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A comparison of workshop methods of counsellor education on the topic of death and dying Flowerdew, Julie 1982

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A COMPARISON OF WORKSHOP METHODS OF COUNSELLOR EDUCATION ON THE TOPIC OF DEATH AND DYING BY JULIE FEOWERDEW B.A., The U n i v e r s i t y of B r i t i s h Columbia, 1 9 7 1 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES (Department of C o u n s e l l i n g Psychology) We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1 9 8 2 (c) J u l i e Flowerdew, 1 9 8 2 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. I t i s understood that copying or publication of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. The University of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Department of DE-6 (3/81) i A b s t r a c t Three workshop formats, namely, d i d a c t i c , e x p e r i e n t i a l , and a combined d i d a c t i c and e x p e r i e n t i a l , were compared with a c o n t r o l group to explore the p o s s i b l e d i f f e r e n c e s i n promoting e f f e c t i v e c o u n s e l l o r responses to h y p o t h e t i c a l d e a t h - r e l a t e d s i t u a t i o n s . Twenty-four p a r t i c i p a n t s responded i n w r i t i n g to twenty h y p o t h e t i c a l d e a t h - r e l a t e d s i t u a t i o n s . Responses were rated u sing Atkinson's f i v e - p o i n t s c a l e . R e s u l t s i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e between treatment groups. The more e f f e c t i v e workshops seem to be the d i d a c t i c and the combined d i d a c t i c and e x p e r i e n t i a l workshop. As t h i s was mainly an e x p l o r a t o r y study, f u r t h e r r e s e a r c h w i l l be necessary to support the f i n d i n g s . 11 Table of.Contents Chapter 1 - I n t r o d u c t i o n . ... ;....1 Problem. . . 1 L i m i t a t i o n s and Assumptions.... 3 Importance of Study 4 Chapter 2 - L i t e r a t u r e Review 6 Avoidance of Death 6 The Rise of Death Education and I t s E f f e c t i v e n e s s .7 Death Education: Knowledge and/or C o n f r o n t a t i o n o f S e l f 9 Acceptance versus Avoidance.. 11 Chapter 3 - Method 13 P i l o t Study 13 Experimental Study 16 Subjects 16 Experimental Design ....17 Treatment • 17 D i d a c t i c Workshop...... 18 E x p e r i e n t i a l Workshop 18 Combined Workshop 19 C o n t r o l Group 19 Procedure 19 Instrumentation . 19 Question n a i r e 19 P o s t t e s t . 20 Hypothesis 21 Chapter 4 - R e s u l t s 22 A n a l y s i s o f v a r i a n c e 23 S c h e f f e m u l t i p l e p a i r w i s e comparison tests.23 Sc h e f f e combined treatment groups comparison t e s t s .24 Chapter 5 - D i s c u s s i o n 25 Summary 25 A n a l y s i s 25 Suggestions f o r F u r t h e r Research. 27 References 30 i i i Appendix One - Atkinson F i v e Category Scale f o r E v a l u a t i n g Responses 34 Appendix Two - Q u e s t i o n n a i r e 35 Appendix Three - H y p o t h e t i c a l S i t u a t i o n s P i l o t Study 37 Appendix Four - H y p o t h e t i c a l S i t u a t i o n s Research Stud y i i i H i Li 40 Appendix F i v e - D i d a c t i c Workshop.... 43 Appendix Six - E x p e r i e n t i a l Workshop 47 Appendix Seven - Combined D i d a c t i c / E x p e r i e n t i a l Workshop 50 Appendix E i g h t - Mean Score f o r Each Subject by Each Rater 51 Appendix Nine - C o r r e l a t i o n s Between Raters Within Each Group 52 Appendix Ten - Questionnaire Responses 54 i v L i s t of Tables Table I - Sample S i z e , Means, Standard D e v i a t i o n s f o r Treatment Groups. 2 2 Table I I - A n a l y s i s o f Variance for.Treatment Groups..... 2 3 V Acknowledgements Without the help and support of many f r i e n d s , f a m i l y , and c o l l e a g u e s t h i s t h e s i s would never have been completed. I would l i k e to thank my r a t e r s , P a t r i c i a T a y l o r , Sharon C o f l i n , and Denis Boyd, f o r t h e i r time, h e l p f u l comments, and encourage-ment. My thanks to my committee f o r h e l p i n g me complete a p r o j e c t of which I am proud. The p a r t i c i p a n t s who gave of t h e i r time f o r t h i s study, are to be thanked f o r t h e i r c o n t r i b u t i o n . I a l s o want to thank the Nicholsons f o r t h e i r c o n t r i b u t i o n to the t y p i n g of t h i s t h e s i s . A s p e c i a l thanks to my f a m i l y , e s p e c i a l l y my mother, and to my f r i e n d s who have stood by me and encouraged me to continue and to f i n i s h . 1 CHAPTER 1. I n t r o d u c t i o n The Problem At times, d u r i n g the sch o o l year, c o u n s e l l o r s are c a l l e d upon to a s s i s t a student, parent, or c o l l e a g u e e x p e r i e n c i n g the l o s s o f a s i g n i f i c a n t o t h e r — a parent, s i b l i n g , r e l a t i v e , f r i e n d . Death i s an event which touches a l l c h i l d r e n as w e l l as a d u l t s , i n some way. Atkinson ( 1980) s t a t e s that " m o r t a l i t y s t a t i s t i c s i n d i c a t e that.by the age of 18, 1 c h i l d i n 20 w i l l have l o s t a parent by death, and i n a sch o o l of 600 students 1 c h i l d can be expected to die every second or t h i r d years" (p. 150). Rosenthal's (1978) s t a t i s t i c s favoured one i n f i v e c h i l d r e n l o s i n g a parent through, death dur i n g the school years. C o n s i d e r i n g these s t a t i s t i c s there appears to be l i t t l e that has been done to educate c o u n s e l l o r s or educators i n the area of death education, a c c o r d i n g to the l i t e r a t u r e . The g r i e f r e a c t i o n s evidenced i n c l i e n t s need to be understood so that c o u n s e l l o r s can. f a c i l i t a t e and encourage the g r i e v i n g process. G r i e f i s an emotional process to which there i s n o t s e t t p a t t e r n . A c o u n s e l l o r cannot predetermine e x a c t l y how a c l i e n t w i l l r e a c t to the death of a s i g n i f i c a n t other. What i s known about g r i e f are the v a r i e t i e s o f emotions which can comprise the g r i e v i n g process. Emotions which may be evidenced d u r i n g the g r i e v i n g process i n c l u d e shock, d e n i a l , numbness, r e l i e f , anger, d i s b e l i e f , d e p r e ssion, g u i l t , emptiness, and hur t . There i s no s e q u e n t i a l order to be expected and any f e e l i n g i s considered a p p r o p r i a t e . 2 G r i e f r e a c t i o n s may i n c l u d e waves of g r i e f , insomnia, t e a r s , s i g h i n g , h a l l u c i n a t i o n s , v i v i d dreams or memory f l a s h e s i n v o l v i n g the deceased, apathy, d i s o r g a n i z a t i o n , i d e n t i f i c a t i o n with the de deceased, and a reassessment of one's goals (Gordon & Klass , 1979; Lindemann, 1944; Reeves & Knowles, 1979 & 1981; Sheskin & Wallace, 1976). C h i l d r e n may r e a c t to g r i e f i n ways unrecognizable to a d u l t s as g r i e f r e a c t i o n s . Some c h i l d r e n ' s r e a c t i o n s may be misunder-stood, as can be the case i n r e a c t i o n s of i n d i f f e r e n c e or nonchalance, f o r example. A c l e a r understanding of "a c h i l d ' s needs, t h e i r d e v e l o p i n g concepts, p o s s i b l e g r i e f r e a c t i o n s , and signs of i n t e r e s t or d i s t r e s s " (Atkinson, 1980, p. 152), need to be understood. Unless the c h i l d ' s r e a c t i o n s are understood, problems may a r i s e which can s u b s t a n t i a l l y block a c h i l d ' s e e d u c a t i o n a l progress. Such problems may be manifested i n the f o l l o w i n g ways: academic f a i l u r e , delinquency, withdrawal, l e a r n i n g problems, depression, and o t h e r s . School c o u n s e l l o r s can be i n a p o s i t i o n to e f f e c t i v e l y i n t e r v e n e and prevent such symptoms i f they are aware, of what the c h i l d i s attempting to communicate (Atkinson, 1980; Bebensee, 1981; Hawener, 1975). To provide the support needed to a g r i e v i n g c l i e n t , c o u n s e l l o r s need to be aware of how to recognize g r i e f r e a c t i o n s and to be aware of what i n t e r v e n t i o n s are h e l p f u l . One of the best i n t e r v e n t i o n s with a g r i e v i n g c l i e n t i s l i s t e n i n g to the c l i e n t t a l k about how he or she i s f e e l i n g and about how he or she f e e l s about the deceased (Atkinson, 1980; Getson & Benshoff, 1977). The i s s u e s and emotions that such a 3 communication may e l i c i t , however, can be d i f f i c u l t not only f o r the c l i e n t to deal with, but a l s o f o r the c o u n s e l l o r . I t i s t h i s d i f f i c u l t y that the c o u n s e l l o r may experience which can i n h i b i t h i s or her a b i l i t y to help the c l i e n t . Most authors i n the reviewed l i t e r a t u r e s t r e s s e d the importance of c o u n s e l l o r s examining t h e i r own f e a r s , f e e l i n g s , and a t t i t u d e s towards death and dying before attempting to a s s i s t c l i e n t s to d e a l with t h e i r g r i e v i n g (Atkinson, 1 9 8 0 ; F rears & Schneider, 1 9 8 1 ; Headington, 1 9 8 1 ; Reeves & Knowles, 1 9 7 9 & 1 9 8 1 ; Rosenthal, 1 9 7 8 ) . What these authors do not mention i s any s t r o n g evidence to support the need f o r s e l f - e x a m i n a t i o n on the part of the c o u n s e l l o r . Without t h i s evidence, the v a l i d i t y of e x p e r i e n t i a l components being i n t e g r a l to a c o u n s e l l o r death education program i s q u e s t i o n a b l e . L i m i t a t i o n s and Assumptions C e r t a i n l i m i t a t i o n s have been imposed on t h i s study. F i r s t , the r e s u l t s are s p e c i f i c to graduate students i n c o u n s e l l i n g psychology and p r a c t i c i n g elementary and secondary school c o u n s e l l o r s who p a r t i c i p a t e d i n the study. The p a r t i c i p a n t s i n the study were a l l asked to v o l u n t e e r to take part i n the a c t i v i t i e s i n v o l v e d i n the study ( i . e . , f i l l i n g out a q u e s t i o n n a i r e , w r i t i n g responses, l i s t e n i n g to a d i d a c t i c work-shop, p a r t i c i p a t i n g i n an e x p e r i e n t i a l workshop, p a r t i c i p a t i n g i n a combined d i d a c t i c and e x p e r i e n t i a l workshop). I t was a n t i c i -pated that t h i s could p o s i t i v e l y skew r e s u l t s as those who p a r t i c i p a t e i n the workshops may be a c t i v e l y t r y i n g to improve 4 t h e i r s k i l l s with the e x p e c t a t i o n of becoming more comfortable with the t o p i c and thereby being able to help t h e i r c l i e n t s more e f f e c t i v e l y . Furthermore, c e r t a i n assumptions have been made. In pl a n n i n g the study, i t was assumed that there would be no d i f f e r e n c e between those who volunteered f o r the four groups: the c o n t r o l group; the d i d a c t i c workshop; the e x p e r i e n t i a l workshop; and the combined d i d a c t i c and e x p e r i e n t i a l workshop. That i s to say, the r e s u l t s of the study would not be due to the sex of p a r t i c i p a n t s , or v a r y i n g years of experience, or v a r y i n g types of experience. Importance of the Study The t o p i c of the present study was to i n v e s t i g a t e the e f f e c t i v e n e s s of c o u n s e l l o r education on death and dying. E x i s t i n g r e s e a r c h , as suggested e a r l i e r , supports the need f o r t r a i n i n g c o u n s e l l o r s i n death education. T h i s study explored the d i f f e r e n c e s i n p a r t i c i p a n t s ' responses to h y p o t h e t i c a l s i t u a t i o n s concerning death and dying issues, between those who attended a workshop and those who d i d not. Further, t h i s study i n v e s t i g a t e d the type of workshop format which i s more e f f e c t i v e i n t r a i n i n g c o u n s e l l o r s to respond more e f f e c t i v e l y to g r i e v i n g c l i e n t s - - n a m e l y , d i d a c t i c , e x p e r i e n t i a l , or a combined d i d a c t i c and e x p e r i e n t i a l workshop. Research suggests the need f o r e x p e r i e n t i a l experiences, yet there i s a l a c k of e m p i r i c a l evidence to support t h i s . Durlak (1978-79), i n h i s study d e a l i n g with a comparison of e x p e r i e n t i a l and d i d a c t i c methods of death education with a heterogeneous h o s p i t a l s t a f f , found: 5 That a death education program with e x p e r i e n t i a l e x e r c i s e s to a s s i s t i n d i v i d u a l s i n c o n f r o n t i n g and s h a r i n g t h e i r personal f e e l i n g s about death and dying was s i g n i f i c a n t l y more e f f e c t i v e i n changing a t t i t u d e s toward death than an e d u c a t i o n a l workshop not c o n t a i n i n g such components. (Durlack, 1 9 7 8 - 1 9 7 9 , p. 6 3 ) Through the course of t h i s study the f o l l o w i n g questions were addressed: Do d i f f e r e n t types of workshops cause p a r t i c i p a n t s to respond at d i f f e r e n t l e v e l s o f e f f e c t i v e n e s s t o . h y p o t h e t i c a l s i t u a t i o n s when t h e i r responses are r a t e d u s i n g the Atkinson s c a l e ? Is one type of workshop b e t t e r than another i n p r e p a r i n g c o u n s e l l o r s to be e f f e c t i v e responders to g r i e v i n g c l i e n t s ? I t should be noted that Atkinson f e l t that p a r t i c i p a n t s who responded at a high l e v e l on her s c a l e were more e f f e c t i v e i n h e l p i n g g r i e v i n g c l i e n t s (Atkinson, 1 9 8 0 , p. 1 6 2 ) . In an e f f o r t to. explore the e f f e c t i v e n e s s of e x p e r i e n t i a l components, an e x p e r i e n t i a l workshop was compared with a d i d a c t i c workshop, a combined d i d a c t i c and e x p e r i e n t i a l workshop, and with a c o n t r o l group. This study, t h e r e f o r e , focused on e x p l o r i n g d i f f e r e n t workshop methods i n an e f f o r t to d i s c o v e r which method more e f f e c t i v e l y prepared c o u n s e l l o r s to respond p o s i t i v e l y to g r i e v i n g c l i e n t s . 