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Grief Counseling (Worden):

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helping people facilitate uncomplicated grief 1) to a healthy completion of tasks of mourning 2) w/in a reasonable time frame

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Grief Therapy (Worden):

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specialized techniques used to help people w/ abnormal/complicated grief

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Mourning is Facilitated Through:

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1) family 2) church 3) funeral rituals 4) social customs

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Goals of Counseling:

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1) main goal 2) subsequent goal

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Main Goal of Grief Counseling:

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1) complete unfinished business w/ decedent 2) become able to say good-bye to the past

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Subsequent Goals of Grief Counseling:

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1) increase the reality of the loss 2) deal w/ expressed & latent effects of loss 3) overcome barriers to readjustment to life after loss 4) memorialize deceased while reinvesting emotionally in life & the living

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Sources of Grief Counseling (Parkes):

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grief counseling can be provided by- 1) trained Dr's, RN's, phychologist & social workers 2) trained volunteer's a) supported by trained professionals 3) self-help groups a) consisting of other bereaved people b) w/ or w/o professional support

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Time Frame for Grief Counseling:

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1) at the earliest-1 week after funeral 2) first 24 hours is to soon

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At-Risk Bereaved:

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people who will not be doing well 1 to 2 years after the death

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Characteristics of At-Risk Bereaved (Beverly Raphael):

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1) high level of perceived non-supportiveness 2) moderate lever of perceived nonpsupportiveness w/ traumatic death 3) previous high ambivalence in relationship w/: a) traumatic death b) unmet needs 4) presence of concurrent stressors

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Bereavment Risk Index (Parkes):

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1) more children @ home 2) lower social class 3) little or no employment 4) high anger 5) high pining (wanting something back) 6) high guilt (can turn into depression) 7) lacking current relationship 8) fragile coping abilities

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Counseling Principles & Procedures:

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1) help survivor actualize the loss 2) help survivor identify & experience feelings 3) assist living w/o deceased 4) help find meaning in the loss 5) facilitate emotional relocation of the deceased 6) provide time to grieve 7) interpret "normal" behavior 8) allow for individual differences 9) examine defenses & coping styles 10) indentify pathology & refer

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Principle #1: help survivor actualize the loss

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1) talk about the loss 2) visit gavesite

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Principle #2: help survivor identify & experience feelings

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1) survivors must work through & experience the pain of grief 2) survivors must not block pain out

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Common Feelings Associated w/ Grief:

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1) anger 2) guilt 3) anxiety & helplessness 4) sadness

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Anger:

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1) must be directed @ decedent 2) must create balance between positive & negative feeling toward decendent can be accomplished by asking 1) what they do & don't miss about decedent 2) how decedent disappointed them

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Guilt:

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most guilt is: 1) irrational 2) focused on circumstances of death

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Reality Checking:

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describing real & practical scenarios to put actions into realistic content

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Real Guilt:

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is more difficult to work w/ (for counslers)

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Anxiety & Helplessness:

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1) bereaved perceives themselves as not being able to get a long by themselves a) need to be reminded of how they got along by themselves prior to the death

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Existential Anxiety:

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fear of one's own death a) have bereaved talk about fear (w/ counsler)

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Sadness:

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1) true sadness must be accompanied by awareness of scope of loss (about 6 months after death) 2) crying should be encouraged

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Principle #3: assist living w/o the deceased

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1) must determine what problems survivors face 2) must determine how problems can be solved 3) problems often rooted in role changes after death

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Principle #3, Primary Decision Maker:

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1) bereaved must be given coping & decision making skills (more of a counslor's role)

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Principle #3, Sexual Partner:

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often manifests as need to be touched

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Bereaved Should Be Discouraged:

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from making major life changes too soon after death (more of counslor role)

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Principle #4: help find meaning in the loss

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1) the why of the death 2) process often more important than meaning found

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Principle #5: facilitate emotional relocation of the deceased

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1) advise agasinst isolation from society 2) advise against getting into new rellationships too quickly 3) reminiscing-recollection & telling of past experiences 4) decathexis-divesting of emotional energy

