Charting Your Course : Teach Charting Your Course : Seminar IV - Facilitator's Guide

Participant Material for Seminar IV
Evaluation Form for Seminar IV

Materials

flip chart and markers
several sheets of paper for each participant
pens

Objectives

Understand normal processes of grief and reasons for expressing feelings and listening to others.
Identify some barriers to communication and learn about skills to overcome them.
Know what "unfinished business" remains in their lives and make choices about action toward completing it.

Opening

Is there anything from last week people want to talk about or have questions about?
List the objectives of this session
What issues came up in doing (or not doing) Advanced Directives?
Discussion points:
Next steps to take with Advanced Directives:
Conversations with lawyer, physician, financial advisor, etc.
Where and with whom we should leave copies
Sharing with family/friends
Proxy issues - abilities/personality, local presence, relationship etc.
Other wishes to be shared? E.g. end of life, organ donation, disposal of body (burial, cremation)
Service/celebration/Memorial Plans.

Grief and Loss

Coping with a serious illness may cause a sense of loss. Many aspects of daily living can change. These are significant losses, and we will experience some difficulty in accepting them.
It was a Swiss psychiatrist, Dr. Elisabeth Kubler-Ross, whose 1964 book, "On Death and Dying", helped us to see that the experience of grieving is a universal and natural one, and that it has some predictable emotions. She observed that most of us will experience denial, anger, bargaining, and depression, as well as a state of acceptance or peace with each significant loss in our lives. There is no steady progression or pattern to our experience; at one moment we might feel overwhelmed by sadness over our situation, and in the next may feel just as overwhelmed by anger. Just when we think we have accepted our situation and found some peace, we may find ourselves trying once again to bargain with the powers beyond us to take away the illness if we become more perfect in some special way. All of these feelings are natural and it is important to let ourselves experience and express all of these feelings.
Let the group discuss the feelings involved in dealing with a life-threatening illness, and the five stages of grief.

Denial
Anger
Bargaining
Depression
Acceptance

Discussion points:
Grief is not a fixed process - it can be fluid or circular or back-and-forth.
The only way to move through any one stage is to express feelings.
Feelings can be expressed by sharing, writing, physical expression (cry, yell, throw things, etc.), talking to "empty chair". Ask the group to brainstorm some other ways.
Exercise:
Take a few minutes to reflect on the following questions:
Who is a good listener with whom I can talk about my experience and feelings?
How well do I listen to others who wish to confide in me?
When have I come to peace with a loss that at an earlier time seemed overwhelming?
How do I express anger when I feel it?

As a final thought on grief: until we feel the sadness, a feeling that comes with the realization that we cannot change our present circumstances, we cannot move on to acceptance. This sadness may be defined as "depression". Depression may be the final step in reaching a sense of peace with illness and the losses it entails.

Listening

Review "good listening" responses from Seminar IV
Exercise:
Split into pairs
Each share for 2 minutes about your relationship with your doctor
Partner - listen & encourage partner to continue
Discuss the results.

Talking

Exercise:
Three comments someone might make to you:
"I'm really afraid of this next checkup"
"I don't want you to die"
"It hurts so much"
Have everyone write down a response to give to each of these.
Discuss the responses.

Unfinished Business

Exercise:
This is an exercise to let us look at what's "unfinished" in our lives today
Shut your eyes and visualize:
What's on your mind that you wish you had done or taken care of?
Think about people, places, tasks, etc.
Make a list of the things you think of that you want to do or take care of (4-5 minutes)
Next to each - first step you will take in the next 2 months toward doing each (4-5 minutes)
Discuss these steps, and how each participant will accomplish one or more.

Closing

Does anyone have comments for the group at the end of this last session?
Make your own closing comment.

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This content is derived from the "Charting Your Course Seminars: A Whole Person Approach To Living With Cancer", provided by Norris Cotton Cancer Center.