Explain how you would apply the grieving model you selected to social work with families in a hospice environment. Explain why you chose this gri

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Interactive Tutorial Transcript: Models of Grieving

Though grief may manifest differently from person to person, the experience can follow a similar pattern. Several models and frameworks have been developed to attempt to explain the common process and tasks associated with grieving. Social workers should draw on these models when helping clients navigate a loss. This interactive tutorial presents five models of grieving and directs to further resources.

Kübler-Ross’s Five Stages of Grief Kübler-Ross’s model involves five key stages through which a person passes toward acknowledgement of the loss and restoration of life. As they are progressing, those who are grieving may move backward and then forward again throughout the stages; it is not always a linear process.

• Stage 1: Denial o Denying that the loss has occurred; experiencing shock

• Stage 2: Rage and anger o Directing anger at others or at a higher power; raging at the unfairness of

the loss

• Stage 3: Bargaining o Attempting to negotiate a restoration of the loss

• Stage 4: Depression o Feeling intense sadness related to the loss

• Stage 5: Acceptance o Acknowledging the loss and its impact on one’s life; seeking coping

strategies to adjust to the new reality Learn More Zastrow, C. H., & Kirst-Ashman, K. K. (2019). Understanding human behavior and the social environment (11th ed.). Cengage Learning.

• p. 694 Moglia, P. (2019). Death and dying. In Magill’s medical guide (online edition). Salem Press.

Westberg Model of the Grieving Process Similar to Kübler-Ross, the Westberg model includes stages through which a person progresses in their grief. However, Westberg includes additional stages and nuances.

• Shock and denial o Upon experiencing a loss, a state of numbness occurs.

• Emotions erupt

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o Realization sets in, and the pain of the loss is expressed through the releasing of emotion (crying, wailing, whimpering, screaming).

• Anger o Anger is directed at others, the person who has died, or a higher power.

There is a sense of powerlessness.

• Illness o Sickness may arise due to the stress of the loss and associated grief.

• Panic o Overwhelming emotions and worry contribute to a feeling of panic about

one’s mental state and what the future holds.

• Guilt o Guilt surfaces as the individual reflects on what they could have done

differently to prevent the loss.

• Depression and loneliness o The individual experiences deep sadness about the loss and a sense of

isolation from others who do not understand.

• Reentry difficulties o Challenges arise as the individual attempts to re-enter the world and

resume activities.

• Hope o The individual may experience flickers of hope and progress toward

healing.

• Affirming reality o The loss is accepted, and a new life is constructed. A sense of control

returns to the individual. Learn More Zastrow, C. H., & Kirst-Ashman, K. K. (2019). Understanding human behavior and the social environment (11th ed.). Cengage Learning.

• pp. 694–695

Dual Process Model of Coping With Bereavement

According to Stroebe and Schut (2010), two simultaneous processes occur following a loss: loss-oriented coping and restoration-oriented coping. This model posits that people move back and forth, oscillating between these two processes, as they navigate their grief and build a new life.

• Loss-oriented coping o Thoughts, emotions, and actions directly related to grieving and the lost

person

• Restoration-oriented coping

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o Processing the new reality; incorporating new tasks, roles, or identities as a result of the death; engaging in distractions from grief; avoiding loneliness

Learn More Stroebe, M., & Schut, H. (2010). The dual process model of coping with bereavement: A decade on. Omega: Journal of Death & Dying, 61(4), 273–289. https://doi.org/10.2190/OM.61.4.b

Tonkin’s Growing Around Grief Framework

The central idea described by Tonkin (1996) is that grief is never resolved. It is ever- present, but one’s life steadily grows up and around the grief, encompassing it. In this way, individuals never “get over” a loss; rather, they “live with loss.” Learn More Tonkin, L. (1996). Growing around grief—another way of looking at grief and recovery. Bereavement Care, 15(1), 10. https://doi.org/10.1080/02682629608657376

Worden’s Four Tasks of Mourning Worden set forth specific tasks to accomplish in order to mourn and process a loss.

