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Outline on Grief Management:
Malia A. Reynolds
I)
Goal of Grief Management
Charles Zastrow states, “Social workers have to know how to handle the eventuality of
their own death before helping the terminally ill or their surviving friends and
relatives…”
-Primitive societies-age lower at death, frequent witnessing of death of friends and
family, natural occurrence
-Here we shy away from death, individuals die in institutions (hospitals and nursing
homes), seldom exposed to dying people, avoid thinking about it, avoid funerals, and
conversations about the subject
-Material goods-live forever-eventually all die, we should become comfortable with the
idea of our own eventual death then we can be better prepared for loved ones deaths
-This will help us as SW’s to be better prepared to relate to terminally ill and survivors
who have experienced death of a loved one
-We may encounter as Social workers clients who are terminally ill or grieving
-Clients in nursing homes, hospitals, and hospices
-In recent years sw’s have become more involved in a variety of settings in organizing
and leading support groups for the terminally ill or for surviving friends and relatives
-also we have become involved in leading groups in educational settings that are
designed to help people become more comfortable with their own deaths and to learn
how to better handle grief
Exercise 1 – Questionnaire on Death and Dying
II)
Basic Points of Grief
-Funerals (Children, hiding of emotions, sudden deaths of young people, and health
professionals)
-Necessary for survivors and help initiate the grieving process
-Help serve to demonstrate the person is gone
-Do not shelter children-take them to funerals-answer any questions they may have
honestly about the process of death-Max’s example
-Help children to learn death is a natural process of life
-Strong at funerals-may later experience intense grief-guilt over not enough emotion
-Sudden deaths-difficult because survivors did not have time to prepare and they do not
have the opportunity to get closure in the relationship
-Tell the person how they felt or resolve any interpersonal conflicts
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-Grieving is intensified when it is sudden
-Doctors, nurses, and other health professional find death difficult to deal with
-Terminal illness may make health professionals feel guilt because they cannot do
anything to help the patient or they may have made a mistake that contributed to the
person's death
III)
The Grieving Process
-Grieving over losses (end of a romantic relationship, moving away from friends and
parents, the death of a pet, failing to get the grade we wanted, or someone’s death)
-The normal grief period can be the lifetime of the person who has suffered the loss.
-It is a process and over time there will be hours, days, weeks, and then months where the
person who was lost will not be thought of, but there will always be certain times of the
year where he or she will be remembered.
IV)
Models
Kubler-Ross Model
1) Denial – During this stage a person thinks, “No, this can’t be. There must be a
mistake. This just isn’t happening. “Denial is often useful because it helps cushion the
impact of the loss.
2) Rage and anger – In this stage and individual reacts by asking, “Why me? This just
isn’t fair.” For example, terminally ill persons resent that they will soon die while
other people remain healthy and alive. During this stage, God is sometimes a target of
the anger.
3) Bargaining – During this stage a person attempts to strike a bargain to regain all or
part of the loss. The terminally ill may attempt to bargain with God for more time.
They promise to do something worthwhile or to “be good” in exchange for another
month or year of life.
4) Depression – During this stage those having a loss tell themselves, “The loss is true,
and it’s really sad. This is awful.” People at this stage become depressed and mourn
the loss that has occurred. The depression may also be exacerbated by guilt or shame
about the acts of omission or commission.
5) Acceptance – Now the person fully acknowledges the loss. The terminally ill tell
themselves, “I will die soon, and it’s all right.” Those close to the terminally ill
person accept the loss and begin working on alternatives to cope with it and minimize
it. By involving friends and relatives in the grieving process, dealing with required
legal arrangements, and seeking spiritual counseling, the terminally ill person and
surviving friends and relatives begin to restructure their lives.
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Westberg Model
1) Shock and Denial – Many people who are informed about a tragic loss are in such a state of
shock that they are practically void of feeling. When emotional pain is unusually intense, it is
possible that the human emotional system temporarily blows out. This reaction insulates the
person from emotions that are too intense. Denial is a way to avoid.
2) Emotions Erupt – As the realization of the loss becomes evident, the person expresses the
painful loss by crying, screaming, or sighing deeply
3) Anger – At some point in time, the bereaved person usually experiences anger. There could
be anger feelings towards God or the one that died-desertion
4) Illness – Grief may produce stress-related illnesses, such as a cold, flu, ulcers, tension
headaches, diarrhea, rashes, insomnia. Intense grieving causes high levels of stress.
5) Panic – Person may have feelings of being insane. Nightmares, unwanted emotions that
appear uncontrollable, being less able to attend to family and work responsibilities, and
having stress-related illnesses contribute to the panic feeling.
6) Guilt – The person who is grieving may blame themselves for having done somethin that
contributed to the loss, or they feel guilty for not having done something which might have
prevented the loss.
7) Depression and Loneliness – At times, the grieving person may feel very sad, isolated, and
lonely. He or she may also withdraw from others who are not supportive or understanding.
