Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
Currently Skimming:
Pages 237-280
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 237... ...
Bereavement Intervention Programs
|
From page 238... ...
. 3G~ _-G Hospices, manymutua]
|
From page 239... ...
In this chapter, the more formal bereavement programs and approaches are discussed. Many of the techniques used by mental health professionals and experienced lay care-givers to assist the bereaved are similar to those advocated in Chapter 9 as appropriate for health professionals generally.
|
From page 240... ...
Bereaved persons may avail themselves of one or more of these interventions sequentially or simultaneously. THE MUTUAL SUPPORT APPROACH Mutual support or self-help groups are associations of people who share the same problem, predicament, or life situation and who unite for the purpose of mutual aid.
|
From page 241... ...
It is unclear whether and how these groups offer systematic help with bereavement when death actually occurs, but there is informal support given among a smaller network of individual members. Postbereavement mutual support groups fall into two categories: {~)
|
From page 242... ...
. information on, for example, the types of services and benefits offered members; the grief process and its impact on marriage and family, including guidance for sibling grief; suggestions for the behavior of friends, relatives, and health professionals; community resources; reference lists and resource materials dealing with the latest scientific findings on causes and treatments; personal experiences of survivors; and public policy issues.
|
From page 243... ...
Mutual support groups were useful later. The goals of the program centered around change, not around "recovery." It was discovered in talking to widows that they never "recovered" in the sense of returning to all prebereavement baselines, but that
|
From page 244... ...
Professionals may act as occasional consultants, provide routine backup support for the volunteers, train volunteers, or run support groups. It is also interesting to note that there are very few mutual support groups for widowers or other groups of bereaved men.
|
From page 245... ...
Two of these studies were large surveys of participants in mutual support groups to determine whether intensity of involvement "meeting attendance and leadership roles) with the group was related to bereavement outcome.
|
From page 246... ...
a' 4= o o By o By ce On o · 4= 4= '1 1 o As cn fee Ci2 c)
|
From page 248... ...
Barretti randomly allocated widows to three different types of mutual support groups and a nonintervention control group. Each support group concentrated on a specific aspect of widowhood.
|
From page 249... ...
Hospice care is delivered in both inpatient and home care settings in a number of different
|
From page 250... ...
or contract for services as needed.3i Despite the fact that patients with many different types of diseases could be appropriately cared for, the vast majority of patients in hospice programs have some form of cancer, and these programs have tended to favor the middle class. Hospice services are provided by multidisciplinary teams usually composed of physicians, nurses, social workers, chaplains, psychiatrists, physical therapists, and volunteers.
|
From page 251... ...
Thus Boulder County Hospice has two rather separate sets of care-givers available one for patient and family care before the death, the other for follow-up family support after the death.22 Although all hospices offer some type of bereavement intervention to families, at least in preparation for the death, they vary greatly in the breadth and magnitude of services offered. During the predeath phase, the interventions are likely to be informal rather than formal, with a focus on information and education, support, and validation by the care-givers who are tending to the patient's needs and assisting the fam : 1 ~.
|
From page 252... ...
Hospice bereavement programs have much in common with mutual support groups. In fact, most hospice programs can be characterized as mutual support offered under the umbrella of a newly institutionalized health care option.
|
From page 253... ...
The Impact of Hospice Bereavement Programs Hospices offer a rich opportunity for addressing a number of important questions on bereavement, including the effects of caring for a dying patient at home on the subsequent bereavement reactions of families, the nature of anticipatory grieving and its effect on subsequent be ~ ~ ~ - v reavement, and the relative effectiveness of different approaches to bereavement support. Hospices that are affiliated with prepaid or other closed health plans provide a unique opportunity to study family reactions over time.
|
From page 254... ...
received significantly more bereavement assistance than the PCPs from conventional care settings.4i Because survivors were followed for only a few months, the Tong-term effects of the different modalities of hospice and conventional care on bereavement outcomes are not known. However, this study is important because it begins to document the impact of hospice care on survivors and points the way to research hypotheses deserving further study.
|
From page 255... ...
A bereavement intervention study began when the hospice first opened.3 Twenty close adult relatives of patients who died of cancer during a sixmonth period in the hospice were matched with 20 relatives of patients who died in the active treatment part of the hospital. The PCU families received total hospice care including predeath support before the death and bereavement counseling.
|
From page 256... ...
It should be noted that it is not at all clear what has been assessedthe bereavement process, the effects of hospice care generally, the effects of a bereavement intervention, or even the evaluation process, which itself became an intervention. In this study, as in others that do multiple assessments in person, evaluation interviews themselves may facilitate grieving because they provide an opportunity to interact with a compassionate person and to review feelings about the loss.
|
From page 257... ...
