UNIVERSITY OF SOUTHERN CALIFORNIA



UNIVERSITY OF SOUTHERN CALIFORNIA

SCHOOL OF SOCIAL WORK

Linda Cox, Psy.D, LCSW, BCD SOWK 692

Office: 117 Fall 2011

Office Hours: TBA

E-mail: lcox@usc.edu

Phone: (949) 660-1657

Loss, Grief and Bereavement

I. COURSE DESCRIPTION

Issues pertaining to loss and grief are core in nearly every clinical situation that social workers address. Loss occurs throughout the life cycle. Loss and grief issues include, but are not limited to, dying and bereavement. Issues such as divorce, loss of a job, effects of a disaster, and acute illnesses, are all examples of losses other than death. This course will focus on the experiences of loss, death and bereavement as it is viewed by individuals, families and loved ones. How we cope with grief shapes our lives, challenges our responses to change and can determine how we form, maintain, and let go of relationships. This course will examine theories on grief and loss across the lifespan. In addition, we will consider how social factors i.e. culture, ethnicity/race, gender, class and sexual orientation may impact the grieving process. Further, the role of spirituality and coping will be explored and discussed to increase the clinician’s ability to work with this content in therapy. We will look at ethical debates in right-to-die issues as well as social issues about quality of life.

In our clinical work with clients, we confront aspects of loss on a daily basis. Given our societal tendency to avoid the subject of loss, social workers can play a critical role in providing clients with an opportunity to grapple with painful and devastating losses in the clinical encounter. Despite this, most social workers report being ill prepared to explore these issues with clients. It is essential that social workers be trained in the understanding and assessment of grief and loss. This course will address the role of the therapist and effective use of self with clients and their families in diverse settings and different modalities. This course will give students an opportunity to explore and understand their perceptions and beliefs of death and dying and how individual cultural differences influence that experience and prepare them for working with clients on grief and loss issues. Finally, we will consider interventions and resources needed to provide appropriate and effective services.

I. COURSE OBJECTIVES

Upon completion of the course students will be able to fulfill the following:

To identify the theoretical constructs of loss, grief and bereavement

To apply theoretical knowledge to clinical practice

To identify and differentiate transference and countertransference in the clinical encounter.

Determine ways to effectively use one’s self with clients and their families.

To assist clients in examining the intersection of spirituality, coping and end of life care.

To understand the variety and complexity of losses people suffer throughout the course of a lifetime.

To increase one’s awareness of how culture and race impact choices in end of life care. Gain increased comfort level in exploring these issues within clinical practice.

Identify their own loss histories and beliefs and differentiate their personal boundaries form their professional roles and apply a health perspective in assessments and clinical interventions.

Critically analyze and assess values and ethical dilemmas regarding death, dying, grief and loss.

III. COURSE EXPECTATIONS – COURSE REQUIREMENTS, GRADING POLICY, CLASS PARTICIPATION AND ATTENDENCE

Student Evaluation

Students are expected to attend class sessions, participate in class discussions, and submit quality work on the date and time specified by the instructor.

Evaluation of the student’s academic productivity for the course will be determined as follows:

Reflection writings 20%

Midterm Assignment 35%

Final Assignment 35%

Class Participation 10%

Assignments

Detailed hand-outs describing the assignments and expectations will be distributed in class with ample time to complete the assignments.

Assignments are due on the day and time specified. Extensions will be granted only for extenuating circumstances, and is left to the discretion of the course instructor. If the assignment is late without a medical reason or instructor permission, the grade will be affected accordingly.

A final grade of “Incomplete” can only be given under extreme circumstances.

Assignments must adhere to the citation and referencing standards put forth in the 2001 Publication Manual of the American Psychological Association (5th Ed.).

