Social Welfare Programs, Understanding Grief, Bereavement, Loss And Change

This article is one of a series of best social welfare programs that aim to help people understand what lies behind techniques in health and social welfare practice.

Much of the procedures have been developed from psychological sources.

Here we discuss grief and bereavement and how these ideas are integrated into a broader subject on loss and change.

This is because much of these emotions are transferable and experienced in much the same - although to a greater or lesser extend and are variable depending on the individual.


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Why Is Understanding Grief and Bereavement (or Loss and Change) Important In Health And Social Welfare Work?

This article will summarise why an understanding of loss and change is important in health and social welfare work by using theories about loss, grief and bereavement from an array of academics in these fields.  It will then find how these theories can be applied to building and finally ending the worker - user relationship.


Courtesy of Flickr & Patrick Hoesly:: 'Helping Hands'
Courtesy of Flickr & Patrick Hoesly:: 'Helping Hands'

Change, Loss, Grief and Bereavement

The understanding of change, loss, grief and bereavement within a health and social welfare setting is important because the knowledge acquired will help the client accept and accelerate the recover process. This will enable the service user to aquire coping mechanisms and skills that can be transferable and used in the context of present and future experiences.

A predicted, or managed, change or loss, therefore, may become less stressful than an unpredicted one. To minimise unpredictability, preparation, planning and worker expertise are the key components to a smoother route toward acceptance of the new reality.

Knowledge of theories and the impact of change, loss, grief and bereavement, can help the worker to empower the client, especially in supporting them with the emotional aspects of the change.

Expertise input, therefore, can help to ascertain what the client's needs are and how to satisfy those needs appropriately. Importantly, maintaining objectivity within the confines of the worker - user relationship is fundamental to success.


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Community Networks

People's needs are varied, diverse and individual. Examples of needs could be fundamentally social, personal, educational or health orientated. These needs may lead people to specialist fields of health and social welfare; which are but a small component of a whole community of networks. Community networks evolve and change. Networks and relationships never stand still and their influences impact on the individual as these changes occur. For this reason, an individual's requirements are never fixed either and are always subject to change.

  • People are individual. Their experiences, needs and requirements are influenced by many factors and changing dynamics.


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Psychological & Physical Impact

In Maslow's Hierachy of Needs - click what makes people happy for more - the route to 'self actualisation' has to start with the fulfillment of basic human needs (for example, food, drink, sleep, security and protection from danger). The is necessary before an individual can develop meaningful and effective relationships, participate socially and, further on, aquire a reasonable level of self worth. Maslow, further suggests, that if, within his five stage model, basic needs are unmet, then he considers it impossible to advance to the next stage. He also highlights that, like a ladder, people can commence up and down each rung depending on what needs are met at what time in the individual's life.

Case Study Example:

Natasha was living with abuse. She didn't feel safe. This effected the 'safety' component in Maslow's model of basic need and it wasn't until there was stability established in her life that she could started to grow. This happened when she entered a care home that had supportive workers that helped her with her issues. This enabled her to reassess her life, search within accept the new reality by coming to terms with her past. She learned coping mechanisms from the experience and skills which could be transferred should problems arise in the future. She learned:

  • To be assertive
  • Problem solving and insight
  • Self awareness

This example highlights the importance the role of her keyworker, the expertise and the relationship the client (Natasha) had with the worker. You can see, from this example, how important the dynamics and skills within the relationship between the user and worker are.

By guiding the user and understanding Maslow's theory, this helped the user through a time of change (the transition from one environment to another), grief and bereavement for what was. When people are in abusive situations, they may stay within them because they hope things will be different. When they are not, people go through a period of grief and bereavement for the loss of expectation and hope that they have held onto during the abusive period.


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Client Centred Approach In Action Here!

Carl Rogers and the Client Centered Approach

Carl Rogers (1951) suggests that for a good relationship to develop between worker and user, a counselling method termed person centred practice may be effective when dealing with loss, change, grief and bereavement. The theory enables the worker to assist the user in self-exloration. In order for the relationship to thrive, Rogers suggests three core conditions:

  • Empathy
  • Warmth
  • Genuiness

This is about listening, being available, non-judgemental and unconditional, thus allowing others to open up in a non-threatening, trusting relationship. Using Rogers approach, therefore, may help with self exploration and reflection.

If you want to know more about Carl Rogers and his client centered theory, please click for my article on client centered therapy.

The expertise of the worker within the relationship, clarifies clients perspective, which may enable users to solve problems from within and enable a smoother route toward acceptance of the loss, change, grief and bereavement.

You can see, therefore, how useful Carl Roger's theory is within a user - worker relationship. Worker's have something to adhere to when empowering users. Without this knowledge workers may stray into realms that are more disempowering. This goes against the ideas of a role as an enabler to users individuality.


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Health and Social Welfare Professionals Have To Develop Social Distance

Having said about the benefits of the client centred approach we mustn't forget about the needs of workers who can suffer greatly from taking on the pain of others.

Purtilo (1986) highlights the importance of 'social distance' to avoid this within the user or client relationship. It is rather like establishing 'caring boundaries' with an interpersonal distance. This strategy may protect the worker from their own emotions and enable objectivity within the user's recovery process.

Case Study:

Student Nurse Smith got very upset after she had built a meaningful relationship with a recovering addict. During a time of cold turkey as a result of withdrawal of medication, the suer pleaded for money in order to buy drigs for pain relief. Student Nurse Smith saw the agony that the user was in and through shock, denial, sadness and anger the student left the requested money. This hindered the recovery process for the user during a crucial time in his treatment. However, it is understandable that the student felt empathy and humanistic in relieveing the user of pain.

