Funeral Service Counseling - MSFS 401

Attachment Theory

Created by John Bowlby; gives us a way to understand the tendency for human beings to create strong affectional bonds w/ others and a way to understand the strong emotional reaction that occurs when those bonds are threatened/broken; attachments are based on safety and security, developed early in life

Engel and mourning

Stated that mourning is similar to the process of healing (takes time until restoration of function); the loss of a loved one is psychologically traumatic to the same extent that being severely wounded is physiologically traumatic; grief represents a departure from the state of health and well-being

Normal/Uncomplicated grief

Encompasses a broad range of feelings and behaviors common after loss

Lindemann’s characteristics of normal/acute grief

Somatic/bodily distress of some type, preoccupation w/ the image of the deceased, guilt related to the deceased/circumstances of the death, hostile reactions, the inability to function as one had before the loss, develop traits of the deceased in their own behavior

Sadness

Most common feeling during grief; not necessarily manifested by crying, but often is; Park and Weiss proposed that crying is signal that evokes a sympathetic/protective reaction from others and established a social situation in which the normal laws of competitive behavior are suspended; not allowing sadness will cause complicated grief

Anger

Can be confusing to the survivor, frequently expressed after loss; can become the root of problems during the grieving process; comes from 2 sources: (1) a sense of frustration that there was nothing to prevent the death and (2) a kind of regressive experience that occurs after the loss of someone close

Normal grief behaviors - Guilt and self-reproach

Can be over not being kind enough, not taking the person to the hospital sooner, not doing something for the deceased/arguing with the deceased, etc.; common experience of survivors

Normal grief behaviors - Anxiety

Can range from a light sense of insecurity to a strong panic attack; comes from 2 sources: (1) fear of not being able to take care of oneself and (2) a heightened sense of personal awareness

Normal grief behaviors - Loneliness

Emotional vs social loneliness; social can be lessened by socializing; emotional is “broken hearted”, particularly expressed by those who have lost a spouse

Normal grief behaviors - Fatigue

Can be apathy or listlessness, can lead to clinical depression; can be surprising or even distressing for someone active

Normal grief behaviors - Helplessness

Closely related to anxiety and loss of help from the deceased; spouses

Normal grief behaviors - Shock

Usually occurs related to a sudden death

Normal grief behaviors - Yearning

AKA pining; usually a normal reaction in widows; it diminishing is usually a sign mourning coming to an end

Normal grief behaviors - Emancipation

Can be a positive feeling after the death of someone that was controlling/a burden

Normal grief behaviors - Relief

After a long/painful illness of the deceased

Normal grief behaviors - Numbness

Lack of feelings early on in mourning; between denial and shock

Normal grief behaviors - Physical sensations

Hollowness in stomach, tightness in chest and throat, oversensitivity to noise, sense of depersonalization, breathlessness/feeling short of breath, weakness in the muscles, lack of energy, dry mouth

Normal grief behaviors - Cognitions

Disbelief, confusion, preoccupation, sense of presence (yearning), hallucinations (visual and auditory)

Normal grief behaviors - Behaviors

Sleep/appetite disturbances, absent-minded behavior, social withdrawal, dreams of the deceased, avoiding reminders of the deceased, searching/calling out, sighing, restless hyperactivity, crying, visiting places/carry objects that remind of deceased, treasuring deceased’s objects

Grief (vs depression)

Experienced in waves, diminishes in intensity over time, healthy self-image, hopelessness, response to support, overt expression of anger, preoccupation with deceased

Depression (vs grief)

Moods and feelings are static, consistent sense of depletion, sense of worthlessness and disturbed self-image, pervasive hopelessness, unresponsive to support, anger not as pronounced, preoccupation with self

Mourning

Outward expression of grief; the process of adjustment and adaptation to a loss (mourning indicates process, grief indicates personal experience of loss)

“Stages” in mourning

9-12 stages are mentioned; not as noted since people took these “stages” too literally

“Phases” in mourning

Used by Parkes, Bowlby, Sanders, and others; often seen as phases the mourner must pass through

Phases of mourning - Parkes

Used 4 phases; (1) numbness, (2) yearning, (3) disorganization/despair, (4) reorganized behavior

Phases of mourning - Sanders

Used 5 phases; (1) shock, (2) awareness of loss, (3) conversation withdrawal, (4) healing, (5) renewal