6 CHAPTER 2 L i t e r a t u r e Review Avoidance o f Death The a t t i t u d e o f r e s e a r c h e r s w r i t i n g on t o p i c s r e l a t e d t o death and d y i n g seems t o be t h a t death i s s t i l l a taboo t o p i c a l t h o u g h s o c i e t y may hear o f i t and be exposed to i t more f r e q u e n t l y than i n the p a s t . The m a j o r i t y o f r e s e a r c h e r s a re more commonly i n v o l v e d w i t h h e a l t h p r o f e s s i o n a l s who are i n d a i l y c o n t a c t w i t h s e r i o u s l y i l l , d y i n g , or bereaved i n d i v i d u a l s . These p r o f e s s i o n a l s a r e i n a somewhat d i f f e r e n t p o s i t i o n from the s c h o o l c o u n s e l l o r who may be c o n f r o n t e d w i t h a g r i e v i n g c l i e n t on an i n f r e q u e n t b a s i s . Some i s s u e s o f importance t o h e a l t h p r o f e s s i o n a l s a re a l s o i m p o r t a n t t o c o u n s e l l o r s . I n 1 9 7 7 , F e i f e l made r e f e r e n c e to a number o f s o c i e t a l f a c t o r s which r e i n f o r c e a m b i v a l e n t r e a c t i o n s to death and d y i n g . Those f a c t o r s were the l o s s o f r e l i g i o u s and p h i l o s o p h i c c r eeds which s u p p o r t an a f t e r l i f e and i m m o r t a l i t y ; the f r a g m e n t a t i o n o f the f a m i l y u n i t ; the d e r i t u a l i z a t i o n o f g r i e f ; and the e x p u l s i o n o f death from everyday l i f e t o the c o n f i n e s o f the i n s t i t u t i o n . F i n a l l y , death i s d i f f i c u l t f o r us t o l o o k a t s t e a d i l y because we a r e lodged i n a c u l t u r e t h a t comes c l o s e t o w o r s h i p p i n g y o u t h , p r o d u c t i v i t y , achievement. The p r o s p e c t o f no f u t u r e a t a l l and l o s s o f i d e n t i t y , , which death r e p r e s e n t s , becomes an a b o m i n a t i o n . Hence, d y i n g and death s o l i c i t our h o s t i l i t y and r e p u d i a t i o n . ( F e i f e l , 1 9 7 7 , pp. 6 - 7 ) Kastenbaum ( 1 9 7 7 ) saw the p r o l i f e r a t i o n o f death e d u c a t i o n c o u r s e s as a f u r t h e r a v o i d a n c e o f death's unique i m p l i c a t i o n s . 7 He d i d not d i s p u t e the p o s i t i v e s t r i d e s which had been made by the death awareness movement. He d i d f e e l t h a t "the e a r l y waves of d e s c r i b i n g and c r i t i c i z i n g our s o c i e t y as 'death denying' were somewhat i n d i s c r i m i n a n t and overdone" (pp. 87-88). F e i f e l Stated that i t depended where and how one looked at s o c i e t y and what comparisons with other s o c i e t i e s were made. I f one wanted to see s o c i e t y as "death denying", evidence could be found. The opposite i s true a l s o . The Rise of Death Education and I t s E f f e c t i v e n e s s Death education courses have been a r e s u l t of Kubler-Ross's r e s e a r c h on how to help dying p a t i e n t s . Her r e s e a r c h of the s i x t i e s l e d to a more humane and c a r i n g treatment of p a t i e n t s by h e a l t h care p r o f e s s i o n a l s and a.theory o f the stages a dying person experiences. Th-Those stages were d e s c r i b e d as d e n i a l , anger, b a r g a i n i n g , depression, and acceptance. Out of t h i s work grew a g r e a t e r understanding of dying and a b e l i e f that those who are g r i e v i n g the death of a s i g n i f i c a n t other a l s o need care and understanding. Few courses i n death education e x i s t e d i n 1970 at any l e v e l of the education system. By 1977 a c o n s e r v a t i v e estimate of courses a v a i l a b l e i n the United S t a t e s was 1,100 courses e x i s t i n g above the high s c h o o l l e v e l . The emphasis had been, p r i o r to 1977, at the c o l l e g e l e v e l ; however, at t h i s time formal death education courses e x i s t e d a l s o at elementary, secondary, profession" p r o f e s s i o n a l , and a d u l t education l e v e l s ( L e v i t o n , 1977, p. 41). Death education courses now appear to be g a i n i n g i n p o p u l a r i t y at a l l l e v e l s of i n s t r u c t i o n . The r e s e a r c h suggests that most c 8 courses can reduce a p a r t i c i p a n t ' s • f e a r of death and anxiety-concerning death and dying and i n c r e a s e comfort with the t o p i c (Bugen, 1 9 8 0 - 8 1 ; Hardt, 1 9 7 6 ; L e v i t o n , 1 9 7 7 ; . Rosenthal, 1 9 7 8 ; T a t u m , 1 9 7 8 ; Whelan & Warren, 1 9 8 0 ) . I t should be noted that the m a j o r i t y of r e s e a r c h on r e d u c t i o n of a n x i e t y has been done at the c o l l e g e l e v e l or with h e a l t h care p r o f e s s i o n a l s (Bugeh-^n, 1 9 8 0 - 8 1 ; L e v i t o n , 1 9 7 7 ) - . Courses have been i n i t i a t e d at the secondary s c h o o l l e v e l under the assumption that the r e s u l t s w i l l be s i m i l a r to those f o r c o l l e g e students and p r o f e s s i o n a l s . The r e s e a r c h i s s t i l l c o n t r a d i c t o r y i n i t s r e s u l t s . B a i l i s and Kennedy ( 1 9 7 7 ) found that d e a t h - r e l a t e d a c t i v i t i e s were not n e c e s s a r i l y worthwhile endeavours f o r high s c h o o l students as the a n x i e t i e s and f e a r s were not always reduced. In t h e i r study,, f e a r o f death and dying was shown to i n c r e a s e . Heron ( 1 9 7 9 ) , on the other hand, found that a course i n death and dying o f f e r e d to l a t e a d o l escents (aged 1 6 - 1 8 ) could have a s i g n i f i c a n t p a s t o r a l impact on the l i v e s o f those t a k i n g the course. Authors w r i t i n g on elementary and p r e - s c h o o l c h i l d r e n seem to favour the i n f o r m a l approach to death education. Galen ( 1 9 7 1 ) supports being honest with c h i l d r e n and encouraging t h e i r gradual comprehension of the f a c t s . D e a l i n g with the t o p i c as i t presents i t s e l f seems to be the most common method of t a l k i n g about death with c h i l d r e n o f t h i s age (Atkinson, 1 9 8 0 ; Berg, 1 9 7 3 ; Clay, 1 9 7 6 ; Galen, 1 9 7 7 ; Hawener & P h i l l i p s , 1 9 7 5 ) . Events which may p r e c i p i t a t e t h i s type of d i s c u s s i o n could be the death of a classroom, pet, a t e l e v i s i o n program, or a student's experience 9 w i t h death, to name a few. P r e v e n t i v e c o u n s e l l i n g may be i n i n i t i a t e d from a d i s c u s s i o n based on t h e s e types o f events or a . c l a s s r o o m t e a c h e r may choose a. f i l m or book which would s t i m u l a t e d i s c u s s i o n o f death and d y i n g , and.would a l l o w the c h i l d r e n t o e x p l o r e t h e i r f e e l i n g s and p e r c e p t i o n s ( C l a y , 1 9 7 6 ; Hawener & P h i l l i p s , 1 9 7 5 ; N e l s o n , P e t e r s o n , & S a r t o r e , 1 9 7 5 ) - The above-mentioned a u t h o r s a l l seem to s t r e s s the f a c t t h a t by i g n o r i n g a c h i l d ' s q u e s t i o n s about death or by d e n y i n g death's importance to a c h i l d , the c h i l d ' s sound mental h e a l t h development can be a f f e c t e d . Hart ( 1 9 7 6 ) b e l i e v e s t h a t i m p l e m e n t a t i o n o f an e f f e c t -i v e m e n t a l h e a l t h e d u c a t i o n program would i n c l u d e t e a c h i n g a c c e p t -ance o f death as a p a r t o f l i f e . Death E d u c a t i o n : Knowledge and/or C o n f r o n t a t i o n o f S e l f A l l d e ath e d u c a t i o n c o u r s e s r e v i e w e d . i n the l i t e r a t u r e c o n t a i n e d some a c t i v i t i e s i n v o l v i n g s e l f - a w a r e n e s s o f a t t i t u d e s and f e e l i n g s about death and d y i n g (Bugen, 1 9 8 0 ; D u r l a k , 1 9 7 8 - 7 9 ; Gordon & K l a s s , 1 9 7 9 ; R o s e n t h a l , 1 9 7 8 ; . W h e l a n and Warren, 1 9 8 0 ) . R e s e a r c h e r s s p e c i f i c a l l y w o r k i n g w i t h c o u n s e l l o r s s t r e s s the importance o f awareness o f one's a t t i t u d e toward death as t h i s may a f f e c t a c o u n s e l l o r ' s a b i l i t y t o h e l p (Bascue & K r e i g e r , 1 9 7 4 ; B e n o l i e l , 1 9 8 1 ; Berg, 1 9 7 3 ; C l a y , 1 9 7 6 ; Gordon & K l a s s , 1 9 7 9 ; Hawener & P h i l l i p s , 1 9 7 5 ; Nelson & P e t e r s o n , 1 9 7 5 ; R o s e n t h a l , 1 9 7 8 ; S t e e l e , 1 9 7 7 - 7 8 ) . The p r i m a r y d i f f i c u l t y i n c o u n s e l i n g when the c e n t r a l c o n c e r n i s death i s your p r e p a r a t i o n f o r c o n f r o n t i n g d eath i n your own l i f e . You can improve your a b i l i t y t o c o n f r o n t death and thus become more ready to h e l p o t h e r s . (Getson & B e n s h o f f , 1 9 7 7 , p. 3 1 1 ) 10 Getson and Benshoff ( 1 9 7 7 ) d e s c r i b e a number of questions and a c t i v i t i e s that can help a c o u n s e l l o r ' s e x p l o r a t i o n of the i s s u e of death. The purpose of these e x e r c i s e s i s to f a c i l i t a t e the c o u n s e l l o r ' s a b i l i t y to be comfortable with the topic.. Jones ( 1 9 7 7 ) r e i t e r a t e s the need f o r the c o u n s e l l o r to confront h i s or her f e e l i n g s about death so that he or she i s comfortable with the s u b j e c t . F e i f e l ( 1 9 7 7 ) p o i n t s out the importance of the 'health care p r o f e s s i o n a l l o o k i n g at and t r y i n g to contend with h i s or her i n d i v i d u a l a n x i e t i e s concerning death and dying. Rosenthal's ( 1 9 7 8 ) seminar f o r teachers and c o u n s e l l o r s i n c l u d e d both knowledge of p e r t i n e n t i n f o r m a t i o n on the s u b j e c t and c o n f r o n t a t i o n of one's awareness of h i s or her own a t t i t u d e s , b e l i e f s , and f e e l i n g s about death. A l a r g e m a j o r i t y of p a r t i c i -pants found the seminar u s e f u l p r o f e s s i o n a l l y and p e r s o n a l l y . A t kinson ( 1 9 8 0 ) , as mentioned i n the previous chapter, advised knowledge of c h i l d r e n ' s developmental concepts and a teacher's self-knowledge as necessary elements to enable a teacher to help a g r i e v i n g student. Durlak's ( 1 9 7 8 - 7 9 ) r e s u l t s e m p i r i c a l l y supported an e x p e r i e n t i a l ( c o n f r o n t a t i o n of s e l f ) ' 'workshop format as compared to a d i d a c t i c ( l e c t u r e ) workshop with a heterogeneous h o s p i t a l s t a f f of a l a r g e southeastern medical c e n t e r . In summary, r e s u l t s : . i n d i c a t e d that the e x p e r i e n t i a l workshop decreased p a r t i c i p a n t s ' f e a r s and concerns about death while only s l i g h t l y h e i g h t e n i n g t h e i r a n x i e t i e s about death. In c o n t r a s t , the d i d a c t i c workshop had negative e f f e c t s s i n c e p a r t i c i p a n t s r e p o r t e d g r e a t e r fears.jand a n x i e t i e s about death at the end of the workshop than when they began i t . C o n t r o l s showed s l i g h t negative changes on these death concerns over time. (Durlak, 1 9 7 8 - 7 9 , pp. 6 2 - 6 3 ) 11 Durlak's study was the only one found which d e a l t s p e c i f i -c a l l y with the comparison of workshop formats. A l l other s t u d i e s appeared to assume that workshops needed both knowledge of s u b j e c t matter and self-knowledge. Acceptance versus Avoidance In Atkinson's study (1980), she found, that " s u b j e c t s with the most f a v o r a b l e a t t i t u d e s towards death were more l i k e l y to r e c a l l i n c i d e n t s Cof t h e i r students i n v o l v e d with death] than those with the l e a s t f a v o r a b l e a t t i t u d e s " (p. 156). To r a t e the e f f e c t i v e n e s s of teacher i n t e r v e n t i o n s i n the r e c a l l e d i n c i d e n t s , Atkinson devised a f i v e - c a t e g o r y s c a l e (see Appendix 1). Atkinson ( 1980) seemed to f i n d that "working through a d i f f i c u l t s i t u a t i o n , r a t h e r than.Jdenying--<or .avoiding i t , i s apt to a f f e c t one's view of another person as able to cope with the d i f f i c u l t y " (pp. 160-161). Avoidance of what a c h i l d i s e x p e r i e n c i n g was seen as an i n e f f e c t i v e way to respond to a c h i l d . Acceptance of the c h i l d and h i s or her f e e l i n g s appeared to lead to the most e f f e c t i v e response. To be e f f e c t i v e , however, the teacher must have reached a p o i n t of a c c e p t i n g how he or she f e l t about death. Headington (1981) viewed death as a "core experience" and as such saw coping s u c c e s s f u l l y with death as a developmental task everyone f a c e s . Acceptance of death and r e s o l u t i o n of one's f e e l i n g s about death are key t a s k s . As c o u n s e l l o r s wer cannot avoid the c h i l d ' s or a d o l e s c e n t ' s sense of l o s s . To do so .