The Process of Change in Complicated Grief Group Therapy for Bereaved Dementia Caregivers: An Evaluation Using the Meaning of Loss Codebook

ABSTRACT

Caring for a person with dementia has adverse health and mental health effects that, for 9–25% of caregivers, persist as complicated grief (CG). For bereaved dementia caregivers unable to satisfactorily grieve, specialized Complicated Grief Group Therapy (CGGT) can restore healthy grief. We investigated therapeutic change in CGGT participants, using an adapted version of the Gillies’ Meaning of Loss Codebook. Participants demonstrated positive gains in 16 thematic areas, notably in moving on with life, summoning pleasant memories, and ascribing bad memories to disease rather than decedent. Meaning transitioned from negative to positive interpretations of the death over the course of treatment.     

Group leaders’ experiences in heterogenous grief support groups

Group processes in social work are complex. In this article, the authors examine how Norwegian leaders experience these processes during their grief support group work. The authors take a qualitative approach, specifically semistructured interviews. Seven group leaders participated. Using qualitative content analysis, the authors found new and supporting information as presented in two inter-related themes: (1) Achieving cohesion is a challenging balance and (2) Facilitating the group activity is linked to group leaders’ engagement and competence. The authors suggest that group work is enhanced by well-qualified leaders paying attention and understanding toward the ongoing group processes, homogenous groups, prescreening, individual timing, and group cohesion.     

September 10, 2001

Abstract

This essay chronicles the impact of a patient's suicide on the therapist, reflecting on the initial trauma, the therapist's repeated attempts to deal with the loss, and her ultimate physical collapse. Time off from work began the healing of her physical symptoms, and the spontaneous writing and immediate sharing of her raw and unformulated feelings with a writing group she had just joined, began the process of grieving which, until this point, had only been known physically. Working and re-working this essay kept her safely, but affectively connected to the loss and gave her experiential understanding of the adaptive function of somatization, leading finally to the acceptance of the limitations of both patient and therapist.     

Recurrent grief in mothering a child with an intellectual disability to adulthood: grieving is the healing

Much of the literature on mothering a child with a disability focuses on grief in the context of diagnosis, with a paucity of longitudinal studies focusing on ongoing grief as the child moves through the life stages. This qualitative study explores the existence of recurrent grief within the lived experience of six women, in mothering their children with intellectual disability through to young adulthood. Informed by the differing theories of grief and disability, the study considers mothers' perception of the experience of recurrent grief as influenced by personal and societal factors, with a focus on its triggers, its manifestation and its amelioration. The findings have relevance to social work practice, policy and research in revealing the necessity for ongoing support and advocacy for mothers of children and young adults with intellectual disabilities.     

The return to the sacred path: Healing the historical trauma and historical unresolved grief response among the lakota through a psychoeducational group intervention

Abstract

This article, based on research conducted with Lakota human service providers, concludes that the Lakota (Teton Sioux) suffer from impaired grief of an enduring and pervasive quality. Impaired grief results from massive cumulative trauma associated with such cataclysmic events as the assassination of Sitting Bull, the Wounded Knee Massacre, and the forced removal of Lakota children to boarding schools.

The research studied a culturally syntonic four‐day psychoeducational intervention designed to initiate a grief resolution process for a group of 45 Lakota human service providers. The methodology included assessment at three intervals: (a)apre‐ and post‐test, utilizing a Lakota Grief Experience Questionnaire andthe semantic differential, (b) a self report evaluation instrument at the end of the intervention, and (c) a six‐week follow‐up questionnaire.

The results confirmed the hypotheses that: (a) education about historical trauma would lead to increased awareness of the impact and associated grief related affects of the traumatic Lakota history, (b) sharing these affects with other Lakota in a traditional context would provide cathartic relief, and (c) grief resolution would be initiated, including a reduction in grief affects, more positive identity, and a commitment to individual and community healing.     

The Grief Experience of Prison Inmate Hospice Volunteer Caregivers

Correctional institutions are obligated to provide end-of-life care to a population with complex medical needs. Prison hospices are increasingly being formed to address this demand. Few empirical studies have examined the impact of caring for dying inmates on the hospice inmate volunteers, who, in several prison health care systems, provide direct care. In this study, experiences of the inmate hospice volunteers with death were investigated to illuminate their grief processes. Understanding the bereavement needs of hospice volunteers and how prison hospice volunteers navigate grief and remain committed to providing excellent hospice care can inform the grief processes and practices of hospice care professionals.     

Identity reconstruction as shiduers: Narratives from Chinese older adults who lost their only child

The purpose of this qualitative study was to illustrate how the identity of Chinese older adults who lost their only child changed after the traumatic event in the context of unique culture and policy settings. The individuals studied were 14 adults over the age of 50. Each respondent was interviewed concerning his or her post‐loss experiences. Results indicated that these bereaved parents are not only deeply impacted by the loss of the most loved one, but are also stigmatized by the culture and victimized by the one‐child policy. The collective identity as shiduer is defined not only by personal grief but also by cultural uniqueness and the unintended consequences of the one‐child policy.     

