GriefPerspectives | Keeping Up in the Changing Field of Bereavement

One of the psychotherapists with whom I visited early in my processing of my car crash experience last year asked me part way through the initial interview, “So where do you think you are in the stages of grief?” For colleagues who have listened to my diatribes on this topic, this news will come with great amusement. Debbie, my wife of nearly 30 years was sitting next to me when this clinical psychologist asked the question. Having heard me “pontificate” no few times on how grief defies such “staging” and that I resolutely reject attempts to turn it into a linear process, Debbie remarked quietly in response to the question, “Now this is going to be good.”

What this therapist’s question telegraphed to me is here is one who is not “up to date” on the state of our field. Though many, if not most professional bereavement specialists prefer more fluid models of the bereavement process, one can be forgiving of those who do not broker in our field on a continual basis. After all, how can one professional be expected to keep up in so many sub-disciplines of the counseling enterprise? Yet, keep up is what I believe we must do, at least in the specialties and sub-specialties in which we practice. For those whose counsel of bereaved persons involves billing third party payers such as federal benefit programs or private health insurance, evidence-based practices are essential. Knowing current diagnostic criteria and the clinical interventions with strong evidence support will become more important in the years ahead.

Whether one is required by reimbursement rules to “keep up” or not, however, is really beside the point. We owe it to the individuals and families we serve to provide the best care we can that is based on the most current thinking and research about what works best with bereaved people. We owe it to ourselves, our patients/clients/constituents, and the organizations we represent to be up to date with current terminology and strategies. I am more convinced than ever that a continually educated professional (and volunteer) must be an ethical standard of care.

In recent years, our understandings of the finer points of bereavement have expanded exponentially. Population studies have helped identify characteristics common among individuals with complicated grief reactions. Healthy debate continues about what timeframe to use in describing complicated grief. Researchers and clinicians alike work to discover where to “draw the lines” between complicated grief and other mental health disorders such as Major Depressive Disorder, anxiety disorders, and Post-Traumatic Stress Disorder. The explosion of brain imaging technology such as functional magnetic resonance imaging (fMRI) has led to better—if not always consistent—understandings of how bereavement experiences affect neurological functioning. And of course, our growing understanding of how cultural groups experience and express their losses provides constant need for update in skills and understanding.

Just the major English language journals devoted to matters of death and bereavement (see them listed below) collectively publish more than 500 peer-reviewed articles every year reporting new perspectives, intervention strategies, and descriptions of bereaved populations to help us better understand the “terrain.” A recent Amazon.com search showed more than 150 new books on death and bereavement due out over the next eight months in addition to more than 400 published in the last two years. And these just address the print media.

So how does one keep up in a field that sees such monumental changes? Here are a few ways I have found over the last few years that seem to help.

Schedule time every week for “keeping up.”
The largest impediment to staying current in one’s field is the pressure of too many “to do’s” and too little time. One of the compensatory strategies I have begun using as I adjust to cognitive deficits from last year’s car wreck is to schedule everything, including time every week to just read. What has been amazing is how easy it is to respond to so many “opportunities” (i.e. unnecessary

demands on our time) with the simple words, “I am sorry; I have another commitment then.”

Investing some time in reading and reflecting on our field has been one of my professional priorities for many years. I work well in the early mornings and so after 30 minutes or so for my personal devotional life, these early hours often provide time for such reading and reflection. Admittedly, that strategy has worked better in the years since our children became teens, and especially now that as adults, they are out of the house. What would happen if three days each week, one set aside 60 minutes before others arise in the morning just for reading and reflecting, perhaps utilizing one of the sources below?