-ignores the developmental nature of the c h i l d ' s r e l a t i o n s h i p 12 to l o s s (Headington, 19.81, p. 339). By d e c i d i n g to accept or avoid o n e ' s . f e e l i n g s , b e l i e f s , and a t t i t u d e s toward death, the c o u n s e l l o r can a l s o become aware of h i s or her i n a b i l i t y to deal with c l i e n t s who are attempting to deal with t h e i r death concerns. A number of authors c o n s i d e r i n g t h i s p o i n t of view suggest that a c o u n s e l l o r i n t h i s p o s i t i o n needs to r e f e r the c l i e n t to another p r o f e s s i o n a l who f e e l s comfortable with, the t o p i c (Atkinson, 1980; Bascue & K r i e g e r , 1974;. Jones, 1977; Nelson.& Peterson, 1975). As can be noted from the l i t e r a t u r e reviewed, no r e s e a r c h has i n v e s t i g a t e d the r e l a t i o n s h i p between workshop format and e f f e c t i v e responses to g r i e v i n g c l i e n t s . To explore t h i s r e l a t i o n s h i p , the r e s e a r c h study d e s c r i b e d i n the f o l l o w i n g chapter was designed. Due to the l a c k of previous s t u d i e s , the r e s e a r c h e r found i t necessary to c r e a t e a measurement instrument of h y p o t h e t i c a l s i t u a t i o n s to which responses could be w r i t t e n and to use a r a t i n g s c a l e from an e a r l i e r study which d e a l t with e f f e c t i v e responses. 13 CHAPTER 3 Method In an attempt to t e s t a d m i n i s t r a t i o n of the p o s t t e s t , to determine the amount of time needed to respond to p o s t t e s t h y p o t h e t i c a l s i t u a t i o n s , to choose r a t e r s , and to provide r a t e r s with an o p p o r t u n i t y to p r a c t i c e with the r a t i n g scale, to be used du r i n g r e s e a r c h , a p i l o t , study was conducted with twelve graduate students i n the C o u n s e l l i n g Psychology Department at UBC. Seven women and f i v e men began the workshop. A b r i e f two-hour workshop combining d i d a c t i c and e x p e r i e n t i a l experiences was presented. At the c l o s e o f the workshop s i x women and f i v e men responded to t h i r t e e n of twenty h y p o t h e t i c a l s i t u a t i o n s . Three r a t e r s were o r i g i n a l l y s e l e c t e d to p a r t i c i p a t e i n the p i l o t study as a r e s u l t o f t h e i r experience i n the f i e l d of bereavement. From these three, two were chosen to p a r t i c i p a t e i n the r e s e a r c h p r o j e c t together with the re s e a r c h e r , as r a t e r s . An i s s u e of importance i n a d m i n i s t e r i n g . t h e p o s t t t e s t became apparent d u r i n g the p i l o t study. This i n v o l v e d the reasea r e s e a r c h e r i n s t r u c t i n g p a r t i c i p a n t s to respond as though the c l i e n t were i n f r o n t of them and to respond v e r b a l l y ( i n w r i t t e n response form) or to d e s c r i b e nonverbal a c t i o n s . I n s t r u c t i o n s such as these seemed, to c l a r i f y the manner i n which p a r t i c i p a n t s were asked to respond. The amount of time allowed f o r p a r t i c i p a n t s to respond to each of the h y p o t h e t i c a l s i t u a t i o n s was one minute. P a r t i c i p a n t s i n the p i l o t study appeared agitated, and rushed when w r i t i n g t h e i r 14 responses. This was f u r t h e r s u b s t a n t i a t e d by p a r t i c i p a n t s ' comments a f t e r responses had.been completed and c o l l e c t e d . To allow f o r g r e a t e r p a r t i c i p a n t comfort i n responding and.to thereby l e s s e n a n x i e t y which would h o p e f u l l y i n c r e a s e the ease i n responding, response time was doubled to two minutes f o r the experimental study. As the purpose of the study was to compare i n i t i a l responses to the h y p o t h e t i c a l s i t u a t i o n s , more than two minutes to w r i t e a response would have i n c r e a s e d the response l e n g t h to beyond that r e q u i r e d by the study. In p r e p a r a t i o n f o r r a t i n g the responses, the reasearcher met with each r a t e r , e x p l a i n e d the s c a l e , and the g l o b a l manner i n which responses were to be r a t e d . I n d i v i d u a l l y , the r a t e r s were given a l l p a r t i c i p a n t s ^ responses to t h i r t e e n h y p o t h e t i c a l s i t u a t i o n s from which p a r t i c i -pants' names had been removed. Each r a t e r r a t e d a l l responses by a l l p a r t i c i p a n t s at one s i t t i n g . Using the Atkinson s c a l e , the r a t e r s r a t e d each response u s i n g a g l o b a l p e r s p e c t i v e — t h e response was read and a r a t i n g given f o r the t o t a l response. The scores f o r each p a r t i c i p a n t by each r a t e r were t a b u l a t e d and mean scores d e r i v e d . To s e l e c t the two r a t e r s to work with the r e s e a r c h e r , the r e s e a r c h e r used the Pearson c o r r e l a t i o n c o e f f i c i e n t . R e s u l t s i n d i c a t e d that r a t e r s X and Z, of r a t e r s X, Y, and Z, c o r r e l a t e d most p o s i t i v e l y with the r e s e a r c h e r ( r =0.72; r =0.68; r =0.73, where uo= r e s e a r c h e r and x, u, z-uox ' voy ' wz 1 > y> r a t e r s ) , and t h e r e f o r e they were s e l e c t e d to p a r t i c i p a t e i n the r e s e a r c h p r o j e c t . Only two of the three r a t e r s were s e l e c t e d due to the p r o j e c t e d amount of time that r a t i n g by three d i f f e r e n t r a t e r s would r e q u i r e . Two of three r a t e r s were chosen, f o r t h e i r 15 high c o r r e l a t i o n s i n the p i l o t study as t h i s was expected to provide a more r e l i a b l e score f o r each p a r t i c i p a n t i n the r e s e a r c h study. During the r a t i n g of responses, i t became evident that some h y p o t h e t i c a l s i t u a t i o n s d i d not have a death i s s u e as t h e i r i n i t i a l s i t u a t i o n . T h i s l e d to responses concerned with non-death i s s u e s which i n turn caused a low r a t i n g . As t h i s appeared to set up p a r t i c i p a n t s to respond with low I l e v e l g l o b a l responses, the f o l l o w i n g h y p o t h e t i c a l s i t u a t i o n s were changed: #4 and #19 (see Appendices 3 & 4 ) . I t became evident a l s o d u r i n g the r a t i n g o f responses, that the Atkinson s c a l e was not completely a p p l i c a b l e f o r the purpose of the study. Although t h i s s c a l e deals with r a t i n g responses to r e c a l l e d i n c i d e n t s and t h i s study was concerned with r a t i n g responses to h y p o t h e t i c a l s i t u a t i o n s , the two d i d not seem to be f u l l y compatible. Responses to h y p o t h e t i c a l s i t u a t i o n s could tend to be l e s s t h r e a t e n i n g than would be true o f r e a c t i o n s to an a c t u a l s i t u a t i o n . This could mean that responses to h y p o t h e t i c a l s i t u a t i o n s would be based on how a person would most l i k e to r e a c t . In a c t u a l i t y , however, t h i s type of response might be i m p o s s i b l e . For example, although someone might f e e l hugging a c l i e n t could be most e f f e c t i v e , i n r e a l i t y he or she might be a person who f i n d s hugging uncomfortable and he or she would not normally respond i n t h i s way. The Atkinson s c a l e does not seem equipped to handle t h i s and i t was not designed with t h i s pus purpose i n mind. A. f u r t h e r m i s s i n g element i n the Atkinson s c a l e was the l a c k of expansion on touch as being an e f f e c t i v e 16 response. As no other r a t i n g s c a l e was a v a i l a b l e at the time o f the study, the Atkinson s c a l e was r e t a i n e d . Subjects O r i g i n a l l y the s u b j e c t s we're to be a randomly s e l e c t e d group of evenly d i s t r i b u t e d males and females, forming four groups of f i f t e e n members each. Due to only s i x of a p o s s i b l e two hundred p a r t i c i p a n t s responding, changes i n the s u b j e c t p o p u l a t i o n were necessary. As a r e s u l t of the above, students i n the C o u n s e l l i n g Psychology Department at UBC were requested to v o l u n t e e r f o r the study. Of the f o r t y graduate students who responded, twenty-one graduate students and four c o u n s e l l o r s from the Coquitlam School D i s t r i c t a c t u a l l y p a r t i c i p a t e d i n the study. Twenty women and f i v e men completed the study. Random assignment o f v o l u n t e e r s to the four groups ( d i d a c t i c , e x p e r i e n t i a l , combined d i d a c t i c and e x p e r i e n t i a l , and c o n t r o l ) , was attempted but h i g h l y u n s u c c e s s f u l due to the demands of course work f o r the graduate students and to personal commitments of v o l u n t e e r s f o r the scheduled Saturday workshops. In an e f f o r t to r e t a i n as many p a r t i c i p a n t s as p o s s i b l e , v o l u n t e e r s were allowed to s e l e c t a workshop date which was ac c e p t a b l e to t h e i r schedule. The type of workshop to be given was not r e v e a l e d u n t i l the v o l u n t e e r had made a commitment to a date. The v o l u n t e e r s d i d not s e l e c t a workshop with p r i o r knowledge of the content and t h e r e f o r e , t h e i r assignment to a treatment group was as unbiased as p o s s i b l e . 17 E x p e r i m e n t a l Design A X 0 B Y 0 C X Y 0 D 0 Where A = D i d a c t i c Workshop B = E x p e r i e n t i a l Workshop C = Combined D i d a c t i c and E x p e r i e n t i a l Workshop D = C o n t r o l Group X = D i d a c t i c Treatment Y = E x p e r i e n t i a l Treatment 0 = P o s t t e s t Treatment A l l workshops p r e s e n t e d were a p p r o x i m a t e l y f o u r to f o u r and a h a l f hours i n l e n g t h and were p r e s e n t e d i n the same c l a s s r o o m a t UBC. A l u n c h break o f one and a h a l f hours was t a k e n d u r i n g each workshop. The C o n t r o l group met a t the Richmond C o u n s e l l o r T r a i n i n g C e ntre a t Hugh Boyd J u n i o r Secondary S c h o o l f o r the a d m i n i s t r a t i o n o f the p o s t t e s t which took a p p r o x i m a t e l y one hour. A l i k e amount o f time was used f o r a d m i n i s t e r i n g the p o s t t e s t a t the c l o s e o f 18 each o f the workshops. The o r d e r i n which the workshops were g i v e n was: f i r s t l y , the d i d a c t i c workshop was a t t e m p t e d , but as too few p a r t i c i p a n t s a r r i v e d , t h i s workshop was c a n c e l l e d and r e s c h e d u l e d f o r f o u r weeks l a t e r ; s e c o n d l y , the e x p e r i e n t i a l workshop o c c u r r e d as planned; n e x t , a week l a t e r , the combined workshop was g i v e n as planned; due to a v i s i t i n g l e c t u r e r s p e a k i n g to many p a r t i c i p a n t s , two weeks e l a p s e d b e f o r e the d i d a c t i c workshop a c t u a l l y took p l a c e . A f t e r a l a p s e o f . f i v e and a h a l f weeks f o r the C h r i s t m a s break, and as a r r a n g e d w i t h the p a r t i c i p a n t s a t a time c o n v e n i e n t to them, the C o n t r o l group met. At the s t a r t o f each s e s s i o n w i t h a l l f o u r groups, a q u e s t i o n n a i r e (see Appendix 2) was p r e s e n t e d and f i l l e d out by a l ] p a r t i c i p a n t s . Upon c o m p l e t i o h o o f each workshop and w i t h the C o n t r o l group, the p o s t t e s t was a d m i n i s t e r e d . D i d a c t i c Workshop (see Appendix 5) T h i s workshop, f o l l o w e d a l e c t u r e format and f o c u s e d on h i s t o r i c a l a s p e c t s o f death and d y i n g , i s s u e s a f f e c t i n g p r e s e n t day g r i e v i n g p a t t e r n s , g r i e f r e s p o n s e s , c h i l d r e n ' s d e v e l o p m e n t a l r e a c t i o n s to d e a t h , and some s u g g e s t i o n s f o r w o r k i n g w i t h the g r i e v i n g c l i e n t . S i x p a r t i c i p a n t s began the workshop. F i v e completed the p o s t t e s t a t the c o n c l u s i o n o f the workshop. E x p e r i e n t i a l Workshop (see Appendix 6) T h i s workshop p r o v i d e d a number o f o p p o r t u n i t i e s f o r p a r t i c i p a n t s t o e x p l o r e t h e i r f e e l i n g s , b e l i e f s . , and a t t i t u d e s 19 towards death and d y i n g and to d i s c u s s these r e a c t i o n s i n as s u p p o r t i v e an atmosphere as p a r t i c i p a n t s c o u l d c r e a t e . Seven p a r t i c i p a n t s began and completed the workshop. A l l p a r t i c i p a n t s completed the p o s t t e s t . a t the end o f the workshop. Combined D i d a c t i c and . E x p e r i e n t i a l Workshop (see Appendix 7) A c o m b i n a t i o n o f d i d a c t i c and e x p e r i e n t i a l t e c h n i q u e s which p r o v i d e d p a r t i c i v p a h t s : : w x t h t t h e ' ; : b a s i c i i h f o r m a t i o n o c o v e r e d i i n t ' t h e d i d a c t i c workshop and some.of the e x e r c i s e s from the e x p e r i e n t i a l workshop, comprised t h i s workshop. O p p o r t u n i t i e s f o r d i s c u s s i o n and mutual s h a r i n g were i n t e g r a l components o f t h i s workshop. Nine p a r t i c i p a n t s began, the workshop. E i g h t completed