John William Worden’s 4 Tasks of Mourning

(1) To accept the reality of death, (2) to experience the pain of the death, (3) to adjust FINISH

Worden’s 4 Tasks - To accept the reality of death (1)

Griever begins to grasp that the person has actually died (intellectual vs emotional acceptance), traditional rituals assist the bereaved in moving forward, ask for details about death in stories from family, not what to/not to say

Worden’s 4 Tasks - To experience the pain of death (2)

Necessary to acknowledge and work through the pain, avoidance comes in many forms, hinders one’s ability to heal, and can cause complicated grief (active suicidal/homicidal ideations, negative hallucinations)

Worden’s 4 Tasks - To adjust to an environment in which the deceased is missing (3)

Grieving person may need to learn new skills/perform functions that the person Wordenwho died had previously taken care of (during acute grief), bereaved tries to regain sense of control in life, help family start thinking about the “legacy” their loved one will leave (story telling, memory boxes, hand molds, etc.), grieving person’s identity is gone along w/ relationship w/ decedent

Worden’s 4 Tasks - To find an enduring connection w/ the deceased in the midst of embarking on a new life (4)

Bereaved finds new ways to develop continuing bonds w/ the deceased, create a new “normal”, create/continue traditions/rituals which allow them to honor the memory of the person, extremely prevalent to relationships where deceased was highly valued and/or looked up to

Harvard Child Bereavement Study

Conducted by Worden and Phyllis Silverman; followed 125 parentally bereaved children and their families and provided insights into the process of childhood grief; shows that large number of children stayed connected to deceased parent by speaking to, thinking of, dreaming of, and feeling watched over by parent

Vamik D. Volkan - Mourning

Mourning ends when mourner no longer has need to reactivate representation of the dead w/ exaggerated intensity in the course of daily living

Shuchter and Zisook

Survivor’s readiness to enter new relationships depending not on “giving up” the dead spouse, but on finding a suitable place for the spouse in the psychological life of the bereaved (place that’s important but leaves room for others)

Mediators of mourning

How people grieve is determined by many factors and we must understand how these tasks are mediated by various factors; the 7 MofM are a list of variables that influence the experience and intensity of grief for an individual; developed by J. William Worden

Mediator of mourning #1 - Who the person who died was

What sort of kinship existed between the deceased and the survivor (spouse, mother, child, etc.), closer relationship usually intensifies grief

Mediator of mourning #2 - The nature of attachment

The degree of grieving also dictated by nature of attachment to deceased; strength of attachment (greater love, greater grief), security of attachment (necessary to sense of wellbeing), ambivalence in relationship (conflict can lead to guilt/anger), conflicts w/ deceased (unfinished business, especially w/ sudden death), dependent relationships (grieving more difficult if dependent)

Mediator of mourning #3 - How the person died

Deaths can be natural, accidental, suicidal, homicidal; proximity (greater distance creates unreality about death), suddenness/unexpectedness (more time to prepare brings easier grief), violent/traumatic deaths (long lasting and may cause complicated grief), multiple losses (too much grief/pain), preventable deaths (guilt/blame/culpability), ambiguous deaths (not knowing if dead), stigmatized deaths (less support)

Mediator of mourning #4 - Historical antecedents

To better understand how someone will grieve, find out if they’ve experienced loss in the past and how they dealt w/ that loss; unresolved loss can transcend several generations and affect current mourning process; person’s mental health history can play big factor

Mediator of mourning #5 - Personality variables

Age and gender (women and men/older and younger grieve different), coping styles (changing thoughts/acts that individual uses to manage internal/external demands of stressful situations), attachment style (usually developed as child, healthy to internalize deceased into themselves), cognitive style, optimistic/pessimistic, ego strength (self-esteem and self efficacy), assumptive world (beliefs and values/spirituality)

Problem solving coping style

Change to a method that works or ineffectively quit when that one method doesn’t work

Active emotional coping style

Redefinition, or the ability to find something positive in a bad situation (using humor, venting, accepting support)

Avoidant emotional coping

Least effective; includes blaming, distraction, and social withdrawal

Secure attachment style

Developed through good parenting and other early healthy relationships; when a loss is experienced, the pain of sorrow is processed and develop continuing bonds with the lost loved one

Insecure attachment style

When parenting/early relationships are not secure

Insecure attachment style - Anxious/Preoccupied

Super sensitive to slights and other neglect in a relationship; show high levels of stress at the time of a death and coping is difficult

