Published: 14/07/2005, Volume II5, No. 115 Page 44

Such is the pace of change in the NHS that managers often have to deal with a workforce essentially grieving for a system about to be abandoned.

Mourning is widely known as 'grief work' in psychotherapy.

Since Sigmund Freud proposed the idea of grief work in 1917, bereavement researchers and practitioners have generally accepted that a healthy process of adjustment needs the bereaved to confront and express their feelings about the death of a loved one, and that failure to do so is maladaptive.

But now, Wolfgang Stroebe, Henk Schut and Margaret Stroebe have reviewed previous medical research and conclude that the benefit of emotional disclosure is far from proven.

For example, one raft of research concerns the kind of investigation where subjects have to attend a laboratory for several consecutive days to write about either a recent traumatic loss or a trivial topic. Those who write about trauma are asked to express their deepest thoughts and feelings.

Psychotherapeutic theory suggests that writing about a traumatic event is beneficial because the task breaks down inhibition to confront threatening thoughts.

But the new paper has found that 61 randomised controlled trials on this kind of disclosure task raise serious doubts about its effectiveness in improving mental health. And studies that have investigated the efficacy of disclosure specifically on bereavement have yielded generally negative results.

Their own research suggests that the most common difficulty is emotional loneliness. It is possible, they argue, that this abates only with time.

It is useful for managers to know that much of the traditional approach to helping people cope with change or loss might be useless and that time - or a new relationship - is the only healer.

Maybe the secret is to get workers enthused about the new system to stop them mourning. Grief might even be telling a manager something useful: It is not so much that the old system is being mourned but that the new one is being resisted. The key for managers is to assist acceptance of the new.

Dr Raj Persaud is consultant psychiatrist at South London and Maudsley trust and Gresham professor for public understanding of psychiatry.