Abstract
Working with grieving clients requires an understanding of the affects, cognitions, and relational factors influencing clients’ unique process of mourning. Much has been written from the perspective of psychodynamic theories and techniques as well as from a cognitive-behavioral perspective to assist clients who are grieving. However, combining the approaches offers a unique opportunity to draw on the strengths of each theoretical framework as the included case descriptions illustrate, specifically in the areas of counterfactuals and guilt, inhibited grief, and adjusting to the psychosocial aspects of loss.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Some authors make a distinction between grief and mourning, contending that grief is the immediate psychology experience following a death, while mourning is the process of recovery. However, this paper uses the two terms synonymously. See, for example, Rando (1993).
Rando (1993) points out, however, that Mourning and Melancholia, from which this quote is taken, is not Freud’s only publication to examine bereavement, and not even the first. In other volumes and in letters, Freud states that a lost object is never relinquished, contrary to what he says in Mourning and Melancholia.
Names and other details have been changed to protect the identities of clients.
See Beck (2011) for a full discussion of Socratic questioning and its role in CBT. Socratic questioning involves purposive questioning to help the client clarify, examine, and evaluate the logic and assumptions underlying dysfunctional thoughts.
Interestingly, Mary’s version of the story focused on the insensitive priest who broke the news, precipitating her sister’s outburst. She had no insight into the significance of her own behavior, “closing the doors” on the intense affect.
Certainly, he was lonely for his wife, but he also recognized that his days were an empty vacuum because he had no friends or acquaintances in the area.
Research has shown that men and women grieve differently. Men tend to be “instrumental” grievers who cope not by opening up about their feelings, but by doing something (Lister 1991).
References
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. New York: The Guilford Press.
Berzoff, J., Flanagan, L. M., & Hertz, P. (2011). Inside out and outside in: psychodynamic clinical theory and psychopathology in contemporary multicultural contexts. Plymouth: Rowman & Littlefield Publishers, Inc.
Boelen, P. A., de Keijser, J., van den Hout, M. A., & van den Bout, J. (2007). Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 75(2), 277–284.
Bowlby, J. (1980). Loss: Sadness and depression. New York: Basic Books, Inc.
Casement, P. (1997). Further learning from the patient. London: Routledge.
Cohen, J. A., Mannarino, A. P., & Staron, V. R. (2006). A pilot study of modified cognitive-behavioral therapy for childhood traumatic grief. Journal of the American Academy of Child and Adolescent Psychiatry, 45(12), 1465–1473.
DeLaCour, A. (1999). Integrative brief treatment. In T. B. Northcut & N. R. Heller (Eds.), Enhancing psychodynamic therapy with cognitive-behavioral techniques (pp. 319–344). Northvale: Jason Arsonson Inc.
Fleming, S., & Robinson, P. (2001). Grief and cognitive-behavioral therapy: The reconstruction of meaning. In M. S. Stroebe, R. O. Hansson, W. Stroebe, & H. Shut (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 647–669). Washington, DC: American Psychological Association.
Freud, S. (1957). Mourning and melancholia. In J. Strachey (ed., trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 14), pp. 243–258. London: Hogarth. (Original work published 1910).
Gabbard, G. O. (2010). Long-term psychodynamic psychotherapy (2nd ed.). Arlington: American Psychiatric Publishing, Inc.
Goldstein, E. G. (1995). Ego psychology and social work practice (2nd ed.). New York: The Free Press.
Gray, E. L. (1999). Treating women survivors of childhood abuse. In T. B. Northcut & N. R. Heller (Eds.), Enhancing psychodynamic therapy with cognitive-behavioral techniques (pp. 215–242). Northvale: Jason Arsonson Inc.
Guntrip, H. (1971). Psychoanalytic theory, therapy, and the self. New York: Basic Books.
Heller, N., & Northcut, T. (2011). The integration of psychodynamic and cognitive behavior. In J. Berzoff, L. M. Flanagan, & P. Hertz (Eds.), Inside out and outside in: Psychodynamic clinical theory and psychopathology (pp. 208–221). Lanham: Rowman & Littlefield Publishers, Inc.