the p o s t t e s t a t the c l o s e o f the workshop. C o n t r o l Group The c o n t r o l group met f o r the a d m i n i s t r a t i o n o f the p o s t t e s t . F i v e p a r t i c i p a n t s completed the p o s t t e s t . Procedure An e q u i v a l e n t s i t u a t i o n was attempted f o r a l l groups f o r the a d m i n i s t r a t i o n o f the q u e s t i o n n a i r e . I t was p r e s e n t e d as the i n i t i a l a c t i v i t y f o r each group f o l l o w i n g a b r i e f explanation-. An e q u i v a l e n t s i t u a t i o n was a l s o attempted f o r a d m i n i s t r a t i o n o f the p o s t t e s t . b y h a v i n g the r e s e a r c h e r g i v e a l l groups the same i n s t r u c t i o n s and by u s i n g the same procedure w i t h a l l groups. I n s t r u m e n t a t i o n Q u e s t i o n n a i r e (see Appendix 2 ) : An i n f o r m a t i o n q u e s t i o n n a i r e was p r e s e n t e d to a l l p a r t i c i p a n t s so t h a t post hoc a n a l y s i s 20 might take p l a c e . For r e s u l t s of the q u e s t i o n n a i r e , see Appendix 10. Items concerning t r a i n i n g , school c o u n s e l l i n g experience, workshop experiences on death and dying, and a d e a t h - r e l a t e d i n v e n t o r y comprised the q u e s t i o n n a i r e . The i n v e n t o r y was used.as a method f o r the r e s e a r c h e r to be a l e r t e d to p a r t i c i p a n t s who might have been extremely s e n s i t i z e d to the s u b j e c t matter due to a recent death and who, t h e r e f o r e , might experience d i f f i c u l t y with e x p e r i e n t i a l a c t i v i t i e s i n p a r t i c u l a r . P o s t t e s t (see Appendix 4) The p o s t t e s t was composed of twenty h y p o t h e t i c a l s i t u a t i o n s i n v o l v i n g a c l i e n t or c l i e n t s with d e a t h - r e l a t e d i s s u e ( s ) . P a r t i c i p a n t s were i n s t r u c t e d , before beginning the p o s t t e s t , to respond to each s i t u a t i o n by i n d i c a t i n g v e r b a l and/or nonverbal responses they would make to the c l i e n t . A f t e r each s i t u a t i o n was read aloud by the r e s e a r c h e r i n a. f a c t u a l manner, p a r t i c i p a n t s were allowed two minutes, as timed u s i n g a stopwatch, i n which to respond to a s i t u a t i o n . The responses were r a t e d by three r a t e r s u s i n g Atkinson's f i v e - p o i n t s c a l e of responses (see Appendix 1 ) . Raters were chosen f o r t h e i r e x p e r t i s e i n the f i e l d o f bereavement c o u n s e l l i n g as mentioned e a r l i e r . The t o t a l score f o r each i n d i v i d u a l was d e r i v e d by averaging the three r a t e r s ' scores f o r each p a r t i c i p a n t ' s response. The h y p o t h e t i c a l s i t u a t i o n s were crea t e d by the r e s e a r c h e r and Denis Boyd, a p r a c t i s i n g c o u n s e l l i n g p s y c h o l o g i s t working i n the area of bereavement c o u n s e l l i n g , as no e x i s t i n g 21 measurement o f responses t o d e a t h - r e l a t e d i s s u e s was found. The s i t u a t i o n s used i n the p o s t t e s t were the same as those used i n the p i l o t s t u d y except f o r s i t u a t i o n s f o u r and n i n e t e e n . These were changed as a r e s u l t o f the p i l o t s t u d y . New s i t u a t i o n s were o b t a i n e d from the bank o f t h i r t y - f o u r o r i g i n a l h y p o t h e t i c a l s i t u a t i o n s c r e a t e d . The r e s u l t i n g twenty s i t u a t i o n s were a r r a n g e d i n age groups, f r o m . a d o l e s c e n t s t o younger c h i l d r e n t o a d u l t s as c l i e n t s , and had odd numbered s i t u a t i o n s w i t h male c l i e n t s , even numbered s i t u a t i o n s w i t h female c l i e n t s , so t h a t an e q u a l number o f each sex was r e p r e s e n t e d as c l i e n t s . H y p o t h e s i s There i s no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e a c r o s s t r e a t m e n t groups i n mean s c o r e f o r responses t o h y p o t h e t i c a l s i t u a t i o n s as measured on the A t k i n s o n s c a l e . S t a t i s t i c a l H y p o t h e s i s : H 0 : y i =u 2 = \i3 =y1+ H x : u--^u f o r some -i and j J 22 CHAPTER 4 Resu l t s Although not a l l of the e m p i r i c a l comparisons reached s i g n i f i c a n c e , some i n t e r e s t i n g trends and p o s s i b i l i t i e s f o r fu t u r e r e s e a r c h are e v i d e n t . The r e s u l t s suggested s i g n i f i c a n c e could be a t t r i b u t e d to a d i d a c t i c format. The e x p l o r a t o r y nature of the study needs to be kept i n mind when reviewing the f o l l o w i n g r e s u l t s . Table I below records the sample, s i z e , means, and standard deviations;., fdnreaehhgroup. Table I: Sample S i z e , Means, Standard D e v i a t i o n s f o r Treatment Groups Group A Group B Group C Group D Sample Si z e 5 7 8 5 Mean 3.66 3.37 3.65 3.08 Standard D e v i a t i o n 0.18" 0 . 42 0.37 0. 42 Group A r e p r e s e n t s the d i d a c t i c workshop group. Group B re p r e s e n t s the e x p e r i e n t i a l workshop group; Group C, the combined d i d a c t i c and e x p e r i e n t i a l workshop group; and Group D, the c o n t r o l group. Three r a t e r s were used to score responses as i t was assumed a combined score or an average score would lead to a c l o s e r true score f o r each p a r t i c i p a n t . See Appendix 8 f o r a re c o r d of 23 mean score f o r each s u b j e c t by the three r a t e r s . Using the Pearson product moment c o r r e l a t i o n c o e f f i c i e n t the f o l l o w i n g c o r r e l a t i o n s were found: between r a t e r X and r a t e r Y the c o r r e l a t i o n c o e f f i c i e n t was 0.66; between r a t e r s X and Z, the c o r r e l a t i o n c o e f f i c i e n t was 0.66; and between r a t e r s Y and Z, the c o r r e l a t i o n c o e f f i c i e n t was 0.74. See Appendix 9 f o r i n t e r r a t e r c o r r e l a t i o n w i t h i n each group. A n a l y s i s of v a r i a n c e was used to compare the means of the four groups. The r e s u l t s (see Table II) i n d i c a t e that the d i f f e r e n c e among the treatment groups w a s . s i g n i f i c a n t at the .05 l e v e l . Table I I : A n a l y s i s of Variance f o r Treatment Groups Source of V a r i a n t i o n Sum - o f Squares df Variance F Between Groups 1 .2657 21 0.4219 3.082* Within Groups 2.8743 3 0.1369 T o t a l 4.1400 24 *p<.05 To f u r t h e r t e s t the hypothesis the. Scheffe m u l t i p l e p a i r w i s e comparison t e s t was used. Re s u l t s i n d i c a t e d that no two means are s t a t i s t i c a l l y d i f f e r e n t at the .05 l e v e l of s i g n i f i c a n c e . With t h i s r e s u l t , a d e c i s i o n was made to repeat the S cheffe t e s t at a .10 l e v e l of s i g n i f i c a n c e (Winer, 1971, pp. 13-14). At t h i s l e v e l of s i g n i f i c a n c e , a comparison between the combined 24 d i d a c t i c and e x p e r i e n t i a l group and the c o n t r o l group was s i g n i f i c a n t . This r e s u l t i n d i c a t e s r e j e c t i o n of the n u l l h y p o thesis. To- c l a r i f y these f i n d i n g s f u r t h e r , the Scheffe t e s t , u s i n g a .05 l e v e l of s i g n i f i c a n c e , was conducted on combined treatment groups i n comparison with the c o n t r o l group. A comparison of groups A, B, and C with the c o n t r o l group, showed no s i g n i f i c a n c e . A s i g n i f i c a n t d i f f e r e n c e was.recorded when groups A and C were o compared with the c o n t r o l group. A p o s i t i v e e f f e c t was r e a l i z e d by a t t e n d i n g a combined d i d a c t i c and e x p e r i e n t i a l workshop. Although s u p p o r t i n g s i g n i f i c a n c e was not found f o r a t t e n d i n g j u s t a d i d a c t i c workshop, the s i m i l a r i t y i n mean score f o r t h i s group and f o r the mean scores of the combined group suggests a promising c o n s i d e r a t i o n i n fu t u r e r e s e a r c h . The r e s u l t s of the Scheffe t e s t conducted on combined treatment groups i n comparison with the c o n t r o l group, suggests that the e f f e c t o f a d i d a c t i c workshop i n comparison with a combined d i d a c t i c and e x p e r i e n t i a l workshop needs to be f u r t h e r i n v e s t i g a t e d . Some c a u t i o n i s warranted i n g e n e r a l i z i n g these r e s u l t s due to the low sample s i z e and the problems with randomization. S i g n i f i c a n t r e s u l t s u s i n g the Scheffe' t e s t s are promising and warrant f u r t h e r i n v e s t i g a t i o n . 2 5 CHAPTER 5 D i s c u s s i o n The l i t e r a t u r e reviewed suggested the need f o r c o n f r o n t a t i o n concerning one's own death (Getson & Benshoff, 1 9 7 7 ) , and awareness of one's a t t i t u d e toward death (Bascue & K r i e g e r , 1 9 7 4 ; B e n o l i e l , 1 9 8 1 ; Berg, 1 9 7 3 ; Clay, 1 9 7 6 ; Gordon & K l a s s , 1 9 7 9 ; Hawener & P h i l l i p s , 1 9 7 5 ; Nelson & Peterson, 1 9 7 5 ; Rosenthal, 1 9 7 8 ; S t e e l e , 1 9 7 7 - 7 8 ) , and knowledge of c h i l d r e n ' s developmental concepts about death and dying and t h e i r g r i e v i n g r e a c t i o n s (Atkinson, 1 9 8 0 ; Knowles & Reeves, 1 9 7 9 ? & 1 9 8 1 ) as components i n death education f o r c o u n s e l l o r s and teachers.. Further, Durlak's ( 1 9 7 8 - 7 9 ) r e s u l t s e m p i r i c a l l y supported an e x p e r i e n t i a l workshop format as compared to a d i d a c t i c workshop. The purpose of t h i s study was to i n v e s t i g a t e d i f f e r e n t methods of c o u n s e l l o r education workshops on the s u b j e c t of death and dying. The d i f f e r e n t workshop formats being.compared were d i d a c t i c , e x p e r i e n t i a l , a combined d i d a c t i c and e x p e r i e n t i a l , and a c o n t r o l group. Althoughtthe r e s u l t s of the study i n d i c a t e a s i g n i f i c a n t d i f f e r e n c e among the d i f f e r e n t workshop formats, t h i s s i g n i f i c a n t d i f f e r e n c e appears to be b o r d e r l i n e - and t h e r e f o r e , should be accepted c a u t i o u s l y . The r e s u l t s were weakened f o r a number of reasons. One reason was the low sample s i z e of t w e n t y - f i v e p a r t i c i p a n t s . The group s i z e s v a r i e d from a low of f i v e p a r t i c i p a n t s to a high of e i g h t p a r t i c i p a n t s . V a r i a t i o n i n group s i z e was taken i n t o c o n s i d e r a t i o n i n the r e s u l t s , (but l i t t l e confidence 26 can be g i v e n to the r e j e c t i o n of the n u l l hypothesis when the r e s u l t i s based on a sample s i z e o f . t h i r t e e n . T h i r t e e n i s the t o t a l f o r Groups A and C. Another problem was the u n s u c c e s s f u l randomization of s u b j e c t s e l e c t i o n and. treatment assignment. Without randomization i t i s impossible to have f u l l confidence i n the r e s u l t s being g e n e r a l i z a b l e to the p o p u l a t i o n i n a l l respects;... F u r t h e r , as the sample represented a s p e c i a l i z e d group, namely the m a j o r i t y were graduate students i n the C o u n s e l l i n g Psychology Department at UBC, g e n e r a l i z a t i o n to a p o p u l a t i o n of c o u n s e l l o r s i s not warranted. Even g e n e r a l i z a t i o n to the p o p u l a t i o n of graduate students i n C o u n s e l l i n g Psychology would be suspect due to the s m a l l sample s i z e . As can be noted above, weaknesses e x i s t i n t t h i s study which weaken the f i n d i n g s . The r e s u l t s d i d support a p o s i t i v e e f f e c t o c c u r r i n g i n c o u n s e l l o r r e s p o n s e s . f o l l o w i n g a workshop on the t o p i c of death and dying. This study, then,, g i v e s some credence to the b e l i e f s o f many r e s e a r c h e r s i n the f i e l d o f death education and i n the f i e l d o f c o u n s e l l o r / t e a c h e r education on the s u b j e c t (Atkinson, 1980; Getson & Benshoff, 1977; Jones, 1977; Knowles & Reeves, 1979 & 1981; Rosenthal, 1978). T h e o r e t i c a l l y , , however, t h i s study does not support the r e s e a r c h reviewed which i n d i c a t e d a need f o r s e l f - e x p l o r a t i o n on the part 6'f the c o u n s e l l o r . This r e s u l t may be due to the nature of the p o p u l a t i o n s t u d i e d , namely c o u n s e l l o r s , who are l i k e l y to have a l r e a d y d e a l t with t h e i r own f e e l i n g s and a t t i t u d e s . The need f o r e x p e r i e n t i a l work, t h e r e f o r e , may be more evident with a n o n - c o u n s e l l o r p o p u l a t i o n . This would need 27 f u r t h e r i n v e s t i g a t i o n . Support f o r Durlak's f i n d i n g s of the s u p e r i o r i t y of the e x p e r i e n t i a l workshop over the d i d a c t i c workshop was not found. Furt h e r r e s e a r c h on t h i s . i s s u e w i l l be necessary to e i t h e r confirm or r e f u t e Durlak's f i n d i n g s as they compare to c o u n s e l l o r education on the s u b j e c t . I t should.be remembered, however, that Durlak was seeking a l e s s e n i n g of a n x i e t y r a t h e r than a high l e v e l of p a r t i c i p a n t response.to d e a t h - r e l a t e d i s s u e s . To confirm the f i n d i n g s of t h i s study and to gain a more