The Dutch study on therapy

I read on this site that a Dutch study showed “that psychotherapy doesn’t work” with families in which there were suicides. To put it another way, people whose loved ones killed themselves have a hard time getting over their grief and psychotherapy didn’t seem to help.

Marieke de Groot, at the University of Groningen, and team members explain that "complicated grief" has an unusually long duration of symptoms, which include avoiding reminders of the dead person and having feelings of purposelessness, yearning, disbelief and bitterness. The researchers' goal was to prevent this complicated grief from taking over the subjects' lives.

As the author of a book on such matters (SILENT GRIEF: Living in the Wake of Suicide) I found it difficult to believe that therapy didn’t help. I myself have had many family suicides, and I found that therapy was a tremendous help.

So what’s up?

I read the report as carefully as I could, and here’s what I think is going on.

First of all, the therapy used was “family-based” cognitive-behavioral therapy. This kind of therapy helps people re-arrange the stories they are telling themselves. So, for instance, for depressed people, the “I’m worthless” story is re-arranged to “I only think I’m worthless. Let me count the ways I’m not so bad.” (I’m giving this a very short-hand description!)

As the researchers in this study said:

The intervention was designed "to offer relatives a reference frame for their grief reactions, engage emotional processing, enhance effective interaction, and improve problem solving," de Groot and associations explain.

But is cognitive-behavioral therapy the best kind of therapy for people who are not only depressed because of grief, but subject to Post-Traumatic Stress Disorder? (For instance, finding the body.)

Families with suicides have usually been going through lots of stress long before the suicide. A trouble youth didn’t just pop up and kill himself. This family has had a lot of long-term problems, including family conflicts.

A family where there is one suicide is often a family where there are more than one suicide, often in the distant past. This fact has ramifications and reverberations, even if one generation has hidden the fact from another generation.

I know from my own experience that there’s a lot of anger at people who are suicidal. We think “how dare you threaten us like this?” So when the suicide occurs, we may be guilty (self-blame) as well as angry that they’ve finally gone through with it; and, sometimes, relieved.

It’s a very complicated mess.

Perhaps what is needed is not short-term therapy in groups (families) but longer therapy that deals with some of the feelings of loss that relate back to earlier events in a person’s life; to the conflicts (I loved him; I hated him) that are brought on by suicide. And to the deeper waves of feelings that are not necessarily related to thought processes – the usual meat and potatoes of cognitive-behavioral therapy.