8) Reentry Difficulties – At this point the grieving person makes efforts to put his or her life
back together. Reentry problems arise – the person resists letting go of the past. Loyalties to
memories hamper pursuit of new interests and activities
9) Hope – Gradually, hope that one’s life can be put back together returns and begins to grow
10) Affirming Reality – The grieving person regains a feeling of having control of life. The
reconstructed life is not the same as the old, and memories of the loss remain, but the
reconstructed life is OK.
V)
How to Help Others Cope
-Crying, talking about a loss with someone close or a trusted person, religion can be
helpful to accept a loss, writing out a rational self-analysis, grief can cause stress, use of
medication, and feelings of guilt.
-Death can cause us to reexamine and question our faith, but this is normal and one
should not be discouraged. It is best to discuss those feelings.
-Writing out a rational self-analysis will help to identify irrational thinking that
contributes to grief
-Suggest members become involved in meaningful and enjoyable activities that will help
to energize and motivate them
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VI)
Relating to People with Terminal Illnesses
-To relate to the terminally ill one needs to accept the eventuality of one’s own death.
-If the social worker is uneasy or has concerns then they should discuss that with the
dying person.
-Discuss any limitations you may have when dealing with death
-Discuss any concerns with the person and try to touch and hug, but also recognize the
person may not want these things
-Answer any questions the person may have about his or her illness and find a physician
if you do not know the answer
-Allow the person to accept the reality of his or her situation at their own pace
-The person has a right to all of the relevant information
VII) Relating to Survivors
-Support groups for survivors and the guidelines for dealing with survivors.
-It can be beneficial for survivors to be in a group setting where they hear how others are
putting their lives back together after experiencing the loss of a loved one.
-Important to tell a survivor you are sorry for their loss and are available for support
-Use active listening with survivors and person who is dying
-Continue to visit the survivors and show them care and support by a card, gift, or food
VIII) Becoming Comfortable with your Own Death
-Groups
-Talking about death
-Attending funerals
-Watching quality films, and TV programs about death and dying
IX)
Exercises
-D: Achieving Closure in a Lost Relationship
-F: Desensitizing Fears about Dying
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Exercise 1 – Questionnaire on Death and Dying :
1) Which of the following describes your present conception of death?
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
Cessation of all mental and physical activity
Death as sleep
Heaven-and-hell concept
A pleasant afterlife
Death as mysterious and unknown
The end of all life for you
A transition to a new beginning
A joining of the spirit with an unknown cosmic force
A kind of endless sleep
Termination of this physical life with survival of the spirit
Other: Please explain
2) Which of the following aspects of your own death do you find distasteful?
a)
b)
c)
d)
e)
f)
g)
What might happen to your body after death
What might happen to you if there is life after death
Concerns about what might happen to your dependents
The grief that it would cause to your friends and relatives
The pain you may experience as you die
All your plans and projects coming to an end
Other: Please explain
3) If you could choose, what age would you like to be when you die?
4) When you think of your own eventual death how do you feel?
a)
b)
c)
d)
e)
f)
g)
h)
Depressed
Fearful
Discouraged
Purposeless
Angry
Pleasure in being alive
Accepting, as you realize death is a natural process of living
Other: Please explain
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5) For what or for whom would you be willing to sacrifice your life?
a)
b)
c)
d)
e)
An idea or moral principle
A loved one
In combat
An emergency where another life could be saved
Not for any reason
6) If you could choose, how would you prefer to die?
a)
b)
c)
d)
e)
f)
g)
h)
A sudden violent death
A sudden but nonviolent death
A quiet and dignified death
Death in the line of duty
Suicide
Homicide victim
Death after you have achieved your life goals
Other: Please explain
7) If it were possible, would you want to know the exact date on which you would die?
a) Yes
b) No
8) If you had a terminal illness, would you want your physician to tell you?
a) Yes
b) No
9) If you had six more months to live, how would you want to spend this time?
a)
b)
c)
d)
e)
f)
g)
Through satisfying hedonistic desires (sex) and through traveling
By withdrawing
By contemplating or praying
By seeking to prepare loved ones for your death
By completing projects and tying up loose ends
By considering suicide
Other: Please explain
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10) Have you seriously contemplated suicide? What are your moral views of suicide? Are there
circumstances in which you would take your life?
11) If you had a serious illness and the quality of your life had substantially deteriorated, what
measures do you believe should be taken?
a) All possible medical efforts
b) Medical efforts should be discontinued when there is practically no hope of returning to a life
with quality
c) Other: Please explain
12) If you are married or if you intend to marry in the future, would you prefer to outlive your
spouse? Why?
13) How important do you believe funerals and grief rituals are for survivors?
14) If it were up to you, how would you like to have your body disposed of after you die?
a)
b)
c)
d)
e)
Cremation
Burial
Donation of parts of your body for organ transplants
Donation of your body to medical school or science
Other: Please explain
15) What kind of funeral would you prefer?
a)
b)
c)
d)
e)
f)
g)
In church
As large as possible
Small, with only close friends and relatives present
A lavish funeral
A simple funeral
Whatever your survivors want
Other: Please explain
16) Have you made a will? Why or why not?