered.
One of the truisms generally accepted by researchers and clinicians in the area is that to recover from bereavement, one needs to do one's "grief work." Used in slightly different ways depending on the theoretical orientation, the concept of grief work implies a cognitive process of confronting the reality of loss, of going over events that occurred before and at the time of death, and of focusing on memories and working toward detachment from the deceased. The concept has been central in the major theoretical formulations on grief and bereavement since Freud (1917). Freud's view that grief work was necessary for the resolution of grief was shared by Lindemann (1944) and later by Bowlby (1981). Within his framework of bereavement as a "psychosocial transition," Parkes (1986) emphasized the importance of grief work, going further than previous formulations to describe various components of the grief work process. Principles of counseling and therapy also assign a central role to grief work in adjustment to loss. Pathological grief is generally regarded as the failure to undergo or complete grief work (see W Stroebe & Stroebe, 1987). Counseling and therapy programs for the bereaved share the common goal of helping the bereaved to adapt to life without the loved one by facilitating grief work (see Raphael & Nunn, 1988). Despite the centrality of the grief work concept, the belief that it plays an essential role in the process of recovery from bereavement has rarely been queried. Yet there are reasons for questioning the assumption. There are conceptual ambiguities, such as the distinction between grief work (which is supposedly adaptive) and rumination (maladaptive). Furthermore, empirical evidence is contradictory. Some studies (e.g., Wortman &
Silver, 1989) have been interpreted as showing that working through grief is associated with poor adjustment, whereas others (e.g., Mawson, Marks, Ramm, & Stern, 1981) support the opposite conclusion. The purpose of our study was to collect preliminary empirical data to examine the assumption that grief work is necessary for adjustment to bereavement (the grief work hypothesis). Using data from the Tubingen Longitudinal Study of Bereavement (see W Stroebe, Stroebe & Domittner, 1988), in which recovery from conjugal bereavement was examined over a 2-year period, an attempt was made to assess the coping strategies of confronting versus avoiding grief. An advantage of the design of this study was that it was longitudinal, enabling one to establish whether doing grief work during the early months of bereavement was actually predictive of recovery in the long run.
Method Widowed individuals (30 widows and 30 widowers) under the age of 60, drawn from five towns in southern Germany, participated in the study. Names and addresses and sociodemographic information were supplied by the local registrars' offices for all persons in this age category whose spouses had died between 4 and 6 months previously. These individuals were sent a letter asking for their cooperation. No pressure was put on them to participate. Although the general level of acceptance was rather low (28%), this rate is not atypical for this area of research. Furthermore, the sociodemographic characteristics of the widows and widowers were similar to each other and not substantially different from those who refused to participate (see M. Stroehe & Stroebe, 1989). The participants were interviewed three times: (a) 4-7 months after their loss, in their homes; (b) approximately 14 months after loss, also at home; and (c) just over 2 years after the loss, by telephone. Data collection relied on questionnaires containing self-report scales (including health measures) as well as on the structured interviews.
The research reported in this article was funded by a grant from the Deutsche Forschungsgemeinschaft to Wolfgang Stroebe. We are grateful to Kenneth Gergen, Gerd Gigerenzer, Arie Kruglanski, Colin M. Parkes, James Pennebaker, and Paul Rosenblatt for helpful comments on a draft of this article and to Georgios Abakoumkin for his assistance in data analysis. Correspondence concerning this article should be addressed to Margaret Stroebe or Wolfgang Stroebe, Department of Psychology, Tubingen University, W-7400 Tubingen, Federal Republic of Germany.
GriefWork In order to reduce the confounding observed in previous studies between grief work on the one hand and rumination, yearning, and negative affect on the other, grief work was operationalized as a strategy of confrontation versus avoidance. Our main measure of grief work 479
480
BRIEF REPORTS
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
was a scale that assessed suppression (versus confrontation) and consisted ofsix statements, such as, LT avoid anything that would be too painful a reminder," or "At the moment any activity is a welcome distraction." The scale has a Cronbach alpha of .60. The following items of the interview were used as additional information on grief work: avoidance of reminders (Do you avoid places, things, or people that remind you of the deceased?); distraction (Do you keep yourself busy with other things, in order not to think about the loss?); control of emotionality (How do you cope with pangs of grief? Do you pull yourself together or do you let yourself go?); and nondisclosure (Do you avoid talking to others about your loss?). Grief work was assessed at the first two time points.
Measure of Psychological Adjustment Because of the high intercorrelation among the different measures of distress and adjustment used in this study, this report is based on only one of the measures that were used, the German version of the Beck Depression Inventory (BD1; Rammer, 1983). The BD1 consists of 21 items that assess the major symptoms of depression. The "lack of sexual interest" item was not used because pretest data had shown that the bereaved resented having to respond to this question.
Results Table 1 presents the means and standard deviations for the BDI for all three time points and for the grief work measures at the first two times. A two-factor (Sex X Time) analysis of variance (ANOVA) conducted on the BDI scores resulted in the following effects: Widows had somewhat higher BDI scores than widowers, F(\, 46) - 3.25, p
Copyright 1991 b> the American Psychological Association, Inc. D022-006X/91/S3.00
Does "Grief Work" Work?