Psychotherapeutic methods and approaches encompass a wide range. · The service providers most commonly are psychiatrists, psychiatric social workers, or clinical psychologists, who may practice either independently or as part of teams in medical centers, in counseling agencies, or in programs specifically aimed at helping the bereaved.
|
From page 258... ...
or surviving family as the "patient," helping to identify and ameliorate patterns of communication and behavior that are putting strain on individual family members. :~ ~ Hi:_ _.: _ ~ 07 PA =~ 1 ~ , ~ ~ By contrast, the newly developed Interpersonal Therapy is designed to treat individual patients who have depression associated with abnormal grief reactions.
|
From page 259... ...
Counseling is done by clinical psychologists or psychiatric social workers on a one-toone basis and in groups. Clients may refer themselves to this service, be referred by the volunteer service if their problems seem too extensive to be handled by laypeople, or be referred by their physicians or clergy.
|
From page 260... ...
Many bereaved children are seen each year in the Situational Crisis Service. Staff workers at the Center believe that bereavement places a child at increased risk for the rest of his or her life if not properly attended to.
|
From page 261... ...
These limitations of psychotherapy research generally apply to bereavement intervention research as well. In fact, most psychotherapy in general as well as for bereavement in particular is provided by individual practitioners in private offices where the content of the interactions and outcomes are kept confidential.
|
From page 264... ...
c: lo on m 4 ._ o cn o Cal At> CO C)
|
From page 265... ...
4 ~ c ~ ~ ~ ~ ~ ~ - ~ ~ ~ ~ ~ By ce - of 0 5 O ~ ~ ~ ~ ~ S - ·= TIC ~ O V ._ ~ ~ ~ O ; > I_` U)
|
From page 266... ...
Contrary to the findings in many other reports, perceived social support was not related to outcomes. Death of a mother, cumulative life events, social class, and development of self-concept were related to outcomes.
|
From page 267... ...
Bereavementlntervention Programs / 267
|
From page 268... ...
Finally, although there are no controlled studies of therapeutic interventions for bereaved children, there is one Israeli study of an intervention designed to assist children whose parent was dying.38 Two to three months of weekly counseling during the parent's illness resulted in a significant decrease in children's anxiety and significant improvement in scholastic performance and social functioning at school, while
|
From page 269... ...
while others do not. No studies have been directed specifically at evaluating the efficacy of any of these drugs in bereaved persons.~249 An tid epressan ts Tricyclic antidepressants and monoamine oxidase inhibitors have been shown to be effective in relieving symptoms and other manifestations of clinical depression in a large number of controlled studies.
|
From page 270... ...
The majority of cTinicians who report using psychopharmacologic drugs for bereaved persons do so in the early phases of intense distress. However, concern has been expressed over possible adverse effects of these compounds.
|
From page 271... ...
Dosages for these populations must be carefully adjusted, and more rapidly eliminated drugs [e.g., temazepam, triazolam, and oxazepam] are preferable." Although the committee is aware that antidepressants are sometimes used for bereaved persons, it does not recommend their use for individuals whose grief remains within "normal" bounds of intensity and duration.
|
From page 272... ...
Should AL Bereaved People Be in an Intervention Program: The evidence suggests that everyone needs support, reassurance, and some education and information following bereavement. This may be provided by family, friends, or clergy in an informal way, by laypeople in similar circumstances, by a community support group, or by health
|
From page 273... ...
, and to monitor their progress and make referrals to mental health professionals as appropriate. There is no evidence that all bereaved people need or want formal interventions, though mutual support groups may fill a gap for those who have little other social support.
|
From page 274... ...
For example, although numerous anecdotal reports and a few controlled studies attest to the positive features of mutual support, it is possible that peer pressure exerted on individuals who are psychologically vulnerable following bereavement could lead to some poor outcomes, such as feelings of failure for not living up to group expectations or changing in ways that, while consistent with group norms, are ultimately not helpful to the individual. Perhaps those who are vulnerable to these potential problems are the ones who choose not to participate in these programs.
|
From page 275... ...
These basic variables and other modifiers of responses, such as the actual and perceived availability and adequacy of social support, must be adequately controlled for in the research designs and analyses before conclusive statements can be made about the impact of interventions. Research on preventive interventions should be designed to test hypotheses generated from basic research on the grieving process and its multiple outcomes.
|
From page 276... ...
V.H. Manual on Palliative/Hospice Care {Ajemian, I., and Mount, B.M., eds.~.
|
From page 277... ...
Ethical issues arising in hospice care. In: Hospice Programs and Public Policy iTorrens, P.R., ed.
|
From page 278... ...
The recent literature: self-help and mutual support groups. Community Mental Health Review 5:15-25, 1980.
|
From page 279... ...
Crisis intervention: effects of crisis intcrvention on family survivors of sudden death situations. Community Mental Health Journal 12:128-136, 1976.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.