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Flashcards in Exam 2 Deck (90)
1

To serve people when they need comfort, counsel and direction. The more we know about people in grief, the better we can serve them. A well grounded understanding of the grieving process. You need to know about grief because that is where the families are. Help solve problems arising from the death of someone in a social circle.

Why funeral directors need funeral service psychology and grief counseling.

2

- a thorough understanding of grief and bereavement because the general public now has a more in-depth knowledge of the subject.
- be familiar with the purpose and techniques of counseling.
- the funeral director is not a grief counselor and does not and should not be providing therapy to bereaved individuals, but often does assume the role of a counselor.

Things a funeral director should understand

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Aside from performing the many legal, administrative and embalming tasks necessary in caring for the dead, are professional caregivers that work with bereaved families providing sensitive, effective intervention during a time of emotional need.

The funeral director

4

Involves assisting clients to better understand themselves and how to cope with their problems.

The helping process

5

Bring empathy and specific helping skills to guide clients in exploring their feelings and values, understanding their problems, making choices, and implementing changes in thought, affect and behavior.

The counselor

6

Hill and O'Brien three stage model for helping and Wolfelt's phases in a helping relationship fit together nicely to form this.

Matrix for helping clients

7

Phase 1: The client and funeral director enter into a helping relationship.

(calling a funeral director to handle arrangements and notification of the death is a "cry for help").

Phase 2: The building of a helping relationship.

(relationship moves from basic to helping as rapport develops between the funeral director and the family).
- Funeral director must be empathetic, warm, respectful, and genuine by showing concern and a willingness to assist the family however is necessary.

The Exploration Stage

8

Phase 3: Exploration and assistance in helping the family understand their alternatives.

- funeral director gathers information about the deceased, and that family's needs, wishes and feelings and then explains the options available to them.

Phase 4: Consolidation and planning.

- the funeral director assists the family in planning a funeral that meets their needs.

The Insight stage

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Phase 5: Implementation and action.

- funeral director implements the plan desired by the family.

Phase 6: Conclusion of the funeral process.

- funeral director assists the family with a sense of closure

Phase 7: Post funeral follow-up.

- "aftercare"

Action Stage

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- Confirm the reality
- Express their emotions
- Modify emotional ties with the deceased
- memorialize the person's life
- recognize and complete unfinished business
- receive emotional support
- be assured feelings are normal
- be accepted for where they are
- establish stability and security
- provide a basis for building new interpersonal relationships

Needs of the Bereaved

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Talking helps survivors to understand what has happened and to make it real. Every fiber of their emotions wants the death not to have happened.

Confirm the reality.

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Allow the expression of emotions. Avoid cliches or the suppression of feelings. Emotions can be expressed in the form of crying, screaming, or just quietly saying the words. The form that the expression takes does not matter, as long as the feelings are being expressed.

Express their emotions

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Survivors want to acknowledge how they felt about the deceased and to tell others about that person's life and what type of person he/she was. Can be done at a funeral or memorial service. This can mark the end of the old and the beginning of the new relationship.

-start a charity or scholarship in the person's name, wealthy may build a wing in a hospital or naming it after the person, not well off people it may be as simple as a headstone about the deceased's grave.

Memorialize the person's life

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People sometimes have to be shown different ways to complete unfinished business.
- talking to the deceased's body at a wake, writing a letter to the deceased, visualizing the person and telling them what you wanted to say while they were alive.

Recognize and complete unfinished business

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The love and attention given to a bereaved family from family and friends is comforting. They need nonjudgemental acceptance of people who care about them. If not from family and friends, then a counselor can supply this.

Receive emotional support

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May have the feeling of going crazy, feelings following a death can be foreign and strange to the survivor. A counselor can relieve the fear and anxiety experienced and assist the survivor in realizing these feelings are normal responses to a major loss.

Be assured feelings are normal

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Should not rush the mourning of a survivor. The bereaved should be accepted for where they are in the grieving process. A counselor can help a surviver clarify issues they have and help move them along in their journey.
- never tell the person that he/she should be somewhere other than where he/she is in the grieving process.

