ABCD Exchange : April 1999 : Lunch Bunch - New Models of Grief

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Group Learns How New Models Of Grief Can Aid The Bereaved

Americans for Better Care of the Dying and Hospice Foundation of America co-hosted the fifth in the "Lunch Bunch" series of meetings to inform policymakers, healthcare professionals, and others on end-of-life issues. Kenneth Doka, Ph.D., Professor of Gerontology, College of New Rochelle, presented five challenges new research poses to existing models of grief and their clinical implications for health care providers. Doka, a senior consultant to the Hospice Foundation of America, is widely known for his work in educating others about bereavement, and edits the journal, Omega.

In an interview with Exchange, Doka said that a concern among grief educators is that with the rise in medical and palliative care, lessons from the hospice model not be lost. "The medical community needs to recognize that grief occurs throughout the disease process, and that patient and family are involved in grieving," he said. One goal for clinicians, said Doka, is to support the dying through their anxieties and any issues they may want to resolve, in part by acknowledging their grief.

According to Doka, among the myths about grief are that depression/distress is inevitable, distress is natural, one needs to work through the loss, recovery is expected, and resolution will be reached. Instead, Doka suggests new models for grief work, some of which have been proposed and investigated by other researchers. Doka recommended extending the concept of grief to include what he calls "disenfranchised grief," or grief that cannot be openly acknowledged, such as:

Doka also described "task models of grief," which emphasize individuality and stress autonomy. Tasks include accepting reality, working through grief, adjusting to loss, and restoring one’s own life. More work is needed to recognize the many ways grief affects individuals, and how it varies in its physical, emotional, cognitive and spiritual effects, but that grief, like most emotions, is a universal experience.

Doka suggested that "recovery" from a loss may not be possible or desirable, and instead describes "amelioration" of grief, a return to similar (or better) levels of functioning with diminished pain. The bereaved maintain connections to the deceased through memory, biography, legacy, and spirituality. Bereavement counselors, Doka said, face the challenge of helping the bereaved to celebrate connections while avoiding potential problems, such as an inability to grow or move forward.

Asked to recommend public policy changes that might promote grief education or counseling, Doka said that a starting point would be for consumers to ask managed care organizations if grief counseling is a covered benefit. "Managed care needs to recongize that people need more than one visit for bereavement. What’s needed is supportive education, and policies that enable people to cope," he said. Mandating bereavement leave would present many challenges, and Doka cautioned that when "some issues are translated into policy, they have a built-in inflexibility and tend to become commandments, and a new standard of care."

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