Grief Therapy in the Emergency Room

Dear Dr. Neimeyer,

I know from you writings and my own experience as a social worker in other settings that people contending with a traumatic loss benefit from having a safe space to slowly and fully tell the story of their loved one’s death, and reflect on its meaning for their lives. This can be very powerful and very healing, as they sort through a confusing and painful experience and their feelings about it with the therapist, without any judgment. But I recently have taken a position in a hospital, where I work in the Emergency Room, and interact with families as they accompany injured loved ones or those who have had a sudden medical event (like a cardiac event or aneurism). Obviously, the priority in the department is saving the life of the patient–which is not always possible–and time for the family is limited and secondary. So my question is, can your emphasis on the therapeutic impact of storytelling have any role in such an environment?

Dear Deborah–

Having spent a bit of time in Emergency Room settings myself, both as a treatment team member and visitor, I can readily imagine the central importance of stabilizing and life-saving medical interventions in that environment, even if the patient is commonly then transferred to another medical unit or service for less urgent care or follow-up. In just this way, you might find it helpful to consider the “short stories” you invite or hear spontaneously from family members (or when conscious and perhaps mending, the patients themselves) to be psychological “first aid” whose goal is to help stabilize the teller as well as inform the listener. Asking a simple question such as “What can you tell me about what happened?” often opens the door to a meaningful, if brief exchange, giving the teller an initial opportunity to begin processing and making sense of a troubling experience for him- or herself, sequencing events and filling in details. Aside from the intrinsic value of the story, which can provide practical information to orient the medical team, being given the chance to relate it can also validate the contribution of the teller to the loved one’s treatment, and begin to build a sense of connection and trust between the family and at least one member of the treatment team. In more traumatic cases or when the patient dies, the family is then more likely to accept a referral for outpatient psychological services when indicated, in which their initial narrative processing of the event can be expanded considerably into a fuller restorative retelling of a troubling life transition.

–Dr. Neimeyer

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