• Task 1: To accept the reality of the loss o Believing that the loss has happened, on both cognitive and emotional

levels.

• Task 2: To process the pain of the grief o Feeling and acknowledging the range of emotions surrounding a loss.

Emotions may be more complex depending on the type of loss and the circumstances.

• Task 3: To adjust to a world without the deceased o Adapting externally, internally, and spiritually to the loss. External

adjustments include performing day-to-day activities for which the deceased had been responsible and assuming the deceased’s role; internal adjustments refer to the effect of the loss on one’s identity and self-esteem; and spiritual adjustments include the way in which the loss has changed one’s worldview and beliefs.

• Task 4: To find an enduring connection with the deceased in the midst of embarking on a new life

o Keeping the deceased’s memory alive without becoming stuck in the past. Learn More

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Worden, J. W., & Winokuer, H. R. (2011). A task-based approach for counseling the bereaved. In R. A. Neimeyer, D. L. Harris, H. R. Winokuer, & G. F. Thornton (Eds.), Grief and bereavement in contemporary society: Bridging research and practice (pp. 57–67). Routledge.

Yousuf-Abramson, S. (2020). Worden’s tasks of mourning through a social work lens. Journal of Social Work Practice. https://doi.org/10.1080/02650533.2020.1843146

An Ecological Systems Framework for Professional Resilience in Social Work Practice

Jason M. Newell

The cumulative effects of chronic work-related stress pervasively and persistently affect the well-being of the human services workforce. As a preventive measure, the ongoing commit- ment to self-care strategies and resources is essential in maintaining a healthy and resilient professional quality of life. This article describes a holistic approach to cultivating profes- sional resilience through the ongoing practice of self-care. A model for self-care using an ecological systems framework with activities across the biological, interpersonal, organiza- tional, familial, peer-related, spiritual, and recreational aspects of the biopsychosocial self is proposed. Within this model, emphasis is placed on the role of compassion satisfaction and vicarious resilience as key components to fostering meaningful and rewarding careers for social workers.

KEY WORDS: burnout; compassion fatigue; compassion satisfaction; professional resilience; self-care

F or those who self-select the pursuit of acareer in human services work, social workis far more than a career path, it is a call to embrace a professional life of deep, meaningful, and rewarding service. Congruent with the mission, values, and humanitarian spirit of the social work profession (National Association of Social Work- ers [NASW], 2009), social workers dedicate their professional lives to providing services to those who are poor, vulnerable, underserved, underpriv- ileged, or otherwise suffering in some way. Yet many social workers find themselves unprepared for the chronic day-to-day exposure to clients and the emotionally distressing narratives of their myr- iad psychosocial problems.

The implications of nearly three decades of practice research have demonstrated that the emo- tionally challenging aspects of direct social work practice have potentially deleterious and some- times consequential psychological effects on social workers themselves. This research bears particu- lar relevance for students and newly degreed social work professionals pursuing careers in child wel- fare, clinical social work, disaster mental health, military social work, and other forms of trauma- related care (Gilin & Kauffman, 2015; D. Greene, Mullins, Baggett, & Cherry, 2017; Knight, 2010). It has been suggested that stress-related condi- tions such as professional burnout, secondary trau-

matic stress, vicarious traumatization, and compas- sion fatigue may be underestimated “occupational hazards” for those providing social work services (Pryce, Shackelford, & Pryce, 2007).

The wealth of evidence in the literature on the emotional effects of direct social work prac- tice clearly implies the need for well-developed and comprehensive training and education on the practice of self-care as an ongoing professional behavior for all social workers (Strand, Abramovitz, Layne, Robinson, & Way, 2014). Yet the emotional and psychological risks associated with being in direct practice with vulnerable populations, and the essential utilization of self-care strategies to address this important aspect of human services work, has been an overlooked issue in the academy of social work education (D. Greene et al., 2017; Newell & MacNeil, 2010). The need for continued student education, training, and professional development at the undergraduate and graduate levels is sup- ported by NASW, which encourages

the recognition by social work education pro- grams of their critically important roles in edu- cating social work students about the practice of professional self-care by integrating such content into existing student standards, poli- cies, foundation and advanced curriculums, field practicum, and assignments and projects. (NASW, 2009, p. 270)

