Different Approaches to Grief Support

At my internship site two different grief support group models are offered, which I will label traditional and alternative models. Both groups support individuals experiencing grief. Yet the atmosphere and energy in the groups are decidedly different. The traditional group openly discusses individuals’ grief and coping, and the agenda for these groups are centered on this ‘deficient’ or loss individuals have experienced. In the alternative group, the atmosphere of the group is one of a social club, and has an air of affirming the survivor’s life, and exploring what is next for them. The opportunity to compare and contract two different models of group facilitation has been exciting and clinically rewarding, as I move from reading about theoretical frameworks toward practice. The traditional support group model at my internship placement involves clients and facilitators coming together and sitting in a circle. The facilitators begin the group session in various ways; they may remind the group members of group etiquette, read a poem, practice a mindfulness exercise, or some combination of these. Facilitators rephrase and reflect back to clients what they heard, and make connections between experiences or stages two clients may have had which have similarities, for example. The clients take turns if they choose, sharing their feelings, struggles, successes, all centrally focused around the event of their loved ones passing. Clients may be at different stages of grief within the group, yet those who have been there longer can offer inspiration and wisdom to others who are just beginning the grieving process. Additionally this model allows everyone in the group the opportunity to hear each person’s story and be apart of their process. Another perspective is that this model may be difficult for individuals who feel burdened by listening to other individuals share their grief, if their own grief is still overwhelming. Also clients could feel uncomfortable with the idea of talking about personal/private concerns in a group setting, depending on their background. An alternative model support group is also offered. The atmosphere of this support group reminds me of a church coffee hour. Two clinicians facilitate the group. The clinician who developed the group describes the approach as being a “lighter touch” to grief support for those individuals who are not as comfortable participating in a traditional group setting (Whitt, 2013). The demographics are mostly retired individuals who have lost lifelong partners. These older individuals may not be comfortable with more modern support group models, which encourage sharing personal feelings publicly. With this model the focus in on building a relationship with and between the clients and the facilitators. Once a sense of relationship, trust, and in some instances friendships is established among clients, then there is a natural progression toward sharing more personal information. In this alternative grief support group the facilitator sets a theme for each session, which is uplifting and life affirming, and usually a surprise for the clients. Themes may be around spring arriving, a person’s birthday, or a special tea party. Additionally the primary facilitator is enthusiastic and excited to greet each client. During the first hour clients and facilitators greet each other, and visit around a large table over coffee and refreshments. The unstructured nature allows clients to have lengthy conversations with each other in dyads or small groups, and for facilitators to have one on one conversation with individuals who may need additional support. The thirty minutes of the group is reserved for sharing a community calendar of events. The calendar gives clients ideas for getting out in the community again by themselves or perhaps with another group member, and is delivered in a humorous manner. The overall the group seems to focus on client empowerment and strengths, in an accessible and developmentally appropriate format for older individuals (Robbins, Chatterjee, & Canda, 2006, pp. 434-435).

Learning to make ethical decisions as a social worker and managing ambiguity around the NASW Code of Ethics will be a significant challenge, and will vary depending on work contexts. As I reflect on the meaning of ethical principles and practice in social work, my first question is: what is the definition of ethics, and whose definition is it? Goldberg Wood and Tully (2006) explores the complex history of ethics and the social science and philosophy of this area of study, as well as how this area relates to the National Association of Social Work (NASW) Code of Ethics. The origin of the word dates back to Greek times meaning custom or character. Ethics are tied to societal ideals, moral values, and cultural norms. Goldberg Wood and Tully’s final assessment is that societies define ethics for their own benefit, and for the purpose of controlling individuals. The NASW Code of Ethics reflects the professional values and ethics of social work as a profession and assists in communicating these cultural norms to new generations of social workers (Goldberg Wood & Tully, 2006). Ethical reasoning and decision making in a professional context can refer to utilizing theoretical principles and ethical codes of conduct as a basis for our decisions regarding policies or client treatment and access. For example, in my current internship at Hospice in bereavement services, federal regulations state that bereavement counseling must be provided for family members of hospice patients, however the federal regulations also state that bereavement services are not reimbursed by Medicare or Medicaid. Given this ‘double message’, services must be provided, but there is no monetary support for them, some organizations could take this as permission to limit bereavement services that are offered and exclude /graduate clients. Yet Hospice has been creative in how they approached this issue, given the rural area we live in, and the limited availability of bereavement supports in our community. There are two bereavement counselors to work primarily one on one with clients. In addition Hospice recruits volunteers to facilitate weekly support groups throughout the community, and recently expanded training opportunities into a local Indigenous community. At Hospice grief support services has made specific decisions around ethic practice regarding inclusive access to services, which supports the concept of social justice for the overall population of our rural community.