MORT 294 - Funeral Counseling - Section 1

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MORT 294 - Funeral Counseling - Section 1 - Boettger - Cypress College

Sociology

the science that deals with social groups - their internal forms, or modes, of organization - the processes that tend to maintain, or change, the forms of organization and the relationships between groups

Rite

a specific act, or function, dealing with death

Funeral

rites with the body present

Memorial Service

rites with the body not present

Funeral Rite

all inclusive term, it encompasses all funeral and/or memorial services

Ceremony

an instrumental action dealing with death. It is expressional and it may or may not be charged with symbolic content; and expressing the attitudes of the participants and possible onlookers, who may be regarded as co-beneficiaries or passive participants

Ceremony Ritual

an act that is charged with symbolic content

Ceremony Symbols

things to which socially created meaning is given

contemporary

Now

Modern

in the immediate past

Religion

a culturally entrenched pattern of behavior, which is made up of sacred beliefs, emotional feelings that accompany the beliefs, and overt (observable) behavior. The overt behaviors are presumably implementing the beliefs and feelings.

Contemporary Funeral Rite

a funeral rite that has some measure of religious connotation

Humanistic Funeral Rite

a funeral rite that is devoid of religious connotation

The funeral is a social function

it is an event that allows those who have something in common with each other to deal with one another regarding that in which they share. One of the reasons that funeral services have grown is due to the need that people have the need to participate in social functions.

The funeral rite is a cultural universal (funeral rites of some sort are practiced worldwide)

1. A ceremony or ritual
2. Announcement of the death
3. Care of the deceased
4. A method of disposition
5. Memorialization (ex. Gravemarkers)
6. Patterns of and for living and dying

Culture

1. Complex, consisting of everything we have, think, and do, as members of society. Culture includes rules, ideas, beliefs, and possessions shared by members of society.
2. Cultural universals exist which are learned directly and indirectly. We can identify a culture based on how they take care of their dead

Social Behaviors - custom

these are not must behaviors. This is social behavior concerning death as dictated by the traditions of a people (ex. To have a visitation or not)

Social Behaviors - Folkways

these are not must behaviors. Behavioral patterns that are less compulsive than mores of the same society (to have a procession to the cemetery or not)

Social Behaviors - Mores

this is a must behavior. The basic and important patterns of ideas and acts of a people as related to the treatment of the dead. These call for a strong reaction from society if violated. (ex. We must care for the dead)

Social Behaviors - Taboos

this is a must behavior. They dictate that an individual must abstain from certain acts dealing with death. (ex. Body mutilation)

Social Behaviors - Laws (Rules)

this is a must behavior. They are not necessarily a basic, or important, pattern of a people. Rather, they are enforced by those governing (ex. Any legal method of disposition)

Social stratification

the categorization of people by money, prestige, and power, into classes

subculture

a division or smaller identifiable unit of a culture. It is connected to the main culture by common traits, but it has traits unique to itself.

Types of subcultures

Geographic, religious, ethnic, and language

Ethnocentrism

an emotional attitude that one's own race, nation, group, or culture is superior to all others ("my way of doing things is the only way")

Cultural Relativism

the emotional attitude that all cultures are equal and pertinent, all cultures are unique and important. ("all types of funeral rites are pertinent within a given culture or subculture")

Patriarchal

the father governs, or rules, the family. Power is passed to the oldest male child

Patriarch

the father, or ruler, of the family (or tribe). He is usually a man of great age and dignity. He is the oldest person of a class or group

Matriarchal

the mother rules, or governs, the family

Matriarch

is a woman holding the position, analogous to that of the patriarch

Egalitarian

the male and female have equal rights, duties, and governing power

Extended (Joint) Family - Example

people living in the Appalachian Mountains, Amish, Native Americans, deep South Share Croppers

Extended (Joint) Family - common characteristics

historically patriarchal, farm based, and self-sufficient. Key relationship is father to son and always oldest male first. Women "don't count" and are subservient to the dominant male. Religion is taught in the home