Grading Policy

Within the School of Social Work, grades are determined in each class based on the following standards which have been established by the faculty of the School:

(1) Grades of A or A- are reserved for student work which not only demonstrates Excellent mastery of content but which also shows that the student has undertaken a complex task, has applied critical thinking skills to the assignment, and/or has demonstrated creativity in her or his approach to the assignment. The difference between these two grades would be determined by the degree to which these skills have been demonstrated by the student.

(2) A grade of B+ will be given to work which is judged to be very good. This grade denotes that a student has demonstrated a more-than-competent understanding of the material being evaluated in the assignment.

(3) A grade of B will be given to a student work that meets the basic requirements of the assignment. It denotes that the student has done adequate work on the assignment and meets basic course expectations.

(4) A grade of B- will denote that a student’s performance was less than adequate on an assignment, reflecting only moderate grasp of content and/or expectations.

(5) A grade of C would reflect a minimal grasp of the assignment, poor organization of ideas and/or several significant areas requiring improvement.

(6) Grades between C- and F will be applied to denote a failure to meet minimum standards, reflecting serious deficiencies in all aspects of a student’s performance on the assignment.

Course Evaluation

Depending on the way in which your instructor prefers to calculate his/her grades, your final grade in this class will be based on 100 point scale

96 – 100 A

90 – 95 A-

87 – 89 B+

83 – 86 B

80 – 82 B-

77 – 79 C+

73 – 76 C

70 – 72 C-

Class Participation

Class participation is an important component of the student’s grade and socialization into professional social work practice. Participation is more than class attendance. It involves coming to class prepared to participate actively in the class discussions. Class participation involves meaningful discussion based on having read the required readings for the week. Participation may involve such activities as raising meaningful questions for clarification, but more importantly, offering critical thinking regarding issues under discussion or extending the discussion to related material from other social work courses Failure to meet these expectations may result in reduction in grades. It is expected that each student will maintain confidentiality with classroom sharing.

NOTE: Please refer to SCampus: The Handbook for Students () and the University Catalogue () for additional discussion for grades and grading procedures and for discussions regarding academic integrity.

Attendance

Students are expected to attend all classes. Students with more than two unexcused absence may risk failure. This policy exists because the social work program is one of professional preparation. In addition to acquiring theoretical knowledge, students are expected to acquire professional values, to integrate knowledge from a range of courses, to develop professional skills and be socialized into the profession. The faculty of this School of Social Work emphasizes that this cannot be accomplished through independent study alone. Thus, attendance at classes is required unless legitimate and special reasons exist for absences or tardiness. Any such absences or tardiness should be discussed directly with the course instructors.

Attendance also means “being present” when in class. Cell phones and other electronic devices that distract or cause interruption or annoyance are to be turned off during class.

University of Southern California policy permits students to be excused from class, without penalty, for the observance of religious holy days. This policy also covers scheduled final examinations which conflict with students’ observance of a holy day. Students must make arrangements in advance to complete class work which will be missed, or to reschedule an examination, due to holy days observance.

Academic Accommodations

Any student requesting academic accommodations based on a disability is required to register with Disability Services and Programs (DSP) each semester. A letter of verification for approved accommodation can be obtained from DSP. Please be sure the letter is delivered to me as early in the semester as possible. DSP is located in STU 301 and is open 8:30 AM – 5:00 PM, Monday through Friday. The phone number for DSP is 213-740-0776. Web-based information regarding DSP can be found at

IV. Class Format

The class format will consist of didactic instruction as well as large and small group discussions. Case vignettes, videos, guest speakers, experiential exercises, and other learning aids will complement the course instruction as deemed instructionally appropriate. The instructor may include additional readings to enhance the course topics.

V. Required Text

Required Text:

Berzoff, J. & Silverman, P. (Eds.) (2004) Living with Dying: A handbook for end-of-life

healthcare practitioners. New York: Columbia University Press.

Recommended Texts:

Csikai, E. & Chaitin, E. (2006). Ethics in end of life decisions in social work practice. Chicago: Lyceum Books, Inc.