Subscribe to journal table of contents alerts. The major English-language journals specifically dedicated to death and loss issues are:

Death Studies (10 issues annually)
Omega: Journal of Death & Dying (8 issues annually)
Mortality (4 issues annually)
Journal of Loss and Trauma (8 issues annually)
Illness, Crisis, and Loss (4 issues annually)

On the home pages of each of these journals, one can sign up to receive a free email alert with the publication of each new issue of the journal. The email alerts from these five journals collectively add four or five emails to my inbox every week and I usually simply drop those unopened emails into a “Newsletters” folder right in my email inbox. There are probably automated ways to do this but I am too techno-challenged to know them.

With this folder set up in my email inbox, during my next “keep up” time, I review the article titles and click on the handful that are of interest to read the abstracts. Complete PDF articles for current and back issues of Death Studies and Omega are available free to members of the Association for Death Education and Counseling. Whether I actually read the articles, this brief survey helps me identify key issues of conversation in the field. The book reviews in each journal also help me stay abreast of new books.

Choose specialty interests to develop depth in perspective. In reviewing the journal table of contents alerts, watch for the two or three specialized interests you have developed or are currently pursuing (mine have changed over time). If I were a school counselor running bereavement groups, I would be especially alert to articles about child/teen grief and about groups; if I were again practicing in a hospice organization, I would be on the lookout for articles about end-of-life care. While few have the opportunity to concentrate on only sub-specialty fields (bereaved adolescents or individuals dying from congestive heart failure), we can all profit by developing depth in one or two areas of interest. The specialties I am particularly interested in now are quite different than they were when I looked after a child and family bereavement program.

Get to know—and love—PubMed.

While the five key journals I listed above publish much of the landmark research and practice ideas in our field, they do not collectively publish all, or even most, of the articles. Therefore, every couple of months, I type the terms “death bereavement” into the search box at PubMed just to see what pops up; I also limit this search to the last 12 months so I am not overwhelmed with search results.

PubMed is the joint venture of European, Canadian, and American medical libraries, available most easily through the U.S. National Library of Medicine; PubMed Central Canada was permanently taken offline last month accompanied by directions to use the U.S. PubMed site above. Here, one will find the richness of research studies with clinical applications in our field. Because at last count, PubMed indexed more than 30,000 journals from around the globe, it is a compendium of information; I frequently spend 30 minutes just looking at the newest publications on a narrow topic in my field of interest. Because I pay close attention to the role of poverty in end-of-life choices, I often look at new studies related to this. Without using the search “limiters,” broad topic searches (such as “death and bereavement”) will produce so many results that it will be like drinking from a firehose!

Search online book retailers regularly. Now that electronic books are so easy to produce and sell through online retailers, this has become my least useful “keep up” tool but it still has merit. A few times each year, I simply type “death and bereavement” into the search box on Amazon.com and then set the sort feature to “Publication Date.” As any online purchaser knows, quality varies markedly but it is easy to see what is new in the field. Especially for those who work with bereaved individuals and groups, this periodic search can be helpful because it is what clients and group members use to access resources.

What readers of this newsletter might notice is that there is no mention here of attending workshops and seminars. Though I am honored to partner with organizations across the U.S. and Canada to provide such programs—often for free or a nominal fee—I realize that the money to attend is just one aspect of the cost; with smaller staffs in many health care organizations, there simply is no staff “coverage” for professionals to be away from patient care for day-long continuing education programs. Many health care organizations have developed clinical “journal clubs” to help address this concern (see “Research that Matters” and “Resource Review” below for more ideas on this).

The ideas in this article require little time away from patients or clients. Instead, articles can be downloaded to one’s mobile device or printed and carried along for those short times between appointments. Even if reading few full articles using these “keep up” strategies, the broad exposure to the field will enhance knowledge and skills in caring for the dying and bereaved. And in the end, that means much better care for the dying and bereaved individuals we serve.

The Author: For more than three decades, William G. Hoy has been counseling with the bereaved, supporting the dying and their families, and teaching colleagues how to provide effective care. After a career in congregation, hospice, and educational resource practice, he now holds a full-time teaching appointment as Clinical Professor of Medical Humanities at Baylor University in Waco, Texas.