Extended (Joint) Family - restrictions

those common to any small, independent, unit. Mobility is restricted. Lack of resources from the outside. Tend to exhibit "withdrawal" type behavior. The family is bypassed by advancements of society

Extended (Joint) Family - impact of the death of a member (extended/joint family)

the death of one member does not threaten the unit to any great extent. All members will contribute and are able to fulfill the duties of the member who has died. The death of a child is softened because of the number of children and the support from all the other family members. If the patriarch dies, the family already expects the oldest son to fill his shoes; it is highly structured and lots of support.

Nuclear family - examples

"Leave it to Beaver", "Denis the Menace", etc.

Nuclear family - common characteristics

considered to be the smallest family unit. Governance may be patriarchal, Matriarchal, or egalitarian. The key relationship depends on who governs (may be the oldest son, oldest daughter, or any of the children). Economics are structured around the total income of the unit. Religion is taught at church; it is "institutional based". Children, more often than not, reflect the attitudes of the parents, regarding death and dying

Nuclear family - restrictions

there are few restrictions existing. This is the most mobile family unit. This family is considered to be extremely liberal compared to the extended/joint family

Nuclear family - impact of the death of a member (nuclear family)

a) The death of the bread winner, or either spouse where both contribute, may cause great economic hardship on the remaining spouse or the unit.
b) The death of any family member, may curtail the fulfillment of mental expectations. (Dreams have died). This can be a center point of anguish.
c) The death of either spouse forces the surviving spouse to re-enter society as a widow or widower. The surviving spouse is also forced to raise the children alone.
d) The death of a child is more greatly felt because there is less support and fewer children in the family.
e) The funeral can act as the first function, the new and smaller unit, uses to begin to regain security when a family member dies. The nuclear family tends to be the family that experiences the greatest occurrence of internal discontent, they tend to treat the funeral as a mere "detail", and are most likely to request direct disposal. They may result in higher suicide frequency (they have reached a level of hopelessness).

Extended (joint family)

a household, or family unit, consisting of father and mother, all their issue (children), except married daughters, also their son's wives and issue (children), except married daughters

Nuclear Family

a household or family unit, consisting of one man and one woman, married to each other, and their issue (children) if any

Modified Extended Family

household, or family unit, created by nuclear families and/or friendships. They are "chosen" for social bonds, security, protection, and help. When the death of a member occurs, the funeral offers a social function that allows members of the family to give security and demonstrate help. Example: "Friends" and "Everybody Loves Raymond"

Single Parent Family

a household, or family unit, consisting of one adult, either male or female, and his or her children

Blended Family

a household, or family unit, consisting of one male and one female and the children from their previous marriages and may include children from the present marriage

Changes to Society that have Affected Funeral Service

all of the following (industrialization, urbanization, bureaucratization, extended life, death in institutions) brought about an evolution away from extended family toward nuclear family

Industrialization

created the change from independent, multi-talented, self-sufficient family units to employment of family members in jobs outside the unit. It made the family dependent on outside resources for total needs and saw a loss of craftsmanship

Urbanization

This is the change in society from rural to urban in character. It makes it difficult for the funeral director to know everyone in a community. It also gave way to "anonymous" characteristics in the community and created a loss of individual identity.

Bureaucratization

this is a creation of a system that governs through departments and subdivisions managed by sets of officials following an inflexible routine

Extended Life Expectancy (Longevity)

a. Each generation lives longer due to improvements in the medical profession. This has reduced exposure to death and produces our death denying society.
b. "Sandwich Generation" - parents are living longer and possibility using up their own financial resources, so children (adult) may exhibit an inability or reluctance to spend very much when their parents die (for the funeral).

Death in Institutions

a. It is more common for death to occur in institutions rather than in the family home. Death is even more removed from our day-to-day experience. This has produced a decline in visible death and death is longer a part of life.
b. We are seeing more retirement villages and old-age homes and all of this has given to the rise to isolation of the old among the old; and death is more abstract and less tangible.