Horowitz, M. J., Siegel, B., Holen, A., Bonanno, G. A., Milbrath, C., & Stinson, C. H. (2003). Diagnostic criteria for complicated grief disorder. Focus: The Journal of Lifelong Learning in Psychiatry, 1, 290–298.
Kendler, K. S. (2010). A statement from Kenneth S. Kendler, M.D., on the proposal to eliminate the grief exclusion criterion from major depression. American Psychiatric Association: DSM-5 Development. Retrieved from http://www.dsm5.org/about/Documents/grief%20exclusion_Kendler.pdf.
Klass, D., Silverman, S., & Nickman, S. (Eds.). (1996). Continuing bonds: New understandings of grief. Washington, DC: Taylor and Francis.
Klein, M. (1960). The psycho-analysis of children. New York: Grove Press.
Lister, L. (1991). Men and grief: A review of research. Smith College Studies in Social Work, 61(3), 220–235.
Malkinson, R. (2001). Cognitive behavioral therapy of grief: A review and application. Research on Social Work Practice, 11(6), 671–698.
Matthews, L., & Marwit, S. (2004). Complicated grief and the trend toward cognitive-behavioral therapy. Death Studies, 28(9), 849–863.
Menzies, P. (2009). Counterfactual theories of causation, The Stanford encyclopedia of philosophy (Fall 2009 Edition). In Edward N. Zalta (Ed.) http://plato.stanford.edu/archives/fall2009/entries/causation-counterfactual/.
Miehls, D. (1999). Treating depression. In T. B. Northcut & N. R. Heller (Eds.), Enhancing psychodynamic therapy with cognitive-behavioral techniques (pp. 265–284). Northvale: Jason Arsonson Inc.
Modell, A. (1976). The ‘holding environment’ and the therapeutic action of psychoanalysis. Journal of Psychoanalytic Association, 24, 285–307.
Neimeyer, R. A. (Ed.). (2001). Meaning reconstruction and the experience of loss. Washington, DC: American Psychological Association.
Northcut, T. B., & Heller, N. R. (Eds.). (1999). Enhancing psychodynamic therapy with cognitive-behavioral techniques. Northvale: Jason Arsonson Inc.
Osterweis, M., Solomon, F., & Green, M. (Eds.). (1984). Bereavement: Reactions, consequences, and care. Washington, DC: The National Academies Press.
Rando, T. A. (1993). Treatment of complicated grief. Champaign: Research Press.
Rose, E. (2005). www.cumc.columbia.edu/publications/invivo/vol4_mar_apr05/translation_rese. The Newsletter of Columbia University Medical Center. Retrieved 3/6/2012.
Shapiro, E. (2004). Family bereavement and cultural diversity: A social developmental perspective. Family Process, 35(3), 313–332.
Springer, C. (1999). “No way!” “You know?” “Whatever”: Clinical work with adolescents. In T. B. Northcut & N. R. Heller (Eds.), Enhancing psychodynamic therapy with cognitive-behavioral techniques (pp. 183–214). Northvale: Jason Arsonson Inc.
Steele, W. (2012). Grief and trauma: The confusion, the difference. National Institute for Trauma and Loss in Children. Retrieved 3/6/2012 www.assets1.mytrainsite.com/500051/confusiondifference.
Westen, D. (2001). Integrative psychotherapy: Integrating psychodynamic and cognitive-behavioral theory and technique. In C. R. Snyder & R. E. Ingram (Eds.) Handbook of psychological change: Psychotherapy processes & practices for the 21st century (pp. 217–242) Hoboken: Wiley.
Winnicott, D. W. (1969). The use of an object. International Journal of Psychoanalysis, 50, 711–716.
Winnicott, D. W. (1973). The child, the family and the outside world. Middlesex: Penguin.
Woolf, S. H. (2008). The meaning of translational research and why it matters. Journal of American Medical Association, 299(2), 211–213.
Worden, J. W. (2009). Grief counseling and grief therapy. New York: Springer.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Butler, S., Northcut, T.B. Enhancing Psychodynamic Therapy with Cognitive-Behavioral Therapy in the Treatment of Grief. Clin Soc Work J 41, 309–315 (2013). https://doi.org/10.1007/s10615-012-0406-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10615-012-0406-1