Study Guide for Exam 3

Crisis "crucial time" & a turning point in the course of anything-Webster

term for an individual's internal reaction to an external hazard. Involving a temporary loss of coping abilities, implied assumption that emotional dysfunction is reversible-Howard Stone

• * a period of heightened psychological accessibility; a highly emotional state in which an indivdual's feelings or anxiety, grief, confusion or pain impair his/her ability to act.
• *is usually stimulated by an outside precipitator or emotionally hazardous situation. Precipitators are situational & frequently of an interpersonal nature.
• -precipitating event-the stimulus which initiates the crisis
• -individual's particular appraisal of the situation:
• what people "make" or a precipitating event--their perception of the event as a serious threat & importance of the loss to the individual
• * normal reactions to emotionally hazardous situations, not signs of mental illness.
• * individual's appraisal (preception) of the emotionally hazardous sitation greatly determines both the occurance & seriousness of the crisis
• *more seriously threatening an individual's appraisal of an event, the greater the likelhood for primitive of coping behaviors.
• *person in crisis tend to pull away from contact with "significant others" Positve interpersonal relationships tend to foster positive resolution of a crisis, while lack of interpersonal contact tend to lead to a slower or less adaptive outcome

• death + survivors= heighten need for intervention counseling:
• Suicide
• Homicide
• A.I.D.S.
• S.I.D.S.

• Cause
• Investigation & Interrogation
• Severity of Loss
• Relational problems (family, marriage, siblings & significant others)

• Crisis- contact or establishing counseling relation
• ship with person in crisis; establish rapport (trust & empathy)
• *Attending behavior
• *Listening
• *Non-judgmental
• Coping-
• 1. establishment of goals
• 2. inventory of resources
• 3. formulation of alternatives
• 4. review & refinement
• 5. action
• *follow-up of the counseling process
• *re-affirms your caring
• *provides opportunity to deal with residue from the crisis
• Boling (down the the problem to it's essentials)- responding, verbal and non-verbal to get a response, discover & understand real feelings, focus on the clients cause of problem to help reduce anxiety & stress level for the person in crisis; enhance self esteem

• phone contact
• personal contact-home visits
• letter/cards-bereavement program
• literature (pamphlets, books, audio-visual)
• community education programs
• professional after-care programs
• referrals to support groups or professional therapists

• most often in funeral homes the idea of making a family feel comfortable & secure as possible in the main concern helping them see the counselor as their source of resource--their security blanket.
• arrangement room should be pleasant, comfortable & private with the director sitting apart of the group paying attention to the details of the person participating and not simply to oversee the process. Asking alot of questions to fill out the forms.
• post-funeral counseling giving the funeral director counselor a pivotal spot to become the primary or referral counselor for families of different cultures and various life styles. Making contact with the family 10 days to 2 weeks following the funeral & again at a later date. Seeing each and every encounter at church, in the business or social world as a potential counseling situation for repeat business.

Definition: a death has occurred & the funeral director is counseling w/ the family as they select the service & items of merchandise in completing arrangements for the funeral service of their choice.

• 1. Need or problem defined-the proper care of the body & its disposition, need of the family to be counseled "needs" "wants/desires"
• 2. Need or problem determined & verbalized- evident, unexpressed or completely unrecognized making it an evaluation procedure. Needing the counselor to say "tell me about it or what are your feelings?" making no assumptions
• 3. Resolutions & actions-review the needs for clarity, offer suggested viable options & discuss relative merits of ea. family. Give examples how others may resolve similar needs be suggestive in line with responsiveness never mandate.
• 4. Decision- lead those confusied to counsel to make the best decisions that will fullfill their needs & resolve their situations

• Dr. Erich Lindeman--"Acute grief" or "Grief Syndrome"
• John Bowlby--"Post-loss grief" or "Attachement theory"
• Dr. Elizabeth Kubler-Ross-Five stages of Death & Dying

