Kissane, D.W., McKenzie, M., Bloch, S., Moskowitz, C., McKenzie, D.P., & O'Neill, I. (2006). Family focused grief therapy: A randomized, controlled trial in palliative care and bereavement. American Journal of Psychiatry, 163, 1208–1218.
To examine the efficacy of family focused grief therapy on psychosocial functioning in families of patients who are terminally ill
Patients and relatives in several palliative care centers and hospices were recruited for the study. Families were randomly assigned to receive the focused grief therapy or usual care stratified based on recruitment site. Usual care consisted of standard palliative care provided by homecare programs, which involved counseling when deemed clinically appropriate. Focused grief therapy was provided by qualified family therapists who had received standardized training in the intervention. Clinical supervision of the therapists was provided throughout the trial, and fidelity to the intervention was independently evaluated from review of audiotaped sessions. Family focused grief therapy typically included four to eight sessions of 90 minutes provided across 9–18 months. It included exploration of family cohesion, communication, and handling of conflict. Families were assigned to functional classes: dysfunctional (sullen or hostile) or intermediate. Data at baseline and follow-up at 6 and 13 months postbereavement were obtained from relatives by a research assistant.
A randomized controlled trial design was used.
Among all participants, those receiving the study intervention had significantly greater change in mean score of the Brief Symptom Inventory (BSI) (0.12, p = 0.02). BSI showed a nonsignificant improvement at 13 months in the intervention group than in the control group. Grief phenomena diminished similarly in both groups. There was no significant difference in social adjustment in both groups. There were no other significant differences between groups. Among family members who were most distressed, differences were greater, with 0.83 improvement in the BSI (p < 0.01), Beck Depression Inventory (p < 0.01), and the Bereavement Phenomenology Questionnaire (p = 0.05). In both the intervention and control groups, the general patterns of change in outcomes measures showed overall decline in symptoms over time. Families with intermediate functioning who received the intervention had a larger reduction in conflict level at six months than intermediate families in the control group (p = 0.03). Hostile families that received the intervention deteriorated more than hostile control families over the 13 months of bereavement (p = 0.001). Intermediate families received an average of 7 sessions, sullen families received an average of 6.4 sessions, and hostile families received an average of 9.4 sessions.
Family focused grief therapy appeared to have some benefit for the most distressed family members in terms of reduction of symptoms; however, these changes were not accompanied by improvement in family functioning. This intervention may protect against pathologic grief in highly distressed individuals. Among hostile families, the intervention was counterproductive
Family focused interventions to mitigate grief issues may be helpful in some families for highly distressed individuals; however, among the most dysfunctional families, this type of intervention might be counterproductive. Additional research is needed to determine the appropriate role of this therapy approach in palliative care.