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GriefPerspectives
Local News
Scholar's Corner
Resource Review
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Greetings to Our Partners in Care!

Welcome to this month's edition of GriefPerspectives!


AUGUST WORKSHOPS are coming your way! Dr. Hoy is going to be back in town with great topics to share with us. He'll be here August 18-20, just click here to see a full schedule of what he will be speaking on.

Be sure to RSVP to me and let me know which workshop(s) you plan to attend!
I look forward to seeing you there!

Your partner & resource in the community,

Becky Lomaka
blomaka@oconnormortuary.com
(949) 581-4300 ext. 229
GriefPerspectives
 

What Grief Support Staff Need to Know

by William G. Hoy

(Excerpted from Dr. Hoy’s book on grief support groups to be published next year by Routledge).
 
At this writing, it has been well over a quarter century since I led my first bereavement support group. I had led teaching and training experiences many times in both large groups and small groups. I had worked with many individuals and families facing the crisis of a loved one’s death. But what I had never done—nor been specifically trained to do—was to lead a support group for bereaved people. From the vantage point of three decades, I now realize how little I knew about what I was doing.
 
At that time, I think I might have been too overwhelmed to realize how little I really knew about what I was doing. In any case, there had been precious little instruction in my educational training about how to lead a group. In fact, the closest I got to such training was a very fine course I took in college on small group communication. The principles I learned there, it seems to me from this vantage point all these years later, must have been instrumental in helping me get through that first experience leading a group.
 
What I now realize and what my ongoing research interviews with bereavement leaders bears out is that every group facilitator needs a basic understanding of the bereavement process and how it works as well as some fundamental understanding of how groups function. However, just because these are important concepts with which new leaders need to be familiar, it does not follow that classroom instruction is the most effective way to teach them. Even with more than 600 pages of “instruction” in his book on group psychotherapy, Yalom (1995) observed, “Though some introductory didactic sessions are useful, I find much of the material presented in this book can be best discussed with students around appropriate clinical material that arises over several months of an observed group” (pp. 513-514). In a brief, outline section, here are some of the concepts to be included in leader training
 
Reconstruction of meaning is a central activity of the grief experience. “What does all of this mean?” and “Who am I now that this person has died?” are fundamental questions bereaved people explore. Robert Neimeyer and colleagues have been instrumental in exploring this arena and in developing theoretical models of how meaning reconstruction functions in the lives of bereaved individuals (Gillies & Neimeyer, 2006; Neimeyer, 2000).
 
Also of importance for bereavement group leaders is an understanding of the context of ongoing attachment to the deceased. While death ends a physical life it does not erase the relationship to the person who died. The work of Klass, Silverman, & Nickman (1996) on continuing bonds has assisted clinical helpers and peer volunteers alike understand the texture of an ongoing connection to the deceased. Another area of basic knowledge for group facilitators is in the ongoing discussions about the relationship between gender and grief. While hypotheses abound about this connection, a helpful construct with growing empirical support is the notion of instrumental vs. intuitive “styles” of grief described by Ken Doka and Terry Martin (2010).
 
In their training, group leaders should also be helped to shed their over-reliance on culturally-popular approaches to simplifying grief into a set of stages or phases that proceed predictably from one to the next. While such models provide clean, easily compartmentalized understandings of the bereavement experience, they fail to grasp the nuances of individual experiences with loss and the utter un-predictability inherent in much of the process (Neimeyer, Keesee, & Fortner, 2000; Stroebe & Schut, 1999, 2010; Worden, 2009).
 
Twin concepts bereavement group leaders must grasp in their training are the importance of social support and the nature of disenfranchised grief (Doka, 2002). Social support as a vital component for the effective negotiation of the bereavement process is a central premise of what I have been talking about and writing about for many years—whether in the context of bereavement support groups, the ministry of faith communities to mourners, or to the role of funerals in the grief process. This support is lacking for many individuals, in part, because of the presence of culturally disenfranchised grief, a term coined by Kenneth Doka. The loss experience can become disenfranchised because the loss is not recognized in the mourner’s cultural group (such as the loss of a pregnancy) or because the mourner is not acknowledged (business partners and ex-spouses are two examples).
 
Program coordinators will want to insure that bereavement group leaders are well-versed in the diversity of cultural beliefs and customs related to loss. Especially in urban contexts, bereavement leaders are likely to work with individuals whose cultural customs are dissimilar to those of the facilitator; fascination with and a desire to learn about differing funeral rituals, beliefs about loss, and religious tenets are helpful attributes for group leaders. In groups, I have often invited participants to bring funeral memorabilia to share, including such items as symbols used, printed memorial tributes, and photos; in the group context, participants talk about the significance of these items in their grief, becoming both a meaningful time of sharing and a fascinating opportunity for comparing cultures (Hoy, 2013; Lewis & Hoy, 2011).
 
