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Grief Perspectives
Research that Matters
Professional Bookshelf

Social Support's Vital Role in Grief

By William G. Hoy

Recent research studies have borne out what clinicians have known intuitively for many years—there is a decided difference between the ways people resolve losses when they are connected to a supportive community. While good social networks do not prevent all complication in the bereavement process, the right support from the right people seems to be an effective tool in managing crises and loss.
A Finnish study from several years ago interviewed 52 bereaved mothers, revealing that the study participants felt most supported by family and close friends. Interviews and surveys conducted at least one year after the child’s death showed evidence of greater personal growth, less blame and anger, and less disorganization for the mothers who had good personal support versus the mothers who had little personal support or received only professional assistance.
The mothers in this study overwhelmingly reported that, if they were in a support group, they wanted it to be a support group of parents with similar experiences since in their opinion, only fellow sufferers would understand the experience of losing a child. The negative support reported by these mothers consisted primarily of interference from other family members and the dissolution of long-time friendships (Laakson & Paunonen-Ilmonen, 2002).
More than a decade ago, Howard Stone and colleagues (Stone, Cross, Purvis & Young, 2004) at the Brite Divinity School of Texas Christian University studied how church members supported each other during crisis. Similar to the results of previous research, Stone and his colleagues found that the social support afforded by active involvement in a faith community was a strong buffer against many of the long-term negative effects of the crisis. Reflecting on the ways their interviewees felt supported by the community, the presence of caring friends spoke volumes. The researchers wrote,
“One of the most striking themes of the interviews in our sample was the immediate and profound impact of these (acts of kindness). Indeed, the simplest acts—merely showing up at the grieving person’s house and doing the dishes, for example
—appear to be the most profoundly helpful to those in crisis”
(pp. 413-415).
In the congregation studied, every active member belonged to a shepherd group, a small “family” of 20 to 30 people with a trained leader. On a number of occasions reported by the interviewees, members of the person’s shepherd group actually arrived at the hospital or home before the subject’s own family members. The researchers first saw the “acts of kindness” as helpful because they removed some of the “burden” of the crisis so that the subject could focus on more pressing needs. “Soon, however, we became aware that they were perceived as acts of solidarity or support—a physical way of expressing concern, love, and care” (p.418).
A third study pointing to the efficacy of social support was one engaged in by Lauren Vanderwerker and Holly Prigerson at the Yale University School of Medicine. In their study (Vanderwerker & Prigerson, 2004), 293 bereaved individuals were interviewed during the first year after the death. While Vanderwerker and Prigerson were examining the role of technologically advanced systems for support (i.e. cellular telephone and internet use), the study conclusively demonstrated that overall social support was protective against Major Depressive Disorder, Post-Traumatic Stress Disorder, and complicated grief, as well as being associated with an overall better quality of life.
Interestingly, the word often used to describe these kinds of technologies—“connectivity”—implies the presence of and importance of social support. Vanderwerker and Prigerson demonstrate amply the important benefits to bereaved people of such technologies as online grief support chat rooms and the ready accessibility to others that cellular phone service provides, making it possible to largely banish isolation. With the rapid growth of Facebook, Instagram, and other social networking sites since the publication of this study, one might expect this technological support factor to have become more significant.
Swedish researchers (Benkel, Wijk, & Molander, 2009) interviewed spouses, adult children, siblings and friends of deceased palliative care patients. Study participants were interviewed shortly after the death and again at one year post-loss. Confirming earlier studies, survivors indicated they both needed and generally received good support from family members and friends. Those who described dysfunctional or non-existent support networks tended to need more professional support than those who had functional support systems in place before the death.
Ghesquiere (2013-14) interviewed older adults who were participating in a randomized clinical trial for an intervention support group for people with bereaved people. Prior to enrollment in the 13-week group, these subjects sought social support and viewed the group intervention positively, but had generally found support lacking from family and friends. None of the study participants received ongoing support from a religious community and most described attempts of family and friends to “change the subject” when the deceased’s name came up (p. 11). Prior to finding the complicated grief treatment group, participants had generally been frustrated in attempts to connect with mental health professionals, usually because the focus of treatment was not specific to grief or because the therapist seemed to lack experience with grief. In some cases, participants described mental health professionals’ incompetence with one quoting a therapist as saying, “’In three months you will feel better; in one year you will be better.’ But three months and a year went by and I felt worse” (p. 12).
These research studies reflect varied approaches to learning about social support from individuals whose loved ones died from a diversity of causes and reflecting differing relational statuses. Social support is extremely important in most (though not all) cases. However, counselors and other helpers must still grapple with two important issues: 1) how do we know whether a bereaved client senses support? and 2) what do we do when perceived support is lacking?
How to assess levels of social support. While most bereaved individuals seem to readily admit the level of social support or the lack of it, helpers must be sensitive to those who do not. I have worked with many older adults who initially indicate they have “wonderful” support from their adult children. Upon further inquiry, however, these same adults sometimes admit to feeling alone in grief. The questions I have learned to ask to assess levels of support are these:
  1. Who is “in your camp?” In other words, who do you feel like is really “there for you” in loss?
  2. What specifically do these people do to communicate their concern and help?
  3. Would you like connections to more people or to receive different kinds of support?
In addition to conversations designed specifically to assess levels of social support, helpers need to listen attentively to words used to describe other aspects of the bereaved individual’s relationships with others. Sometimes bereaved people will say things like, “I used to be involved in this great church…” or “People always thought we were a close family…” Learning the “rest of the story” after such comments can provide important details about present levels of social support.
What to do in the absence of strong social support.
While never disparaging support that is perceived by the bereaved person to be helpful and adequate, helpers will want to be ready to offer suggestions for support outside his or her natural support system; bereavement support groups provide one possible avenue for such support. Helpers should point out to bereaved individuals, however, that every group develops its own “personality” and not every bereaved person fits well within every group. Knowing the support groups presently operating in a community, how they are structured (open to participants at any time; meeting for a set duration of time; focused on a particular loss) is essential.
Interaction with a caregiving professional may also be beneficial, but again, knowledge of the credentials and approaches used by various professionals is essential. When interviewing potential clinicians and other caregiving professionals, I ask questions about how they view the role of loss in mental health, who the bereavement theorists and clinicians are who have most influenced their thinking, and what specific training they have received about dealing with loss. A common theme heard in both research (Ghesquiere, 2013-14) and clinical practice is disappointment with some professionals’ experience with grief. When asked to refer bereaved individuals to resources outside of my geographical area, I begin by searching the membership directory and the “Find a Specialist” link maintained by the Association for Death Education and Counseling (
For those of us who provide care to bereaved people, these studies and our own clinical observations provide conclusive evidence. Our work with bereaved people is most effective when we help them connect—with families, friendship circles, faith communities, and support groups of people who have experienced similar losses. Indeed, grief is not intended to be a solitary, isolated issue. We are made for community, and we grieve best when that loss is supported by a network of social support.
Benkel, I., Wijk, H., & Molander, U. (2009). Family and friends provide most social support for the bereaved. Palliative Medicine, 23, 141-149.
Ghesquiere, A. (2013-14). “I was just trying to stick it out until I realized that I couldn’t”: A phenomenological investigation of support seeking among older adults with complicated grief. Omega: Journal of Death & Dying, 68 (1), 1-22.
Laakso, H. & Paunonen-Ilmonen, P. (2002). Mothers’ experience of social support following the death of a child. Journal of Clinical Nursing, 11, 176-85.
Stone, H.D., Cross, D. R., Purvis, K.B. & Young, M. J. (2004). A study of church members during times of crisis. Pastoral Psychology, 52, 405-421.
Vanderwerker, L.C. & Prigerson, H. G. (2004). Social support and technological connectedness as protective factors in bereavement. Journal of Loss & Trauma, 9 (1), 45-57.

