How to Run a Good, Long-Term Support Group for Death Loss Grief

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Based on having conducted over 500 support group meetings over a fourteen year period - JS

THE 'DO's 'n' DON'T's

How to run and maintain a successful, long-lasting support group mostly for widows and widowers

By Jim Surkamp, coordinator of The Grief Support Network, Inc.

copyright, 1999, Jim Surkamp

(as appeared in Healing Ministry Journal, Jan.-Feb., 1998)

The "What" of Support Groups

The "Why"

The "Where"

The "When"

And the "How"

Having a successful support group for widows(ers) requires a real emotional commitment more unique in its constancy than its intensity. The psychologist Milton Erickson best described this relationship with the bereaved with his two exhortations to: "Be interested" in those you support as a human being, knowing they are your teacher, not the reverse; and, to "Observe" which means to not bring a lot of textbook theory to your caring which tends to obscure your ability to directly observe and learn from the experience of the grieving person before you. Book learning about grief has a tendency to be used as a personal defense mechanism by the caregiver against accepting the most important task of developing one's emotional strength and tranquility through continual exposure to emotional intensity. Put another way: being able to stand in that state of a deeply personal encounter with another and providing light with which they can see.

This caveat of coming into grief work as the learner rather than the teacher is especially true for the first four years of regular involvement with those grieving, the time in which the psychic terrain of the bereaved has not come fully into focus for the caregiver. It takes about four years to begin to see a kind of spectrum of grief in the persons you help, ranging from desperate helplessness to functioning.

A second caveat in beginning work either in support groups or individually is to know that most literature on grief has been distorted by "stage-itis:" the tendency to claim stages of grief which portray the grief process as a ladder which you climb, rather than to depict its true nature as an episodic process, shaped by dozens of varied circumstances.

This article explores lessons learned over twelve years and some sixty hours a month doingone-on-one phone communication and conducting about 500 support group meetings, mostly with widow(ers), the remaining persons being murder victims' families, parents of deceased children and a few people grieving the loss of a parent.

I'll describe the what, why, when, where, and how of doing successful support groups. But God knows - and you now will know - that it won't work unless you like this kind of work, that you stand under those you help in order to understand them, and that you do grief work for the simple reason that it you feel good afterwards for really helping someone.

The nasty news for some is it that really helps a lot to go into this as a volunteer rather than as a paid person. There's no getting around the fact that these people are quite aware of whether you get paid or not to be their friend. If you choose to do this kind of work and charge even a small fee earmarked for something called your "time," you get the money but you lose the healing power of being able to say the words: "I'm here only because I care about you."

A hard reality, too, is that accepting payment creates a legal contract in which a service is offered for a fee, making you liable in a court of law should any misfortune occur that could motivate such a suit from one you have sincerely reached out to help.

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A support group is a mutual self help group of people who have lost a spouse or similarly close loved one. Its purpose is be an opportunity to listen to the experiences of others and gain perspective on how one's grief loss is different, easier or harder than the losses of the others. I also believe that the mere act of verbalizing an experience is a major step toward that person's acceptance of it, however terrible and painful.

Support groups also have the purpose of providing the griever with a circle of people with whom they have no other relationship so that this relationship to them tends not to have any other confusing dimensions or "power issues" that characterize ties with family members.

Support groups for grieving spouses work well not in isolation but buttressed by two other types of interaction: a monthly get-together dinner at a local restaurant of the groups' members two weeks removed from the monthly support group meeting. Secondly, the facilitator(s) should call everyone in the group and prospective attendees on the phone once a month, most conveniently a few days prior to the support group so that the call serves the dual purpose of catching up and to also remind them of the imminent meeting.

It should be noted that studies have been attempted to compare the relative effects of one-on-one, professional counseling verses the benefits accrued by the bereaved attending a support group facilitated by a trained volunteer, who, also went through a death loss earlier. The results, which fit my experience, is that the support groups and professional counseling were equally effective.

But the study also indicated great care must be taken by the facilitator in order that a fragile newcomer to the group does not get filled up with more grief issues in hearing the experiences of others in the group. This can be dealt with best by simply keeping your groups no larger than ten, ideally around five to seven.

You also need a ratio of about two or three people in the group with over a year of "grief experience" for every new griever to serve more as helpers to newcomers with a recent, raw grief loss than is less than four months old.

