Social Work With Groups

Expanding Horizons

Stanley Wenocur

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9781560242963
• eBook ISBN: 9781317940074
• Topic: Medicine
• Subtopic: Diseases & Allergies

Social Work With Groups describes continuity and change in group work. It revisits the theoretical ideas of group work and group work topics of the past decade, focusing on the continuity of group work theory and practice. At the same time it emphasizes the need for change to more effectively work with deal with people in new groups in need--people with AIDS, gangs, persons in grief, and minorities, as well as groups always in need but now with new and additional needs--families, children, adolescents. This book deals with how to meet the needs of existing and emerging populations. It shows a good combination of theory and practice of group work in a variety of settings and using traditional techniques with new groups.Chapters in this book revisit the theoretical ideas of group work such as stages of development and the question of self-determination in groups. The sections of theory are the basis for the more practical emphasis of what today's group worker is doing and how they are doing it. Social Work With Groups is very practice oriented. As such, anybody who uses groups to help people will find much to read and reflect upon. With its across-the-board appeal, persons new to group work will delight in the practical information, and experienced group workers will find the revisiting of the issues a helpful and refreshing approach. Clinical social workers and faculty with an interest in theory and theoretical approaches to group work will appreciate the theory addressed in the book. Social change oriented practitioners searching for new methods of empowerment among the people will find helpful suggestions in this book for social, political, and grassroots activism.

SELECTED PAPERS

An AIDS Bereavement Support Group: One Model of Intervention in a Time of Crisis

Robert C. Amelio

INTRODUCTION

In February 1987 an AIDS bereavement support group began under the auspices of the AIDS Action Committee of Massachusetts. The purpose of this group is to offer bereaved individuals who have lost someone to AIDS an opportunity to mourn the death with others suffering similar losses. The AIDS Action Committee (AAC) is the major provider of services for people affected by AIDS in New England. This group is one of more than a dozen support groups offered through the AAC. At the time this group began it was the only bereavement group offered with membership open to both straight and gay, men and women, lovers, widows, adult children, friends, siblings, parents-essentially anyone who lost someone to AIDS. This paper will focus on several aspects of this particular group including demographics and group structure, AIDS bereavement issues, countertransference issues, and advantages and disadvantages of the group model.

AIDS BEREAVEMENT

The bereavement of a loved one is a difficult period in an individual’s life, one that can last an indeterminate amount of time. The death of a loved one to AIDS may complicate this process of grieving due to the stigma associated with this disease. Worden (1982) listed three conditions that may complicate the grieving process: (1) when the loss is socially unspeakable; (2) when the loss is socially negated; (3) in the absence of a social support network. AIDS bereavement may and often does carry all of these conditions with it leaving bereaved individuals more vulnerable to complications in their grieving, the potential resolution of their grief, and the reconstruction of their lives.

There are many examples of how society stigmatizes people with AIDS (PWAs) and their survivors. Some forms of this stigmatization take shape in ostracism and isolation by family, friends, and community (Batchelor, 1984; Geis, Fuller & Rush, 1988; Morin, 1984), loss of jobs (Baker, 1988; Kaplan, 1988), loss of housing (Baker, 1988; Kaplan, 1988), and even a house-burning (Monmaney, 1987).

The response of PWAs and their survivors to this stigma varies. Some responses are: the decision to keep the true nature of the disease a secret (Kaplan, 1988; Oerlemans-Bunn, 1988; Walker, 1987), isolating self from others (Geis et al., 1988; Oerlemans-Bunn, 1988), fearing intimate contact with others (Morin, Charles, Malyon, 1984), and not grieving publicly (Kaplan, 1988).

Many of the bereavement issues of the survivors relate directly to their feelings about the stigmatization they have experienced while their loved one was still living with AIDS. These include issues of: anger at society, fear of rejection in new relationships, suicidal thoughts, self-punishing thoughts, severe depression, fear of developing new relationships, fear of being HIV (human immunodeficiency virus) positive, curtailed sexual activity, thoughts of being a leper, and keeping the true cause of a loved one’s death to AIDS a secret (Batchelor, 1984; Geis et al., 1988; Kaplan, 1988; Monmaney, 1987; Morin, 1984; Morin et al., 1984; Oerlemans-Bunn, 1988; Walker, 1987; Whitmore, 1988).

GROUP STRUCTURE

As a result of the perceived stigma of bereaved individuals who have lost someone to AIDS this particular bereavement group was formed with three basic goals: (1) to provide a forum for bereaved individuals to discuss their feelings and other issues related to the deaths; (2) to create a mutual-aid network for group members; (3) to enable and empower members to deal with their grief reactions and the stigma and isolation often experienced due to AIDS.

