social workers and lmhcs how to obtain your continuing … · 2017-12-14 · social workers and...
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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
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 anti-technological 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)
Restoration- oriented
Loss- oriented -Grief work
-Intrusion of grief -Letting go-continuing-
relocating bonds / ties
-Denial/avoidance of restoration
changes
-Attending to life changes
-Doing new things -Distraction from
grief -Denial/avoidance
of grief -New roles/ identities/
relationships Oscillation
Everyday life experience
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
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