The assessment and recognition of complicated grief among group participants is also essential for group leaders. Both the language labeling the phenomenon of complicated grief and the way symptoms are classified have changed dramatically over the last 30 years. In its fifth edition published in 2013, the editors updating the Diagnostic and Statistical Manual of Mental Disorders stopped short of calling complicated grief a clearly defined clinical disorder, but the editors did provide a framework for encouraging further research. By categorizing complicated grief as a “condition for further study,” the DSM-5’s nomenclature for “Persistent Complex Bereavement Related Disorder” delineates “normal grief from persistent grief” (American Psychiatric Association, 2013, p. 790). In theory, this distinction should result in more effective intervention for the estimated eight to 15% of bereaved people whose grief does not proceed in an expected fashion (Keyes, et.al., 2014; Rando, 1993; Shear, et.al., 2011; Worden, 2009)
 
Some clinical scholars see complicated bereavement as a much wider issue than the ongoing chronicity of loss typically assumed to be envisioned in the “persistence” notation of the DSM-5. Worden (2009) has categorized four “constellations” of complicated grief, only one of which (“chronic grief”) seems to be subsumed under the current model of complicated grief. He believes delayed grief, exaggerated grief, and masked grief are three other often-overlooked constructs not specifically addressed in the emerging diagnostic criteria for Persistent Complex Bereavement Disorder.
 
This quick overview of “current thinking” in the bereavement field makes for important considerations for bereavement group leaders thinking about the content of their groups, program coordinators considering how to train and supervise group leaders, and front-line professionals considering how best to support the bereaved individuals and families they meet. Like most fields, the world of bereavement support and counseling continues to change. New clinical insights coupled with good research helps us find increasingly better ways to support bereaved people. Few items should rank as high on the agenda of bereavement group leaders and individual support personnel than keeping up with the times.
 
References:
Doka, K.J. (Ed.). (2002). Disenfranchised grief: New directions, challenges, and strategies for practice. Champaign, IL: Research Press.
 
Doka, K.J. & Martin, T.L. (2010). Grieving beyond gender: Understanding the ways men and women mourn (2nd ed.). New York: Routledge.
 
Gillies, J. & Neimeyer, R.A. (2006). Loss, grief, and the search for significance: Toward a model of meaning reconstruction in bereavement. Journal of Constructivist Psychology, 19, 31-65. doi: 10.1080/10720530500311182
 
Hoy, W.G. (2013). Do funerals matter? The purposes and practices of death rituals in global perspective. New York: Routledge.
 
Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry, 171(8), 864-871. doi:10.1176/appi.ajp.2014.13081132
 
Lewis, L. & Hoy, W. G. (2011). Bereavement rituals and the creation of legacy. In Neimeyer, R.A., Thornton, G.B., Harris, D. & Winokuer, H.G. (Eds.) Grief and bereavement in contemporary society: Bridging research and practice (pp. 315-323). New York: Routledge.
 
Neimeyer, R.A. (2000). Searching for the meaning of meaning: grief therapy and the process of reconstruction. Death Studies24(6), 541-558.
 
Neimeyer, R. A., Keesee, N. J., & Fortner, B.V. (2000). Loss and meaning reconstruction: Propositions and procedures. In R. Malkinson, S. Rubin, & E. Witztum (Eds.), Traumatic and nontraumatic loss and bereavement (pp. 197-229). Madison, CT: Psychosocial Press.
 
Rando, T.A. (1993). Treatment of complicated mourning. Champaign, IL: Research Press.
 
Shear, M.K., Simon, N., Wall, M., Zisook, S., Neimeyer, R.A.,…& Keshaviah, A. (2011). Complicated grief and related issues for DSM5. Depression & Anxiety, 28, 103-117. DOI 10.1002/da.20780
 
Worden, J.W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner (4th ed.). New York: Springer.
 
Yalom, I.D. (1995). The theory and practice of group psychotherapy (4th ed.). New York: Basic Books.


The Author:
For three decades, William G. Hoy has been counseling with the bereaved, supporting the dying and their families, and teaching colleagues how to provide more effective care. After a career in congregation, hospice, and educational resource practice, he now holds a full-time teaching appointment on the Medical Humanities faculty at Baylor University in Waco, Texas.

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Local News

Dr. Hoy is back in town

August 18 - 20!