Insecure attachment style - Anxious/Ambivalent

Love and hate coexist in a relationship; usually only the love comes out when the person dies and makes them larger than life

Insecure attachment style - Avoidant/Dismissing

Behavior organized around the goal of self-reliance and independence, show minimal emotions to a death

Insecure attachment style - Avoidant/Fearful

Have long histories of tentative attachments and can go into depression when an attachment is severed due to a death

Mediator of mourning #6 - Social variables

Grieving is a social phenomenon; the perceived social support inside and outside a family is very important to grieving; support can lessen after time due to the need to move on with life; social mediators are support satisfaction (is available support adequate/lacking?), social role involvement (the more supportive social roles one takes on, the better transition), and religious/ethnic expectations (different social groups/religions have rituals that assist w/ bereaved)

Mediator of mourning #7 - Concurrent stress

Experiencing high levels of disruption (secondary loss) following a death can create higher levels of depression (economic factors of spouse dying affect whole family)

When is mourning finished?

When person completes final mourning phase of restitution or all mourning tasks have been completed; when a person can think of deceased w/out pain; when a person can reinvest their emotions into life and the living

Counseling (Webster)

Advice, especially that given as a result of consultation

Counseling (Jackson)

Any time someone helps someone else with a problem

Counseling (Rogers)

Good communication within and between men; or good (free) communication within or between men is always therapeutic

Counseling (Ohlsen)

A therapeutic experience for reasonably healthy persons; a counselor’s clients are encouraged to seek assistance before they develop serious neurotic, psychotic, or characterological disorders

Informational counseling

Counseling in which a counselor shares a body of special information with a counselee

Situational counseling

Related to specific situations in life that may create crises and produce human pain and suffering

Psychotherapy

Intervention with people whose needs are so specific that they usually can only be met by specially trained physicians/psychologists; practitioners in this field need special training because they often work with deeper levels of consciousness

Directive counseling

Counselor takes an active speaking role, asking questions, suggesting courses of action

Non-directive counseling

Includes any type of counseling in which the counselor doesn’t offer any direct advice/direction, but encourages the client (as by repeating phrases) to talk freely

Person-centered (client-centered) counseling

A non-directive method of counseling which stresses the inherent worth of the client and the natural capacity for growth and health

Pre-need counseling

Counseling which occurs before a death

At-need counseling

FD consulting with the family from the time the death occurs until the final disposition

Post-funeral counseling (aftercare)

Those appropriate and helpful acts of counseling that come after the funeral

Grief counseling

Helping people facilitate grief to a healthy resolution

Grief therapy (Worden)

Specialized techniques which are used to help people with 43 complicated grief reactions

Complicated/Unresolved/Chronic grief

Grief extending over a long period of time w/out resolution

Grief support groups

Groups that meet, dealing w/ specific grief (death of a child, parent, suicide, etc.)

Worden’s Goals of Grief Counseling

(1) To increase the reality of the loss, (2) to help the counselee deal with both expressed and latent affect, (3) to help the counselee overcome various impediments to readjust after loss, (4) to encourage the counselee to make a healthy emotional withdrawal from the deceased and to feel comfortable re-investing that emotion in other relationships

Worden’s Counseling Principles and Procedures (1/5)

(1) Help the survivor actualize the loss, (2) help the survivor to identify and express feelings [retroflected feelings, reality testing], (3) assist living without the deceased, (4) facilitate (to assist the understanding of situations and options concerning the circumstances) emotional withdrawal, (5) provide time to grieve

Worden’s Counseling Principles and Procedures (6/10)

(6) Recognize “normal” behavior, (7) allow for individual differences, (8) provide continuing support, (9) examine defense mechanisms and coping styles, (10) identify pathology and refer [“gatekeeper” role]

Ways FDs facilitate grief (Worden)

(1) Fulfilling their responsibility in counseling during the entire service, (2) following up with post-funeral counseling, (3) providing contacts for the family with other support groups, (4) providing a service in teaching people about grief and healthy grieving by sponsoring and presenting educational programs in the community

FD’s Counseling Responsibilities

Normalize grieving behavior, identify pathology and refer, follow up with post-funeral counseling, provide contacts for the family w/ other support groups, provide service in teaching people about grief and healthy grieving by sponsoring and presenting educational programs in the community

Characteristics of the Effective FD (Wolfelt)

