11 Conclusions 297
In another study considering how childhood trauma and adult trauma
may interact, Fossion et al. (2013) explored how “Formerly Hidden Children”
(FHC) in World War II (WWII) Belgium coped with loss in adulthood. FHC’s
were Jewish children hidden during WWII and living under persistent, life-
threatening circumstances. Fossion et al. compared FHC who were currently
bereaved adults with bereaved adults who had also lived in Belgium as chil-
dren during WWII (but not under threat) and found that the FHC group had
decreased resilience compared to the control group. They posit that the early
trauma makes adults more vulnerable to later life stressors and bereavements.
They suggest that reinforcing resilience after each trauma or loss and helping
individuals develop a renewed sense of coherence would likely protect resil-
ience over time.
The typical symptoms of PTSD (dissociative symptoms, numbing, and
hypervigilance) may mask typical grief responses making it difficult to distin-
guish what treatment is needed for the trauma and what for the grief. Yet, a
reassuring aspect of this tangle is that both trauma and complex grief share an
intervention strategy: Successful treatments for both encourage the individual
to tell a repeated and coherent story of the loss and/or trauma (exposure).
Combining this with psychoeducation to help adjust expectations about grief
and trauma is part of the work as well. Developing the coherent story helps
individuals “relearn the world” (Attig, 2015) and may promote meaning-
making that helps them develop a sense that the world is predictable and
fairly safe again, a necessity for recovery from trauma in its many forms.
We believe that the Winnicottian notion of the safe holding environment
(Winnicott, 1965) is important here. For Winnicott, the holding environment
consists of fundamental “caregiving activities and processes that facilitate
growth and development” during infancy, and which is repeated in therapeu-
tic environments (Winnicott, 1965, p. 33). Therapeutic holding environments
may provide the bereaved with the sense of safety necessary to move back
and forth between the LO and RO of the dual process model. When clinicians
provide a space of safety and nurture, individuals may be most able to process
their trauma and grief
Grief Counseling Efficacy and Hidden Losses
The field of grief counseling is undergoing critical examination. Some
researchers question its validity (Currier, Holland, & Neimeyer, 2007; Jordan &
Neimeyer, 2003) while others (Larson & Hoyt, 2007) challenge such pessimis-
tic conclusions. At the 30th Annual Conference of the Association for Death
Education and Counseling in April/May of 2008, during the panel presen-
tation “Research that Matters 2008: Does Grief Counseling Work—Yet?,”
Currier et al. (2007) argued that there is not much evidence that grief counsel-
ing makes a difference. However, the lively discussion that ensued made clear
that research had failed to consider the client/worker relationship. Because
variables of empathy, positive regard and authenticity have been so critical
in understanding positive outcomes in research of other therapeutic methods
(Lambert & Barley, 2002), it is logical that research on grief counseling should
proceed similarly. We suspect that future research of this sort will demonstrate