Burning the Candle at Both Ends
2.0 CEU Credits

Tuesday, August 18th, 2pm – RCFE Workshop at Hospice Care of the West
9890 Research Drive, Suite 100, Irvine 92618 (map)

Unique Contributions of Pastoral Care in Life's Transitions
1.0 CEU Credit

Tuesday, August 18th, 5:30pm – Clergy/Chaplain Dinner & Workshop at
O'Connor Mortuary
25301 Alicia Pkwy, Laguna Hills, CA 92653 (map)

Spiritual Care at the End of Life
1.0 CEU Credit

         Wednesday, August 19th – Community Workshop at Temple Beth El
2A Liberty, Aliso Viejo, CA 92656 (map)

Today's Memorial Option: Helping Families Make Wise Choices 3.0 CEU Credits
Thursday, August 20th, 8am – Professional and Hospice at
Saddleback Memorial Medical Center
24451 Health Center Dr, Laguna Hills, CA 92653
Basement Level | Conference Room 1 (map)


To register early, email Becky at blomaka@oconnormortuary.com
or call (949) 581-4300 and please specify which workshop you are RSVP'ing for

 
FAITH LEADERS
Motivational Interviewing
Guest lecturer is Renee Sievert, RN, MFT and Master Coach

Please come learn about a useful technique commonly utilized in the therapeutic setting called Motivational Interviewing (MI). We recognize that many of your congregants will turn to you first for help with emotional and mental health issues. This technique will serve you as leaders to your congregations.

You will walk away with:
  • The ability to ask open ended questions
  • The ability to provide affirmations
  • The capacity for reflective listening
  • The ability to periodically provide statement to the client
Breakfast will be served
Wednesday, September 2, 2015
8:00 to 11:00 a.m.
Mission Conference Center, Rooms A&B
26726 Crown Valley Parkway
Mission Viejo

*Free parking (map with instructions) 

Please RSVP by Thursday, August 27, 2015
to Sandy Fant at (949) 364-1400 ext. 5399
or email to sandy.fant@stjoe.org
 
Scholar's Corner
 
Stahl, S. T., & Schulz, R. (2014). Changes in routine health behaviors following late-life bereavement: A systematic review. Journal of Behavioral Medicine, 37(4), 736-755. doi:10.1007/s10865-013-9524-7
 
Sarah Stahl and Richard Schulz from the psychiatry department at University of Pittsburgh have done a  nice job of reviewing recent research literature in the influence of bereavement on the health behaviors of older adults. The authors reviewed what they call six behavioral domains or “modifiable risk factors” that are important for maintaining health: physical activity, nutrition, sleep quality, alcohol consumption, tobacco use, and body weight status. Their review examined 32 research studies published between 1980 and 2011, finding varying levels of effect in the relationship between bereavement and health.
 
For example, the researchers found strong evidence for a link between bereavement and nutritional risk as well as involuntary weight loss; nutritional risk is usually defined in the literature as poor eating habits such as consumption of the wrong food (junk food, highly processed food) or simply not eating enough to maintain weight and vitality. The researchers also found moderate evidence for impaired sleep quality and increased alcohol consumption. The relationship between bereavement and physical activity was unclear in the studies reviewed.
 
Likely of most interest to our readers, however, are the clinical implications of this review. Like the researchers they are, Stahl and Schulz recommend ideas for studies to further examine elements of the relationship between bereavement and physical health. But they also note the importance of attending to physical health in the assessment and intervention of those who interact with bereaved older adults. Few bereavement groups seem to fully address the importance of nutrition, sleep, and exercise and fewer still seem to teach self-management strategies to their participants. With habits of nutrition, rest, and activity having such a profound effect on mental health as well as making such an important contribution to overall physical well-being, we must be the ones who lead the efforts to teach bereaved people how to cook for one, make good food choices, limit unhealthy foods, and interact around healthy food. Perhaps we can even model the behavior in our bereavement groups by replacing high calorie, sweet, fatty commercially-prepared baked goods with healthy snacks like granola bars, apples, bananas, and nuts.
 
Resource Review

On its website, the Dougy Center (www.dougy.org) in Portland, Oregon dubs itself as “The National Center for Grieving Children and Families.” If any group can claim such prominence, it is the Dougy Center. Begun in 1982, it is the oldest peer support center for bereaved children and their families in the United States, and it has served more than 30,000 children, teens, and family members. Their highly-acclaimed training and consultation has launched many dozens of other family bereavement centers around the world and their website is a treasure-trove of helpful information. Perhaps the most helpful aspect of the website is their searchable database of more than 500 other bereavement centers and programs (first item under the tab “Grief Resources.”)
Bookshelf
 
Stillion, J.M. & Attig, T. (2015). Death, dying, and bereavement: Contemporary perspectives, institutions, and practices. New York: Springer Publishing.
 
In 27 chapters, two of the pioneers of the field of thanatology (death, dying, and bereavement) have woven together history of the movement with much of the current thinking in the field. In this volume, they have drawn on the clinical scholarship and wisdom of some of the world’s leading luminaries in the field, including Kenneth Doka, Therese Rando, Robert Neimeyer, J. William Worden, Sandra Bertman, Tony Walter, and Jack Jordan. Whatever one is looking for in a survey of the field, it will be found here. Though the “list price” is US $ 75, enterprising shoppers can find copies on the internet for about $ 55.


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