Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
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10 Bereavement Intervention Programs
10 Bereavement Intervention Programs
Pages 239-282
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From page 239... ...
This is exemplified by emotional distress, physical symptoms, and loss of social functions in many people and by the excessive mortality, morbidity, and use of health services of some individuals. Second, there has been a growing recognition that the normal bereavement process may take at least a year for most people and often longer.
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From page 240... ...
Many different theoretical perspectives guide the training of grief workers and provide the framework for the actual programs. But whether they are formal or informal, naturally occurring or deliberate, run by peers or by professionals, the goals of all bereavement interventions include the facilitation of the grieving process and, implicitly or explicitly, the prevention or alleviation of the detrimental consequences of bereavement.
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From page 241... ...
A few, like "Make Today Count" and "Candlelighters," are concerned with the overall needs of adults and children as they face the uncertainty associated with a variety of diseases, especially cancer. Such organizations offer support, education, and practical advice to their members during the course of an illness.
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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.
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From page 243... ...
:[mmediately following bereavement widows are likely to be numb and to act reflexively. Clergy, funeral directors, family, and friends are there to help with the specific tasks of the funeral and mourning rituals.
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From page 244... ...
Thus, in addition to emotional support, the intervention provided specific information about various practical concerns and about bereavement, as well as helping the widows develop alternate coping strategies.44 The original program was funded by the National Institute of Mental Health and the national and Massachusetts associations of funeral directors. It was designed by Silverman, who convened a forum in which the widow aides could pool their experiences as widows reaching out to new widows, discuss coping mechanisms, and develop strategies for program development.
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From page 245... ...
Indeed, the respondents to a newspaper notice asking for widows to join a study had been widowed on the average almost five years and only one-third of those replying had been widowed less than two years.' In addition, information about the bereavement process and the opportunity to interact with others in similar circumstances appear from these reports to help by reassuring the newly bereaved that they are not "going crazy" and by providing a forum for the bereaved to talk openly about their feelings with others who are not uncomfortable listening. This kind of impressionistic data, useful in some ways, also has its limits.
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From page 246... ...
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From page 248... ...
was administered, along with another self-administered instrument designed to examine demographic and situational variables, social support, and physical symptoms. A structured interview was conducted to elicit more sensi
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From page 249... ...
Hospice care is delivered in both inpatient and home care settings in a number of different
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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.
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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 ~.
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From page 252... ...
The goals of follow-up bereavement services are: "to provide family members with information about the normal grief process; to provide grieving family members an opportunity to review and reflect on the experience of caring for their loved one and their loss experience; to assess and monitor individual coping ability, stress levels, and available support; to encourage family members to utilize existing support systems or to seek and create additional sources of support."22 Although some hospices offer limited psychotherapeutic counseling, most do not. They typically make assessments and refer people to other community resources if they are experiencing abnormal grief reactions.
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From page 253... ...
With the advent of Medicare reimbursement for hospices, a number of federal agencies and private foundations have become interested in studying the effects of this type of care. Although their principal interest seems to be on the cost of care for the terminally ill, studies of the preventive implications of bereavement interventions for survivors should not be overlooked.
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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.
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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.
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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.
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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.
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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.
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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.
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From page 260... ...
Children are typically in therapy twice a week for about a year following bereavement and are then seen annually thereafter for many years. This periodic mental health checkup is believed to be an important way to make certain that the child is progressing normally and to offer additional brief therapy if new problems have emerged.
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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.
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From page 265... ...
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From page 266... ...
A number of self-administered instruments and clinical rating scales were used to assess symptoms of psychologic distress, adjustment, functioning, self-concept, life events, perceived social support, and sociodemographic variables. Not surprisingly, initial levels of distress were significantly higher for patients than for controls.
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From page 267... ...
Bereavementlntervention Programs / 267
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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
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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.
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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.
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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.
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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
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From page 273... ...
There is some evidence to suggest that intervention programs help people to move faster through the grieving process, but ultimately most people get through it regardless of whether they have formal support. Still, shortening a process that is painful for an individual and for those around that person may be of considerable intrinsic value and deserves further study.
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From page 274... ...
, psychotherapeutic interventions may be warranted. In addition, certain categories of people may be at such high risk following bereavement that they should perhaps lee evaluated by mental health professionals and followed for some period of time, with psychotherapeutic interventions as indicated.
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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.
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From page 276... ...
Hamburg, B.A., and Killilea, M Relation of social support, stress, illness and use of health services.
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From page 277... ...
Interaction of crisis theory, coping strategies and social support systems. In: The Modern Practice of Community Mental Health iSchulberg, H.C., and Killilea, M., eden.
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From page 278... ...
Primary care persons' bereavement outcomes. In: Final Report of the National Hospice Study {Greer, D., Mor, V., Sherwood, S., Morris, I.M., and Birnbaum, H., eden.
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From page 279... ...
Crisis intervention: effects of crisis intcrvention on family survivors of sudden death situations. Community Mental Health Journal 12:128-136, 1976.
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From page 281... ...
Cor~c~usions and Recommendations
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