s i g n i f i c a n t r e s u l t , f u r t h e r r e s e a r c h i s necessary. More evidence i s needed to support the s t r e n g t h of a combined d i d a c t i c and e x p e r i e n t i a l workshop as the best workshop format to use with t h i s s u b j e c t . The r e s u l t s of the S c h e f f e t e s t comparing combined t treatment groups A and C with the c o n t r o l group may suggest that the d i d a c t i c component could be the c o n t r o l l i n g f a c t o r i n r e c o r d i n g a d i f f e r e n c e . F u r t h e r r e s e a r c h could s u b s t a n t i a t e t h i s . To c r e a t e a v i a b l e r a t i n g s c a l e f o r responses, f u r t h e r r r e s e a r c h would a l s o be r e q u i r e d . The Atkinson s c a l e would need a d d i t i o n a l c l a r i f i c a t i o n of v e r b a l and nonverbal responses i f i t were to be used again, to r a t e c o u n s e l l o r ' r e s p o n s e s to h y p o t h e t i c a l s i t u a t i o n s . Increased use and. f u r t h e r refinement of the h y p o t h e t i c a l s i t u a t i o n s i s another c o n s i d e r a t i o n f o r f u t u r e r e s e a r c h . The focus of some of the s i t u a t i o n s could be improved by being more c l e a r l y on d e a t h - r e l a t e d i s s u e s r a t h e r than on an immediate nondeath-related c r i s i s which upon deeper i n v e s t i g a t i o n r e v e a l s 28 a d e a t h - r e l a t e d i s s u e . P a r t i c i p a n t s i n . t h e e x p e r i e n t i a l workshop i n d i c a t e d f e e l i n g s of inadequacy i n responding to the h y p o t h e t i c a l s i t u a t i o n s and s t a t e d a need f o r f u r t h e r knowledge of how c h i l d r e n and a d o l e s c e n t s r e a c t i n g r i e v i n g s i t u a t i o n s . T h i s i n f o r m a t i o n was provided i n the d i d a c t i c workshop. As a r e s u l t of p a r t i c i p a n t s ' comments, e x p e r i e n t i a l p a r t i c i p a n t s were i n v i t e d to attend the d i d a c t i c workshop when.it took p l a c e . Only one p a r t i c i p a n t from t h i s group attended the d i d a c t i c workshop and she had l i t t l e c o ntact with d i d a c t i c p a r t i c i p a n t s as she only attended the f i n a l hour and a h a l f of the workshop. Her attendance at the d i d a c t i c workshop was not seen as a p o s s i b l e source of contamination of the r e s u l t s . The c o n t r o l group, a f t e r completion of the p o s t t e s t , was presented with a b r i e f combination workshop. This provided a l l p a r t i c i p a n t s i n the study with an exposure to death education. P a r t i c i p a n t s i n the workshops gave p o s i t i v e feedback concern-i n g t h e i r i n c r e a s e d comfort with the t o p i c and t h e i r i n c r e a s e d a b i l i t y to respond to a g r i e v i n g person v e r b a l l y and n o n v e r b a l l y . A n a l y s i s of the q u e s t i o n n a i r e r e s u l t s was not considered r e l e v a n t due to the s m a l l sample s i z e , , the s m a l l number of male p a r t i c i p a n t s , the l a c k of previous workshop exposure f o r the m a j o r i t y of p a r t i c i p a n t s , and the range of present and past exp experience i n 'job p o s i t i o n s . The r e s u l t s did not appear to be a f f e c t e d by any of these f a c t o r s . The most v a l u a b l e s e c t i o n of the q u e s t i o n n a i r e was the l o s s i n v e n t o r y (see Appendix 10). I d e n t i f i c a t i o n of recent. 29 l o s s e s a l e r t e d the r e s e a r c h e r to those p a r t i c i p a n t s who might need g r e a t e r a s s i s t a n c e i n some e x p e r i e n t i a l a c t i v i t i e s than other p a r t i c i p a n t s . Those who had experienced recent l o s s e s d i d appear to be a c t i v e l y i n the process of g r i e v i n g . Although some a c t i v i t i e s were p a i n f u l f o r them, those who had had recent l o s s e s f e l t the a c t i v i t i e s were a l s o growth experiences. Perhaps the a c t i v i t y which sparked the most i n t e r e s t was A c t i v i t y Four: C o n f r o n t i n g Death (see Appendix 6). This a c t i v i t y provided much d i s c u s s i o n and openeduup new areas o f e x p l o r a t i o n f o r many p a r t i c i p a n t s . F u r t h e r use of the questions posed was suggested,with the r e s u l t that many p a r t i c i p a n t s planned to share t h i s a c t i v i t y with someone,or s e v e r a l p e o p l e , c l o s e to them. An important s e c t i o n o f each of the workshops, e s p e c i a l l y the e x p e r i e n t i a l and combined workshops and a f t e r the p o s t t e s t with the d i d a c t i c workshop, i n v o l v e d the s h a r i n g of experiences. Sometimes the s h a r i n g was c a t h a r t i c ; at other times, e n l i g h t e n i n g . T h i s t o p i c lends i t s e l f to s h a r i n g experiences and even seems to r e q u i r e t h i s mode of communicating. In c o n c l u s i o n , t h i s r e s e a r c h i n d i c a t e d that a. r e l a t i o n s h i p e x i s t s between the type o f workshop presented and the l e v e l o f e f f e c t i v e n e s s d i s p l a y e d i n responses to h y p o t h e t i c a l s i t u a t i o n s . In a p r a c t i c a l sense, the r e s u l t s suggest a d i d a c t i c workshop may be the best workshop f o r p r e p a r i n g c o u n s e l l o r s to e f f e c t i v e l y a i d g r i e v i n g c l i e n t s . When the concern i s with s e l f - u n d e r s t a n d i n g , an e x p e r i e n t i a l approach may s t i l l be most e f f e c t i v e . As t h i s study was p a r t i a l l y e x p l o r a t o r y i n nature, a d d i t i o n a l research i s necessary to f u r t h e r s u b s t a n t i a t e the r e s u l t s . 3 0 References Atkinson, T r u d i e . Teacher i n t e r v e n t i o n with elementary school c h i l d r e n i n d e a t h - r e l a t e d s i t u a t i o n s . Death  Education, 1 9 8 0 , 4, 1 4 9 - 1 6 3 . B a i l i s , Lawrence,A., & Kennedy, W i l l i a m R. E f f e c t s of a death education program upon secondary s c h o o l students. J o u r n a l o f E d u c a t i o n a l Research, November-December 1 9 7 7 , 71, 6 3 - 6 6 . Bascue, Loy 0. & K r i e g e r , George W. Death as a c o u n s e l l i n g concern. Personnel and Guidance J o u r n a l , 1 9 7 4 , 5 2 , 5 8 7 - 5 9 2 . Bebensee, Dr. Barbara. Loss--a n a t u r a l p a r t o f l i v i n g . Englewood, Colorado: E d u c a t i o n a l C o n s u l t i n g A s s o c i a t e s Inc., 1 9 8 0 . Bebensee, Dr. Barbara, & Pequette, Jane Rich. P e r s p e c t i v e s on l o s s . P ublished by the authors, and acq u i r e d through attendance at ECA workshop i n Vancouver, B.C., A p r i l , 1 9 8 1 . B e n o l i e l , Jeanne Q. Death c o u n s e l i n g and human development: i s s u e s and i n t r i c a c i e s . Death Education, 1 9 8 1 , 4_, 3 3 7 3 3 5 3 . Berg, Constance DeMuth. Cognizance of the death taboo i n c o u n s e l i n g ; c h i l d r e n . The School Counselor, 1 9 7 3 , • 21 , 2 8 - 3 3 • Bugen, L a r r y A. Coping: e f f e c t s of death education. Omega, 1 9 8 0 - 8 1 , J _ l , 1 7 5 - 1 8 3 -C a l l e r , Donna/ Separ a t i o n and l o s s . Paper presented at ICASSI Conference, G e r o l d s w i l , S w i t z e r l a n d , J u l y 1 9 7 9 -Clay, V i d a l S. C h i l d r e n deal with death. The School Counselor, 1 9 7 6 , 2 3 , 175 -183 . Durlak, Joseph A. Comparison between e x p e r i e n t i a l and d i d a c t i c methods of death education. Omega, 1 9 7 8 - 7 9 , 9, 5 7 - 6 6 . Embleton, Leota. C h i l d r e n , cancer and death: a d i s c u s s i o n of a.supportive care system. Canada's Mental Health, December 1 9 7 9 , 2 7 , 1 2 - 1 5 / F e i f e l , Herman. Death and dying i n modern America. Death  Education, S p r i n g 1 9 7 7 , 1 , 5 - 1 4 . F r e a r s , L o i s H., & Schneider, John M. E x p l o r i n g l o s s and g r i e f w i t h i n a w h o l i s t i c framework. Personnel and Guidance  J o u r n a l , February 1 9 8 1 , 3 4 1 - 3 4 5 . 31 Frederick,Jerome F. G r i e f as a disease process. Omega, 1 9 7 6 - 7 7 , 1 -Galen, Harlene. A matter of l i f e and death. Young C h i l d r e n , 1 9 7 1 , 2 7 , 3 5 1 - 3 5 6 . Getson, R u s s e l l F., & Benshoff, D i x i e L. Four experiences of death and how to prepare to meet them. The School  Counselor, May 1 9 7 7 , 2_4, 3 1 0 - 3 1 4 . G i n o t t , Jaim G. Between.Parents and C h i l d . Avon, 1 9 6 5 . Gordon, Audrey K., & K l a s s , Dennis. They Need To Know: How To  Teach C h i l d r e n About Death. Englewood C l i f f s , New Jersey: P r e n t i c e - H a l l , 1 9 7 9 . Gordon, David Cole. Overcoming The Fear Of Death. Penguin, 1 9 7 2 . Hawener, Rebecca M., & P h i l l i p s , Wallace. The g r i e v i n g c h i l d . The School Counselor, 1 9 7 5 , 2 2 , 3 4 7 - 3 5 1 . Headington, Bonnie Jay. Understanding a core experience: l o s s . Personnel and Guidance. J o u r n a l , February 1 9 8 1 , 3 3 8 - 3 4 1 . Heron, James. Teaching death and dying to l a t e a d o l escents (ages s i x t e e n to eighteen) w i t h i n a p r i v a t e c h u r c h - r e l a t e d p r e p a r a t o r y s c h o o l . . D i s s e r tatlon^.Abstnacts Ilhfcennational , 1 9 , 9-A, 5 5 6 1 . ( A b s t r a c t ) I n s e l , Shepard A. On c o u n s e l i n g the bereaved. Personnel and  Guidance. J o u r n a l , November 1 9 7 6 , 5 5 , 1 2 7 - 1 2 9 . I n t e r n a t i o n a l Work Group On Death, Dying and Bereavement. Assumptions and p r i n c i p l e s u n d e r l y i n g standards f o r t e r m i n a l care. American J o u r n a l of Nursing, February 1 9 7 9 , 2 9 6 - 2 9 7 . Jones, W i l l i a m H. D e a t h - r e l a t e d g r i e f c o u n s e l l i n g : the s c h o o l counselor's r e s p o n s i b i l i t y . The School Counselor, May 1 9 7 7 , 2 4 , 3 1 5 - 3 2 0 . Kastenbaum, Robert. We covered death.today. Death Education, S p r i n g 1 9 7 7 , 1 , 8 5 - 9 2 . Knowles, Don, & Reeves, Nancy. Understanding c h i l d r e n ' s concerns about death and dying. B. C. J o u r n a l of S p e c i a l  Education, S p r i n g 1 9 8 1 , 5, 3 3 - 4 0 . Kubler-Ross, E l i z a b e t h . On Death.and Dying. New York: MacMillan, 1 9 6 9 . Kubler-Ross, E l i z a b e t h . L i v i n g With Death and Dying. New York: MacMillan, 1981. 3 2 Kubler-Ross, E l i z a b e t h , & Worden, J. W i l l i a m . A t t i t u d e s and experiences of death workshop attendees. Omega, 1 9 7 7 - 7 8 , 8. . ~~ Landers, Ann. Coping with c r i s i s . Reader's Digest, October 1 9 8 0 , 1 4 5 - 1 4 8 . L e v i t o n , Dan. The scope of death education. Death Education, S p r i n g 1 9 7 7 , 1 , 4 1 - 5 6 . Lindeman, E r i c h . Symptomatology and management of acute g r i e f . Paper read at the Centenary Meeting of the American P s y c h i a t r i c A s s o c i a t i o n , P h i l a d e l p h i a , May 1 5 - 1 8 , 1 9 4 4 . Menig-Peterson, Carole, & McCabe, A l l y s s a . C h i l d r e n t a l k about death. Omega, 1 9 7 7 - 7 8 , 8. M i l l s , Gretchen C , R e i s l e r , Ray, Robinson, A l i c e . E . , & Vermilye, Gretchen. D i s c u s s i n g Death: A Guide to Death Education, I l l i n o i s : ETC P u b l i c a t i o n s , 1 9 7 6 . Moody, Raymond A., J r . L i f e A f t e r L i f e . New York: Bantam, 1 9 7 5 . Moody, Raymond A., J r . R e f l e c t i o n s on L i f e A f t e r L i f e . New York: Bantam, 1 9 7 7 . Moya, Miguel. F a c i n g the i n e v i t a b l e end. The Vancouver Sun, August 1 4 , 1 9 7 9 , B6. Moya, Miguel. A new c l a s s of care. The Vancouver Sun, January 9, 1 9 8 1 . Neale, Robert E. The A r t of Dying. New York: Harper and Row, 1 9 7 5 . Nelson, Richard C. Counselors, teachers, and death education. The.School.Counselor, May 1 9 7 7 , 2 4 , 322-329. Nelson, Richard C.,'A Peterson, W i l l i a m D. C h a l l e n g i n g the l a s t great taboo: death. The School Counselor, 1 9 7 5 , 22:, 3 5 3 - 3 5 8 . Ordal, C a r o l C. Death as seen i n books f o r young c h i l d r e n . Death Education, 1 9 8 0 , 4, 2 2 3 - 2 3 6 . Parkes, C o l i n Murray. Bereavement: Studies of G r i e f i n Adult  L i f e . Great B r i t a i n : Penguin Books, 1 9 7 5 . Paulay, Dorothy. Slow death: one s u r v i v o r ' s experience. Omega, 1 9 7 7 - 7 8 , 8, 1 7 7 - 1 7 8 . Peterson, W i l l i a m D., & S a r t o r e , Richard L. Issues and d i a l o g u e : h e l p i n g c h i l d r e n to cope with death. Elementary School Guidance and Counseling, March 1 9 7 5 , 2 2 6 - 2 3 2 . ~ 3 3 Reeves, Nancy, & Knowles, Don. Death concerns of c h i l d r e n and ad o l e s c e n t s . B. C. C o u n s e l l o r , 1 9 7 9 , 5 - 1 4 . Reeves, Nancy, & Knowles, Don. Helping c h i l d r e n deal with death concerns. B. C. J o u r n a l o f S p e c i a l Education, S p r i n g 1 9 8 1 , 5, 4 1 - 4 8 . Rosenthal, Nina Ribak. Teaching educators to deal with death. Death Education, F a l l 1 9 7 8 , 2, 2 9 3 - 3 0 6 . Rosenthal, Ted. How Could I Not Be Among You? New York: Avon, 1 9 7 5 . Ryan, C o r n e l i u s , & Ryan, Kathryn Morgan. A P r i v a t e B a t t l e . New York: Fawcett Popular L i b r a r y , 1 9 8 0 . S c h i f f , H a r r i e t S a r n o f f . The Bereaved Parent. New York: Penguin, 1 9 7 7 . Sheskin, Arlene, & Wallace, Samuel E. D i f f e r i n g bereavements: s u i c i d e , n a t u r a l , and a c c i d e n t a l death. Omega, 1 9 7 6 , ]_. Simpson, Michael A. Death education—where i s thy s t i n g ? Death Education, Summer 1 9 7 9 , 3, 1 6 5 - 1 7 3 -S p i n e t t a , John H. The dying c h i l d ' s awareness of death: a review. P s y c h o l o g i c a l B u l l e t i n , 1 9 7 4 , 8J_, 2 5 6 - 2 6 0 . S t e e l e , Donald W. The counselor's response to death. Personnel and Guidance J o u r n a l , 1 9 7 7 , 5_6, 1 6 4 - 1 6 7 . Sternberg, Frank, & Sternberg, Barbara. I f I Die and When I Do:  E x p l o r i n g Death with Young People. Englewood C l i f f s , N.J.: P r e n t i c e - H a l l , Inc., 1 9 8 0 . Tatum, Dorothy R. The teacher as a support system f o r the young c h i l d d e a l i n g with death and dying. A mini-course f o r the te a c h e r . t o help the young c h i l d d e al with the su b j e c t of death and dying. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1 9 7 8 , 3 9 , 3-A, 1 3 1 6 . ( A b s t r a c t ) Temes, Roberta. L i v i n g with an Empty C h a i r : a guide through  g r i e f . Amherst, Maine: Mandala, 1 9 7 7 . U l i n , Richard 0. Death and Dying Education. N a t i o n a l Education A s s o c i a t i o n o f the United S t a t e s , 1 9 7 7 -Whelan, W. Michael, & Warren, W i l l i a m M. A death awareness v o r h o p workshop: theory, a p p l i c a t i o n and r e s u l t s . Omega, 1 9 8 1 , H , 6 1 - 7 1 . Winer, B. J. S t a t i s t i c a l P r i n c i p l e s , i n Experimental Design. 2 n d E d i t i o n . McGraw H i l l Book Co., 1 9 7 1 . 34 Appendix One: Atkinson F i v e Category Scale  For E v a l u a t i n g Responses The category of teacher behavior considered l e a s t h e l p f u l i s 'extreme avoidance,' which i n d i c a t e s an u n w i l l i n g n e s s to acknowledge or do anything o n e s e l f about a death s i t u a t i o n . The r e a l i t y of death and the c h i l d ' s f e e l i n g s are avoided.... In the category of 'postponement' the teacher .shows an awareness of the death s i t u a t i o n and i n d i c a t e s a w i l l i n g n e s s to t h i n k about i t with the i n t e n t to a c t on i t l a t e r . . . . . The category of 'acknowledgement' denotes awareness that death has occurred and that f e e l i n g s are aroused, but the teacher avoids r e f e r e n c e to death as a r e a l i t y of l i f e or to the c h i l d ' s f e e l i n g s as a n a t u r a l response.... In 'acceptance with r e s e r v a t i o n ' the teacher r e c o g n i z e s the r e a l i t y of death and some of the c h i l d ' s f e e l i n g s , but the a d u l t i s not e n t i r e l y open to what death e n t a i l s , or to the c h i l d ' s frame of r e f e r e n c e . . . . 'Acceptance,* the most h e l p f u l teacher i n t e r v e n t i o n , conveys i n words and a c t i o n s that death i s a. part of l i f e , and the c h i l d ' s r e a c t i o n s and f e e l i n g s are embraced as they are. The teachers here took the i n i t i a t i v e and helped c h i l d r e n d e a l with t h e i r g r i e f by mutual expressions of f e e l i n g s and s h a r i n g e x p e r i e n c e s . . . . ( A t k i n s o n , 1980, pp. 157-161.) 35 Appendix Two: Questio n n a i r e Name The purpose of t h i s r e s e a r c h p r o j e c t i s to i n v e s t i g a t e d i f f e r e n t methods of c o u n s e l l o r education on the s u b j e c t of death and dying. P a r t i c i p a n t s i n the study may gain knowledge of and understanding o f i s s u e s r e l a t e d to death and dying as they apply to themselves and to t h e i r c l i e n t s . P a r t i c i p a n t s i n t h i s p r o j e c t are requested to f i l l i n the f o l l o w i n g q u e s t i o n n a i r e . This i n f o r m a t i o n w i l l be c o n f i d e n t i a l , although r e s u l t s may be used when r e p o r t e d anonymously. P a r t i c i p a n t s w i l l be d i v i d e d i n t o groups and may have an oppor-t u n i t y to p a r t i c i p a t e i n one or two workshops. Regardless of the workshops attended, a l l p a r t i c i p a n t s w i l l be asked to w r i t e responses to h y p o t h e t i c a l s i t u a t i o n s at. the end of the study. The t o t a l amount of. time r e q u i r e d w i l l be one Saturday s e s s i o n from 9 a.m. to approximately 4 p.m. As a p a r t i c i p a n t , you have the o p t i o n to withdraw from the study at any time or r e f u s e to answer any questions without p r e j u d i c e . Please note that i f t h i s q u e s t i o n n a i r e i s completed, i t w i l l be assumed that consent has been given f o r the r e s u l t s to be used. Your c o o p e r a t i o n i s much a p p r e c i a t e d . Please check the a p p r o p r i a t e blanks i n the f o l l o w i n g : 1. P r o f e s s i o n a l t r a i n i n g : degree(s) held: BEd. MA. BA. PhD . MEd . Other ................ 2 . I am c u r r e n t l y : a) an elementary classroom teacher b) a secondary school classroom teacher c) t e a c h e r / c o u n s e l l o r at secondary l e v e l d) elementary (area) c o u n s e l l o r e) f u l l time secondary c o u n s e l l o r f) other (please s p e c i f y ) Years o f experience i n c u r r e n t p o s i t i o n : a) 0-1 year d) 6-7 years b) 2 -3 years e) 8-10 years c) 4 -5 years f ) g r e a t e r than 10 years P o s i t i o n held immediately before present p o s i t i o n : a) an elementary classroom teacher b) a secondary school classroom, teacher c) t e a c h e r / c o u n s e l l o r a t secondary l e v e l d) elementary (area) c o u n s e l l o r e) f u l l time secondary c o u n s e l l o r f) other (please s p e c i f y ) 3 6 Years of experience i n previous p o s i t i o n : a) 0-1 year d) 6-7 years b) 2 - 3 years e) 8 - 1 0 years c ) 4 _ 5 years f) g r e a t e r than 10 years 4. Previous workshop exposure to the t o p i c of death and dying: a) no previous workshop experience b) 1 workshop c) 2 - 3 workshops d) 4 or more workshops e) support group p a r t i c i p a t i o n f o r those who are dying or f o r those who have l o s t someone through death 5. Workshops attended d e a l i n g with the t o p i c o f death and dying. Please i n c l u d e as much i n f o r m a t i o n on the f o l l o w i n g about each workshop you have attended: the name of the workshop, content covered, l e n g t h of time of workshop, and date. 6/ Please i n d i c a t e the l o s s e s you have experienced and the time f a c t o r i n v o l v e d : A B C Loss Inventory 0-6 Months 6 Mths-1 Year 1 Year - 4 Years a) death of parent b) death of b r o t h e r / s i s t e r c) diagnosed t e r m i n a l i l l n e s s - - s e l f , parent, s i b l i n g d) death of c l o s e r e l a t i v e e) death of a f r i e n d f) a b o r t i o n / m i s c a r r i a g e g) death of a pet (abridged from Loss Inventory designed by Bebensee & Pequette, 1 9 8 0 , pp. 1 0 - 1 1 . ) 37 Appendix Three: H y p o t h e t i c a l S i t u a t i o n s - P i l o t Study 1. A seven year o l d boy,. Jason, asks you, "Where do people go when they d i e ? " You are aware that Jason's mother has r e c e n t l y died from c o m p l i c a t i o n s f o l l o w i n g surgery. 2. One of your c o l l e a g u e s i s pregnant. In her f i f t h month of the pregnancy c o m p l i c a t i o n s a r i s e and the f e t u s d i e s . The c h i l d r e n i n t h i s woman's c l a s s have been e x c i t e d about her pregnancy and are concerned when she i s absent f o r s e v e r a l days. The s u b s t i t u t e teacher.has asked you to come and t a l k to the c l a s s because of a l l the questions she's been r e c e i v i n g from the students. You go i n t o the classroom. 3. Jimmy, a 6 year old.whose o l d e r s i s t e r has been k i l l e d i n a h i t - a n d - r u n a c c i d e n t , wants to know where h i s s i s t e r i s and when she's coming home. He sounds angry and demanding. 4. C h r i s t i n e , a grade 3 student, has gone i n t o her classroom and found the c l a s s hamster dead i n i t s cage.. She has s t a r t e d to c r y. Her. classroom teacher b r i n g s her to you because C h r i s t i n e can't stop c r y i n g . 5/ Ben (aged 10-12) i s d i s c u s s i n g . h i s . f e a r at the thought of h i s mother's impending death. He mentions the many s i m i l a r i t i e s between the present s i t u a t i o n and the circumstances surrounding the death of h i s grandmother a year ago. 6. The p r i n c i p a l approaches you with the f o l l o w i n g s i t u a t i o n : She has r e c e i v e d a phone c a l l from Mrs. G., the mother of ten year o l d Sandra. The mother has t o l d the p r i n c i p a l that her husband has been suddenly k i l l e d and she., wants Sandra home immediately. The p r i n c i p a l asks you to speak with Sandra and then to take her home. 7. An e i g h t year o l d boy whose f a t h e r has died, r e t u r n s to s c h o o l a f t e r the f u n e r a l . He becomes withdrawn i n the classroom yet can a l s o act out to draw a t t e n t i o n to h i m s e l f . He comes i n t o your o f f i c e and s i t s huddled i n a c h a i r , s t a r i n g at the f l o o r . 8. A student, Paul (aged 16-18), asks you to give him permission to miss c l a s s e s that day (Monday) as he has had a f r i e n d d i e i n an automobile a c c i d e n t on Saturday. Paul says he j u s t can't s i t s t i l l l ong enough to do anything i n c l a s s . You n o t i c e that he i s f i d g e t y while t a l k i n g with you. 38 9. A t a l e n t e d and i n t e l l i g e n t student commits s u i c i d e . Her teachers and f e l l o w students are stunned. One of her f r i e n d s (aged 15-17), while t a l k i n g about S h e i l a , says she misses S h e i l a so much that sometimes she t h i n k s about k i l l i n g h e r s e l f . She t r i e s to change the t o p i c but her v o i c e quivers and her words fade away. 10. Andy, a f i f t e e n year o l d , comes i n to see you about problems he's having with h i s courses. He a l s o mentions having d i f f i c u l t y c o n c e n t r a t i n g i n c l a s s and doing h i s homework. He says that things aren't very happy at home. You are aware that Andy's younger brother has died r e c e n t l y . 11. You've n o t i c e d that Janice (aged 14-16) becomes very angry with l i t t l e p r o v o c a t i o n . This happens with teachers and with f e l l o w students. You know that J a n i c e ' s f a t h e r died about a year. ago. She i s i n your o f f i c e a f t e r an outburst with a teacher. She s i t s t e n s e l y i n the chair, tapping her f i n g e r s . 12. Fred (aged 14-15) complains of not being able to s l e e p at n i g h t . T h i s s t a r t e d to occur the night of h i s f a t h e r ' s sudden death i n an a c c i d e n t and has continued f o r s e v e r a l weeks. A r e s u l t of t h i s i s that Fred i s r e g u l a r l y one h a l f hour to an hour l a t e f o r s c h o o l . 13- S a l l y ' s mother i s c r i t i c a l l y i l l with kidney f a i l u r e . She has had a t r a n s p l a n t and her body i s r r e j e c t i n g i t . S a l l y (aged 14-16) i s t a l k i n g with you and you n o t i c e that she i s o v e r l y b u b b i l y about an upcoming sc h o o l event. Her eyes i n d i c a t e that she i s f e e l i n g d i s t r a u g h t , even f e a r f u l . You ask her how things are going and she responds, "Oh, f i n e . " 14. George (aged 14-16) a r r i v e s l a t e to s c h o o l and i s sent to you. While d i s c u s s i n g the l a t e n e s s , George b l u r t s out a n g r i l y t h at h i s grandmother died l a s t n i g h t . His eyes f i l l with t e a r s and he turns away, swearing. 15. Mary (aged 13-14), whose f a t h e r i s dying of cancer, begins to miss c l a s s e s , a r r i v e s l a t e to school r e p e a t e d l y , and s t a r t s to be absent f u l l days at a time. Her teachers are concerned and ask you to speak with her. The teachers s t r e s s the number of assignments not handed i n and the p o s s i b i l i t y of f a i l u r e . 15. :'»irJL;i;>: tne us <• Cv.-a. , eo . 11 .-• ..-.c", ^looivo-j ?. telephone 16. During the. day Mrs. T., a c o l l e a g u e , r e c e i v e s a telephone c a l l i n f o r m i n g her that her f a t h e r i s s e r i o u s l y i l l f o l l o w i n g a heart a t t a c k . She i s needed immediately at home--2,000 m i l miles away. Mrs. .T. a r r i v e s at your door l o o k i n g shocked. She b l u r t s out what she has j u s t heard. 17. A c o l l e a g u e , John M., and h i s spouse have undergone g e n e t i c c o u n s e l l i n g . John's wife becomes pregnant. Amneoscenthesis 39 i s performed and i n d i c a t e s a number of a b n o r m a l i t i e s e x i s t i n the f e t u s . John and h i s wife decide on a b o r t i o n . S e v e r a l weeks l a t e r you n o t i c e that John seems depressed and withdrawn. 18. You are t a l k i n g with a parent i n your o f f i c e . You have heard from a r e l i a b l e source that her husband i s near death. She mentions that he w i l l be coming out of the h o s p i t a l soon which w i l l be good as he w i l l be able to help with the c h i l d r e n . 19- You enter the sta f f r o o m and n o t i c e a male c o l l e a g u e s i t t i n g by h i m s e l f . He looks very sad and withdrawn. His wife has died suddenly two months ago from a massive heart a t t a c k i n the middle of the n i g h t . She was f i f t y years o l d . You decide to go and s i t beside him. He does not acknowledge your presence. 20. A female c o l l e a g u e has been away f o r a week f o l l o w i n g the sudden death of her husband. You are c h a t t i n g about gen e r a l t o p i c s when you make a comment about your own spouse. Your bereaved f r i e n d becomes f l u s h e d , her eyes moisten, and she looks away embarrassed. 