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Notwithstanding the evidence in the literature supported by NASW, the most recent revision to the Educational Policy and Accreditation Stan- dards by the Council on Social Work Education (CSWE) makes no direct mention of the im- portance of including material on the practice of self-care in social work educational curriculum or course content (CSWE, 2015). The lack of re- quired content on self-care as a component of social work education at the BSW and MSW lev- els of practice may be a contributing factor to the higher rates of indirect trauma and professional burnout in social work practice. It has been noted that some social work students graduate from their professional training programs with little knowl- edge or ability to appropriately use self-care as an ongoing and essential practice behavior (Gilin & Kauffman,2015;Newell,2017).Furthermore,many social work students may be exiting their programs and entering the workforce without the profes- sional training to recognize or address the signs and symptoms of professional burnout, compas- sion fatigue, and the indirect or vicarious effects of trauma-related care (D. Greene et al., 2017).

To address this demanding issue for professional social workers, this article conceptualizes profes- sional resilience using a multidimensional frame- work for the practice of self-care. Grounded in the ecological systems perspective, a fundamen- tal approach to social work practice, the proposed framework conceptualizes self-care as a broader set of practice behaviors pertaining to the whole per- son, including the physical, interpersonal, organi- zational, familial, and spiritual domains of the psy- chosocial self. The model emphasizes self-care as a holistic set of personal and professional prac- tice behaviors cultivated through the positive and growth-promoting aspects of direct practice. Fur- thermore, the model offers an alternative approach to addressing the inherent stress in social work practice by focusing on the rewarding aspects of the work, rather than the potentially deleteri- ous effects, as described in the literature using terms such as “vicarious traumatization,” “sec- ondary traumatic stress,” “compassion fatigue,” and “professional burnout.”

LITERATURE REVIEW Conceptualizing Resilience Human resilience is a broad construct that has been studied as an adaptive response to stressful external

stimuli and as the use of coping skills as modera- tors or buffers to the effects of stress and trauma (Kent, Davis, & Reich, 2014; van der Walt, Suli- man, Martin, Lammers, & Seedat, 2014; Yehuda, Flory, Southwick, & Charney, 2006). The con- cept of resilience has been examined as a func- tion of healthy development across the life span in infants, children, adolescents, adults, and fami- lies (Masten, 2001; Walsh, 2015). From a cognitive perspective, resilience has been studied as the vari- ous ways human beings appraise, process, and regu- late the emotions attached to external stimuli, with emphasis on the application of positive thoughts and emotions to promote psychological well-being (Duckworth, Steen, & Seligman, 2005; Fredrick- son, 2004). As a function of spirituality, resilience has been examined in the form of demonstrating compassion for the care of others, honoring one’s own personal and spiritual sense of morality, and adhering to personal and professional values and ethics (Pyles, 2018; Seagar, 2014; Wicks & May- nard, 2014).

The collective literature on the construct of re- silience reveals no universally agreed-on opera- tional definition for the term “resilience” (R. R. Greene & Dubus, 2017). Studies examining resil- ience often use the term interchangeably with other similar personality attributes or character- istics such as hardiness, personal growth, positive adaptation, and psychological well-being (Luthar, Cicchetti, & Becker, 2000). The American Psy- chological Association (2016) described resilience as “the process of adapting well in the face of adver- sity, trauma, tragedy, threats or significant sources of stress—such as family and relationship problems, serious health problems or workplace and financial stressors” (para. 1). A broader definition describes resilience as a multifaceted process of well-being demonstrated by “a sustained adaptive effort that prevails despite challenge, as a bouncing back or recovery from a challenge, and as a process of learn- ing and growth that expands understanding, new knowledge, and new skills” (Kent et al., 2014, p. xii).

