Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar

Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar Create a Username & Password at the NYU Silver CE Online Portal : https://sswforms.es.its.nyu.edu/ Log on to the Continuing Education Online Portal for the NYU Silver School of Social Work page, click on All Events & Programs tab Scroll down & select today s webinar under Online Learning Click Register Fill in the billing information, click register, and pay the CE registration fee

Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar, cont. After registering, you will receive a confirmation email with a link to complete an evaluation Once the evaluation is submitted, within 24-48 hours, log back on to NYU Silver CE Online Portal, go to Your Registrations and you will see Take Assessment in red next to the name of the program Complete assessment Once done, you will be directed how to download your CE certificate For Questions: Call us at 212-998-5973 or email us at silver.continuingeducation@nyu.edu

Beyond Kübler-Ross: New Perspectives in Death, Dying and Grief KENNETH J. DOKA, PHD PROFESSOR, THE COLLEGE OF NEW ROCHELLE SENIOR CONSULTANT, THE HOSPICE FOUNDATION OF AMERICA December 14, 2017

Discussion Question What therapeutic approach and/or theory informs your work when working with clients who are dying or bereaved?

Challenge to the Grief Work Hypothesis One must work through painful feelings in order to detach from the deceased and reinvest in life

The Grief Work Hypothesis Never fully accepted Co-existed with other approaches Were oversimplifications of ideas that had more subtlety and nuance Were continually challenged

Challenges to the Grief Paradigm Application of new models Beyond affect Beyond coping Continuing bonds Extending the definition of loss

New Models Application of New Models

Kübler-Ross The Stages of Dying Denial Anger Bargaining Depression Acceptance and Hope

The Stage Model Retains a hold on popular culture Parodied and portrayed in television, movies, etc.

The Stage Model (con t) Neimeyer noted that part of the popularity was due to epic structure of work Allowed medical management of dying Kübler-Ross was a charismatic advocate whose message resonated in the antitechnological mood of the 60 s natural birth and natural death

An Evaluation of Kübler-Ross Her work should always be respected for her pioneering effort For the enduring legacies of the need to communicate with persons who are dying and to be sensitive to their needs Practice demands currency. Yet a 2012 study (Ober, Granello & Wheaton) still showed the stage theory to be the most well known and used Would you wish to be treated by an oncologist using 1969 methods?

Current Grief Theory Emphasizes individual pathways rather than universal stages

Grief is manifested in many ways: Physically Emotionally Cognitively Behaviorally Spiritually

Grief is a very individual reaction The need to assess

Assessing Grief The nature of the relationship The nature of the attachment Circumstances of the loss Personality and history of the individual Family and Social support Culture and Spirituality What do I need to know about your culture/spirituality to work with you effectively? Concurrent stresses Health and coping abilities

Research on Grief Assessment 3 Major Predictors (Evidence-Based) 1. Nature of the Relationship (conflict, dependence, ambivalence) Bonanno s study found excessive dependency the best predictor of complicated grief 2. Pre-existing conditions (depression, anxiety etc.) 3. Global Assessment of Therapist (gut feeling)

The Grief Process A Roller Coaster of Reactions

Pathways of Grief (Widows) (Bonanno, Wortman, & Nesse, 2004) Common Grief Pattern (10.7 %) Resilient Pattern (45.9 %) Chronic Grief Pattern (15.6%) Chronic Depression Pattern (7.8%) Depressed-Improved Pattern (10.2%)

The Dual Process Model of Coping with Bereavement (Stroebe & Schut,1999) Lossoriented -Grief work -Intrusion of grief -Letting gocontinuingrelocating bonds / ties -Denial/avoidance of restoration changes Everyday life experience Oscillation Restorationoriented -Attending to life changes -Doing new things -Distraction from grief -Denial/avoidance of grief -New roles/ identities/ relationships

Dual-Process Model Revised Individual and Family Coping (Stroebe and Schut, 2016)

Meaning Reconstruction or Narrative Approaches to Grief In grief, one must reintegrate the loss into one s sense of self and the world either by assimilating the loss into existing perspectives or modifying the perspectives to accommodate the loss (Neimeyer)

The Tasks of Grief Acknowledge the loss Express manifest and latent emotion Adjust to a changed life Relocate the loss Reconstitute faith and philosophical systems challenged by the loss Worden (Modified)

Utilizing Process and Tasks Models Assess problem areas Identify barriers Structure interventions Implications of Process and Task Models for Grief Groups and Curricula

Grief is manifested in many ways Physically Emotionally Cognitively Behaviorally Spiritually

Beyond Affect

Moves Beyond Affect Greater attention to spiritual Neimeyer Loss as Meaning Reconstruction Attig Relearning the World Martin and Doka Intuitive vs. Instrumental Styles of Grief

Beyond Coping

Grief as a Transformative Process Renewed Spirituality Greater Appreciation of Life, Relationships, and Priorities Growth in Character Perceptions of Strength Existential Awareness Growth in Skills Changes in Lifestyle Calhoun & Tedeschi

How Can We Enhance Transformation? Language of Survivorship Small choices empower bigger ones Examination of positive and negative adaptations Reflection How has this loss changed you? The value of benefit finding in the experience of grief

Looking Backward What is lost? What is left? Reviewing strengths Internal External

Looking Forward What do I need to bring from my old life into my new life? What do I need to leave behind? What do I need to add?

Grief Counseling Studies show that clients will do better in groups when leaders have transformation rather than coping as a goal of therapy or support

Continuing Connections

Grief is not a time bound process that ends in detachment

Amelioration of Grief Over time pain lessens Persons function at similar (or sometimes better levels) than prior to the loss Yet, grief still has a developmental aspect

Dennis Klass Inner Representation presaged his interest in Continuing Bonds

Types of Connections Memories Biography Legacies and liabilities Spiritual Extraordinary Experiences

Extraordinary Experiences Sense of presence Sense experiences Symbolic experiences Third-party experiences Dreams

Extending the definition of grief

Disenfranchised Grief A loss that cannot be socially sanctioned, openly acknowledged or publicly mourned

Summation: Contemporary Grief Theory Acknowledges variety of losses that engender grief Skeptical of a predictable set of stages from universal stages to personal pathways Increased attention to cognitive and spiritual aspects of loss Increased recognition of continuing bonds Increased recognition of post-traumatic growth Recognition of culture move away from universal reactions Eclectic approaches yet evidence-based

The Challenge to Professionals To remain current in a rapidly expanding field that is also a core competency To expand our understandings of dying, grief and loss

Beyond Kübler-Ross: New Perspectives on Death, Dying, and Grief Two Ways to Order 1) Call HFA at (202) 457-5811 2) Visit hospicefoundation.org/hfa- Products/Beyond-Kubler-Ross-Book BOOK

Beyond Kübler-Ross: Self-Study Two Ways to Register 1) Call HFA at (202) 457-5811 2) Visit hospicefoundation.org/hfa- Products/Beyond-Kubler-Ross- Online-Self-Study 2.5 CE credits available for a variety of boards including NY State Education Department s State Board for Social Work and State Board for Mental Health Practitioners.

Q&A