Empathy (the ability to perceive another’s experience and communicate that perception back to the person), respect (the ability to communicate the belief that everyone possesses the capacity and right to choose alternatives/make decisions), warmth and caring (the ability to be considerate and friendly as demonstrated by both verbal/non-verbal behaviors), genuineness (the ability to present oneself sincerely)

Important points of contact

Initial contact, communication between initial contact and arrangements, arrangement conference, coordination of service details, funeral rite, post-funeral follow-up, aftercare

Goals of grief counseling

Help the survivor adapt to the loss of a loved one and be able to adjust to a new reality without that person; specific goals are increasing the reality of the loss, helping the counselee deal w/ both the emotional and behavioral pain, helping the counselee overcome various impediments to readjustment after the loss, helping the counselee find a way to maintain (?)

Who does grief counseling?

Professional services by trained doctors, nurses, psychologists, etc., volunteers are selected and trained, self help groups like Compassionate Friends

When to do grief counseling?

Usually w/in a week following the death

Where should grief counseling be done?

Office, hospital, or home; grief therapy should only be done in professional office

Who receives grief counseling?

Three philosophies; (1) All individuals, (2) people wait to experience difficulty and then seek counseling, (3) preventative model for mental health, predict in advance who will have difficulty coping

Counseling principles and procedures - Help the survivor actualize the loss (1)

Make sure the individual understands the loss actually occurred

Counseling principles and procedures - Help the survivor to identify and express feelings (2)

Anger, guilt, anxiety, helplessness, sadness

Counseling principles and procedures - Assist the living w/out the deceased (3)

Create the ability to make independent decisions in an environment w/out the deceased

Counseling principles and procedures - Help find meaning in the loss (4)

Understanding the reason for the death, even when senseless/traumatic

Counseling principles and procedures - Facilitate emotional relocation of the deceased (5)

Find a new place in the person’s life for the lost loved one and move forward w/ new relationships (done through reminiscing)

Counseling principles and procedures - Provide time to grieve (6)

Allowing time to go through the grieving process and facilitate the mourning (can be slowed down by those around the person that want to rush process)

Counseling principles and procedures - Interpret “normal” behavior (7)

Let the survivor understand that the feelings they’re going through are normal and they aren’t crazy

Counseling principles and procedures - Allow for individual differences (8)

Allow individuals to deviate from normal grieving and that it can be ok to be different than other grieving members of the family

Counseling principles and procedures - Examine defenses and coping styles (9)

Developed over time and through trust w/ the counselor (drugs/alcohol not good coping mechanisms)

Counseling principles and procedures - Identify pathology and refer (10)

Identify when someone is in serious trouble and refer them to a professional for grief therapy

Facilitating grief through the funeral ritual

The funeral service can aide and abet the healthy resolution of grief; can help make real the fact of the loss; seeing the body of the deceased can help bring home the reality and finality of the loss; can give people an opportunity to express thoughts and feelings about the deceased, drawing a social support network close to the bereaved shortly after the loss, continued contact with the family helps facilitate grief (may consider sponsoring bereavement support groups/community as well)

Why people fail to grieve - Relational factors

The highly ambivalent w/ unexpressed hostility is usually toughest to mourn; narcissistic (when the deceased was an extension of oneself, to admit the loss would necessitate confronting a loss of part of oneself)

Why people fail to grieve - Circumstantial factors

When the loss is uncertain (soldier MIA), multiple losses (due to natural or manmade disasters)

Why people fail to grieve - Historical factors

If someone had an abnormal grief reaction in the past, they will most likely have one again; early parental loss can be a factor in future mourning

Why people fail to grieve - Personality factors

Inability to tolerate emotional extremes, withdraw as a defense; having a weak self concept can lead to complicated grief (you know you can’t handle it)

Why people fail to grieve - Social factors

Socially unspeakable death (embarrassment of the death - suicide, miscarriages, etc.), socially negated (when the person acts as if the death never happened), absence of a social support network (moving to a new area and not having friends/family/neighbors that understand the person is grieving)

How grief goes wrong

Grief without progression of the mourning process; normal and abnormal, complicated and uncomplicated have a continuous relationship, but the pathology is more related to the intensity and/or duration of a reaction

Complicated mourning

Something that is impeding the mourning process and not allowing it to move forward toward a good adaptation to the loss

Complicated mourning - Chronic grief reactions

Excessive in duration and never comes to a satisfactory conclusion