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Greetings to Our Partners in Care!
Welcome to this month's edition of GriefPerspectives!
At Windsor Chapel we greatly value our relationships within the community and we look forward to continuing to be a strong resource for you as care providers.
Thank You for doing what you do day in and day out. Your passion and commitment to excellence in care is of great value to so many individuals and families in Windsor and Essex County. Our community is a better place because of you. I trust that this month’s edition of Dr. Hoy’s GriefPerspectives will be a benefit to you as you continue to provide excellence in care and service to others.
Please be sure to check out the Local News section of this newsletter to hear of the exciting events upcoming at Windsor Chapel.
Your partner & resource in the community,
Scott Lockwood
Director of Community Development & Education
Windsor Chapel Funeral Homes Ltd.
slockwood@windsorchapel.com
Cell 519-566-8175
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GriefPerspectives
Six Vital Movements in Bereavement Assessment and Support
by William G. Hoy
 The GPS capability of my smart phone astounds me! When I ask it to guide me to the closest gas station or pizza establishment, it first takes a moment to determine where the phone and I presently are. The principle is pretty simple: you cannot get good directions to a new location if you don’t know where you are starting out. The same is true in supporting bereaved people.
One vital objective in the training of caregiving professionals is the development of skills in making good assessments. Whether we are discussing a social worker’s assessment of a client’s psychosocial functioning, a psychotherapist’s assessment of psychological health or a physician’s assessment of physical well-being, asking the right questions to learn the history and current state of the patient or client is imperative. Without this information, it is impossible to know how to proceed in helping.
The following are six proven questions to get the conversation started with a new (or not-so-new) client. Experienced counselors will probably recognize many of these as the building blocks of their practice with bereaved clients; they are questions I have used in one form or another for most of my career. They all lead to the discovery of important information that the caring person needs to know in order to best serve the client find his or her way through grief. Most importantly, they invite the client to share the significant details of life with the loved one and the profound ways life has changed since the death.
Will you share with me the details about your loss? or Please tell me what happened. Friends and family members often quickly tire of hearing details recounted about the loss and the continuing impact this has had on the bereaved individual. In a quest to “cheer up” the bereaved individual, these well-meaning people often discourage the bereaved from telling about their experiences with the loss. Yet, knowing the details--the what, when, where, how and who of the loss story is important for the counselor’s understanding. More importantly, the vast majority of bereaved people long to tell this story to compassionate listeners who will “bear witness” to the pain being experienced. Invite the patient to share details and even photos. Remember that if the details and photos are mostly about the death event itself (details of the accident, for example, rather than recounting the relationship with the deceased), your patient is likely dealing more with traumatic issues than grief issues.
Since I didn’t know your wife/son/mother, will you please tell me about him/her? I like to ask for details about the person who died because it helps me better understand the contours of relationship between the deceased and the bereaved. When character words (loving, generous, happy, faithful, compassionate, etc.) are not forthcoming, I frequently ask a prompting follow-up question such as, “So what did you love most about N.?” Bereaved people often possess an inordinate fear of forgetting the person who died; engaging him or her in sharing details about the deceased’s life helps emblazon those characteristics into his or her memory.
 How have your eating and sleeping habits changed since this happened? Professional counselors reading these words will recognize the importance of assessing for physical manifestations of grief. Listen for tales of weight loss or gain, insomnia, chest tightness, and loss of appetite as part of a thorough assessment. If these are present, clinicians will want to investigate a bit about how the bereaved sees himself, how she views the world, and what sense he makes of the future since poor self-esteem and hopelessness about the situation is more indicative of clinical depression than it is of normal bereavement. Whether or not the physical symptoms of grief are accompanied by other manifestations of depression, wise counselors recommend practical plans for assuring a balance of nutrition, rest and exercise for bereaved people. If the client presents symptoms of persistent clinical depression, this should be addressed as part of the clinical intervention.
