Geriatric Mental Health Disaster and Emergency Preparedness

The Length of Mourning
Chapter 15 Bereavement and Grief 303
The length of mourning is another point of differentiation often invoked.
Some religious customs have specified periods of mourning. DSM IV-TR
(American Psychiatric Association, 2000, p. 299) allows only 2 months before
the symptoms qualify as a “major depressive episode.”
To what extent does grief counseling resemble the psychotherapy of
depression? As we have seen, the classical psychodynamic methods are
considered inapplicable by some authorities. The cognitive therapy of
Beck, Rush, Shaw, and Emery (1979) and the rational-emotive therapy
of Ellis (Ellis & Dryden, 2007) also have intrinsic limitations in the face of
grief. These therapies involve trying to convince the patient that things
are not really as bad as they think. Advocates of Klerman’s Interpersonal
Therapy (Klerman, Weissman, Rounsaville, & Chevron, 1984, p. 5)
recommend concentrating on the “here and now” for treating depression
regardless of the possible influence of such factors as childhood
bereavement.
Grief Counseling
The principles of grief counseling are well described in works such as
that of Worden (2009). Severe grief may have a negative effect on family,
friends, and therapists such that there may be a tendency to avoid the
grieving person. Family, friends, and caregivers, including therapists,
should be encouraged to avoid such avoiding.
Experts differ about the need to work through the stages of grief.
There is no consensus that this is necessary or helpful, although reminiscence
and ventilation must at least be allowed. In talking about the
deceased, we encourage survivors to remember them during life. Talk
directed toward memories of the loved one during life often brings a
smile and slight relief. Talk about the exact circumstances of death tends
to increase distress. Much of the counseling is intuitive; sensitive helpers
will assess what helps, what is to be avoided, and when advice and commiseration
are needed.
The bereaved often say the most effective comforters are those who
have been though a similar loss. Support groups of several kinds exist to
facilitate this and are included in the resources section of this book.
As in the stage of acute agitation, there are demands for sleeping
medication. The philosophical objection to these is, for some reason,
less than the objection to antidepressants. Again, the medications most