40 Appendix Four: H y p o t h e t i c a l S i t u a t i o n s  - Research Study 1. A student, Paul (aged 16-18), asks you to give him permission to miss c l a s s e s that day (Monday) as he has had a f r i e n d d i e i n an automobile a c c i d e n t on Saturday. Paul says he j u s t can't s i t s t i l l long enough to do anything i n c l a s s . You n o t i c e that he i s f i d g e t y while t a l k i n g with you. 2. A t a l e n t e d a n d . i n t e l l i g e n t student, commits s u i c i d e . Her teachers and f e l l o w students are stunned. One of her f r i e n d s (aged 15-17), while t a l k i n g about S h e i l a , says she misses S h e i l a so much that sometimes she t h i n k s about k i l l i n g h e r s e l f . She t r i e s to change the t o p i c but her v o i c e q u i v e r s and.her words fade away. 3. Andy, a f i f t e e n year o l d , comes i n to see you about problems he's having with h i s courses. He a l s o mentions having d i f f i c u l t y c o n c e n t r a t i n g i n c l a s s and doing h i s homework. He says that things aren't very happy at home. You are aware that Andy's younger brother has died r e c e n t l y . 4. A student, Susan (aged 14-16), has come to your o f f i c e i n response to your request. You are concerned about her poor grades s i n c e a r r i v i n g at the s c h o o l three months ago. In t a l k i n g with her parents a f t e r Susan had r e g i s t e r e d , you d i s c o v e r e d that her o l d e r brother died i n a drowning a c c i d e n t two years ago. The s u b j e c t of the brother's death comes up i n your i n t e r v i e w with Susan and she suddenly breaks down, sobbing u n c o n t r o l l a b l y . 5. Fred (aged 14-15) complains of not being able to s l e e p at n i g h t . T h i s s t a r t e d to occur the n i g h t of h i s f a t h e r ' s sudden death i n an a c c i d e n t and has continued f o r s e v e r a l weeks. A r e s u l t of t h i s i s that Fred i s r e g u l a r l y one h a l f hour to an hour l a t e f o r s c h o o l . 6. S a l l y ' s mother i s c r i t i c a l l y i l l with kidney f a i l u r e . She has had a t r a n s p l a n t and her body i s r e j e c t i n g i t . S a l l y (aged 14-16) i s t a l k i n g with you and you n o t i c e that she i s o v e r l y b u b b i l y about an upcoming school event. Her eyes i n d i c a t e that she i s f e e l i n g d i s t r a u g h t , even f e a r f u l . You ask her how t h i n g s are going and she responds, "Oh, f i n e . " 7. George (aged 14-16.), abnivesY.late to s c h o o l and i s sent to you. While d i s c u s s i n g the l a t e n e s s , George b l u r t s out a n g r i l y that h i s grandmother died l a s t n i g h t . His eyes f i l l with t e a r s and he turns away, swearing. 41 8. Mary (aged 13-14), whose f a t h e r i s dying of cancer, begins to miss c l a s s e s , a r r i v e s l a t e to s c h o o l r e p e a t e d l y , and s t a r t s to be absent f u l l days at a time. Her teachers are concerned and ask you to speak with her. The teachers s t r e s s the number of assignments not handed i n and the p o s s i b i l i t y of f a i l u r e . She a r r i v e s i n your o f f i c e as the r e s u l t of being l a t e yet again. 9. A seven year o l d boy, Jason, asks you, "Where do people go when they d i e ? " You are aware that Jason's mother has r e c e n t l y d i e d from c o m p l i c a t i o n s f o l l o w i n g surgery. 10. One of your c o l l e a g u e s i s pregnant. In her f i f t h month of the pregnancy c o m p l i c a t i o n s a r i s e and the f e t u s d i e s . The c h i l d r e n i n t h i s woman's primary c l a s s have been e x c i t e d about her pregnancy and are concerned when she i s absent f o r s e v e r a l days. The s u b s t i t u t e teacher has asked you to come and speak to the c l a s s because of a l l the questions she's been r e c e i v i n g from the students. You go i n t o the classroom. 11. Jimmy, a 6 year o l d whose o l d e r s i s t e r has been k i l l e d i n a h i t - a n d - r u n a c c i d e n t , wants to know where h i s s i s t e r i s and when she's coming home. He sounds angry and demanding. 12. C h r i s t i n e , a grade 3 student, has gone i n t o her classroom and found the c l a s s hamster dead i n i t s cage. She has s t a r t e d to c r y . Her classroom t e a c h e r . b r i n g s her to you because C h r i s t i n e can't stop c r y i n g . 13. Ben (aged 10-12) i s d i s c u s s i n g h i s - f e a r at the thought of h i s mother's impending death. He mentions the many s i m i l -a r i t i e s between the present s i t u a t i o n and the circumstances surrounding the death of h i s grandmother a year ago. 14. The p r i n c i p a l approaches you with the f o l l o w i n g s i t u a t i o n : She has r e c e i v e d a phone c a l l from Mrs. G., the mother of 10 year o l d Sandra G. The mother has t o l d the p r i n c i p a l that her husband has been suddenly k i l l e d and she wants Sandra home immediately. The p r i n c i p a l asks you to speak with Sandra and then to take her home. 15. An 8 year o l d boy whose f a t h e r has died, r e t u r n s to s c h o o l a f t e r the f u n e r a l . He becomes withdrawn i n the classroom yet can a l s o act out to draw a t t e n t i o n to h i m s e l f . He comes i n t o your o f f i c e and s i t s huddled i n a c h a i r , s t a r i n g at at the f l o o r . 16. During the day Mrs. T., a c o l l e a g u e , r e c e i v e s a telephone c a l l i n f o r m i n g her that her f a t h e r i s s e r i o u s l y i l l f o l l o w i n g a heart a t t a c k . She i s needed at home immediately--2,000 miles away. Mrs. T. a r r i v e s at your door l o o k i n g shocked and she b l u r t s out what she has j u s t heard. 42 17- A c o l l e a g u e , John M., and h i s spouse have undergone g e n e t i c c o u n s e l l i n g . John's wife becomes pregnant. Amneoscentesis i s performed and i n d i c a t e s a number of a b n o r m a l i t i e s e x i s t i n the f e t u s . John and h i s wife decide on a b o r t i o n . S e v e r a l weeks l a t e r you n o t i c e that John seems depressed and withdrawn. 18. You are t a l k i n g with a parent i n your o f f i c e . You have heard from a r e l i a b l e source that her husband i s near death. She mentions that he w i l l be coming out of the h o s p i t a l soon which w i l l be good as he w i l l be able to help with the c h i l d r e n . 19. A male c o l l e a g u e has suddenly l o s t h i s wife as the r e s u l t of a t r a f f i c a c c i d e n t i n which he was not i n v o l v e d . Since her death Andy has been going to the pub n i g h t l y . You n o t i c e dark c i r c l e s , under h i s eyes from l a c k of s l e e p . He drops down i n t o a c h a i r i n your o f f i c e two months a f t e r h i s wife's death. He sighs l o u d l y , and says, "God, I f e e l awful." 20. A female c o l l e a g u e has been away f o r a week f o l l o w i n g the sudden death of her husband. You are c h a t t i n g about g e n e r a l t o p i c s when you make a comment about your own spouse. Your bereaved f r i e n d becomes f l u s h e d , her eyes moisten, and she looks embarrassed. 43 Appendix F i v e : D i d a c t i c Workshop This workshop followed a l e c t u r e format as a means of communicating i n f o r m a t i o n . I n t r o d u c ft >i o n •; t o <;,t h e I h e c t u r e T B o n m a t - t o p i c s to be.covered -a 15 minute break to be scheduled -ask f o r ways to complete t h e • f o l l o w i n g sentence stem and put ideas up on•the board. "Death i s . . . ." - d i s c u s s what turns up H i s t o r i c a l Aspects: r u r a l community; f a m i l i a r i t y with death -technology; death as a taboo s u b j e c t -why taboo? - d e n i a l : i . e . , a t t i t u d e s ; media r e p r e s e n t a t i o n ; c y r o n i c s Relevance of the i s s u e f o r c o u n s e l l o r s B a s i c C o u n s e l l i n g S k i l l s needed: - l i s t e n i n g ; empathy; r e s p e c t ; c l a r i f i c a t i o n ; s e l f - d i s c l o s u r e ; c o n f r o n t a t i o n -honesty - a c c e p t i n g the c l i e n t as i s or r e f e r elsewhere Common Fears A s s o c i a t e d with Death and Dying: 1. Fear of time a f t e r death a. f e a r of f a t e of the body b. f e a r of judgement c. f e a r of unknown 2. Fears A s s o c i a t e d with Dying--the Process of Dying a. f e a r of pain b. f e a r of i n d i g n i t y c. f e a r of being a burden 3. Fear of Loss of L i f e a. l o s s of c o n t r o l or mastery b. f e a r of incompleteness, f a i l u r e c. f e a r o f s e p a r a t i o n Developmental Stages C h i l d r e n Experience -before age 3--separation i s key i s s u e -between 3-5--a temporary s i t u a t i o n -around 5 - 6 - - p e r s o n i f i c a t i o n o f death; the bogeyman - from 6 - 9 - - c u r i o s i t y - - n o t ready f o r f i n a l i t y -from 10-12--understanding of death--make j o k e s - - f e a r s death -from 1 3 - T 8 - - b e l i e f i n immunity to death -end of t e e n s — c l e a r understanding *these are not p r e s c r i p t i v e r e a c t i o n s 44 Other t h i n g s which may a f f e c t a c h i l d ' s r e a c t i o n - t e l e v i s i o n - i n t e l l i g e n c e - r e l i g i o n - " p r e p a r a t i o n " ( a d u l t responses - r e s p o n s e s o f o t h e r s which are a l l o w e d ) - d i r e c t p a s t e x p e r i e n c e s w i t h death When wo r k i n g w i t h p a r e n t s : - e x p l a i n s t a g e s o f r e a c t i o n s -need f o r l i s t e n i n g - s t e p s t o f o l l o w f o r p a r e n t s , t e a c h e r s , c o u n s e l l o r s 1. f u l l e x p r e s s i o n o f f e a r s , f e e l i n g s , f a n t a s i e s a l l o w e d 2. v o c a l i z e some f e e l i n g s c h i l d might be unable t o 3. show i n t e r e s t , u n d e r s t a n d i n g o f f e a r s , f e e l i n g s , f a n t a s i e s 4. answer q u e s t i o n s b r i e f l y and t r u t h f u l l y A i d s t o h e l p i n g a. f a m i l y : - s t r e s s need f o r communication l i n e s t o s t a y open -answer q u e s t i o n s when c h i l d needs answer - a l l o w c h i l d t o v i s i t i l l p e r s o n , but prepare them f i r s t - -i f c h i l d wants to go - d i s c u s s f u t u r e s e p a r a t i o n from d y i n g person -keep e x p l a n a t i o n s and answers s i m p l e - p a r e n t s may need own s u p p o r t system o f s e v e r a l people f o r t h e i r own g r i e f - a f t e r a sudden o r expected death - a l l o w c h i l d t o take p a r t i n d i s c u s s i o n s , acknowledge f e a r s - l e t him know he's not a l o n e i n g r i e v i n g - - s h a r e mourning -not b e i n g honest l e a d s t o f r i g h t , mystery, not c o p i n g -do not use euphemisms -God i s i n the c l o u d s -God l i k e s good people -dead person i s a s l e e p -death o f p a r e n t : * * c h i l d needs t o know h e ' l l not be l e f t a l o n e - c h i l d needs r e a s s u r a n c e he's not r e s p o n s i b l e -no r e t r i b u t i o n -spend time t a l k i n g and l i s t e n i n g - i t ' s okay f o r c h i l d t o see you c r y - t h i s g i v e s p e r m i s s i o n , t o g r i e v e - m a i n t a i n r e g u l a r r o u t i n e and normal d i s c i p l i n e • f o r s e c u r i t y needs F u n e r a l - a t t e n d i n g may be a growth e x p e r i e n c e - g i v e s c h i l d chance to be p a r t o f a r i t u a l - g i v e c h i l d a c h o i c e about a t t e n d i n g - l e t c h i l d see body i f need i s t h e r e - b e f o r e v i e w i n g body or a t t e n d i n g f u n e r a l be sure t o prepare c h i l d f o r what might be seen or happen 4 5 C h i l d ' s e x p r e s s i o n o f g r i e f -review Kubler-Ross stages: - d e n i a l and shock -anger - b a r g a i n i n g - d e p r e s s i o n -acceptance -no time l i m i t or p r e s c r i b e d manner f o r g r i e v i n g Key f a c t o r s i n a b i l i t y to cope -number of major l o s s e s experienced -coping s k i l l s a l r e a d y l e a r n e d -support system -type of f a m i l y communication Symptoms of Loss h o l i e r i n g / s c r e a m i n g h i t t i n g o t h e r s / t h i n g s obscene gestures withdrawal not e a t i n g / o v e r - e a t i n g a c t i n g i n d i f f e r e n t c h e a t i n g vandalism f i g h t i n g / h o s t i l i t y / a g g r e s s i v e behavior t a k i n g d r u g s / a l c o h o l i r r i t a b i l i t y daydreaming not doing classroom work temper tantrums throwing things p r o f a n i t y i s o l a t i o n c r y i n g l y i n g s t e a l i n g absenteeism a c t i n g tough & c o o l / hypermaturity s u i c i d e / a t t e m p t e d s u i c i d e r e s t l e s s n e s s e m o t i o n a l i t y at unexpected times not wanting to l e a r n new m a t e r i a l r e p e t i t i v e p h y s i c a l d i s t r e s s e s : stomachache, headaches, c o l d s , f l u , e t c . r e g r e s s i o n f e e l i n g s of g u i l t f e e l i n g s of anger inadequacy demanding a t t e n t i o n change i n peer i n t e r - change i n appearance a c t i o n As a c o u n s e l l o r -be aware of symptoms, communication s k i l l s , your own f e e l i n g s -don't assume you know how c l i e n t i s f e e l i n g - t a l k with and e x p l a i n some experiences c h i l d might go through such as 5 stages (Kubler-Ross); r o l l e r c o a s t e r . e f f e c t Steps to recovery: 1 . recognize, the l o s s 2. be with the f e e l i n g s 3 . support of others 4. l o s i n g i s n ' t f a i l i n g 5 . the end 6 . i t takesu-time . 