1. Pastoral Counseling

2. Physical Illness Sickness is a part of living.
Care, compassion and healing are important for Christians
Sickness, sin, and faith are not necessarily related
Sickness raises important questions about suffering
Serious illness can raise difficult questions about the right to die.

3. What they are facing Stress and helplessness Guilt and self-criticism
Fear and depression
The experience of pain
Family influences

4. The patient Denial Defensiveness Withdrawal Depression and anxiety
Resistance and anger
Manipulation of others

5. Counselor Page 454-5 Encourage people to discuss their attitude.
Help people deal with pain.
Instill hope.
Focus on family and patient
Help find meaning.

6. Variables that influence Grief
Nature of prior attachment/perceived value of loss.
Way in which the loss occurred: e.g., shocking, gradual, young.
Coping strategies of the bereaved.
Age of bereaved.
Social support available.

7. Mourning Process of coping with loss and grief
Bowlby and Parkes 4 Phase Model
Shock and numbness: usually the initial reaction to loss. Difficulty in taking care of basic needs.
Yearning and searching: effort to return to things as they once were.
Disorganization: unable to concentrate on challenges. Death has interfered with life.
Reorganization: begin to reshape a new life
Similar critiques as with Kubler-Ross model.
Makes mourning a passive process.

8. Tasks of the Mourning Process
William Worden makes mourning an active process.
Accept the reality of the loss: includes funeral process, social validation, sharing of memories, talking about the death, maintaining security and routine.
Experience the pain of the loss: permit grief, allow to express feelings, permit respite from grief. Problem occur when grief is hidden by drug use and denial.

9. Worden’s Grief Tasks Adjust to the environment with the deceased.
Use of social support network.
Help in dealing with problems.
Be aware of unasked questions and concerns.
Problems: sense of helplessness and dependency.
Moving on
Commemoration
Enhance old relationships and form new ones
Challenge unrealistic beliefs
Reconstruction of a new identity
New activities and traditions

10. Complicated Grief Reactions
Although grief is normal and appropriate, like everything else it can become unhealthy.
Excessive
Distorted
Unproductive

11. How Can You Help? Five fundamental needs
Social support: main variable in determining high vs. low grief.
Nutrition
Hydration
Exercise
Rest

12. Unhelpful Messages
Don’t try to minimize the loss: e.g., you can get married again.
Suggestions that strong grief reactions are inappropriate: e.g., be strong, you’ll be fine.
Suggestions to get back to living and disturb others with your grief.

13. Constructive Suggestions for Bereaved
Don’t blame self.
Don’t try to be brave and strong.
Don’t’ try to run away.
Don’t feel you owe it to deceased to stay where they lived.
Don’t feel sorry for yourself.

14. Constructive Suggestions for Helpers
Do something specific to help.
Respect preferences to be alone.
Do not avoid contact with bereaved.
Act normally and naturally in referring to the deceased.
Allow bereaved to determine when they want to talk about the deceased.
Don’t force your beliefs on the grieving.
Don’t say “I know how you feel.”

15. Societal Programs One on one intervention: peer counseling.
Hospice follow-up: transitional. Usually lasts months.
Support groups: help from others who have had similar experience.
Some are practical groups, some provide social support (of course, some do both!).

16. Support Groups Helping Factors
Degree of universality: you realize that reactions are not unique or bizarre.
Allows catharsis.
Provides guidance through example.
Instillation of hope.
Creation of a safe and caring environment.
Altruism: as you move on, you can help others.