Klass, D., Silverman, P., & Nickman, S., (Eds.). (1996). Continuing bonds: New

understandings in grief. Philadelphia, PA: Taylor and Francis.

Course Outline

Class 1&2

Loss and Grief in Different Contexts

Basic Facts about Loss and Grief

Symbolic Loss

Film

Self-Preparation for Professionals Encountering Loss and Grief

Assignment: Reaction Paper

Readings:

Berzoff & Silverman (2004). Chapters 1-3.

Chapter 1. Browning, D. Fragments of love: Explorations in ethnography of suffering and professional caregiving.

Chapter 2. Pulleyblank-Coffey, E. The symptom is stillness: Living with and dying from A.L.S.

Chapter 3. Hoffman, R. The loss of a child to cancer: From case to caseworker.

(Assignment: Reaction Paper)

Kirchberg, Thomas. M., Neimeyer, R. A., James, R.K. (1998). Beginning counselors’ death concerns and empathic responses to clients’ situations involving death and grief. Death Studies 22: 99-120.

Class 3

Loss and Grief across the Lifespan

Theoretical aspects of Loss, death and bereavement

Ethical Issues

Film

Readings:

Berzoff & Silverman (2004). Chapters 13 and 14.

Chapter 13. Berzoff, J. Psychodynamic theories in grief and bereavement.

Chapter 14. Levine, A. & Karger, W. The trajectory of illness.

Baker, J. (2001). Mourning and the transformation of object relationships: Evidence for

the persistence of internal attachments. Psychoanalytic Psychology. 18(1), 55-73.

Csikai, E. & Chaitin, E. (2006).

Chapter 2. Ethical issues at the end of life. p. 23-69

Recommended:

Bourgeois, S. & Johnson, A. (2004). Preparing for dying: Meaningful practices in

palliative care. Omega: The Journal of Death and Dying, 49(2), 99-107.

Class 4

Role of the Social Worker

Required Readings:

Berzoff & Silverman (2004) Chapters 5, 7, 8 and 15

Chapter 5, What is a Respectful Death? pp. 102-125

Chapter 7, The History of Social Work in Hospice. pp. 150-159

Chapter 15, Clinical Social Work Practice at the End of Life. pp. 297-317

NASW Standards for Palliative and End of Life Care (2004). National Association of

Social Workers. Retrieved on 5/14/2004 from .

Hudson, P., Aranda, S., and Kristjanson, L. (2004). Meeting the supportive needs of

family caregivers in palliative care: Challenges for healthcare professionals.

Journal of Palliative Medicine, 7 (1), 19-25.

Recommended Readings:

Hospice Palliative Care Nursing Standards of Practice. (Feb. 2002). CHPCA Nursing

Standards Committee.

Sellick, M., Delaney, R., & Brownlee, K. (2002). The deconstruction of professional

knowledge: Accountability without authority. Families in Society: The Journal of

Contemporary Human Services, 83(5/6), 493-498.

Abrahamson, J. & Mizarahi, T. (1996). When social workers and physicians collaborate:

Positive and negative interdisciplinary experiences. Social Work Journal 41(3),

270-281.

Beder, J. (2003). Picking up the pieces after the sudden death of a therapist: Issues for the

client and the “inheriting therapist.” Clinical Social Work Journal, 31(1), 25-36.

Bonham, V. (2001). Race, ethnicity and pain treatment: Striving to understand the causes

and solutions to disparities in pain treatment. Journal of Law, Medicine and

Ethics, 29:52-68.

Class 5 Cultural/ Diversity

Berzoff & Silverman (2004). Chapters 22 & 24.

Chapter 22. Del Rio, N. A framework for end of life care: Enhancing social work practice.

Chapter 24. Thompson & Colon. Lesbians and gay men at the end of their lives: Psychosocial concerns.

Braun, K. (1997) Death and dying in four Asian cultures: A descriptive study. Death

Studies 21, 327-359.

