Bereavement support group practice-based research

¶ … hospice situation the focus in terms of death and bereavement is usually upon the dying patient and the immediate family. When the patient has died, grief normally becomes lost in elements such as funeral arrangements and accommodating family members who traveled for the sake of the funeral. When all the administration and arrangements have been finished, those closest to the demised person often suffer delayed feelings of grief. This often occurs alone, as the public display of the death is now over. The reality of the death, while still present, now takes a second position to the activities of the living going on with their lives.

Carson (2005) addresses this with her TEAR strategies for dealing with grief: To accept the reality of the loss; Experience the pain of the loss; Adjust to the new environment without your loved one; and Reinvest in the new reality. Most often the bereaved has the bulk of support in terms of hospice workers, family members and friends only during the first period, where the pain is at its most intense. The survivor is then often obliged to go through the rest of the strategies by herself.

When a daughter suffers the loss of her mother, the feelings of emptiness and delayed grief are particularly connected to the nature of the relationship. According to Shaw (2005), the mother-daughter relationship becomes most fulfilling during the adult life of the daughter, depending of course on the particular nature of the relationship beforehand. If the relationship was a healthy and nurturing one, it becomes very difficult for a daughter to cope with her life that is now without a mother figure. The support system in terms of family and friends plays a very important role, and is vital to the healing process. Nonetheless, nobody can truly understand what women in this situation go through, unless they had been through it themselves.

Daughters and mothers share a very particular and unique bond (Shaw, 2005). This is why a support group can help meet the needs of daughters suffering the loss of their mothers. Women in such a group can lend support and comfort when family and friends have left to go on with their lives.

B.

There are few groups focusing specifically on daughters grieving for their mothers who passed away. The main reason for this is that it is such a particular type of population. Support groups for grieving persons usually include people of both sexes who lost a mother or father. Mostly these support groups are inclusive of several types of loss, rather than focusing on the particular loss of a particular person.

C.

There are several types of groups that could be used to meet the need of bereaved daughters. The most conventional of these is a physical support group that meets several times during the month. The atmosphere would be very relaxed, friendly, supportive and sympathetic. This is substantiated by the bereavement groups transcribed by Tuck (2005). Meetings can be held at a venue arranged by hospice personnel, or occasionally at a group member's home.

Another support group type that could be considered, possibly to combine with the above setup, is the Internet. Current technology has made it much easier to find support for specific situations than it may have been in the past. The group leader could then set up a web presence for the group, where members log in online and share their thoughts whenever they feel the need. This would be greatly beneficial for the healing process, as group members can feel connected with the group and its support systems on a continuous basis (Tuck, 2005).

The time scale of the group will be dependent upon the women's needs. It is however anticipated that membership will be fairly dynamic, as each woman has a unique way of working through her grief. For some of the members the group will be fairly short-term, while others will take a longer time to receive the benefits they need. New members will then be admitted as the number of members changes according to the group's collective needs. The group as an entity will then provide a long-term environment to which participants may come for help and leave when they have sufficiently recovered.

D

The main purpose of the group will focus on the women and their needs. It will provide them with a safe environment where they can work through the problems and issues arising from their bereavement (Ford-Martin, 1999). Those who are less confident about the social interaction required for the group can benefit from the Internet supplement to the group. They can attend meetings and will not be required to say anything other than what they are comfortable with. Working through the Internet can also help them to become more confident during the physical meetings themselves. The goals of the group entail helping each member to work through her grief on a time scale with which she is comfortable. The group provides a supportive and understanding environment within which this can be accomplished. The companionship and understanding from other women will help the group to achieve its goal, as also occurs with the groups discussed by Tuck (2005).

II. Theoretical Orientation

A.

Throughout a woman's life, her relationship with her mother, or mother figure, plays an extremely important role (Shaw, 2005). The death of such a person is a huge shock that affects each woman in a unique way (Carson, 2005). The exact dynamics of the resultant grief may be difficult for friends and family members to understand when they have not been through the same ordeal. A support group of the type described above will then provide a loving environment in which bereaved women can talk about how they feel. The focused purpose of this group will also support women by understanding their needs, as opposed to well-meaning family members who nonetheless have their own lives and concerns.

The Internet presence of the group is meant as a supplement for the physical meetings of the support group. Here women who have a difficult time attending all the meetings can access updates on each meeting, as well as information regarding special issues and gatherings. The web site will include an interactive area where group members can share any thoughts or feelings that occur outside of the meeting. Furthermore this will serve the purpose of helping women who are not used to social settings to become more familiar with the group and its members from the perceived safety of their homes. They will then become more integrated in the groups, feel more confident at the meetings, and not be at risk of dropping out for this reason (Ford-Martin, 1999). This will be a more encouraging strategy than expecting silent members to participate right from the beginning.