William G. (Bill) Hoy is an educator, counselor and author who has specialized in end-of-life and bereavement care for nearly 30 years. Dr. Hoy’s passion is equipping the next generation of physicians and other healthcare professionals through his research, writing and teaching responsibilities on the clinical faculty in Medical Humanities at Baylor University. His newest book is Do Funerals Matter? The Purposes and Practices of Death Rituals in Global Perspective (Routledge, 2013).

Since this month’s lead column reviews several important research studies about social support in grief, this month’s Research that Matters has been combined with the lead article. Research that Matters will return to its usual place in next month’s issue of GriefPerspectives.

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Kodanaz, R.B. (2013). Living with Loss, One Day at a Time. Golden, CO: Fulcrum.
Reviews in this column most often reflect books for the helper’s work with bereaved people. Once in a while, however, we review a book designed especially for helpers to suggest to bereaved clients; that is the case with Rachel Kodanaz’ collection of 365 daily inspirations, Living with Loss, One Day at a Time. Kodanaz became a widow at age 31. Far from having led a “charmed life,” Kodanaz tells readers that she had faced many challenges during the first three decades of her life. However, in spite of the challenges, she writes, “I found the perfect husband, gave birth to a wonderful daughter, maintained a fulfilling career, and lived in a house full of love, laughter, and happiness” (p. xv).
Assuming at first that her “perfect life” ended when Rod died at age 32, she realized after “many years of tears and sleepless nights” her life had not ended—it had changed. This book is the accumulated wisdom from two decades of learning to be changed by grief. Far from the typical “my story in grief” genre, this book is conveniently arranged into an entire year’s worth of daily inspirational thoughts. Like most books, helpers nor bereaved individuals will likely agree with every sentiment. Nevertheless, this book is a fine work of inspiration that I would gladly commend to a bereaved individual. It is filled with hope and practical direction for the journey of grief.

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