The facilitator should ask if anyone in the group has a heart condition or has had a heart attack and know that one study found that widowers have fatal heart attacks at a rate several times higher in the year following their spouses' deaths, than men still living with their spouse.

Whether or not this is scientific proof of a broken heart, the facilitator should seriously consider if an at-risk person should be talked to one-on-one and not in a less controllable support group.

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Grieving spouses live in a generally unsympathetic, uncomprehending and opinionated world.

After maybe two months of smothering attentions by church friends and neighbors, for example, there often occurs a "falling off" of attention. The friends often say: "If you need anything, just call me," betraying a lack of true commitment in that they have placed the burden on the bereaved to make the first move when they are hardly strong.

Nothing is more universal than people telling the grieving spouse dumb, hurtful things, statements invariably by people who have never had a serious and similar death loss. Some of my "greatest hits" of ill-conceived words-of-comfort include: "I Know How You Feel". . . "It Was God's Will" . . .or my favorite: "You're Still Young."

The bereaved friends need only to reflect a moment on how many years this couple spent together and how they're expecting the survivor to turn their life and thoughts to other things in a few months. It takes several months for the survivor just to comprehend fully - in heart, not just in mind - that this person is absolutely gone from physical life.

I like to say we live in a quick-fix world, in which deep grief is neither quick nor is it something to fix.

hildren of widow(er)s fall often into two distinct categories, the first of which is that of attentive and loving children who really help the survivor on a daily basis with meals, house, and "getting on."

The other type is spoken for in the oft-said heartbreaking words of many widow(er)s: "They have lives of their own." Families today are scattered over many states making it harder to help the survivor. This lack of support from the grieving spouse's children is sometimes compounded by the fact that the surviving child is a grown son who tends to be less sensitive to their needs; and`by any grown children who are so used to the surviving spouse being self-reliant that they don't help - and the surviving parent is too proud to adjust to the new situation and ask for really needed help; but the worst case is the grown children that are nowhere to be seen during the now deceased parent's agonizing illness, leaving all the care-givingresponsibilities and worries to the exhausted spouse.

These same children, without fail, are conspicuous after the death in their far-fetched criticism and hostility toward the surviving, bewildered care giving spouse/parent, demonstrations which, seem, properly so, guilt-driven.

Another key value of support groups for surviving spouses is to help them trust the world again and to transition from a "We" to a "Me." Hearing others going through this within the safety of a support group is invaluable in gently re-framing the survivor's self-image into a single, self-respecting person.

Many widows, for example, have the hardest time going out to eat alone. In fact, any activity associated with the memory of their spouse and "happy times together" can easily become impossible to bear for the widow to who tries to have that activity again but now alone.

The pain of the spouse's absence is absolutely lacerating at such moments.

A widower once told me that to watch a beautiful sunset alone without his absent wife was like being stabbed in the heart. It is hard business for you to receive that degree of pain. That is your gift to them.

So a support group helps the grieving person from closing off into a mistrusting womb of spiritual death. tell people that once they get the strength to come to a support group meeting, they find they are not the only one with great grief.

They feel understood. They don't feel crazy anymore. They feel they can warm themselves by this fire of common humanity. In this support group, once again, they feel like they are part of something bigger than themselves.

They belong. They slowly begin to trust not only themselves and their judgement in how to cope with life alone, but they simultaneously trust more and more people who are seeming strangers who do not represent blood-based "family," but are representatives of the society at large.

It has been said that under all the layers of different grief from a major life disruption happens there lies the deepest, most fundamental grief: a rupture in faith in life. We are raised to see life as a place where, if you work hard, tell the truth, dress neatly and are clean - that all will go well, due to an implied, albeit mythical rewards system. The survivor faces the truth that bad things happen to good people.

(Most of us, at some point in our development, are particularly unhelpful to the grieving spouse because we too believe on some level that misfortune only befalls those less worthy than ourselves. Hence the value of a facilitator who has undergone a major death loss).

We all learn the existential truth that one must love life, self, and others "Anyway," for no good and practical reason; that everyone dies (some terribly) and there's nothing we can do about that. That we live in an irrational world where random misfortunes crash like mindless meteors into innocent lives.

That good and evil do not reside in events that impact us, but in the constructive or destructive responses to them that we cook up in our minds.

A support group of strangers who understand this aspect of deep loss - of losing the person you love and need more than anyone - helps reweave the wounded survivor's trust in humanity and life.