Sharing feelings of grief and loss with persons who have had the same painful experiences will greatly enhance the healing process (Tuck, 2005). The fact that the group is focused on a very specific target population enhances the atmosphere of support and understanding that is one of the goals of the group.

According to Ford-Martin (1999), support groups are helpful to about 85% of participants. The goals of any support group is to help participants gain better insight into their situation and feelings, develop stronger skills in social setting, and learn to cope more effectively with their problems. This particular group will then use both technology and traditional therapeutic methods to help participants achieve optimal results.

III. Group composition

A.

Selection criteria for the group will include women between the ages of 20 and 45, whose mothers or mother figures passed away fairly recently. The mothers in question do not have to be biological, but can be any woman that played the role of mother in the life of the participant. The death should have occurred at least within the last six months. The women can be from any racial and cultural background, but should probably be from the same geographical region to facilitate attendance at the physical venues of meeting.

B.

Participants are fairly homogeneous in terms of age, although the age criteria are fairly wide and also flexible. The main homogeneity is the fact that all participants should be women who have lost their mothers. This will facilitate the group proceedings and the matters discussed. Women have very particular concerns and homogeneity in terms of sex will facilitate the freedom to express feelings and concerns within the group setting. Cognitive status in most support groups is required to be homogeneous (Ford-Martin, 1999). Women should be on roughly the same level of intelligence to ensure the successful and free flow of communication within the group setting.

Cultural heterogeneity on the other hand is encouraged. This is anticipate to help women understand how each handles her grief and her associated concerns, such as resuming normal duties after the death and funeral. Understanding the cultural associations with grief and feminine duties in and around the home can also have a healing and helpful effect. This will also take the focus away from individual grief by sharing and understanding the concerns of others.

IV. Group structure

A

Recruitment will occur by means of advertisement in a variety of media. The notice boards of medical facilities and pharmacies will be used as a primary advertisement site. Pamphlets will also be available at waiting rooms and at counters of medical venues and hospitals. The local newspaper will furthermore be used for advertising the group, as well as the Internet. The latter will be used on a smaller scale, focusing on local site with relevant content and advertising facilities.

B

The screening process will entail the criteria mentioned above. Advertisements will suggest the criteria, while each woman will be interviewed for a further screening process. In addition to the already determined criteria, all women need to be fairly mentally stable apart from the grieving process. Suicidal, homicidal or psychotic persons will neither benefit from nor bring any benefit to a group setting (Ford-Martin, 1999). If any of the danger signs are encountered during an interview, the person will be referred to an appropriate professional for further help and counseling.

In terms of social skills, the screening process will be fairly tolerant. Women do not need to function particularly well in a group situation to benefit from the therapy (Tuck, 2005). Heterogeneity in this determinant will help less socially apt persons to improve their social skills. The Internet group setting will also be geared towards this.

A hospice volunteer can work with a psychiatric professional to lead the group. The hospice volunteer can then use the experience gained in this way to further benefit the patients she is working with. Gross (2004) identifies a need for death education among hospice volunteers. A support group situation will be ideal in terms of practical education and application.

D

The length of each session will be between 1 and 2 hours. The meetings will be held once per week and supplemented by the Internet website.

E

The weekly meetings will be held mostly at the hospice venue. Once per month, a volunteer from the group can elect to have a meeting at her house. Special occasions and holidays will occur in venues outside of these locations, including restaurants and parks.

F

The group will consist of no more than 10 to 15 persons.

V. Role of the leader

A

The group leader will play the role of facilitator rather than leader. She will provide the group with emotional support, provide questions to start the discussion, and be ready with additions and prompts when the existing discussion runs dry. She will also moderate the discussion. This means that she will, when necessary, maintain control of the order and stability in the group. The leader's role will also be to conduct sessions in such a way that the group establishes a collective and wholesome identity. The co-leader will take administrative duties such as the analysis of questionnaires, and website maintenance, along with her duties of support at the group meetings.

B

The style of the group leader will be very informal. She will fit the profile of the rest of the group members in nearly all respects. If possible, this will be a psychology professional who lost her mother, although not necessarily recently. Her role will be to act as facilitator rather than leader.

VI. Rules and Norms

A

The most important responsibility of group members is to act in a way that is most beneficial to themselves as individuals, as well as to the group as a whole. This entails that all group members need to come to sessions on a regular basis. During sessions, respect for the group leader and other members, honesty and empathy are prerequisites for the success of group therapy. Other norms include confidentiality and no social contact with other group members outside of the sessions or Internet interactions (Ford-Martin, 1999).