The group meets every other week for 1 1/2 hours in the greater Boston area. All members are screened by telephone contact by the AAC group program coordinator who then refers the individual to one of the two group co-leaders. We ask each member for a three session commitment after which the individual can decide when to terminate from the group. The average length of stay is 4–5 months though many members have continued with the group for 6 months or more. Since the group began in 1987 more than 30 individuals have come to the group.

Co-led by a gay male social work graduate student and a straight female psychologist, the group has welcomed inclusion of any person who has lost someone to AIDS. Our first members were a gay man who lost several friends, a straight woman whose fiancee died of AIDS, and a straight woman whose 38-year-old daughter died. Members join at various stages of their bereavement. Some have come to the group two weeks after the death, others months or years later.

Each group meeting begins with a photograph exchange in which members pass around any pictures of the deceased. This procedure was initiated by the members themselves who spontaneously began to bring in pictures and other mementos and thus a formal period was created so that anyone has the opportunity to share photographs or other articles. After the photo session each member “checks in.” A rule of the group is that check-in includes the name of the person who died of AIDS and when that person died. Any other information a member wishes to bring up about the weeks since the last meeting or the grieving process is also welcome at this time. Once all members have checked-in (with the option to pass) discussion is open to any issues the members want to discuss. Any member present for the first time to the group is allowed more time during the check-in to talk in detail about the illness and death of the loved one and the subsequent bereavement.

For many who have come to the group it has been the only place they have been able to talk about and mourn their losses in a supportive and non-judgmental atmosphere. The mutual aid network that has developed within the group had been a primary reason for its successful continuation. Members exchange addresses and phone numbers, have visited each other during hospitalizations, and socialize together. The members are extremely committed to attend each meeting. One member attended the day after being released from the hospital for lung surgery. The actual illnesses, AIDS-related or not, of the members raise great concern for the other members. When a member has missed a meeting and is known to be ill several members will call him and offer any help they can provide. Perhaps this is their way of helping yet another person cope with illness, another way of being a caregiver, which for most is a familiar role. Perhaps it is also their fear of losing someone else to AIDS that compels them to be especially sensitive to one another.

The backgrounds, professionally and personally, of the two co-leaders have also influenced the continuation of this group. Having a straight female psychologist and a gay male social worker lead the group represents an inclusive atmosphere and has enabled both men and women, straight and gay, to be comfortable in the group. Though no one has asked us about our individual sexual orientations I believe the physical presence of a man and a woman encourages all members to feel welcome.

GROUP ISSUES

Bereavement of the death of a loved one to AIDS has similarities and differences with bereavement by other forms of death. A bereaved individual usually learns there is a societally-imposed time limit in which grieving is supposed to occur. After this time limit other people begin to wonder when the bereaved person will “snap out of it.” A grieving person finds other people are not comfortable talking about death or how much the deceased is missed and thus tends to suppress his other true feelings from others often during bereavement (which may last only a few months for some but years for others). The bereaved individual might wear the clothes of the deceased, sleep on the deceased’s side of the bed, or be forgetful and view these and other such behaviors as bizarre. Feelings of sadness, anger, anxiety, relief, fatigue, or helplessness might overtake the bereaved at unexpected and sudden times and seem overwhelming. These are some of the experiences reported by many of the group members and abound in literature about grief which survivors of losses from AIDS as well as other deaths seem to have in common.

Bereavement of a death to AIDS, which is seen by many in our society as a stigmatizing disease, has its own set of issues that may complicate the grieving and reconstruction process. These issues form the core of the work of this group and have been experienced to some degree by all of the members of the group. The major AIDS-related issues presented in this paper are: (1) feeling stigmatized; (2) feeling isolated; (3) asking the questions: “will I be next to get AIDS?”; “should I be tested for HIV?”; “who gave it to whom?” (4) the difficulty in being able to grieve publicly; (5) cumulative losses to AIDS; (6) AIDS overload.

Stigma and Isolation

The issues of stigma and isolation are the most commonly presented concerns in the group, particularly for newer members. These seem equally relevant to gay as well as straight members. One member, a woman whose 38-year-old daughter died of AIDS told us:

No one besides my husband knows how Susan died. If my friends knew she had AIDS it would soil her memory, they’ll look down on her, it would take away any respect anyone had for her. I’ll never tell anyone what killed her.

Another member, a gay man has said:

Being gay, I thought all of our friends would support us and help us out. It was as if we had done something bad, something wrong. After Joe died they were all there at the funeral but only a few have bothered to contact me since then.

A woman whose boyfriend died of AIDS said:

Max had gone clean (from intravenous drug use) 2 years before he died. He was an example to his other (drug-using) friends of someone who was making it. And then–wham!–he gets AIDS and is dead in two weeks. And not one of our friends was there to help us out. Suddenly we were both untouchable. I think it was too scary for them. If Max had gone clean and got AIDS what was going to happen to them?