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Sounds simple, but not really.

The best place to have a support group is in the largest town in your county. Turnout is much better for the support group.

I have found you can keep expenses down and use existing space by approaching a church and asking for a room. The Methodist churches, by and large, have been most responsive to our requests for meeting spaces.

Within the church, pick a room that is well heated in the winter, meaning not too many windows. Notice if there are large fans or air conditioning controls in the room should the room become too hot in the summer.

You should expect to make an annual donation for heating and cooling to the church as a courtesy and it should be offered first by your group. It's a great idea to have your meeting scheduled during other events, such as the night of choir rehearsal, because the building's heat is already on in the winter and you are not creating an expense for the church.

There should be good overhead lighting, because it seems to pick up spirits.

One of the most immediate "where's" is the seating. You have a key choice to make.

I have found, after many years, that communication and bonding is better when your group sits around a table in straight-back, wooden chairs with cushions. People really are in close proximity that way and feel like they belong.

Moreover, and many people like having the table to lean on for a kind of emotional support. I put a simple tablecloth perhaps with a little ivy or plant in the middle that doesn't obstruct anyone's line of vision. And . . .of course, a box of Kleenex.

The alternative is what is often available: a living room type of setting with deep soft chairs. This might be necessary for some group members with bad backs, etc. Let the group determine which type of set-up you have, but only after being sure even the less vocal group members want the "preferred" arrangement.

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If your group is mostly older widows(er)s, Saturday morning around eleven is good, because many older people don't want to drive at night. Saturday is good because it offers a chance to come to the meeting for anyone who works during the week. The only group that can't come to a meeting at this time is the younger, working parent/widow(er) who has a LOT to do on Saturdays. But this younger group of spouses seem to have so much work to do that the work and all their responsibilities become the primary therapy for their grief.

Weekday nights work too, if the group is in the largest town of their county, because wary, older survivors might make the short drive to the meeting even after dark. Weekday evenings are probably the best time for younger people who work.

Thursdays and Mondays have worked well for us. Mondays' meetings become an outlet for weekend experiences. Weekends are when couple are together, so weekends alone can be tough for the survivor.

The meeting begins at 7 PM in the evening, giving many enough time to eat dinner. We go for two hours and serve refreshments and cookies at 8 PM. Sprite and butter cookies or vanilla wafers are popular. (Be sure to have a diet drink alternative).

This liquid refreshment is important because talking about stressful issues causes throat muscles to constrict and a person's throat can become dry. We go to 9 PM. Sometimes it's good not to break the focus of the meeting and the chain of conversation with this pause.

But two functions of the break are 1) to allow time for two people who wish to talk together more specifically about something said to the entire group and, 2) smokers sneak out for a smoke and people with bad backs or poor circulation like to stand and limber up a little.

We have found, as mentioned that the support group works best on a once-a-month basis stressing to the people coming that they should come a minimum of six months. Meeting more frequently creates a kind of dependency.

I do a support group in three towns about twenty miles apart each month; so once a month. The facilitator is also able to see changes more clearly in a person from month-to-month than if they see the person more often.

It's a good idea to alternate the support group meeting with some mealtime out at a local moderately-priced restaurant that, ideally, has a buffet or salad bar format.

This meeting is promoted as a purely social gathering which becomes quite a favorite to those who are further down the road of grief and adjustment and like to continue meeting more as friends outside the support group setting.

We are a welcome sight to these restaurants as good business. But we like buffet style restaurants because it has allowed us to eat leisurely and to stay a long time and "hangout."

We've stayed sometimes for several hours which works just fine, so long as the restaurant is big with plenty of tables and the waitress is remembered in the tip.

found that even a newspaper item listing a meeting's time and place isn't enough encouragement to prospective attendees. Even regulars, in this busy day and age, need a reminder call and chat the day prior to the meeting.

(The fact that you may sometimes have to make unsolicited calls of support to widows and widowers to reach people for the group is another reason that it is ethically preferable to not be a person who will profit materially in offering this emotional support).

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You cannot stress enough to the people, actually attending a support group meeting, the importance of love as our healer. It is important, in making your meeting-reminder calls, to make clear that you'd "love" to have the person come.

People need to hear that they are not only tolerated at a meeting but that their presence is truely desired.