Be accepted for where they are

18

When a loved one dies, a sense of security and stability may seem lost or out of control. Stability and security will come back over time. Life will not be the same as before the death, but their new life can become stable and secure.

Establish stability and security

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People may fill the void of the person who has passed by strengthening present relationships and develop new interpersonal relationships. Not always simple and fast. Does not mean the person has forgotten the deceased, but they learn now to nurture and love a new person.

-can be friendship, love, or both.

Provide a basis for building new interpersonal relationships

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What have we lost?
What do we have left?
What may still be possible for us?

Schneider's important questions for the counselor for the family to be able to effectively cope with and adapt to loss.

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- The functional position or role the deceased played in the family can affect grief in family members

- an emotionally well integrated family may show minimal grief reaction at the time of death, but members may respond later with various physical or emotional symptoms or some type of social misbehavior.

- The value families place on emotions and the kinds of communication patterns that give a person permission to express feelings or not express feelings can affect mourning.

Worden's dynamics that contribute to a family's reaction to and recovery from a death.

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Suggests that many of the bereaved's symptoms were physical. Somatic distresses such as feelings of tightness in the throat, choking, shortness of breath, need for sighing, and empty feeling in the abdomen, and lack of muscular power is extremely common.

Lindemann, in relation to his grief syndome

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*Somatic or bodily distress
*Preoccupation with the image of the deceased
*Guilt relating to the deceased and the circumstances of the death.
*Hostile reactions
*The inability to function as one had before the death.

Lindemann's Grief Syndrome

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Postulated that a major task of grieving is to withdraw the libido that was invested in the deceased.

Sigmund Freud

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*Dejection
*Loss of interest in the outside world
*Loss of capacity of love
*Self reproach

Symptoms associated with the withdraw of the libido

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Soon after death has taken place, mourner is numb and tricks to block out recognition of the loss and painful feelings.

Engel's 6 step model : Stage 1- Shock and disbelief

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Awareness gradually increases, crying, acknowledges the loss, regresses to a more helpless state.

Engel's 6-step model: Stage 2- Developing awareness

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Funerary rights that evoke social support from family and friends.

Engel's 6 step model: Stage 3: Restitution

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Bereaved person reviews the death and focuses mental and emotional energy on the deceased and their entire relationship.

Engel's 6 step model: Stage 4: Resolving the loss

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Stripping the decease of negative qualities, suppresses any and all negative thoughts and emotions about the deceased and may feel guilt.

Engel's 6 step model: Stage 5: Idealization

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Represents the road toward a healthy accommodation to the loss wherein the griever comes to a place where there is less and less preoccupation with the deceased on all of its aforementioned forms.

Engel's 6 step model: Stage 6: Outcome

32

The greater the bereaved's dependence on the deceased (for identity, survival, social standing), the greater the chances that the grief will be intense and the outcome of mourning may be less than optimal.

3 factors that should be addressed:
- The strength of the attachment
-The security of the attachment
- The ambivalence of the attachment

The preexisting relationship

33

Natural, sudden or considered untimely. Generally natural is easier for the bereaved, sudden or untimely is more difficult.

Type of death

34

Refers to ways grievers mourned or failed to mourn prior losses. Not the effect of the losses, but how the bereaved perceived and responded to those events.
-Unashamed feelings, repression, fear of social disapproval, denial or escape, confront circumstances.

If this is the first loss for the griever, other life-changing events may interfere with the mourning process such as divorce, change in residence or employment, birth of a child, or economic reversal.

Previous losses

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- Recognition of the loss and acknowledgement of the unique grief of each family member
-Family must reorganize
-Family members must reinvest in this "new" family while maintaining a sense of connection with the deceased.


*Open and honest communication plus appropriate rituals and ceremonies can assist the family to accomplish each of these tasks.

