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

2 comments on “Grief Therapy in the Emergency Room

  1. Dr. Niemeyer,
    Thank you for your response to the question from the newly hired emergency Department Social Worker. I have worked in hospital setting for many years to include the emergency department of an urban based tertiary care facility. The pace is often very fast, tensions are frequently very high and the impulse to be rushed by physicians is prevalent. However I have found that the role of social work is not only necessary but mandatory particularly in traumatic situations. The ability of the social worker to demonstrate compassion and empathy along with their ability to provide emotional support is imperative. Taking the moments to locate a quiet space, sit with the family and allow them to not only talk but to engage them in story sharing about the patient can bring great peace to a tragic situation.
    Whenever possible escorting the family while they view the deceased will permit the family to step onto the grief journey from a position of reality. Nurses and physicians can be included in this process whenever they take the time, which also empowers them in their own ability to grieve the death of someone they have worked to save.

  2. Pingback: Shared via Larry Barber – Grief Therapy in the Emergency Room – Ask Dr. NeimeyerAsk Dr. Neimeyer | Loss, Grief, Transitions and Relationship Support

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