Economic as it affects funeral rites

the cost of the funeral may determine the type of funeral rite selected

Social Stratification and Class as it affects funeral rites

a. This is the categorization of people by money, prestige, and power
b. The funeral rite may represent a status symbol to some in all classes, the opposite is also true. Conversely, the lack of a funeral rite may represent the status symbol to some in all classes. Intellectual snobbery - those who have the most money spend the least.
c. The lowest socioeconomic class, in the US, will experience the highest frequency of premature deaths (poor people die sooner)

Geographic Factors and Neo-Localism (new location) is it affects funeral rites

a. The area in which a family lives will affect the conduct of the funeral rite
b. Neo-Localism is the tendency of offspring to move away from the area in which they were born. They might not have the same rite that they would have had "back home".
c. In the past, the local funeral director handled all services within one family; nowadays, there is a greater possibility of more than one funeral director serving the family.

Other Social Factors Which Affect Funeral Rites

religion, government, educational level, ethnicity (commonalities other than race such as language), divorce, abuse (child and spousal), demographic issues (the science of vital statistics), living single, population, cohabitants, same sex partnerships

Changes in funeral rites - location of funeral rite and preparation of the body

it is rarely in the family home today

Changes in funeral rites - involvement by the family and friends

this has lessened

Changes in funeral rites - increased responsibility placed on funeral director

Today, there is a need for an increased knowledge in the social sciences (sociology and cultural anthropology). There is a need for increased counseling ability

Changes in funeral rites - cost of funeral is no longer focused upon the price of the casket

Today, the casket represents a small portion of the total expense. A mortuary can emphasize charges for services rendered rather than merchandise sold

Changes in funeral rites - influence of modes of transportation

historically trains were used to transport bodies.
a. Automobile - has allowed for burial a greater distance from home. Families will travel longer distances for better services and/or facilities
b. Airplane - allowed the return of the neo-local family to traditional family burial sites. The fastest mode of transportation.

Changes in funeral rites - influence on disposition

A transition from church yard burial to memorial park burial. This has evolved over time. Today, it is no longer just earth burial, this has evolved over time. There is an increase in cremation, entombments, body donations, direct disposition, etc.

Changes in funeral rites - Influence of organized religions on rites of passage

traditional funeral rites, adaptive funeral rites, humanistic funeral rites, immediate disposition, non-traditional funeral rite

Traditional funeral rites

this follows a prescribed ritual, or ceremony, which may be dictated either by religious belief or social custom

Adaptive funeral rite

a funeral rite adjusted to the needs and wants of those directly involved. It has been altered to adjust to the trends of the time; will never stop evolving

Humanistic funeral rite

a funeral rite devoid of religious connotation

immediate disposition

devoid of any form of funeral rite at the time of disposition

non-traditional funeral rite

this deviates from the "normal" or prescribed established custom

Changes in funeral rites - other changes in funeral rites have been influenced by immigration and the electronic age

this is a constant change

Counseling as defined by - webster

advice, especially advice given as a result of consultation

Counseling as defined by - Edgar Jackson

exists anytime someone helps someone else with a problem

Counseling as defined by - Carl Rogers (Person Centered/Client Centered Therapy)

good communication within, and/or between, men. Good, free, communication, within or between men, is always therapeutic. His method of therapy emphasizes empathic listening and unconditional positive regard (we don't judge or tell people what to do). All of this is the basis for crisis counseling, and that's why it's the basis for counseling in the mortuary.

Counseling as defined by - Dr. James Freuhling

a helping relationship, in which, one party seeks to facilitate the development of informed choices and meaningful actions at a critical time within the context of another's life.

