Family grief counseling helpful for some

NEW YORK (Reuters Health) - Some families who've lost a loved one to cancer may benefit from going to grief counseling together -- though for others, the therapy could be counterproductive, according to researchers.

Their study of 81 families of dying cancer patients found that, depending on the family dynamics, group grief counseling was either a benefit or a potential detriment to family members' mental and emotional well-being.

The benefit was most clear among families who had communication problems and often bottled-up feelings, but who wanted help. They showed the most improvement in distress and depression one year after going through family grief therapy.

On the other hand, "hostile" families showed no improvement in depression with family therapy. What's more, the study found, these families seemed to fare better when they received no therapy.

Hostile families have highly strained relationships and poor communication, and they tend to reject help, according to the study authors, led by Dr. David W. Kissane of Memorial Sloan-Kettering Cancer Center in New York.

Because family therapy may exacerbate these conflicts, individual grief counseling may be more appropriate, the researchers write in the American Journal of Psychiatry.

It's now well recognized, according to Kissane and his colleagues, that grief counseling is not for everyone, and it should be offered only to family members who can truly benefit from it. The question is how to identify the people who need counseling, and decide which form of therapy is best for them.

For the current study, the researchers used screening questionnaires to identify 81 families with some degree of dysfunction; families with strong relationships, according Kissane's team, typically don't need counseling.

Of the 81 families, the researchers randomly assigned 53 to receive group counseling, and 28 to serve as a comparison group. Family members started therapy when their relative entered end-of-life care, and continued it after his or her death.

In general, the researchers found, family grief counseling did show "modest" benefits for family members' distress and depression.

A closer look at the results, however, found that families burdened by conflict and hostility did not see improvements in depression. Moreover, their relationships were more likely to deteriorate when they underwent counseling than when they received no therapy at all.

The findings, say the researchers, offer "preliminary evidence" as to which families are most likely to be helped by family grief counseling. The fact that some families could potentially be harmed by the therapy, they write, "reminds us that we have not discovered a panacea."

SOURCE: American Journal of Psychiatry, July 2006.