Tasks of mourning

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-Bereaved children need to know that they are cared for.
-Bereaved children need to know that they did not cause the death out of their anger or shortcomings.
-Bereaved children need clear information about the death.
-Children need to feel important and involved.
-Bereaved children need continued routine activity.
-Bereaved children need someone to listen to their questions.
-Bereaved children need ways to remember the dead person.

Needs of Bereaved Children

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1. Children do mourn, but differences in mourning are determined by both the cognitive and emotional development of a child.
2. The loss of a parent through death is definitely a trauma, but does not in or of itself lead to arrested development.
3. Children between the ages of 5 and 7 years are particularly vulnerable group.
4. It is important to recognize that the work of mourning may not end in quite the same way for a child as it does for an adult.

Mental health practitioner needs to be aware of these things when dealing with children who've lost parents.

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1. Functional position the deceased played in the family.
2. Emotional integration of the family.
3. How families facilitate or hinder emotional expression.

Three main areas that need to be considered in the assessment of grief and family systems.

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The sickly one, the value setter, the scapegoat, the nurturer, and the clan head.
To the extent that the deceased had a significant role, his or her death is going to create a corresponding disturbance of functional equilibrium.

Functional position the deceased played in the family

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Well-integrated family - better able to help each other cope with death, even that of a significant family member, with little outside help.
Less-integrated family- May how minimal grief reaction at the time of a death, but members may respond later with various physical or emotional symptoms or some type of misbehavior.

Emotional integration of the family

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Understand the value families place on emotions and the kinds of communication patterns that give a person permission to express feelings or not express feelings.

How families facilitate or hinder emotional expression

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-After a death, ask to meet with survivors both individually and as a family unit.
-Identifying the restructured roles within a family is particularly helpful when there are teenage children involved.
-Role assignments are usually made subtly and nonverbally, but there are times when there is a direct verbal assignment.
-In any family situation there are various dyadic alliances formed. Usually these serve the various needs for power that individuals experience, or reinforce self-esteem.
-Making someone a scapegoat.
-Like individuals, bereaved families also struggle with making meaning out of the loss, and this is an important feature in family grief.
-Family therapy can address the impact of incomplete mourning on subsequent family life and interaction.

Family Intervention Approaches

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-Increase in maximum age over the years means a larger population of these people who have experienced bereavement, especially the loss of a spouse.
-widowhood affects three out of four women

-Interdependence
-multiple losses
-Personal death awareness
-Loneliness
-Role adjustment
-Support groups
-touch
-reminiscing
-discussing relocation
-skill building

Elderly and bereavement

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Many elderly widows and widowers were married for a long time which leads to deep attachments and to the entrenchment of family roles.
-bereaved frequently find themselves turning into someone who is not there.

Interdependence of elderly people

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With age, the number of deaths of friends and family members that on experiences increases. This can cause the person to be overwhelmed and be unable to grieve.
other losses:
-Loss of occupation
-loss of environment
-loss of family constellations
-loss of physical vigor, including physical disabilities
-the diminishing of one's senses
-for some, the loss of cerebral functioning

Multiple losses in the elderly community

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Experiencing loss of contemporaries such as a spouse, friends, or siblings may heighten one's personal death awareness.
-can lead to existential anxiety

Personal death awareness

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Many bereaved elderly live alone. Older windows and widowers are more likely to remain in the same home they lived in at the time of the death.
-Social and emotional loneliness
-elderly people who are forced to move out of their homes after losing a spouse may be at higher risk for mortality.

Loneliness of the elderly

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The loss of a spouse and its effect on day-to-day living maya be more disruptive for elderly men than for women.
-new roles and need help adjusting to the roles
-need skill building counseling

Role adjustment of the elderly

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Particularly important for the elderly individuals, whose network of support is often diminished and whose isolation is often pronounced.

Support groups

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Any time this is used as therapy, the counselor must be clear as to its suitability and must also attend to whether or not the person is willing or ready to be touched.

Touch

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Serves an adaptational function for the aging person and that is not a sign of intellectual decline. Contributes to the maintenance of identity. The past can be reworked.

