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Grief Perspectives
Scholar's Corner
Resource Review
Your Professional Library

Shifting Paradigms for the
End of Life

by William G. Hoy
In the face of tragedy and loss, people band together. As assassinated President John F. Kennedy’s funeral unfolded on a cold November day in 1963, more than one million people silently lined the streets of Washington, DC, forming what The Washington Post referred to as a “five-mile lane of sorrow” (Leeke, 2008).

What draws us to seek the support of others in tragedy? Whether in our own personal losses or epic national and global tragedies, something in the human spirit typically draws us together instead of apart. Who can forget the appearance of solidarity when, on the evening of 9/11 the United States Congress put aside their partisan differences and gathered in unison on the steps of the Capitol? When in trouble, people long to be together rather than apart.
But we should not be surprised. One research study after another confirms that people with high levels of “perceived social support” fare better in bereavement than those who are “going it alone.” Finnish researchers interviewed 52 bereaved mothers, revealing that the study participants felt most supported by family and close friends. Interviews and surveys conducted at least one year after the child’s death showed evidence of greater personal growth, less blame and anger, and less disorganization for the mothers who had good personal support versus the mothers who had little personal support or received only professional assistance.
The mothers in this study overwhelmingly reported that, if they were in a support group, they wanted it to be a support group of parents with similar experiences since in their opinion, only fellow sufferers would understand the experience of losing a child. The negative support reported by these mothers consisted primarily of interference from other family members and the dissolution of long-time friendships (Laakson & Paunonen-Ilmonen, 2002).
Howard Stone and colleagues (Stone, Cross, Purvis & Young,2004) at the Brite Divinity School of Texas Christian University conducted a study to explore how church members supported each other during crisis. Like other studies, Stone and his colleagues found that the social support afforded by active involvement in a faith community was a strong buffer against many of the long term negative effects of the crisis. Reflecting on the ways their interviewees felt supported by the community, the presence of caring friends spoke volumes. The researchers wrote, “One of the most striking themes of the interviews in our sample was the immediate and profound impact of these (acts of kindness). Indeed, the simplest acts—merely showing up at the grieving person’s house and doing the dishes, for example—appear to be the most profoundly helpful to those in crisis” (p. 416).
In the congregation studied, every active member belonged to a shepherd group, a small “family” of 20 to 30 people with a trained leader. On a number of occasions reported by the interviewees, members of the person’s shepherd group actually arrived at the hospital or home before the subject’s own family members. The “acts of kindness” were first seen by the researchers as helpful because they removed some of the “burden” of the crisis so that the subject could focus on more pressing needs. “Soon, however, we became aware that they were perceived as acts of solidarity or support—a physical way of expressing concern, love, and care,” Stone and colleagues wrote.
A third study pointing to the efficacy of social support was one engaged in by Lauren Vanderwerker and Holly Prigerson at the Yale University School of Medicine. In their study (Vanderwerker & Prigerson, 2004), 293 bereaved individuals were interviewed during the first year after the death. While Vanderwerker and Prigerson were examining the role of technologically advanced systems for support (ie cellular telephone and internet use), the study conclusively demonstrated that overall social support was protective against Major Depressive Disorder, Post-Traumatic Stress Disorder, and complicated grief as well as being associated with an overall better quality of life.
Interestingly, the word often used to describe these kinds of technologies—“connectivity”—implies the presence of and importance of social support. Vanderwerker and Prigerson demonstrate amply the important benefits to bereaved people of such technologies as online grief support chatrooms and the ready accessibility to others that cellular phone service provides, making it possible to largely banish isolation. With the rapid growth of Facebook and other social networking sites since the publication of this study, one might infer this technological support factor has become even greater. Swedish researchers (Benkel, Wijk, & Molander, 2009) interviewed spouses, adult children, siblings and friends of deceased palliative care patients. Study participants were interviewed shortly after the death and again at one year post-loss. Confirming earlier studies, survivors indicated they both needed and generally received good support from family members and friends. Those who described dysfunctional or non-existent support networks tended to need more professional support than those who had functional support systems in place before the death.
For those of us who provide care to bereaved people, these studies provide conclusive evidence. Our work with bereaved people is most effective when we help them connect—with families, friendship circles, faith communities, and support groups of people who have experienced similar losses. Indeed, grief is not intended to be a solitary, isolated issue. We are made for community, and we grieve best when that loss is supported by a network of social support.
Benkel, I., Wijk, H., & Molander, U. (2009). Family and friends provide most social support for the bereaved. Palliative Medicine, 23, 141-149.
Hoy, W.G. (2016). Bereavement groups and the role of social support: Integrating theory, research, and practice. New York, NY: Routledge.
Laakso, H. & Paunonen-Ilmonen, P. (2002). Mothers’ experience of social support following the death of a child. Journal of Clinical Nursing, 11, 176-85.
Leeke, J. (2008). Long shadows: The farewell to JFK. Alexandria, VA: Attic Window Publishing.
Stone, H.D., Cross, D. R., Purvis, K.B. & Young, M. J.  (2004). A study of church members during times of crisis.  Pastoral Psychology, 52, 405-421.
Vanderwerker, L.C. & Prigerson, H. G. (2004). Social support and technological connectedness as protective factors in bereavement. Journal of Loss & Trauma, 9 (1), 45-57.
The Author: For more than three decades, William G. Hoy has been counseling with the bereaved, supporting the dying and their families, and teaching colleagues how to provide effective care. After a career in congregation, hospice, and educational resource practice, he now holds a full-time teaching appointment as Clinical Professor of Medical Humanities at Baylor University in Waco, Texas.