7. r o l l e r c o a s t e r e f f e c t 4 6 Danger s i g n a l s that i n d i c a t e i n a b i l i t y to cope -drop i n s c h o o l work or s c h o o l grades - a t t a c k i n g others or a g g r e s s i v e behavior -withdrawing;'daydreaming, f a n t a s i z i n g -psychosomatic ailments -being very a f r a i d of t h i n g s out of the usual Things to do: - c r e a t e a group - i n s e r v i c e with s t a f f or at s t a f f meeting - o f f e r to do mini-workshops on l o s s f o r teachers i n t h e i r classroom -do l o s s i n v e n t o r y with students -present a program on l o s s to parent groups -importance of p h y s i c a l contact -be aware of v a r i a b l e s a f f e c t e d by a l o s s .Learn and Do 1 . Know your own f e e l i n g s , philosophy, s p i r i t u a l b e l i e f s 2 . Seek out the g r i e v i n g p e r s o n — d o n ' t shun him 3. What to s a y — k e e p i t simple, no euphemisms; cry with them; t a l k and share; don't use "pat" phrases 4. Accept f e e l i n g s , f e a r s and concerns of person 5 . P h y s i c a l contact 6. R e a l i t y of death i s a c c e p t a n c e — a s s e s s i n d i v i d u a l ' s s t r e n g t h s - - n o t too much too soon 7. Death i s a growth experience Some a c t i v i t i e s -puppet shows -anger T - s h i r t -I l e a r n e d . . . statements - j o u r n a l s - p o e t r y / s t o r i e s - l o s s l i n e - w r i t e your own o b i t u a r y -group d i s c u s s i o n - r o l e p l a y i n g - b i b l i o t h e r a p y -use f i l m s (The above m a t e r i a l s have been compiled from the f o l l o w i n g sources• Bebensee, 1 9 8 0 ; Bebensee & Pequette, 1 9 8 1 ; C a l l e r , 1 9 7 9 - Clay 1 9 7 6 ; F e i f e l , 1 9 7 7 ; Getson & Benshoff, 1 9 7 7 ; G i n o t t , 1 9 6 5 ; Gordon & K l a s s , 1 9 7 9 ; Hawener, 1 9 7 5 ; Headington, 1 9 8 1 ; I n s e l , 1 9 7 6 ; Jones, 1 9 7 7 ; Knowles & Reeves, 1 9 8 1 ; Kubler-Ross, 1 9 6 9 -Lindemann, 1 9 4 4 ; Neale, 1 9 7 5 ; Nelson & Peterson, 1 9 7 5 ; Parkes, 1 9 7 5 ; Peterson & S a r t o r e , 1 9 7 5 ; Reeves & Knowles, 1 9 7 9 & 1 9 8 1 -Rosenthal, 1 9 7 8 ; S c h i f f , 1 9 7 7 ) 47 Appendix S i x : E x p e r i e n t i a l Workshop The format of t h i s workshop c o n s i s t e d of a number of a c t i v i t i e s and d i s c u s s i o n s centred around the c o u n s e l l o r e x p l o r i n g h i s / h e r f e e l i n g s , b e l i e f s , and a t t i t u d e s towards death. E x p l a i n format to be followed and time of break. A c t i v i t y One: Write down your remembrances — e s p e c i a l l y your f e e l i n g s - - s u r r o u n d i n g the f o l l o w i n g : 1. e a r l i e s t death experience 2. most recent death experience 3. most traumatic or h e a v i e s t ' l o s s A f t e r f i v e minutes, have s u b j e c t s form i n t o t r i a d s to share t h e i r responses. A f t e r s h a r i n g , r e t u r n to l a r g e group and ask f o r comments. A c t i v i t y Two: Mediate and w r i t e a b r i e f statement about your own.death. Request p a r t i c i p a n t s to share statements with t h e i r t r i a d . Discuss u n p r e d i c t a b i l i t y of death and ways people deny death. A c t i v i t y Three: Have p a r t i c i p a n t s f i l l out the Neal q u e s t i o n n a i r e on f e a r s f o r s e l f and o t h e r s . A f t e r p a r t i c i p a n t s have been given a few minutes to f i l l t h i s out, r e a r r a n g e . i n t o new t r i a d s and d i s c u s s choices made. Return to l a r g e group f o r comments before moving on to next a c t i v i t y . A c t i v i t y Four: C o n f r o n t i n g Death: The f o l l o w i n g questions are to be used to improve your a b i l i t y to c o n f r o n t death and, a l s o , become more ready to help o t h e r s . 1. Assuming good h e a l t h and no a c c i d e n t s , what i s the l a s t year d u r i n g which you expect to be a l i v e ? 2. Describe the kind of arrangements you would l i k e to have for your death. a. What would be the f u n e r a l arrangements? 3. b. How do you wish to dispose of your body? c. How do you wish to dispose of your possessions? d. How w i l l you arrange f o r your dependents? W i l l you have any? e. What would you l i k e to appear i n the announcement of your death? 48 3. Which o f your l i f e t a s k s w i l l you have completed? 4. Which o f your l i f e t a s k s w i l l you have y e t to complete? 5 . Name f i v e people you know w e l l whom you expect t o o u t l i v e you. 6. Name f i v e people you know w e l l whom you expect t o o u t l i v e . 7. What do you b e l i e v e would be a t r a g i c way to d i e ? 8. What do you b e l i e v e would be an i d e a l way to d i e ? In t r i a d s , d i s c u s s your r e s p o n s e s : Which ones s t i m u l a t e d a l o t o f thought and were i n t e r e s t i n g f o r you to t h i n k about? While they have e l i c i t e d f e e l i n g s o f sadness, d i d the response a l s o seem m e a n i n g f u l and worth c o n s i d e r i n g ? Were t h e r e t o p i c s t h a t you found i r r i t a t i n g or d i f f i c u l t t o take s e r i o u s l y ? D i d you j o k e about them or respond w i t h o u t any r e a l thought? In the l a r g e group s e t t i n g a s k . f o r comments on the a c t i v i t y . A c t i v i t y ; ; - F i v e : F i l l i n Life-Mood Assessment Chart Draw a l i n e w i t h i t s h i g h and low peaks, v a l l e y s , and c u r v i n g l i n e s t o p r e s e n t your l i f e i n v i s u a l form. On the l i n e s p r o v i d e d f o r each major segment o f l i f e , i n d i c a t e the cause o f the h i g h and low peaks. D i s c u s s i n t h e . l a r g e group s e t t i n g how p a r t i c i p a n t s found t h i s a c t i v i t y . Easy? Hard? P a r t i c i p a n t s may want to use some o f t h i s i n f o r m a t i o n i n the next a c t i v i t y . A c t i v i t y S i x : W r i t i n g O b i t u a r i e s Ask the group t o spend 10-15 minutes w r i t i n g t h e i r own o b i t u a r y by w r i t i n g b r i e f l y about t h e i r l i v e s . Have re s p o n s e s shared i n t r i a d s . Resume l a r g e group and ask f o r comments. I f you doubt your own r e a d i n e s s t o c o u n s e l s t u d e n t s concerned w i t h death, the f o l l o w i n g a c t i v i t i e s may b e . h e l p f u l . 1. T a l k about the a c t i v i t i e s we have done w i t h someone c l o s e to you. D i s c u s s the more d i f f i c u l t t o p i c s . L i s t e n to how your p a r t n e r responds. 2. Read about death and c o u n s e l l i n g o t h e r s about death 49 3. Examine your p e r s o n a l c o n v i c t i o n s about the s i g n i f i c a n c e of death. Discuss with a p r i e s t , r a b b i , m i n i s t e r , s p i r i t u a l c o n f i d a n t . Discuss with someone with no r e l i g i o u s commitment. 4. Attend c a l l i n g hours and memorial s e r v i c e s of persons you have known. L i s t e n to f e e l i n g s expressed there. Experience your own r e a c t i o n . P a r t i c i p a t e i n the s e r v i c e . 5. Discuss death with a m o r t i c i a n . Talk about arrangements necessary f o r your own f u n e r a l . Write out i n s t r u c t i o n s f o r your s u r v i v o r s . Discuss matters with the executor of your w i l l or person who w i l l be i n charge of arrangements. 6. V i s i t a n u r s i n g home. S e v e r a l times. Talk with people near the end of t h e i r l i v e s . L i s t e n . Be s e n s i t i v e . ' Don't i n i t i a t e t a l k of death, but f o l l o w t h e i r l e a d . The purpose of these a c t i v i t i e s and those we have completed today i s to make the t o p i c of death more f a m i l i a r to you. I t may be or have been d i f f i c u l t . I f you want to undertake some of the a c t i v i t i e s l i s t e d above, ask a few others to j o i n you so that you can d i s c u s s your experiences, as you do some of the a c t i v i t i e s . (The above a c t i v i t i e s have been compiled from the f o l l o w i n g sources: Getson & Benshoff, 1977; Neale, 1975; Nelson, 1977) 50 Appendix Seven: . Combined D i d a c t i c / E x p e r i e n t i a l Workshop T h i s workshop combined elements of the d i d a c t i c workshop and o f the e x p e r i e n t i a l workshop mentioned i n Appendix F i v e and Appendix S i x . I n t r o d u c t i o n to workshop, format and time o f s c h e d u l e d break D i s c u s s group responses t o "Death i s . . . . " Do A c t i v i t y One f r o m . E x p e r i e n t i a l Workshop H i s t o r i c a l A s p e c t s Relevance o f the i s s u e f o r c o u n s e l l o r s B a s i c c o u n s e l l i n g s k i l l s needed Common f e a r s a s s o c i a t e d w i t h death and d y i n g Do A c t i v i t y Three - Neal Q u e s t i o n n a i r e Developmental s t a g e s c h i l d r e n e x p e r i e n c e Other t h i n g s which may a f f e c t a c h i l d ' s r e a c t i o n When w o r k i n g w i t h p a r e n t s A i d s to h e l p i n g a. f a m i l y F u n e r a l C h i l d ' s e x p r e s s i o n o f g r i e f Key f a c t o r s i n a b i l i t y t o cope Symptoms o f l o s s Do A c t i v i t y Four - C o n f r o n t i n g Death As a c o u n s e l l o r Steps to r e c o v e r y Danger s i g n a l s Things to do Learn to do A c t i v i t i e s 51 Appendix E i g h t : Mean Score f o r Each Subject by Each Rater Rater X Y Z Group A 3 . 4 3 . 2 4.2 3 . 2 3 . 6 4.7 3 . 5 3.1 3 . 9 3-0 3 . 3 4.2 3 . 6 3 . 9 4 . 3 Group B "2.6 . 3. 2 3 . 8 3 . 2 3 . 3 4 . 6 3.0 3 . 3 3 . 9 2 . 3 2 . 3 3.4 3 . 5 3 . 8 4 . 2 3.1 2 . 6 3 . 9 3 . 5 3 . 3 4.4 Group C 3.1 3 . 9 4.8 3 . 3 3 . 2 4 . 2 3.4 2 . 9 3 . 8 3 . 0 2 . 3 3 . 8 3 . 3 3 . 6 4.2 4.1 4.1 4 . 8 3 . 3 3.2 4 . 5 3 - 6 3-1 4.3 Group D 2 . 9 2 . 7 3 . 9 2 . 6 2 . 6 3.2 3 . 2 3.1 3 . 9 3 . 2 3 . 4 4.0 2 . 7 2 . 2 2 . 6 52 Appendix Nine: C o r r e l a t i o n s  Between Raters Within Each Group Group A Raters Scores X Y Z 3.4 3.2 4.2 3.2 3.6 4.7 3.5 3.1 3.9 3.0 3.3 4.2 3.6 3.9 4.3 C o r r e l a t i o n s : rxz- -0.33 ryz= 0.58 Group B Raters Scores X Y ' Z 2.6 3.2 3.8 3.2 3.3 4.6 3.0 3.3 3.9 2.3 2.2 3.4 3.5 3.8 4.2 3.1 2.6 3.9 3.5 3.3 4.4 C o r r e l a t i o n s : rxy-- 0.73 rxz-- 0.84 r = 0.696 yz 53 Group C Raters Scores X Y Z 3-. 1 3-9 4.8 3.3 3.2 4.2 3.4 2.9 3.8 3.0 2.3 3.8 3/3 3.6 4.2 4.1 4.1 4.8 3.3 3.2 4.5 3.6 3.0 4.3 C o r r e l a t i o n s : ryz = °' 87 Group D Raters Scores X Y Z 2.9 2.7 3.9 2.6 2.6 3-2 3.2 3.1 3.9 3.2 3.4 4.0 2.7 2.2 2.6 C o r r e l a t i o n s : rxy= 0.79 vxz= 0.79 r = 0.88 yz 54 Appendix .Ten: Questionnaire Responses Group. A B C D T o t a l P r o f e s s i o n a l t r a i n i n g : BEd. 4 1 3 8 BA. 4 2 4 2 12 MA. 1 1 MEd. 1 1 Other: 2 4 6 T o t a l : 7 7 9 5 28 • Current P o s i t i o n : Elementary teacher 1 1 Secondary teacher 1 1 Teacher/Counsellor Sec. 1 1 3 5 Elementary c o u n s e l l o r 1 1 1 3 F u l l Time Sec. Coun. 1 1 3 1 6 Other: Student 3 1 4 8 Misc. 1 2 3 T o t a l : 6 7 9 5 27 Years i n c u r r e n t p o s i t i o n : 0-1 2 2 3 7 2-3 2 1 1 4 4-5 1 2 2 5 55 6-7 1 1 1 3 8 - 1 0 1 1 g r e a t e r than 10 1 2 3 6 T o t a l : 5 7 9 5 26 P o s i t i o n immediately p r e v i o u s : Elementary teacher 1 3 1 5 Secondary teacher 1 1 6 2 10 Teacher/Counsellor Sec. 1 1 1 3 Elementary c o u n s e l l o r 1 1 F u l l Time Sec. couns. 0 Other: 2 2 1 1 6 T o t a l : 5 7' 8 5 25 Years of experience i n previous p o s i t i o n : 0-1 1 1 2 2-3 2 2 2 2 8 4-5 1 2 3 6-7 1 1 1 1 4 8 - 1 0 1 1 2 g r e a t e r than 10 1 3 4 T o t a l : 5 6 8 4 23 Workshop Exposure: None 6 6 7 5 24 1 workshop 1 1 2 2-3rworkshops 1 0 4 or more 1 1 support group 1 1 5 6 T o t a l 6 7 10 5 28 Workshops attended. -Denis Boyd - 1_ day workshop attended by one person i n i n Group B. -Knowles and Reeves - 2 hour workshop attended by one person i n Group B. -Pil g r i m a g e T r a i n i n g by one person i n Group C. -6 week parent support group t r a i n i n g by one person i n Group C. Loss Inventory: In Group A: one person had l o s t a f r i e n d i n the l a s t 0 - 6 months; two had l o s t c l o s e r e l a t i v e s i n the l a s t 1-4 years; one had l o s t a f r i e n d i n the l a s t 1-4 years; one had l o s t a p e t . i n the l a s t 1-4 years. In Group B: one person had.had a parent diagnosed t e r m i n a l l y i l l i n the l a s t 0 - 6 months; one had had a c l o s e r e l a t i v e d i e i n the l a s t 0 - 6 months; one had had an a b o r t i o n or m i s c a r r i a g e i n the l a s t 0 - 6 months; one had had a c l o s e r e l a t i v e d i e i n the l a s t 1-4 years; one had had an a b o r t i o n or m i s c a r r i a g e i n the 1-4 years; one had had a pet d i e i n the l a s t 1-4 years. In Group C: one person had had a parent d i e i n the l a s t 0 - 6 months; one had l o s t a f r i e n d i n the l a s t 0 - 6 months; one had had a parent d i e i n the l a s t 6 months to a year; one had l o s t a parent i n the l a s t 1-4 years; one had l o s t a s i b l i n g i n the l a s t 1-4 years; two had had c l o s e r e l a t i v e s d i e i n the l a s t 1-4 years; one had l o s t a f r i e n d i n the l a s t 1-4 years; one had had an a b o r t i o n or m i s c a r r i a g e i n the l a s t 1-4 years; and two had had pets d i e i n the l a s t 1-4 years. In Group D: one person had had a c l o s e r e l a t i v e d i e i n the l a s t 6 months to a year. 

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