Professional Resilience in Social Work Practice The term “professional resilience” has been used across the fields of human services work including counseling, social work, education, psychotherapy, and other health-related professions to describe the process by which those who provide services

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to vulnerable or at-risk populations thrive within inherently stressful work conditions (Hegney, Rees, Eley, Osseiran-Moisson, & Francis, 2015; Hernandez, Gangsei, & Engstrom, 2007; Skovholt & Trotter- Mathison, 2011). A recent shift in the trauma lit- erature indicates a stronger focus on constructs that define and measure the growth-promoting aspects of both direct and indirect trauma expo- sure, rather than the adverse effects. An example of this paradigm shift from the direct trauma liter- ature is the conceptualization of posttraumatic growth (PTG) in comparison with posttraumatic stress. Studies examining PTG in survivors of trau- ma emphasize positive changes that occur in the sense of self, in relationships with others, and in overall quality of life perspective (Easton, Coohey, Rhodes, & Moorthy, 2013; Saimos, Rodzik, & Abel, 2012; Tedeschi & Calhoun, 2004).

Similar to the conceptual evolution of PTG, research in the area of indirect trauma exposure has revealed an attempt to bring balance to the consequential effects of trauma treatment includ- ing vicarious traumatization, secondary traumatic stress, and compassion fatigue. Such constructs have focused solely on the emotionally challeng- ing aspects of providing direct services to those who are vulnerable and suffering (Newell, Nelson- Gardell, & MacNeil, 2016). In contrast, the term “vicarious resilience” describes the process of trau- ma recovery as having the potential to foster resil- ience and growth, not only in the client, but in the clinician as well (Hernandez et al., 2007). The pro- cess of vicarious resilience occurs through prac- tice with clients who, through the healing process, overcome the effects of trauma through their redis- covery of the meaningful aspects of life (Engstrom, Hernandez, & Gangsei, 2008). A more commonly cited term in this area is the concept of compassion satisfaction, which refers to those aspects of human services work that provide professional success, reward, and fulfillment (Conrad & Keller-Guen- ther, 2006; Stamm, 1999). Elements of compas- sion satisfaction include positive interactions with clients such as celebrating client successes, the for- mation of meaningful and supportive relationships with colleagues, the personal and spiritual satisfac- tion of being in a helping profession, and the posi- tive professional interactions that occur as benefits of membership in a helping organization or com- munity (R. R. Greene & Dubus, 2017; Kapoulistas & Corcoran, 2015).

Self-Care as a Holistic Process: An Ecological Systems Perspective

The term “self-care” is common to the discourse of professional social workers; however, the actual practice of professional self-care has not been oper- ationalized in the ways of standardized approaches to client treatment. Professional self-care has been described as both a process and a defined set of practice skills and strategies to mitigate the emo- tionally challenging effects of providing services to individuals, families, or communities (Skinner, 2015). Although there are no well-established or rigorously tested models of self-care practice or intervention, synthesis of the research literature anecdotally suggests that the best approach to pro- fessional resilience is an individualized combina- tion of strategies at the personal and the organi- zation levels (Cox & Steiner, 2013; Grise-Owens, Miller, & Eaves, 2016; Lee & Miller, 2013). The ecological systems perspective is useful in concep- tualizing self-care as both a personal and a profes- sional practice that includes aspects related to phys- iological health behaviors, interpersonal coping, organizational strategies, time with family and friends, recreational activities, and spirituality (R. R. Greene & Dubus, 2017). Taking a holistic ap- proach to self-care allows for the application of various strategies to promote positive professional quality of life and an overall sense of physical and emotional well-being.

One of the major premises of the ecological sys- tems theory is the idea of homeostasis, which refers to a human system’s drive and collective ability to maintain its fundamental nature, even during times of sudden or intense change (Payne, 2014; Walsh, 2015). Another principle of systems the- ory suggests that the collective system and all of its domains naturally adapt and adjust to maintain bal- ance or equilibrium as a homeostatic state. In terms of self-care, as the occupational domain directly influences all other domains in the collective sys- tem, too much human energy expended in the stress of work activities takes valuable energy and resources away from other areas (positive health behaviors, time with family and friends, spiritual and recreational activities). Hence, maintaining an ongoing plan of self-care helps to create a healthy work–life balance, which will hopefully recipro- cally contribute to professional resilience and over- all well-being.