Resource Review

At a loss for how to provide support for two couples whose children died days apart in the British city of Coventry where he was a young chaplain, Rev. Simon Stephens struck on the idea of getting these parents together around a kitchen table. Though it has been nearly 50 years, getting those parents together in 1969 was the first meeting of what became the Compassionate Friends. Today, the Compassionate Friends operates through nearly 700 chapters in 30 countries including every province of Canada and all 50 states. Their resources and support groups have become a lifeline to bereaved parents of all ages whose children have died from every conceivable cause: cancer, congenital disease, car crashes, suicides, and homicides among them. What draws these parents together today is the same thing that drew them together with Rev. Stephens leadership so long ago: the sense that they are with people who “get it” when it comes to the death of a child.
Even though the web-based resources are great for virtually everyone, not every parent finds help in the Compassionate Friends support groups; their groups are not a one-size-fits-all panacea for those whose child has died. The nature of TCF groups is that they are open-ended groups meaning parents can attend as long as they like. Some newly bereaved parents find it off-putting to attend a group where parents five years into their grief speak of their loss as if it had just occurred. Nevertheless, the Compassionate Friends has been of incredible help to tens of thousands of bereaved parents and their resources and website should be on the “recommended” list for anyone working with this population.
Your Professional Library
Hoy, W.G. (2016). Bereavement groups and the role of social support: Integrating theory, research, and practice. New York, NY: Routledge.
Reviewed by Molly A. Keating, MA, CT
Editor, GriefPerspectives
Filled with clinical experiences, stories, best practices and danger zones, Bereavement Groups and the Role of Social Support was published in 2016. Here, the new or veteran support group leader will find resources that are up-to-date and practical. The book combines the three most important aspects to consider when creating a successful support group: theory, research, and practice. 
Undergirded by interviews with both professional and lay support group leaders from around the world, this volume offers proven strategies for selecting a site, choosing a group style or focus, and reaching out to potential group participants. With humor and candor, the book introduces the “state of the art” in bereavement support based on the latest research findings from throughout the bereavement caregiving world.
Chapter topics move through the fundamentals of understanding grief and the need for social support, making use of Hoy’s compass model with which many readers are familiar. He discusses the importance of recruiting the right people to lead these groups and how to set up content for your sessions. Complex dynamics can arise in any support group; the book covers the issues most commonly encountered as well as detail out the unique ways children and teens experience support. The concluding chapter discusses dealing with complicated grief within the support group and the unique challenges that a complex griever presents.
Undoubtedly, this volume provides a compelling addition to the support group community and a guide to help strengthen the leader in the choices and directions he or she take a group.
Research that Matters
Will Return Next Month
GriefPerspectives is published monthly by Grief Connect, Inc. Copyright ©2017. All rights reserved, including publication or distribution in any form, electronic or printed. For reprint permissions or suggestions for content, please email us at
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