What has been the most difficult part of this experience so far? Engage the bereaved person in telling about what is hard about grief, embracing the sharing of details. What counselors must do is learn the varied textures that make up the grief story while remaining alert to how these change over the course of time. Listen for what I call the “Big Five” emotions of bereavement: anger, guilt, loneliness, sadness and fear. If you do not hear reference to one or more of these in the course of your discussion, you might try asking, “So Jane, what do you suppose angers you the most about this experience?” or “How do you find yourself managing the fears that so often accompany bereavement?”
Who are the people who have been most supportive to you and what have they done to help? This question helps discover the depth and perceived helpfulness of the client’s natural support network. Some grieving individuals are surrounded by lots of people, while not feeling particularly supported by any of them. Others talk specifically of the helpfulness of one, two or three close friends or family members. Especially if the support system seems small and the client is vague with details, press a bit more by asking, “What kinds of things do these people do that feel particularly supportive to you?” The answer to this question helps resolve whether your client feels genuinely supported or whether she is simply providing what she thinks is the socially-acceptable answer to your question. If support seems insufficient for your client, be prepared to recommend a bereavement support group in the community.
 How have your beliefs been challenged and/or reaffirmed by your loss? Though often overlooked by counselors not trained in theology (and by a fair number of pastoral counselors who were!), spiritual well-being is essential in the bereavement process. In many ways, grief is a process of discovering what values endure in the face of death and represents a sense to make meaning of the loss. In other words, most bereaved people are asking some form of the questions, “What does all of this mean?” and “Who am I now in the face of this loss?” These are profoundly spiritual questions which may also have significant implications for the connection the client has to a faith community. Attentiveness by the counselor to the perceived supportiveness of faith community and belief system provides direction for much of the grief counseling process, whether or not you delve into deeper matters of theological or philosophical belief. Bereaved individuals who believe they have been abandoned by God or for whom the belief system has been shattered find grief much more difficult to navigate.
Effective assessment is not just a matter for the first conversation, but rather, is important throughout the time client and counselor work together. Even a brief examination of these issues in the first visit can yield important clues for direction in subsequent conversations. As we are increasingly learning from the perspectives of narrative therapy and narrative medicine, carefully listening to the details of the client’s story provides important ideas for helping but, more importantly, provides opportunities for the client to feel that he or she is really “heard” on items of utmost importance.
The Author: For more than three decades, William G. Hoy has been counseling with the bereaved, supporting the dying and their families, and teaching colleagues how to provide effective care. After a career in congregation, hospice, and educational resource practice, he now holds a full-time teaching appointment as Clinical Professor of Medical Humanities at Baylor University in Waco, Texas.
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We are very excited to announce that Windsor Chapel has just opened its South Windsor Chapel at 3048 Dougall Avenue.
If you and/or your team would like to arrange for an open house tour and information session, please contact Scott Lockwood at slockwood@windsorchapel.com or by phone at 519-566-8175. |
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 Drs. Gloria and Heidi Horsley is the mother-daughter duo who founded a great interactive website for bereaved people at www.opentohope.org. Open to Hope’s vision is to develop an online website where people can share inspirational stories of loss and love, encouraging visitors to read, listen and share their stories of hope and compassion.
While the website contains many interviews of professionals in the bereavement field, the focus of the resource is interaction between bereaved people using simple, proven strategies. While I was first put off by the question, “What stage of grief are you in?,” I realized that the website captures an often-thought concept in western society and uses it to direct individuals to four or five articles that would be most appropriate for the time since the death and the nature of the relationship with the deceased.  While the resources here are limited for the professional community, this is an incredibly useful place to refer the people with whom we work.
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Your Professional Library
 Dyregrov, K. & Dyregrov, A. (2008). Effective grief and bereavement support: The role of family, friends, colleagues, school and support professionals. London: Jessica Kingsley Publishers.
Effective Grief and Bereavement Support is a well-researched, yet practical book that will serve counselors well. The book begins with a survey of both the historical and current thinking on social support in general and the grief process in particular. Then, the authors proceed to knock down current myths about how grief works, including pointing out that there is no compelling, verifiable evidence that so-called “stages” exist among grieving people.