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Principle #6: provide time to grieve

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1) advise that mourning takes time to complete 2) continue contact w/ bereaved: a) at 3 months - contact b) at 1st anniversary of death c) on holidays

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Principle #7: interpret "normal behavior"

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1) reassure bereaved that their feelings are normal

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Principle #8: allow for individual differences

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1) remember people grieve in defferent ways 2) advise families that not all members will grieve: in the same way or for same amount of time

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Principle #9: examine defenses & coping styles

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1) important to interpret competent coping styles 2) bereaved must be made aware of faulty coping styles

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Principle # 10: identify pathology & refer

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identify pathology & refer

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Bereaved People:

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make others feel helpless

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Avoid Speaking of:

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your own losses

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Avoid:

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platitudes (meaningless things that are said, just to say something)

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Better to Use:

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1)"I don't know how you feel, but I'm here to help in any way that you need" 2)"I don't know what to say to you, but......" 3)"You have my sympathies"

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Useful Counseling Techniques:

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1) evocative language 2) use of symbols 3) writing 4) drawing 5) cognitive restructuring 6) memory book

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Evocative Language:

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1) use language that helps people realize reality of the death 2) must be done w/ tact & compassion

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Use of Symbols:

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1) have survivors bring in artifacts of the deceased 2) objects provide: a) a focus for survivors b) way for counselor to know who decencent was

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Writing:

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1) have survivors write to the decedent 2) have survivors write about their mourning process 3) provides catharsis (release of emotions)

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Drawing:

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have survivors draw pictures that reflect their feelings

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4 Advantages of Art Use (Irwin):

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1) facilitates feelings 2) identifies unknown conflicts 3) heightens awareness of scope of reality of death 4) identifies where bereaved is in the mourning process

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Cognitive Restructuring:

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1) identifying irrational thought processes 2) irrational thought processes are then reality checked (by counsler)

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Memory Book:

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1) helps families reminisce & mourn realistic images of decedent 2) helps growing children reintegrate decedent into their lives

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Guidelines for Group Format:

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1) purpose 2) structure 3) logistics 4) pre-screen participants 5) define expectations

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Purpose:

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emotional support, education & social

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Structure:

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1) open ended-people join & leave as they need 2) closed ended-people join & leave same time

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Logistics:

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1) number of meetings 2) length of meetings 3) where meeting will be held

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Pre-Screen Participants:

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1) exclude people whose loss was 6 weeks or earlier 2) people w/ pschopathologies

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Define Expectations:

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ask what people expect to get from the group

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Interpersonal Dynamics:

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1) inclusion 2) control 3) affection

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Inclusion:

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people need to feel that they fit in/are accepted by group

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Control:

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people need to feel they are important w/in group

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Affection:

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people want the group to care about them

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Ways in Which Funeral Services Facilitates Grief:

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1) fact 2) opportunity 3) reflect 4) support

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Fact:

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helps make fact of death real (w/ body & open casket)

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Opportunity:

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gives people opportunity to express thoughts & feelings about decedent

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Reflect:

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service can reflect decedents life

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Support:

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draws social support close to mourners

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Draw Back of Funeral Services:

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often occur too soon after the death

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Societal Reflections of Modern Funeral Service:

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1) understanding 2) community 3) facing 4) mourning 5) pluralistic

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Understanding:

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more comprehensive understanding of rituals

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Community:

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focus on community as well as individuals

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Facing:

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importance of facing death

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Mourning:

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better understanding of mouring

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Pluralistic:

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more pluralistic society

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Funeral Directors Role in Grief Counseling:

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1) advising 2) ongoing 3) counslers 4) referral 5) grief 6) community

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Advising:

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advising people & assisting in coping w/ important arrangements @ the time of death

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Ongoing:

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ongoing contact w/ families

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Counslers:

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paid counslers on staff

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Referral:

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referral to community counslors

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Grief:

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sponsoring grief counseling groups

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Community:

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sponsoring community education programs

FSE Grief counseling notes – Flashcards

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