This case examples the importance of, as Purtil termed it, 'social distance'. It is about not getting involved and creating a distance within the relationship for the benefit of the mental health of the worker.

It is not abnormal to pity, overindentify and blur the boundary of 'interpersonal distance' within the worker - client relationship because it is 'the price humans pay for attachment to other people'. However the knowledge and example offered by Purtilo, helps workers to identify within themselves issues of becoming too personal.

  • Loss, change, grief and bereavement, therefore, can have a major impact on workers within the client - worker relationship.


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Kübler-Ross Model In Brief

  1. Denial – Disbelief at what has happened.
  2. Anger – Seeking blame, feeling hateful and resentful.
  3. Bargaining – Seeking other ways to delay the inevitable
  4. Depression – Feelings of hopelessness and helplessness
  5. Acceptance – Accepting the new reality and preparing for the outcome.

Dispear
Dispear
Realisation of the new reality
Realisation of the new reality
Independence and acceptance of the new reality
Independence and acceptance of the new reality

Kubler-Ross Model: To Grieve Is To Have Experienced Loss; That Loss Is Relative

As a framework of stages, worker expertise also comes into play by the identifiction of which stage the client has arrived at. This may prove problematic because it may appear that the individual stages are merging.

To grieve is to have experienced loss; and that loss is relative. What is meant by this is that the experience of loss is relative to the loss itself. For instance:

The death of a child may take longer to accept (or learn to live with) than that of a diagnosis of an illness. Although emotions of the grieving process is essentially the same, time taken for recovery may be faster. The processes, therefore, toward 'acceptance' may be worked through quicker, especially with appropriate expertise and support. Although we need to remember that we are all individuals and we will all work through a grief process at varying rates.

Kübler-Ross model is a cycle that we all go through when we suffer grief and bereavement. We tend to flit emotionally in a chaotic manner from one phase to another throughout the process. Please click on the above highlighted link for more on this.

The death of a loved one has a final outcome. Whereas illness has an attachment of hope of recovery. For more on help for grief on the death of a loved one please click on dealing with death and arranging a funeral here.

It appears, therefore, that it is only when time and memories fade that people are more open to acceptance. That isn't to say that we 'get over' death, for example, but we learn to cope with the new reality. It is only when people reflect and analyse the experience more objectively, before moving to the fuller acceptance.

The process of acceptance may be linked to 'experiential learning' (Kolb 1984) because the bi-product of loss, change, grief and bereavement is experience. True empathy, therefore, from workers within a client - worker relationship can only be truly understood if the worker has experienced this.


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Through A Continuous Assessment Process, There Can Be A Way Forward

Although there are many instances of loss, change and transition within a crisis situation, we can safely say that it is better for a transition to be a planned one. However, how can we do this within a client - worker relationship?

Shared action planning is widely used in the field of learning disabilities. Being as the title suggests, it is shared.. like Rogers client centred therapy, it is about partnership and equality within the action planning. This is an approach that is client centred and enables the user ot take control over their lives. Planning in this way may help to develop reciprocal relationships, look at and prepare for the future. Using a plan like this, there is a concrete aim. Essentially highlighting an outcome and preparation thereof.

Going back to Natasha, for example. One day there would be an end to her envolvement in care. Her relationship with her keyworker would come to an eventually. This is life. All things have an end and an end has a start. Through shared action planning, preparation for the change enables her to explore ideas and gain direction in life whilst balancing the realities and presenting real choices. As a result, planning may help with the clients better understanding of his or her circumstances. It can also help create a pathway for slow withdrawal of the worker - user relationship, identifying what is appropriate to satisfy individual need.

Let me give you an analogy. Imagine a crutch is the worker. The user relies on the crutch to get around. Onece the crutch is taken away, without further support, the client falls, but if the crutch is withdrawn whilst other mechanisms are in place (like physiotherapy, a stick) the client now has other mechanisms in place to help with the recovery process. Of course the user, was always aware that one day they wouldn't have the use of the crutch anymore, but the plan was in place and he/she knew where they were aiming for - independents.


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Maslow's Hierarchy of Needs
Maslow's Hierarchy of Needs

Why Understanding Loss, Change, Grief & Bereavement In Summary

Understanding loss, change, grief and bereavement within the context of health and social welfare is important because it helps both the clients of care and the workers. In summary:

  • In utilising the theories developed by the likes of Maslow, Rogers and Purtilo, staff will be empowered to implement good use of practic in worker - client relationships. This helps to bring forth structure to the worker and client.
  • Using preparation techniques like shared action planning and assessments that involve a continuous cycle of assess, plan, implement and evaluate can help both the client and worker keep on track to a better future. One that is controlled and insightful.
  • Setting boundaries and 'meaningful distance' helps both the client and the worker. This lies the foundations for objectivity and provides a safety net for both.
  • Most importantly, it is about good professional practice.


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The Practitioner Needs Understanding To Empower The Client's Successful Recovery and Independence

As you now might now understand in this part of a series of social welfare programs, it is essential for health and social welfare practitioners to develop an understanding in loss and change. This comes, not only from life experience, but from the theories that surround these practices. Not only do practitioners need to be able to empathise with others, especially as regards to grief and bereavement, but they also need to protect themselves with 'social distance'. Walk this fine line is a skill which enables the client of care to become empowered; with the ultimate aim of successful recovery and independence.

© This work is covered under Creative Commons License


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Comments 2 comments

megni profile image

megni 4 years ago

What a great thing to share such excellent information. I'm tweeting it! Thank you!


shazwellyn profile image

shazwellyn 4 years ago from Great Britain Author

Thank you megni. I am glad you found it helpful.

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