This book is not an essay espousing personal opinions on grief. Instead, these authors are researchers on the staff of a large Norwegian bereavement center, the Center for Crisis Psychology in Bergen. With one’s perspective as a sociologist and the other as a psychologist, the authors do a nice job of drawing together both the psychological and the socio-cultural factors present after an unexpected death. The book is well-researched, and concludes with an appendix outlining the five major studies on which the authors relied in reaching their theoretical and practical conclusions.
Perhaps the book would have benefited from somewhat tighter editing; the language is a little choppy and difficult to read at times, likely because the authors are not native speakers of English. However, this minor irritant is more than offset by the very useful perspective this volume is in reminding us all how to encourage social networks to do their best work in the care of bereaved people.
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 Granek, L., Mazzotta, P., Tozer, R., & Krzyzanowska, M.K. (2013). Oncologists’ protocol and coping strategies in dealing with patient loss. Death Studies, 37, 937-952.
As a group, physicians seem to have often earned the reputation for not dealing very forthrightly with death, loss and grief. Because of the nature of their specialty in dealing with the often-fatal processes of cancer, oncologists are particularly vulnerable to the effects of professional loss. To this end, these researchers conducted a qualitative grounded theory study to better understand the protocols followed by oncologists in the deaths of patients and how they reported they coped personally with these losses.
Granek (a psychologist) conducted interviews with the study participants; Mazzotta, Tozer & Krzyzanowska, all practicing oncologists, provided consultation in the development of the study and the recruiting of participants. In all, Granek interviewed 20 oncologists, transcribed the interviews and analyzed the responses according to standard grounded theory study protocols. Qualitative studies typically involve far fewer participants than large-scale numerical investigations, but what they give up in quantity of responses, it is believed they gain in depth.
The interviews in the current study each lasted between 40 and 90 minutes with the interviewer asking questions such as: What happens when a patient dies in your practice in terms of protocol of dealing with the family? I want you to think now of one patient who died that was particularly difficult for you. Can you describe the patient to me? If you wish, you can tell me their name, their age, how long you knew them, what they were like, what they meant to you, etc. How did you feel when they died? How did you cope with the patient’s approaching death? Did you talk about the patient’s death with your family and friends? Did you have any professional resources you could turn to in order to deal with your grief? (i.e., support groups for physicians, fact sheet about dealing with grief, nurses to help with psychosocial care etc.) (pp. 951-52).
The researchers discovered their participants generally employed ad hoc protocols in dealing with the deaths of patients. Some (though not all) interacted with the family in person or by telephone and a few reported attending bereavement rituals (such as funerals or memorial services). Some expressed the intention to at least send a condolence card, though most admitted the practice rarely happened. The researchers noted that other research studies have consistently shown patient families are dissatisfied by physician responses to deaths, and the lack of contact by these oncologists might explain some of the disappointment.
The coping strategies employed by the oncologists in this study showed a strong preference for independent or self-contained coping. When physicians sought social support, it was most likely from spouse or other close family members and less frequently from other healthcare professionals (such as the physician’s lead nurse). While family members were viewed as important support networks, oncologists often expressed concern about “burdening” family members with the details of their work. Some also turned to activity-based coping strategies (hobbies or sports such as golf) to try to manage the emotion of a patient’s death.
The researchers suggested that institutions should consider employing a standard protocol for physicians to follow, providing materials (such as condolence cards), time in their schedule, and reassurance that most families really do desire some follow-up contact from the oncologist and hospital. Many of the oncologists in the study did report meaningful support from their faith or spiritual system, but details were not disclosed about exactly what these factors might entail.
At times, the report disappoints because its relatively small number of interviewees makes generalization quite impossible. Sometimes, however, in-depth qualitative research produces a set of core categories from which to develop questions for surveys and other quantitative research methods, allowing for the examination of much larger participant groups. In any case, this research will have been extraordinarily helpful if it leads to the development of better training and support systems for physicians in practice with the dying and their families.
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