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Figure 1: Ecological Systems Framework for Holistic Self-Care

Given the breadth of the concept of stress and its application across micro and macro domains, the ecological systems perspective provides a use- ful way of thinking about, understanding, and con- ceptualizing the impact of stress on the personal and professional lives of social workers. Using the holistic approach proposed in the ecological sys- tems framework, self-care activities across several domains consisting of biophysiological, interper- sonal, organizational, familial, peer-related, spiri- tual, and recreational activities all contribute to a comprehensive method of practice. Figure 1 pro- vides an illustration of the ecological systems per- spective as it applies to the practice of self-care.

Applying the Ecological Systems Framework Simple strategies for self-care at the individual level range from maintaining positive health behav- iors, spiritual activities, recreational activities, posi- tive forms of self-expression, and connections with family members and close friends. With regard to

the physiological domain of self-care, the most log- ical place to begin is with “the basics” by assess- ing activities related to physical well-being. Positive health behaviors such as meal planning, sleep habits, regular exercise and physical activity, and leisure time are essential to the self-care process (Bush, 2015; Grise-Owens et al., 2016). If the need for an improved meal plan and exercise routine is an iden- tified area of self-care, it is best to start with one reasonable health behavior goal or objective (that is, avoid “pie in the sky” goals). For example, setting a goal to complete a marathon is only reasonable for someone who is interested in training to be a marathon runner. Whereas completing a marathon is a reasonable long-term goal, a reasonable short- term goal is to make time to take a brisk walk at least once each workday for one month. This is also true when setting food intake and food behav- ior goals. Healthy eating goals can be as simple as making a commitment to buying healthy food items and packing a sensible lunch rather than relying on vending machines or fast food as daily

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sources of nutrition; substituting water for soda, coffee, or other caffeinated beverages; or leaving one’s office or computer space to eat lunch for a mental break in a nonworking space.

Social workers understand the value and impor- tance of human relationships in sustaining personal and professional resilience and well-being over time. When social workers allow work responsi- bilities to take time away from family and friends, there is potential for adding an additional layer of stress from the guilt and shame that comes from neglecting those who are most important in our lives. In the absence of individual and familial self- care, the chronic emotional demands of social work practice may result in the depletion of empathy resources to provide care for both the self and oth- ers, leaving an empty reservoir of compassion and empathy for families, friends, and other loved ones. Therefore, part of the practice of self-care is to pre- serve one’s natural empathy by valuing and pro- tecting time for the experience of joy, laughter, and compassion with family, friends, and other loved ones (Giles, 2014; Pennebaker & Smyth, 2016). The use of social support from family, pets, and close friends has been shown to buffer the effects of occupational stress, which ultimately contributes to both the process of self-care and an over- all sense of personal and professional well-being (Grise-Owens et al., 2016; Viswesvaran, Sanchez, & Fisher, 1999).

Organizational self-care begins with simple strat- egies such as avoiding procrastination and allo- cating sufficient work time to complete required assignments, reports, or documentation. Protecting calendar time, which for some is simply learning to control one’s calendar, is an essential time man- agement skill that includes not only setting reason- able deadlines, but also actively prioritizing per- sonal and professional obligations. Social workers may find that taking a task-centered approach, by setting specific goals and objectives for each day of the week and remaining dedicated to these tasks when possible, is useful in developing time man- agement skills. A thorough assessment of out-of- office calendar time (meetings, home visits, and so on) and time spent working in the office may prove useful in determining areas in which time may be used more efficiently.