Counseling as defined by - Ohlsen

a therapeutic experience for reasonably healthy persons. Do not confuse this with psychotherapy, which is the treatment for emotionally disturbed persons

Counselor

the helper; the one doing the helping

Counselee

the helpee; the one being helped

Informational Counseling

this is used by the funeral director counselor; this is counseling in which a counselor shares a body of special information with a counselee

situational counseling

this is used by the funeral director counselor; this is counseling relating to specific situations in life that may create crisis's and may produce pain and suffering

Psychotherapy

a type of counseling not used by the funeral director counselor. This is therapy with people whose needs are so specific that usually they can only be met by specially trained practitioners

Directive Counseling

the counselor takes a live speaking role, asking questions and suggesting courses of action. Many behavioral methods are directive (develop lists, give homework, etc.).

Non-directive or client centered therapy

(Carl Rogers) - the counselor takes a more "passive" role; reflecting back the client's own reactions and feelings. A benefit for the client is an increased self awareness. In non-directive style the counselor needs to -
* Listen sensitively and observe; allow time during an arrangement conference
* Establish rapport with the client; this begins at the beginning of introductions. Set a mood and a comfortable setting to earn their trust.
* Assist the person to gain new perspective; "are you aware that it is possible to..."
* Appraise the client's problem and keep it realistic; boil it down to its basics; be certain that what they purchase is within their means
* Encourage conversational flow by avoiding questions that can be answered yes or no --- ask "open-ended" questions; "it would help me to hear...more about their history, etc." "tell me what you have discussed as a family, concerning plans for a funeral service"
* Accept the client's attitude and feelings and be alert for denial statements, but be non-judgmental once they have made a decision
* Do not assume the client's first statement is either true or complete
* Allow the client to summarize
* Respect the confidential nature
* Write comprehensive notes upon conclusion

Grief Counseling

The loss of a loved person is one of the most intensely painful experiences any human being can suffer. Not only is it painful to experience, but also painful to witness, if only because we are so impotent to help (Bowlby, 1980).
Pain is inevitable in such a case and cannot be avoided. It stems from the awareness of both parties that neither can give up the other what he wants. The helper cannot bring back the person who is dead, and the bereaved person cannot gratify the helper by seeming helped (Parkes, 1972)

The counselor's own grief - Frustration/anger

the counselor can easily feel frustration or anger because the experience of grief makes it difficult for us to be, or feel, helpful. You may not see them begin the process of healing

The counselor's own grief - uncomfortable

the counselor may be so uncomfortable witnessing pain in another person, that the discomfort causes them to cut the relationship short

The experience of bereavement affects the counselor in at least three ways

* Be aware of your own losses - we don't have to have completely healed, but we do need to know where we are at in our own grief work
* Be aware of your own feared losses - it is good to do some introspection to decide who is dear to you and you would fear to lose. If we are working with a death similar to the one we fear losing most, our apprehension may affect our effective counseling skills.
* Be aware of anxiety over our own personal death awareness - we will all die. It is possible to come to terms with the fact that everyone will die.

The benefits of a funeral director exploring your own history of losses include the following

* Reinforce the Funeral Director's understanding of mourning
* Exploring your personal history of losses provide you with a sense of the kinds of resources available to the bereaved
* You can identify any irresolution that is still present from your prior losses
* Looking at one's own grief can help you (the Funeral Director) be aware of your limitations when working with different kinds of clients and different kinds of grief situations

Stress and Burnout - 3 guidelines

the number of families, practice active grieving, reach out

Coping with stress - Stage 1

Intellectualization - Knowledge and Anxiety
*During the initial confrontation with death and dying, caregivers are very intellectualized. They focus on professional knowledge and factual, even philosophical issues. Ineffective means of coping with and managing anxiety may result in withdrawal from families. While caregivers continually feel concerned, these individuals are uncomfortable. At this point, death is unacceptable to them.

Coping with stress - Stage 2

Emotional Survival - Trauma
* At this stage professionals experience trauma being often accompanied by guilt and frustration. Here we must confront the reality of our own mortality. The process of mourning and grieving for self becomes salient. Death is felt at an emotional level. Once again we are faced with the fact that we should have a healthy concept of death and dying or we may pass this on (project it) to the families we are called upon to serve.