• published 1944 article "Symptomatology & Management of Acute Grief"
• most influential single piece of writing on physical expressions of grief
• ideas from interviews & psychotherapy w/ bereaved families of victims of catastrophic fire at the Coconut Grove Night Club
• 1st person to introduce the term "grief syndrom" as a set of symptoms associated with loss.
• Acute grief is a definite syndrome w/ psychology awarness increased of a loss appear of someone or something significant.
• The Syndrome appear immediately after a crisis; may be exaggrated or apperently absent.
• Their may be distorted pictures, each of which represent a special aspect of the grief syndrome.
• Appropriate teccqniques the distorted pictures can be succesfully transformed into a normal grief reaction with resolution.
• "Sensations of somatic distress occurring in waves lasting 20 mins to an hour at a time; feeling tightness in the throat; choking w/ shortness of breath; a need for sighing w/ an empty feeling in the abdomen; lack of muscular power & intense distress described as tension or mental pain"
• Normal acute grief:
• 1. somatic or bodily distrubance of some kind
• 2. preoccupation w/ the image of the deceased, hallicinations
• 3. guilt
• 4. hostile reactions
• 5. inability to function as before the loss; changes in patterns of conduct
• 1st recognized & use the term "anticipatory grief"
• mourning is recognized now as being more complex, that it's important to mourn and be apart of the grieving process to prevent a variety of emotional & physical alliments.

• a symptom characterized by the presence of grief in anticipation of death or loss. Actual death comes as an affirmation of knowledge of a life limiting condition.
• 1. Attachements come from the need of security (developed as a child)
• 2. emotional reactions from situations that endanger the bond of attachement
• 3. a greater potential for loss, a more intense reaction (clinging/crying)

• theory based on "attachement theory"
• -before one can fully comprehend the impact of a loss & the human behavior associated with loss; one must have some understanding of attachement.
• 1. Attachements come from the needs of security (developed as a child)
• 2. Rise in emotional reaction with situations that endangered the bond of attachement
• 3. intense reaction (clinging/crying) with a greater potential for loss

• 1. Numbing
• 2. yearning & searching for the lost figure
• 3.disorganization & despair
• 4. greater or lesser degree of reorganization

• "On Death & Dying" 1969 book has been widespread appeal about realizing that death is close to hand, people go through distinct psychological stages in the process of psychological response to dying.
• These stagess are:
• Denial
• Anger
• Barganing
• Depression
• Acceptance

• when you discover they are dying from terminal illness or condition, initial response is to deny the inevitable event in order to cope with shock of finality.
• Denial is to buffer unexpected shocking news
• its a tempoary defense & is replaced by partial acceptance
• it exist in nearly every patient & they should be allowed
• they recuperate gradually from this state when the initial feeling of numbness begins to disappear & they can collect themselves but their usual response is "NO"

• After denial it's replaced by anger, the patient feels unjustly choosen for death.
• its a different stage and it's directed in all directions
• the questions of "why me?"
• it can be directed towards the family, doctors, nurse & or God

• over time they reach the stage when they want to strike a deal or bargin with death. They start to accept the inevitable but they start to look towards "extending the lease" to postpone death, most often with God, for more time to live as a reward for their "good behavior".
• some say "I have things I need to do before I die"

next stage after barganing moves a person into a depression over the loss of personal life. This important to prepare them for full acceptance of death. They replace anger & rage w a sense of great loss, allowing them to express sorrow. Crying is normal and they will need to feel loved & wanted

finally they accept that they are going to die, they usually are void of feelings not of "giving up" but they are needing time to rest before the end comes, they might want to be left alone in silence at this time or for a specific good purpose. Hope is found in all stages of the copying mechanism this helps to nourish patiences during the difficult time.

• 1. Accept- the reality of the loss
• 2. Experience- the pain of grief & to express the emotions associated with it.
• 3. Adjust- to an enviroment in which the deceased is missing.
• 4. Withdrawl- emotional energy & reinvest in another relationship or emotionaly relocate the decased & move on with life.