The primary group that will be established for bereavement will be a mutual support group, comprised predominately of individuals aged 60+ years that have been recently widowed, defined as individuals who have lost their spouse within the 1 year prior to seeking counseling.
Important to note is the fact that a majority of the elderly dies within nursing homes and medical centers; this fact may directly impact the experience of bereavement that individuals involved experience. According to studies, mortality rates increase as income rates and minority status decrease (Pappas, 1993). Therefore one might expect a larger population of elderly minority victims seeking a mental support relationship within a group setting.
Grief over the death of a loved one presents one of the most frequent and challenging problems mental health counselors face with their clients" (Muller, 2003). Death of a loved one is one of the most "penetrating loss individuals experience" encompassing a physical, emotional and spiritual loss process (Muller 2003 & James and Friedmans, 1998). The mutual support group will bring together individuals of similar backgrounds, economic status and situation to share experiences related to their loss. Important to note is the following statistic: Typically the "wife, husband and daughter (s) of deceased are most attentive at the deathbed, and presumably suffer the most from death." Therefore one might logically conclude that the mutual support group will consist of close family members, including wives, husbands and daughters.
Purpose of group and expected outcomes
Purpose of the group is to reduce the likelihood that individuals aged 60+ currently experiencing loss of a spouse or close family member will fall victim to depression.
A majority of elderly victims of loss witness the loss of a loved one in a controlled environment, such as a hospital or medial facility. According to the National Center for Health Statistics in 1998, and the Centers for disease control, more than 56% of deaths occur in hospitals or medical centers, 19% occur in nursing homes and 21% of people died in homes (EFMoody, 2004).
A recent study conducted of volunteers ranging in age from 44 to 77 who experienced widowing from a time frame ranging from one week to 29 years prior to examination were recently evaluated (Muller, 2003). The interviews with participants suggested that the five most prominent themes among grieving people indicating the following factors as important: (1) coping, (2) affect, (3) change, (4) details and lastly, relationship (Muller, 2003). Coping appears to be the most important theme among widowers. Therefore, the primary purpose of this group will be to assist elderly populations in developing mechanisms to better cope with grief, and affect positive change in their lives.
Unmet educational/Psychosocial needs of intended group members
Some tools that prove effective in coping with loss include: "optimism, intellectualization, positive self-talk, compartmentalization and avoidance" (Muller, 2003). Those enduring a loss noted that familial support was often helpful and appreciated, as well as physical exercise (Muller, 2003). Unmet psychosocial needs among elderly widowers include resources that help develop skills of optimism and positivism. Additionally, as a majority of widowers belonging to groups typically arise from lower socio-demographic populations, as described above, it will be critical to provide community educational resources that delineate methods of stress reduction and acceptance of the loss experienced.
In this particular situation, the group would best be facilitated by a social worker with training in mourning, grief and bereavement and a Psychiatric RN who will be available to address medical considerations such as depression and the possible need for pharmaceutical intervention. A social worker is best suited to deal with minority and aging populations; such a worker will be trained in techniques that need be utilized to adequately address the needs of an aging population, including an increased incidence of alcoholism and depression. The Psychiatric RN is important to deal with the clinical manifestations of such illnesses that are typically present within the elderly population.
Criteria for selection of group members
Mortality is occurring at older ages, and one enduring challenge within group therapy is acknowledgement that "mechanistic approaches to forecasting mortality or maximum life expectancy" which were often used in the past, do not currently provide an adequate picture of the many factors that influence mortality (Caselli, 110).
In England and Wales, evidence suggests that "a substantial shift has occurred in elderly people in societies which stress autonomy, such as in the United States (Caselli, 151). Patterns of social interaction are often influenced by "events and circumstances in early childhood (Caselli, 151).
Clinicians need deselect patients for group therapy rather than select (Yalom, 219), meaning that certain patients should automatically be excluded. The criteria for excluding patients should include evaluation of the following criteria which may be present: those patients that exhibit symptoms of paranoia, hypochondria, obsessive compulsiveness, violence and psychosis (Yalom, 219). Any individual that bears a social front that may be deceptive should automatically be excluded, as their intention might be to exploit other members of the group for personal gratification (Yalom, 219).
Additionally, as a sixth factor patients in the midst of an acute crisis may not be good candidates for therapy as well as deeply depressed or suicidal patients, as they require more individualized and specialized attention that is typically afforded in "heterogeneous therapy" (Yalom, 219).
Group size and type of membership
This group will be a closed therapy group, which typically meet for approximately six months or less (Yalom, 267). This type of group supports the creation of stable memberships facilitating more cohesive group interaction. Research indicates that the ideal size of an "interact ional therapy group" is seven or eight people, though some range as few as five or as many as ten (Yolam, 276). This group will consist of eight members, in order to facilitate interaction within the group without overwhelming participants. Any fewer than this and the group may cease to operate as members are not likely to interact as much
Group members will be asked to prepare for sessions by being willing to describe the following three factors: current lifestyle, age, and grief experiences.
The following will be discussed in group therapy sessions:
1) Current work status
(2) Mechanisms used to cope with grief
3) Current interest/hobbies
4) Any support mechanisms used previously to cope with loss
5) Family members available
6) Group member hobbies, careers, objectives for therapy
Where will group meetings be conducted?
Group meetings can be held in almost any setting, as long as the room in which people are meeting provides privacy and freedom from distraction (Yalom, 266). Additionally members should have the opportunity to sit in a circle to facilitate open communication and sharing. Most group participants prefer not to have obstructions to communication and free thinking, such as tables in the middle of a discussion (Yalom, 266). Such a structure may inhibit the ability of other group members to see the entire body of other members of the group and observe their "postural responses" (Yalom, 266).
Individuals to be contacted for sanction & / consent for group and member participation
Group member peers will be contacted for sanction and consent for participation in addition to social workers or occupational therapists involved in case work for each member; Within agency contacts such as the grief/loss program director will interview each potential member to ensure suitability for group therapy and cohesive personalities of group member.
Ground rules for group participation
Ground rules for participation should include attendance to at least four weekly sixty minute sessions..
Members will be required to maintain the confidentiality of any information shared within group sessions.
Group members will be expected to utilize non-offensive language throughout group sessions.
Group therapy members will be required to participate and share experiences at each session.
Group facilitator's role
The larger the group the less time available to work through individual problems (Yalom, 277) therefore it is critical to keep the size of the group within respectable limitations. The purpose of the group facilitator will be to monitor the effectiveness of group interaction and ensure that the size of the group is appropriate to the therapeutic intention; the facilitator will interact with group members only to facilitate preliminary conversation, however the majority of interaction that occurs will be expected of group members. The facilitator will serve as mediator in instances where conflict or excessive aggressive emotion may arise from the subject matter discussed within the group.
One area of deficiency that has been identified among psychologists, health care providers and support officials is the lack of provision for supplying the dying and their families with attitudes, knowledge and the skills necessary to cope with dying and bereavement, due in part to a failure of professional educators to teach these skills (Field and Cassel, 1997). Psychologists and health professionals must first "understand and manage their own reactions to dying and death" in order to develop "Science based interventions that are responsive to the needs of individuals and families" (PsychNet,…