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Margaret Stroebe and Wolfgang Stroebe University of Tubingen Tubingen, Federal Republic of Germany
This article challenges the long-standing belief in the necessity of "grief work" for adjustment to bereavement. Evidence is offered from a prospective study of 30 widows and 30 widowers that indicates that grief work is not always as essential for adjustment to bereavement as theorists and clinicians have claimed. Widows who avoided confronting their loss did not differ in their depression scores from widows who worked through their grief. However, for widowers, performance of grief work was associated with better adjustment over an 18-month period. The implications of these findings for the grief work hypothesis are considered.
One of the truisms generally accepted by researchers and clinicians in the area is that to recover from bereavement, one needs to do one's "grief work." Used in slightly different ways depending on the theoretical orientation, the concept of grief work implies a cognitive process of confronting the reality of loss, of going over events that occurred before and at the time of death, and of focusing on memories and working toward detachment from the deceased. The concept has been central in the major theoretical formulations on grief and bereavement since Freud (1917). Freud's view that grief work was necessary for the resolution of grief was shared by Lindemann (1944) and later by Bowlby (1981). Within his framework of bereavement as a "psychosocial transition," Parkes (1986) emphasized the importance of grief work, going further than previous formulations to describe various components of the grief work process. Principles of counseling and therapy also assign a central role to grief work in adjustment to loss. Pathological grief is generally regarded as the failure to undergo or complete grief work (see W Stroebe & Stroebe, 1987). Counseling and therapy programs for the bereaved share the common goal of helping the bereaved to adapt to life without the loved one by facilitating grief work (see Raphael & Nunn, 1988). Despite the centrality of the grief work concept, the belief that it plays an essential role in the process of recovery from bereavement has rarely been queried. Yet there are reasons for questioning the assumption. There are conceptual ambiguities, such as the distinction between grief work (which is supposedly adaptive) and rumination (maladaptive). Furthermore, empirical evidence is contradictory. Some studies (e.g., Wortman &
Silver, 1989) have been interpreted as showing that working through grief is associated with poor adjustment, whereas others (e.g., Mawson, Marks, Ramm, & Stern, 1981) support the opposite conclusion. The purpose of our study was to collect preliminary empirical data to examine the assumption that grief work is necessary for adjustment to bereavement (the grief work hypothesis). Using data from the Tubingen Longitudinal Study of Bereavement (see W Stroebe, Stroebe & Domittner, 1988), in which recovery from conjugal bereavement was examined over a 2-year period, an attempt was made to assess the coping strategies of confronting versus avoiding grief. An advantage of the design of this study was that it was longitudinal, enabling one to establish whether doing grief work during the early months of bereavement was actually predictive of recovery in the long run.
Method Widowed individuals (30 widows and 30 widowers) under the age of 60, drawn from five towns in southern Germany, participated in the study. Names and addresses and sociodemographic information were supplied by the local registrars' offices for all persons in this age category whose spouses had died between 4 and 6 months previously. These individuals were sent a letter asking for their cooperation. No pressure was put on them to participate. Although the general level of acceptance was rather low (28%), this rate is not atypical for this area of research. Furthermore, the sociodemographic characteristics of the widows and widowers were similar to each other and not substantially different from those who refused to participate (see M. Stroehe & Stroebe, 1989). The participants were interviewed three times: (a) 4-7 months after their loss, in their homes; (b) approximately 14 months after loss, also at home; and (c) just over 2 years after the loss, by telephone. Data collection relied on questionnaires containing self-report scales (including health measures) as well as on the structured interviews.
The research reported in this article was funded by a grant from the Deutsche Forschungsgemeinschaft to Wolfgang Stroebe. We are grateful to Kenneth Gergen, Gerd Gigerenzer, Arie Kruglanski, Colin M. Parkes, James Pennebaker, and Paul Rosenblatt for helpful comments on a draft of this article and to Georgios Abakoumkin for his assistance in data analysis. Correspondence concerning this article should be addressed to Margaret Stroebe or Wolfgang Stroebe, Department of Psychology, Tubingen University, W-7400 Tubingen, Federal Republic of Germany.
GriefWork In order to reduce the confounding observed in previous studies between grief work on the one hand and rumination, yearning, and negative affect on the other, grief work was operationalized as a strategy of confrontation versus avoidance. Our main measure of grief work 479
480
BRIEF REPORTS
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
was a scale that assessed suppression (versus confrontation) and consisted ofsix statements, such as, LT avoid anything that would be too painful a reminder," or "At the moment any activity is a welcome distraction." The scale has a Cronbach alpha of .60. The following items of the interview were used as additional information on grief work: avoidance of reminders (Do you avoid places, things, or people that remind you of the deceased?); distraction (Do you keep yourself busy with other things, in order not to think about the loss?); control of emotionality (How do you cope with pangs of grief? Do you pull yourself together or do you let yourself go?); and nondisclosure (Do you avoid talking to others about your loss?). Grief work was assessed at the first two time points.
Measure of Psychological Adjustment Because of the high intercorrelation among the different measures of distress and adjustment used in this study, this report is based on only one of the measures that were used, the German version of the Beck Depression Inventory (BD1; Rammer, 1983). The BD1 consists of 21 items that assess the major symptoms of depression. The "lack of sexual interest" item was not used because pretest data had shown that the bereaved resented having to respond to this question.
Results Table 1 presents the means and standard deviations for the BDI for all three time points and for the grief work measures at the first two times. A two-factor (Sex X Time) analysis of variance (ANOVA) conducted on the BDI scores resulted in the following effects: Widows had somewhat higher BDI scores than widowers, F(\, 46) - 3.25, p