Reminiscing

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-It is important to recognize that not everyone in a family will be working on the same task of mourning at the same time.
-Individual members of a family will sometimes be reluctant to come in for counseling with the entire group.

Two points in family vs individual needs

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-Ambivalent with unexpressed hostility - inhibits grief and usually portends excessive amounts of anger and guilty that cause the survivor difficulty.
-Narcissistic- deceased represents an extension of oneself. The admit to the loss would necessitate confronting a lost of part of oneself, so the loss is denied.
-Death may reopen old wounds.
-In some relationships, we grieve for what we wished for and never had or will never have.
-Highly dependent relationships are difficult to grieve.
-Most people who lose a significant other will feel somewhat helpless and see themselves in a helpless position.

Relational factors

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-The loss is uncertain - solider that may be MIA, or the opposite, believe a MIA solider is still alive.
- Multiple losses, such as those occurring in earthquakes, fires, and airplane crashes, or when an accident kills may members of a family.

Circumstantial factors

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-People who have had abnormal grief reactions in the past have a higher probability of having an abnormal reaction in the present.
-People who have had a history of depressive illness may also run a higher risk of developing a complicated reaction.
-Influence of early parental loss

Historical factors

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Related to the person's character and how it affects his or her ability to cope with emotional distress.
-personalities do not tolerate dependency feelings
-self-concept

Personality factors

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-Socially unspeakable- suicides, accidents
-When the loss is socially negated
-absence of a social support network

Social factors

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-Shame
-guilt
-blame
-anger
-low self-esteem
-fear
-distorted thinking

Feelings experienced after suicide of a loved one

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Predominant feeling
-stigma associated with suicide, can be influenced by the reactions of others.
- can dramatically alter relationships within the family unit
-stigma for attempted suicide that fails, negative feelings from people around them can cause successful suicide

Shame (in relation to suicide)

60

Survivors of suicide victims take responsibility for the action of the deceased and have a gnawing feeling that there was something they should or could have done to prevent the death.
-may feel that they need to be punished
- react in a way that causes society to punish them
-sometimes go to extremes to get the punishment they think they deserve

Guilt (in relation to suicide)

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A manifestation of guilt. Some people handle their own sense of culpability by projecting their guilt onto others and blaming them for the death.
-attempt to affirm control and find a sense of meaning in a difficult to understand situation.

Blame (projecting guilt onto others), in relation to suicide

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Perceive death as a rejection.
-intensity of their rage often makes them feel guilty.

Anger (in relation to suicide)

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Correlate of anger, bereaved often speculate that the deceased did not think enough of them or they would not have committed suicide.
Indictment of:
-the survivor's self worth, leading to low self-esteem, and intense grief reactions.

Low self-esteem (in relation to suicide)

64

Higher anxiety among survivors of those who die by suicide than among survivors of those who died natural deaths.
-primary fear is their own self destructive impulses
-sense of fate and doom
-anxiety concerning genetic transmission of the tendency

Fear (in relation to suicide)

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Survivors of suicide victims often, especially children, need to see the victim's behavior nor as a suicide, but as an accidental death.
-develops distorted communication in families

Distorted thinking (in relation to suicide)

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-Reality test the guilt and blame
-Correct denial and distortions
-Explore fantasies of the future
-Work with anger
-Reality test the sense of abandonment
-Help them in their quest to find meaning in the death

Counseling survivors of suicide victims

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May take more time in the case of suicide victim survivors. Much of the guilt felt with be unrealistic and yield itself to reality testing, giving the person some sense of relief.

Reality test the guilt and blame

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Survivors need to face the reality of the suicide in order to be able to work through it.
-sometimes plagued with images of the scene and exhibit symptoms of PTSD
-People not there sometimes imagine an image worse than what actually happened
-explore graphic images
-redefine the image of the deceased
-challenge the illusion of the deceased being all good or all bad

Correct denial and distortions

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Use reality testing to explore the fantasies survivors have as to how the death will affect them in the future.

Explore fantasies of the future

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Allows for its expression while reinforcing personal controls the survivor has over these feelings.