Coping with stress - Stage 3

Depression - Pain, mourning, grieving
* This is the most crucial of all stages, the "grow or go" stage. In this stage, mastery of self is a challenge; such mastery requires a growing acceptance of death and an orientation of the reality of death and dying. Caregivers either accept the reality of death and dying or leave the profession.

Coping with stress - Stage 4

Emotional Arrival - moderation, mitigation, accommodation
* This stage is marked by a sense of freedom from the debilitating effects of the previous stages. Caregivers are no longer preoccupied with their own death and dying. This does not mean they no longer experience pain, actually their sensitivities have been sharpened rather than dulled. Even though they feel the pain, they are free from its incapacitating effects. Their emotional responses are appropriate. They now have the sensitivity to grieve and also the resilience to recover.

Coping with stress - Stage 5

Deep Compassion - self-realization, self-awareness, self-actualization
* This stage is the culminating point of all previous growth and development. The ability to serve another human being and to give of themselves manifests the caregiver's humanity to others

Characteristics of Stress and Burnout

* Exhaustion and loss of energy
* Irritability and impatience
* Cynicism and detachment
* Physical complaints and depression
* Disorientation and confusion
* Omnipotence and feeling indispensible
* Minimization and denial of feelings

Guidelines for Caring for the Care-Giver

* Recognize that you are working in an area of care where the risk of burnout is high
* Create periods of rest and renewal
* Be compassionate with yourself about not being perfect
* Practice setting limits and alleviate stresses you can do something about (learn to say "no")
* Learn effective time-management skills
* Work to cultivate a personal support system
* Express the personal "you" in both your work and play
* Work to understand your motivation to work in funeral service (remember - "why funeral service?"

Indicators of Burn-Out

feelings of emotional and physical exhaustion, occupational fatigue, cynical attitudes, withdrawal from families, attitude problems with peers and/or families

Prevention of Burn-Out Syndrome

Be aware of your own energy level, be aware of your feelings, identify specific stresses, be realistic about how much you are capable of accomplishing, peer conferences, good friends, decompression routines, clarify your priorities between work, self, and home

decompression routines

* Physical activities (but competitive sports are not recommended)
* Meditative activities (start with introspection)
* A quiet walk in one of your favorite places (beach, park, etc.)
* Any form of quiet relaxation
* Others

The 10 commandments for dealing with grief

1. build and maintain an adequate sense of self-esteem
2. Strength your professional qualifications
3. take sufficient vacations
4. Monitor your own life's pace
5. Don't be a perfectionist
6. don't underestimate
7. carefully assess each situation
8. concentrate on the pleasant side of life
9. re-establish your self confidence
10. don't procrastinate

1. build and maintain an adequate sense of self-esteem

people with a decreased sense of personal worth are more likely to become anxious and hostile when they perceive they are being treated negatively in interpersonal relationships. Self-esteem develops when we feel loved and are able to show love in return, especially in devoted service to others or to a worthy cause.

2. Strength your professional qualifications

people only weakly qualified are more vulnerable to suffering from stress. People with strong qualifications experience less stress when crisis comes because they have more options available to them.

3. take sufficient vacations

uninterrupted long-term encounters with stressors cause distress. Our body tissues need intermittent relief from constant bombardment by stress-related hormones and other biochemicals that will otherwise eventually produce illness. A break is not long enough if one does not return to action feeling rejuvenated as well as relaxed

4. Monitor your own life's pace

stress comes from attempting to do too much, always striving to please others and never oneself and from neglecting t live a balanced life (for example - physical exercise and play, intellectual pursuits, prayer or other spiritual exercise, cultural experiences, etc.)