Before developing a formal strategy for orga- nizational self-care, it is beneficial to examine the impact of agency philosophy, culture, climate,

administrative structure, policies, and procedures on agency providers and the clients they serve (Lee & Miller, 2013). For example, the presence of an agency culture that values the use of sup- portive supervision, particularly for those new to the social work profession, is useful in building organizational resilience and professional efficacy (Cox & Steiner, 2013). Social work practice is grounded in the ability to develop healthy rela- tionships through effective forms of communica- tion. Supervisors play a vital role in cultivating pro- fessional resilience by providing effective relational guidance, support, education, and practice wisdom during times of stress and professional insecurity (Skovholt & Trotter-Mathison, 2011). Social sup- port from professional colleagues through acts such as assistance with administrative duties, insight into difficult cases, or comfort during times of crisis have been suggested as helpful for social workers (Maslach, 2003).

Like the other components of the holistic ap- proach to self-care, spirituality or having a spiri- tual life is individually unique. Spirituality has been defined as a “devotion to the immaterial part of humanity and nature, rather than worldly things such as possessions; an orientation to people’s reli- gious, moral, or emotional nature” (Barker, 2014, p. 409). Other components of spirituality include self-perception, adherence to personal values and ethics, belief in the existence and influence of a higher power, and the formation of meaning- ful relationships with others who are like-minded subscribers to a common cause for social justice and peace, a process described as “healing justice” (Pyles, 2018). The presence of spirituality has been shown to buffer the effects of workplace stress and contribute to overall well-being as a vital source of resilience and renewal for individuals and fam- ilies (Brelsford & Farris, 2014; Csiernik & Adams, 2002).

The practice of spiritual self-care involves the development and maintenance of spiritually or religiously based practices as buffers to the effects of personal and professional stress and as sources of self-renewal and overall well-being. Strategies for maintaining the religious component of spir- itual self-care include regularly attending faith- based services and activities, participating in reli- gious observations and rituals, and praying (Falb & Pargament, 2014). Nonreligiously based com- ponents of spiritual self-care include engaging in

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Table 1: Suggestions for Developing a Comprehensive Plan of Self-Care

Self-Care Domain Suggested Strategies

Biological Balanced diet and nutrition; adequate sleep schedule; regular exercise regime; moderation in alcohol use; utilization of health and mental health days to recover from physical or emotional illness, including grief work

Interpersonal Maintenance of professional boundaries with clients; creating a healthy balance between personal and professional obligations; use of adaptive rather than maladaptive coping skills; active engagement of anxiety associated with clients through techniques such as mindfulness, self-talk, and self-awareness; use of psychotherapy, counseling, or support group help (particularly for those with a personal trauma history)

Organizational Seeking out organizations with missions consistent with personal values and career aspirations; ongoing participation in education, training, and professional development opportunities; active participation supervision and ongoing mentorship; engaging in supportive relationships with professional colleagues; setting realistic goals and objectives for the workday or workweek; using coffee and lunch breaks for non-work-related activities; participating in the celebration of client success and fulfillment; maintaining a realistic worldview about the impact of client work on the self

Familial Ongoing use of social support from family and close friends; participation in nonstressful family events; engaging in “no technology” dinners and family time; scheduling family and couples vacation time; participating in children’s activities, school functions, and sports events (if applicable); protecting time to celebrate special family events, birthdays, or anniversaries; scheduling nonfamily time to catch up with close friends; caring for and spending time with family pets

Spiritual Attending faith-based services regularly; engaging in positive forms of self-expression and self-revitalization, for example, yoga, meditation, philanthropic activities

Recreational Reading; drawing; painting; sculpting; team sports; cooking; hiking; swimming; movies; other outdoor activities or forms of positive self-expression; any activity personally or professionally fostering the use of joy, humor, or laughter

positive forms of self-expression and revitalization such as painting, journaling, inspirational reading, and playing or listening to music (Baldwin, 1990; Gladding, 2011; Pennebaker & Smyth, 2016). The application of activities of healing and self-renewal such as the use of conscious relaxation, yoga, and meditation have also been suggested as positively influencing spirituality and well-being (Richards, Campenni, & Muse-Burke, 2010). Finally, recre- ational activities that involve separation from the work environment, p

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