Work with anger

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Perhaps one of the most devastating results of a suicide. This feeling is extreme in the case of a suicide.

Reality test the sense of abandonment

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There is a need to search for an answer to why the loved one has taken his or her life and, in particular, to determine the state of mind of the deceased before the death.

Help them in their quest to find meaning in the death

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1. Contact the person or family right away, before distortions set in.
2. Watch for acting-out potential in counseling.
-try to fulfill their negative self image by getting the counselor to reject them, suicide watch, psychiatric problems.
3. Many survivors of those who die by suicide feel that no one can understand them unless they have undergone a similar loss experience.
4. Counseling should involve the family and the larger social system, if possible. However, don't assume that all families will fall apart.

Additional intervention suggestions for survivors of suicide victims

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-unreality about the loss
-feelings of guilt
- need to blame
-involvement of medical and legal authorities
-sense of helplessness
-agitation
-unfinished business
-need to understand

feelings associated with sudden death

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-help should be firmly offered
-help the survivors actualize the death
-be familiar with the hospital and ensure the physical comfort of the family
-be careful not to handle your own sense of helplessness through the dispensation of platitudes.
-offer follow-up care, either from yourself or community or religious resources.

Counseling survivors of sudden death victims

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-Intrusive images
-Avoidant thinking
- Hyperarousal (hearing a car backfire and thinking it is a gunshot).

Central features of trauma

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-The death occurs without warning in babies that appear healthy
-There is the absence of a definite cause, which gives rise to considerable guilt and blame.
-The involvement of the legal system
-The impact of this kind of death of siblings
-Potential for partners suffering such a loss to break up is high.

Difficulties that arise from SIDS deaths.

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-How the parents are treated in the hospital
-The importance of autopsy permission cannot be overemphasized
-Important for the physician to provide information to the family about SIDS.
-Families can be counseled about subsequent pregnancies.

Better helping SIDS deaths

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-Concern about the mother's health
-Concern about whether she will be able to have children.
-Self-blame (self-directed anger)
-Out of a sense of helplessness, the husbands find an ally in the physician, who may be male and who focuses on the fact that the couple can conceive and have another child soon.
-The longer the pregnancy, the more intense the grief, especially for the father.

Concerns about miscarriages/stillbirths

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-Important for the physician to let the mother see the dead child.
-Need to be able to talk about the loss
-Need to be able to tell other children the mother may have
-Few established rituals for a miscarriage to help make the loss more tangible and facilitate the expression of grief.

Miscarriage grief management

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-Contagion
-stigma
-lack of social support
-untimely deaths
-multiple losses
-protracted illness and disfigurement
-neurological complications

Concerns of AIDS

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-Family structure
-Religion
-Government
-Economics
-Age
-Educational level
-Mobility

The American National Character

83

Majority of the people are living in the nuclear family structure within the guidelines of the modified extended family system.
-Significant percentage of families is made up of two individuals living together outside the boundaries of marriage.

Family structure

84

Basically Judeo-Christian in the US. Overall purpose is the doctrine of atonement. Actual physical aspects of a funeral rite is the permit the bereaved family to call into use their faith and belief concerning life and death.

Religion

85

Democratic nation with freedom of choice in making many decisions, the American public is free to select the funeral rite of their choice, whether it be the traditional funeral, adaptive service or immediate disposal.

Government

86

As a country operating under capitalistic business theories, America is a nation of free enterprise.
-free to open own funeral establishment
-not funded by the government in any way

Economics

87

Youth oriented
Tendency to displace the old
Death denying

Age

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High degree of education available
encouraged to partake in further education
Continuing education for funeral directors required by some states.

Educational level

89

America is a nation on the go.
Very mobile society with evidence of neo-localism.
Relocation is now an accepted way of life.

Mobility

90

-Use of the funeral home
-Use of embalming
-Viewing the remains
-Visitation at the funeral home
-The funeral director
-The use of credit
-Disposition of the remains
-The format of American religious and organizational funeral rites and ceremonies.

Basic American customs in funeral service today