Rosenblatt, P. & Wallace, B. (2005). Narratives of grieving African Americans about racism in the lives of deceased family members. Death Studies, 29: 217 – 233.

Recommended:

Winston, C., Leshner, P., Kramer, J., & Allen, G. (2005). Overcoming barriers to access

and utilization of hospice and palliative care services in African American

Communities. Omega, 50(2).

Class 6 Spirituality

Berzoff & Silverman (2004). Chapters 10 & 21

Spirituality and End-of-Life Care Practice for Social Workers. pp. 188-203

Integrating Spirituality and Religion. Pp. 424-437.

(REACTION PAPER) Page 429: Answer 5 questions

Oltenjenbruns, K. & Batten, M. (1999). Adolescent sibling bereavement as a catalyst for

spiritual development: A model for understanding. Death Studies 23, 9-546.

Richards, T. A. & Folkman, S. (1997). Spiritual aspects of loss at the time of a partner’s death from AIDS. Death Studies, 21: 527 – 552.

Smith, E. (1995). Addressing psycho-Spiritual distress of death as reality: A transpersonal approach. Social Work 40(3), 402-413.

Recommended:

Rizzuto, A.M. (1993). Exploring sacred landscapes. In M.L. Randour (Ed.). Exploring

sacred landscapes: Religious and spiritual experiences in psychotherapy (pp.16-33). NY: Columbia University Press.

Walsh, (2003). Chapters 5 and 7.

Chapter 5. Boyd-Franklin, N. Spirituality and religion: Implications for

psychotherapy with African American clients and families.

Chapter 7. Wolin, S., Muller W., & Taylor, F. Spiritual perspectives on resilience:

Buddhism, Christianity and Judaism.

Wright, L. (2003). Spirituality, suffering, and beliefs: The soul of healing and families. In

Froma Walsh (Eds.). Spiritual Resources in Family Therapy. New York: Guilford

Press.

Class 7:

Adult Loss

.

Berzoff & Silverman (2004). Chapter 11

Chapter 11. Gender and Death: Parallel and Interesting Pathways. Pp. 206-221.

Baum, N. (2003). The male way of mourning divorce: When, what, and how. Clinical Social Work Journal, 31(1), 37-50.

Gilliland, G., and Fleming, S. (1998). A comparison of spousal anticipatory grief and conventional grief. Death Studies. 22:6, 541-569.

Margolies, L. (1999). The long good bye: Women, companion animals, & maternal loss. Clinical Social Work Journal, 27(3), 289 – 304.

Rosenblatt, P. (2004). Grieving while driving. Death Studies, 28: 679 – 686.

Sugarman, I. (2006). The woman who could not grieve: A contemporary look at the journey toward mourning. Clinical Social Work Journal, 34(2), 201-214,

Recommended:

Klass, Silverman & Nickman. (1996). Chapters 10 and 11.

Chapter 10. Moss & Moss. Remarriage of widowed persons: A triadic relationship.

Chapter 11. Conant, D. Memories of the death and life of a spouse

Malkison, R. & Bar-Tur, L. (2005). Long term bereavement process of older parents: The three phases of grief. Omega, 50(2), 103-129.

Reed, M. (2003). Grandparents’ grief – Who’s is listening? The Forum, 29(1), 1-3

Class 8 & 9

Children and Adolescents

Required Readings:

Berzoff & Silverman. (2004).

Chapter 16. Cinotta, N. The end of life at the beginning of life: Working with dying children and their families

Gutierrez, P. (1999). Suicidality in parentally bereaved adolescents. Death Studies, 23:

359-70.

Hogan & DeSantis. (1996). Basic constructs of a theory of adolescent sibling

bereavement. In D. Klass, P. Silverman & S. Nickman (Eds.). Continuing bonds: New Understandings in Grief. Philadelphia, PA: Taylor and Francis.

Kaufman, K. & Kaufman, N. (2006). And then the dog died. Death Studies, 30: 61-76.