Live Discharge from Hospice and the Grief Experience of Dementia Caregivers

When an individual has dementia, family members are involved in many care transitions in their roles as caregivers. One such transition is the ‘live’ discharge from hospice services. This occurs when an individual no longer meets eligibility criteria. This can be difficult for caregivers who have been anticipating an end to understand in the context of their grief process. This qualitative study (N = 24) explored the experience of caregivers of adults with dementia, including Alzheimer’s disease, who experienced a ‘live’ discharge from hospice. Specifically, the experience of grief is examined. Results from this study highlight the complexity of caring for someone with a terminal disease and the grief experience in end-of-life care as caregivers struggle to understand the individual’s terminal prognosis as temporary. This is further complicated for caregivers who must resume caregiving responsibilities or assume a new caregiving role after experiencing a loss of hospice services. Finally, hospice social workers are well positioned to offer emotional and other concrete support to caregivers who experience a ‘live’ discharge.     

黄土地的色调与悲情——高凯、牛庆国乡土诗略论

高凯、牛庆国是西部诗坛 2 0世纪 90年代成名的诗人。他们都致力于乡土诗创作。他们的乡土诗洋溢着对黄土地乡土故乡的爱与情 ,既深染着黄土地的色调 ,亦深蕴着黄土地的悲情 ,既富情感魅力 ,亦具艺术感染力 ,显示出强劲的创作实力     

Loss and grief: The experience of transition to residential aged care

There is growing recognition of the experience of non-death-related loss and grief. One unexplored area of non-death-related loss and grief is associated with older people’s transition from home to residential aged care (RAC). This paper reports findings from a qualitative study that explored the experiences of people living in RAC, carer-relatives of people living in RAC and RAC staff. Using theories of loss and grief, the paper identifies features of the transition to RAC that are associated with unresolved loss and maladaptation to changed circumstances, and the types of support that would mitigate these. Using a series of focus groups with both residents and carer-relatives, as well as staff, the study found that residents and their families need more support to negotiate the multiple, often necessarily hasty decisions and bureaucratic requirements associated with transitioning to RAC, while simultaneously experiencing loss and grief. The types of support that families would welcome from service providers include facilitating shared decision making, valuing family and community carer expertise and providing practical information and assistance to fulfil administrative obligations.     

A Different Kind of Holding Environment: A Case Study of Group Work with Pediatric Staff

ABSTRACT

This paper reports a nearly two-year intervention with staff at a major urban pediatric facility. The authors worked as trainers and consultants for two groups–the Emergency Department (ED) and Chronic Care units (CC). Following two days of training about grief and loss, highlighting skill building for work with traumatized and grieving children and parents, the consultants worked to develop teams which could provide a Winnicottian holding environment for staff. The efficacy of this staff training is analyzed and support needs of staff members are identified. Findings include varied willingness to make use of group support. Chronic care participants are more likely to express willingness to engage in on-going support for one another, while ED staff members seem to prefer structured, educational training and episodic support. The holding environment of the processing groups must be adapted to fit the needs of the medical sub-culture.     

Use of Contemporary Film as a Medium for Teaching an Online Death and Grief Course

Online education is becoming commonplace in the academic world. Schools now offer totally online degree programs or provide a hybrid of face-to-face and online courses for fulfilling academic requirements. Developing courses and teaching online requires instructors to rethink the educational paradigms they have relied upon in the past. The Net Generation of learners brings a different set of expectations, styles, and needs to the classroom than those of previous generations; this mandates that instructors redesign courses and use contemporary teaching modalities. This article describes how film was successfully used as the primary medium to teach a graduate online Social Work course, Death and Grief.     

The Validation of the Texas Revised Inventory of Grief on an Older Latino Sample

Abstract

Purpose: Bereavement is considered to be one of the most profound experiences in older adulthood. However, assessments of emotional reactions to grief and loss have often been based on measures tested on primarily Anglo samples. This study examined the validity and factor structure of a commonly used bereavement measure on an older Latino sample.

Design and Methods: Using convergent and discriminant validation procedures, this instrument was tested using a purposive sample of 134 older, recently bereaved Latinos.

Results: While the instrument was originally designed to measure two domains of grief: Past Behaviors and Present Feelings, confirmatory and exploratory factor analysis revealed a three-factor solution for this sample which included also Disbelief of the loss. Items within this domain included anger, rejection, and a sense of injustice.

Implications: This study underscores the need for improved measures in research on grief and bereavement to capture the intensity and severity of grief in a cross-cultural context.     