5. Don't be a perfectionist

strive to do things that are within your capabilities. Get in touch with your reality and set realistic expectations

6. don't underestimate

genuine pleasure can come from the simple things in life

7. carefully assess each situation

it is "syntoxic" = tolerate it or it is "catatoxic" = engage it in battle. Determine the response that will serve you best and only fight for that which is worth it

8. concentrate on the pleasant side of life

focus on the activities which can improve your situation

9. re-establish your self confidence

remember past accomplishments when you experience a setback or defeat

10. don't procrastinate

tackle the unpleasant, but necessary tasks you have to do; get them over quickly and face life

Grief Counseling (Clearly differentiate this from grief therapy)

Involves helping people facilitate uncomplicated grief to a healthy completion within a reasonable time frame. All families should receive it.

Grief Therapy (Clearly differentiate this from grief counseling)

Involves specialized techniques which are used to help people with complicated grief reactions

The four tasks of mourning/grieving (By William Worden)

1. To accept the reality of the loss
2. To experience the pain of grief
3. To adjust to an environment in which the deceased is missing
4. To withdraw emotional energy and reinvest it in another relationship

1. To accept the reality of the loss

when someone dies, even if the death is expected, there is always a sense that it has not happened. The first task is to come full face with the reality that the person is dead, the person is gone and will not return. Reunion is impossible, at least in this life. Denying the facts of the loss, the meaning of the loss of the irreversibility of the loss only serves to prolong the grief process. Though denial or hope for reunion are normal immediately after the loss, this is usually short lived.

2. To experience the pain of grief

many people try to avoid the painful feelings by various ways - being "strong", moving away, avoiding painful thoughts, keeping busy, etc. There is no adaptive way of avoiding the pain of grief, you must express your feelings. You must go through it, not around it. You must allow yourself the experience and express your feelings. The only way out is through. Many experiences and feelings are "normal" such as: anger, guilt, loneliness, anxiety, and depression

3. To adjust to an environment in which the deceased is missing

the emotions involved in letting go, in not having that person's love, support, or assistance, may be painful but again, necessary to experience. If you do not experience the emotions, you will remain stuck in the grief process and unable to resolve your loss

4. To withdraw emotional energy and reinvest it in another

it is necessary to affect an emotional withdrawal from the deceased person so that this emotional energy can be used in continuing a productive life. This does not necessarily mean finding a new spouse, surrogate mother, etc. It does mean re-entering the stream of life without the deceased loved one. You must rebuild your own ways of satisfying your social, emotional ,and practical needs by developing new or changed activities or relationships. This is not dishonoring the memory of the deceased. There are other people and things to be loved and it does not mean that you love him or her any less.

Goals of Grief counseling

1. To increase the reality of the loss
2. To help the survivors deal with both expressed and latent (dormant) emotions
3. To help the survivors overcome various impediments to readjust after the loss
4. To encourage the survivors to make a healthy emotional withdrawal from the deceased and to feel comfortable reinvesting that emotion in another relationship/activity.

Who does Grief Counseling?

1. Professional persons such as doctors, nurses, funeral directors, psychologists, or social workers who provide support to a person who has sustained a significant loss. It can be done in a group setting or on an individual basis
2. Those services and groups in which volunteers are selected, trained, and supported by professionals. Examples include the American Red Cross, a widow-to-widow program, etc.
3. Self help groups in which bereaved people offer help to other bereaved people, with or without the support of professionals. Again, this can be in a group or individual setting. Examples include MADD, SIDS, support groups, etc.

Who receives Grief Counseling?

1. Bereavement counseling can be offered to all individuals. Particularly to families in which the death has taken a parent or child.
2. Some people will need help with bereavement, but will wait until they get into difficulty. Finally, they will recognize they need help and reach out for assistance
3. The preventive mode - if we can predict in advance who is likely to have difficulty, then we can do something by way of early intervention to preclude an unresolved grief situation. For example - there are 15 ways to identify a high risk widow (covered in Thanatology II). It is helpful to create a community referral resource guide and make it available to your families.

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