Parrish, M. & Tunkle, J. (2005). Clinical challenges following an adolescent’s death by suicide: Bereavement issues faced by family, friends, schools, and clinicians. Clinical Social Work Journal, 33(1), 81-102.

Saldinger, A., Cain, A., Porterfield, K., & Lohnes, K. (2004). Facilitating attachment

between school-aged children and a dying parent. Death Studies, 28:915-40.

Silverman, P. (2001). Chapter 6. Death of a parent.

.

Recommended:

Corr, C. and Balk, D. (1996). Handbook of adolescent death and bereavement. New

York: Springer Publishing Co.

Silverman, P. (2001). Never too young to know: Death in children’s lives. New York:

Oxford University Press.

Class 9

Working with children

Browning, D., and Solomon, M. (2004). The initiative for pediatric palliative care: An interdisciplinary educational approach for healthcare professionals. Journal of Pediatric Nursing. 20(5), 326-334.

Early, P. (1998). Between two worlds: The psycho spiritual crisis of a dying adolescent. Social Thought, 18(2), 67-80.

Sourkes, B. (1992). The child with a life threatening illness. In J. Brandell (Ed.),

Countertransference in psychotherapy with children and adolescents. New Jersey: Aronson Inc.

Class 10

Interventions - Individuals

Berzoff & Silverman. (2004). Chapters 23, 29, 31, 32

Chapter 23. Otis-Green & Rutland. Marginalization at the end of life.

Chapter 29. Silverman. Helping the bereaved.

Chapter 31. Enders. End-of-life care in the prison system: Implications for social work practice.

Chapter 32. Bern-King, & Ellis. End-of-life care in nursing homes.

Class 11

Interventions - Families

Barlow, C.A. & Coleman, H. (2003). The healing alliance: How families use social

support after a suicide. Omega: The journal of death and dying, 47(3): 187-201.

Berzoff & Silverman. (2004). Chapters 28 and 33.

Chapter 28. Blacker & Jordan. Working with families facing life-threatening illness in a medical setting.

Mayfield Arnold, E., Abbott Artin, K.., Lund Person, J., & Griffiths, D. (2004). Consideration of hastening death among hospice patients and their families. Journal of Pain and Symptom Management, 27(6), 523-532.

Recommended:

Walsh, F. (2003). Spiritual resources in family therapy. New York: Guilford Press.

Class 12

Interventions - Groups

Berzoff & Silverman. (2004). Chapters 26 and 27.

Chapter 26. Sutton & Liechty. Clinical practice with groups in the end-of-life care.

Chapter 27. Technology- based groups and end-of-life care.

Hudson, P.L., Aranda, S. & Kristjanson, L.J. (2004). Meeting the supportive needs of

family caregivers in palliative care: Challenges for health professionals. Journal

of Palliative Medicine, 7(1).

Tedeschi, R. (1996). Support groups for bereaved adolescents. In C. Corr & D. Balk (Eds.). Handbook of adolescent death & bereavement. NY: Singer Publishing Co.

Class 14

Leadership

Self Care

Berzoff & Silverman. (2004). Chapters 42 and 44.

Chapter 42. Chachkes & Foster. Taking charge: Social work leadership in end-of-life

care.

Chapter 44 Renzenbrink. Relentless self-care.

Ringel, S. (2001). In the shadow of death: Relational paradigms in clinical supervision.

Clinical Social Work Journal, 29(2) 171-179.

Recommended:

Miller, J. (1999). If not for myself: Caring for yourself as a caregiver for those who

grieve. In J. Davidson and K. Doka (Eds.) Living with Grief at Work, at School and

at Worship. Hospice Foundation of America. DC: Brunner Mazel.

Class 15

Class Review

Rituals

Romanoff, B. & Terenzo, M. (1998). Rituals and the grieving process. Death Studies,

22:8, 697-711.

Imber-Black, E., Roberts J., and Whiting, R. (2003). Rituals in families and family therapy. New York: W.W. Norton & Company.

Press.

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