Summary

• Since the early 1980s there has been a change in theoretical framework from one in which grieving was seen as a finite process in which grief was resolved when emotional investment in the deceased was withdrawn (decathexis) to one in which the bereaved person has a continuing but different kind of relationship with the dead person. 'The inner representation of who died changes as mourners move through the life cycle and their sense of self and other continues to evolve' (Klass, Silverman & Nickman, 1996).

• The search for meaning may take place at several levels. An official inquiry may explain the specific cause of death for an individual but cannot answer the question 'why did the individual I love die?'

• Changing social patterns in Western society such as increased family mobility and the growth of a more secular society have contributed to the development of bereavement services such as self-help groups, counsellors and new social rituals around death.

• There is little unequivocal research evidence that proactive bereavement intervention is effective and there is evidence that it can do harm to some individuals. It may be beneficial for bereaved people who request help. Despite this there is both a social and professional expectation that bereavement services should be provided (National Institute for Clinical Excellence (2004) Scottish Executive: NHSQIS, 2002).

• Recent meta-analyses and reviews of bereavement studies have identified ways of developing the evidence base to identify who might be helped by which intervention, at what point and by whom. The assumption that grief counselling should be available more widely should be treated cautiously until such evidence is available.

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