For newcomers who have seen the announcement of the meeting in the paper, I suggest, in a phone conversation the night before, that they come early and talk with me alone. This helps them to overcome their fear of making that first appearance at this meeting.

Coming for the first time is very difficult and fraught with anxiety.

As people come in, I introduce new to regulars, then deliberately absent myself from the room, often to stand outside the entrance to personally greet people as they arrive.

The purpose of my absence in the meeting room is to encourage independent bonding and encounters with the group's members.

This keeps a negative pattern of excessive dependence on my leadership role in the group from developing.

My absence also makes people feel more like the group is "theirs."

I sometimes wait five or minutes after starting time, because I don't want to start the meeting with interruptions with late arrivals. When the late arrivals are regulars, they invariably trigger a flurry of conversation with old friends in the group that tends to hurt the group's incipient focus on serious subjects.

Experience has taught me to sit in a chair beside either the newcomer(s) or beside a person who is a compulsive talker.

One type of person who comes to groups might lack social skills or formal education tend to retell experiences in pure, un-summarized form - every blink and murmur.

You sit beside this person and before their monologue threatens to cause the rest of the group to burn out from listening, you, as the facilitator can gently place a hand on their arm and say something like: "That is very much like what Joe said earlier. Joe?

Does what Mary said ring a bell for you?" Or, I often like to take the conversation from a longwinded person by saying: "I saw your head nodding up and down when Mary said etc etc. Joe, Does that ring a bell?"

Some might say the group should be free flowing.

But I've learned that for the group to survive and be a constructive evening away from home for the participants, it is the facilitator's responsibility to keep the group experience one where every single person feels comfortable enough to contribute something to the group. A group of five to seven in which the conversation is shared and distributed evenly among everyone is the perfect group.

I open a meeting with the "reading of the rights."

I introduce myself and go around the circle giving the first name and perhaps a sentence of what they have gone through. (It's fascinating how people in a support group skip over any restatement of their specific loss for, say, a newcomer).

A good facilitator learns to provide simple summaries of their loss in the course of the group's sharing).

In opening the meeting, I say: "Everyone here really DOES know how you feel. Everyone here shares the pain of a great death loss. But it is important to remember that almost everything else about our individual lives are likely to be very different. So we must practice respect for differences because there are differences, especially on the subject of religion and afterlife.

(NOTE: Don't take the bait to the periodic request that you type up and circulate to all persons in the group a list of everyone's phone numbers. People are perfectly able to give out their own phone number, if they so choose).

". . .Also what is said here is confidential, which means you can describe lessons you might have learned here to someone not present later on, but you will not repeat a person's name or specifics of any person's situation, as heard in the course of a meeting. "

". . .Most importantly, this is the one place where you can say the most important thing weighing on your heart and mind, where you can leave your tears. Everyone here has brought tears to leave with us. That's our gift to each other. We truely care about each other for this special two hours.

". . .And you are all very special people, some of the finest people I've ever known. You are all special because something in you has a zest for life, that knows that life is too precious to waste, that living is a great blessing even in its worst most wounding and frightening guises. . . something in you drove you to come here today against all fear because you know love is stronger in you than fear. . .and that you sense, somewhere deep down that you are very important and worthy of love and caring. . ."

If someone new is present, I ask the group to hold hands as we sit or stand and ask a prayer that we have strength to listen to one another and I state the name of the person who is new as the one we care about most.

It's also important to clearly offer the new person the choice to just listen. This person usually says they'll just listen; and somewhere halfway through the meeting, I'll see their head nodding affirmatively to something said.

Then I might very tentatively invite comment, framed as a choice rather than a pressured instructive.

At the close, I found a great way to acknowledge the importance of religious or spiritual values but without inciting religious discord is to have a circle of hand-holding.

Sometimes I light a long white candle at the beginning of the meeting and place it in the center of the circle of people or on the shared table. The candle represents the spiritual presence of those departed as well as our own love and hope and memory.

At the closing the newcomer can be asked to put out the flame. We then hold hands in a circle. I go around the circle with my head bowed and say something special about each person, giving them something positive to think about and take with them until the next meeting.

I stress how we will all think of one another in our hearts and prayers in the month ahead.

I think ask: "If anyone would like to add anything - prayer or comment - please feel free to do so now." I wait about thirty seconds. A voice of gratitude fills the silence or the silence just speaks for us all.

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