Grief,loss, and separation: Experiences of birth children of foster carers

Previous research identifies the increased exposure of birth children of foster carers to experiences of separation, grief, and loss due to the transient nature of foster care, but little is known about how birth children manage this loss. This paper reports findings from a qualitative study that examined the retrospective experiences of 15 adult birth children of foster carers (aged between 18 and 28 years) in Ireland. Findings suggest that birth children experience grief and loss when foster children leave their families. They report experiencing a range of emotional responses such as guilt, blame, and sadness. A reluctance to discuss their emotional responses with either their parents or foster care professionals was also reported. Instead, birth children developed strategies to manage the loss, such as distancing themselves from the foster care process. The study highlights the importance of social workers and foster carers explaining to birth children why foster children are leaving and, where possible, maintaining contact between birth children and foster children. Additionally, findings indicate the need for birth children to have safe nonjudgmental spaces to discuss their emotional reactions to loss.     

Social Work,Siblings, and SIDS: Conceptual and Case-Based Guidance for Family System Intervention

ABSTRACT

Sudden Infant Death Syndrome (SIDS) is a tragic loss event within the family, impacting adults as well as children. This article uses three case illustrations to discuss the role of a SIDS event on the family system with a special focus on the emergent challenges for surviving siblings of various ages. Practice application examples are woven throughout the review to illustrate the age-specific grief responses which may occur following a SIDS event. The article also presents a theoretically supported intervention matrix that integrates models of bereavement support and family system responses, taking into account children's varying developmental needs and tasks based on sibling age.     

The Self-Forgiveness Process of Caregivers After the Death of Care-Receivers Diagnosed With Alzheimer's Disease

ABSTRACT

This study explores the relationship of self-forgiveness and adaptive coping, religious/spiritual practices, social support, decreased grief, and mental well-being. 133 caregivers were surveyed. Bivariate analysis and stepwise regression models revealed that decreased grief, adaptive coping, and social support were significant in explaining the variation in self-forgiveness. This is one of the first studies to address self-forgiveness as part of the grieving process of Alzheimer's caregivers. Future directions are explored supporting inclusion of self-forgiveness as an aspect of grief and adaptive coping; which is further enhanced by the level of social support experienced by the caregiver.     

Stillbirth: The Mother's Experience and Implications for Improving Care

ABSTRACT

More children die as a result of stillbirth than all other causes of infant deaths combined (Ananth, Shiliang, Kinzler, and Kramer, 2005; Goldenberg, Kirby, and Culhane, 2004; Froen, 2005; National Institute of Health, 2004); yet, mothers experiencing stillbirth are often left without support afterwards (Kubler-Ross, 2004; Fahey-McCarthy, 2003; Fletcher 2002; Saddler, 1987; DeFrain, 1986; Kirkley-Best & Kellner, 1982). Despite social work's growing involvement in care at the end of life, parents of stillborn children have not experienced consistent, relevant, and competent professional care in coping with the tragedy of death. Forty-seven women between the ages of 19 and 51 were recruited through nonprofit agencies that provide bereavement care to grieving families. Results of this qualitative study suggest that stillbirth is emotionally complex with long-lasting symptoms of grief and significant struggles to find meaning. The findings also support the need for perceived psychosocial and spiritual support from professional caregivers, family, and friends. The women's own experiences argue for comprehensive approaches to support the grief and loss of stillbirth, and for the importance of social work involvement in both immediate and longer term interventions.     

Support Systems of American Urban Widowhood

The life a woman develops in marriage becomes more or less disorganized with the death of her husband. Many characteristics of a society, a community, and a woman influence the degree of disorganization of her life with the death of her husband, and the direction and form of her life that emerges after the period of mourning and heavy grief is over. Aspects of a widow's life that I and my colleagues have studied include her support systems, social roles, lifestyle, and self-concept. These aspects are built gradually, or changed dramatically, as a result of disorganizing events followed by reorganizing processes. This paper examines the support systems American urban women have developed in widowhood.     

Training and Supervision of Counselors at a Residential Grief Camp

Peer-based grief camps, utilizing a volunteer staff, represent one method of mutual aid support for children. Manitou Experience is an example of a week-long residential camp for grieving boys. The recruitment, training, and supervision of Manitou Experience’s camp counselors and clinical team members are explained as they relate to program development and facilitation of positive change in its campers. Strengths and challenges of group processes are explored and discussed.     

Supporting Family Members to View the Body after a Violent or Sudden Death: A Role for Social Work

Supporting family members to view the body of their relative after a traumatic death is a critical role for social workers in hospital and morgue settings; however, this role has had little attention in the literature. In-depth interviews with 48 bereaved family members explored their experiences of helpful and unhelpful aspects of support when viewing the body of their deceased relative. A central theme of “support as a relational interaction” was identified. Aspects of the connection and communication valued by participants within this relational interaction included: “permissions and possibilities,” “information and preparation,” “presenting with care,” “time and timing,” and “tuning to family.” These results are considered with grief practice and theory, to suggest the need for social workers to actively engage with working in the interface between the deceased body and the grieving family. This includes advocating a private location for time with the body and using interpersonal skills to provide paced and dosed information for preparation to view that is consistent with the capacities and needs of the individual and family.