This stigma may remain with the survivor as he begins to explore new romantic relationships. One man told the group:

I want to date again but what do I say–oh, by the way, my lover died of AIDS, but don’t worry, I’m o.k.? I’m negative now but who knows what’s in my system. I feel like a leper.

Our decision to open the group to anyone who has lost someone to AIDS, not only gay men, or parents, or family members, was based in part on our desire to de-stigmatize the disease and create a group of individuals from all walks of life who shared the common bond of losing someone to AIDS. By encouraging parents, wives, gay and straight lovers, adult children, and siblings to talk about their grief with one another the concept of AIDS as a “gay disease” has dissipated and the isolation experienced by so many of the members in their lives outside of the group is diminished.

Unanswerable Questions

For many of the members in the group their bereavement is complicated by unanswerable questions. A primary question members ask is: “Will I be next?” This is particularly true of the bereaved romantic partners in the group, though others have asked this question. Other concerns are whether or not to be tested for exposure to HIV and wondering who gave the disease to whom.

Some discussion about these questions has been:

I’ve been tested positive and now I’m just waiting. I know I’ll get it at some point. And knowing doesn’t really help.

I don’t know if I’m positive or negative. I’m never going to be with someone again so what difference does it make?

I just live with the assumption that I am positive and live every day as fully as I can.

I want to know but I’m afraid. I would only worry more than I already do now.

Though no one can provide any satisfactory answers to these questions it seems once the members verbalize their concerns and are allowed to talk about them at length they are able to ease some anxiety and focus on other bereavement issues as well. Unfortunately, AIDS is a disease characterized by many questions and not enough answers. Survivors carry the burden of these questions long after the loved one has died.

Public Mourning

Some members have expressed their difficulty in mourning publicly for the deceased which is another condition that may complicate the grieving process. Some of the gay men in the group who are not “out” at work have had problems explaining to their bosses and co-workers the true relationship to their “friend” who has died. For some of the straight members in the group it has been equally as difficult to mourn publicly. Some have feared the reactions of friends, co-workers, and relatives to their news that someone close to them has died of AIDS thus forcing them to hide the true cause of death or to withdraw from these people at a time when support and comfort are so important. One member, a public school teacher who lost her husband of over 20 years to AIDS has chosen not to tell most of her co-workers how he died because of her fear of the perceived or real repercussions in doing so. Having to hide the truth of the disease, or even more extreme, that someone very close to the member has died has caused guilt and prolonged grief for some of the members. For many the group is the only place they have to speak honestly about their loss without fear of judgement.

Cumulative AIDS Losses

The issue of cumulative, compounded losses is of particular importance to some of the gay men in the group. One man has lost six close friends in the last year. Almost every member knows someone else who has died of AIDS, has tested positive, or has ARC (AIDS related condition). One member was faced with the news in a short period of time that his two ex-lovers both had AIDS. It is as if these members have no rest from grief. Their grieving becomes chronic. As soon as they feel ready to face the world again another death occurs in their lives.

AIDS Overload

Another closely related issue is one of AIDS overload, that is, being surrounded by AIDS. Members have spoken about their inability to escape the reality of AIDS for even a short time due to the proliferation of articles in the media on AIDS, television programs on AIDS, conferences and seminars on AIDS, AIDS memorial services, AIDS-fund raising events. While they acknowledge the importance of this saturation to raise public consciousness to the magnitude of this disease, many members express anger at being reminded constantly of AIDS and thus the death of the loved one they now mourn. One woman poignantly said: “Seeing AIDS everywhere I go reminds me every day of my own pain. Just for one day I would like not to have a public reminder of my husband’s death, of the intense pain I am living with.” For some members the daily reality of AIDS becomes even more personal when tested positive or at the onset of symptoms of ARC. One such man said: “Everywhere I look there are reminders about AIDS. And now, just when I was getting used to them, I test positive, I start getting a bad cough and there it is right in my face every day again.”

The group has been an outlet for all members to express their fears, mourn their losses, and share their rage. Through mutual support and non-evaluative listening these issues can seem less overwhelming and isolating.

COUNTERTRANSFERENCE ISSUES

There are several issues I have had to examine for myself as a co-leader of this group. The fact that the majority of members have been gay men has caused me to come face-to-face with my own anxiety about AIDS in my life and that of my lover. When I first be...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Series
• Contents
• List of Contributors
• Introduction
• Plenary Sessions
• What Happened to Self-Determination?
• The Rediscovery of Real-World Groups
• Confronting Human Finitude: Group Work with People with AIDS
• Selected Papers
• An AIDS Bereavement Support Group: One Model of Intervention in a Time of Crisis
• Social Work Practice with Groups in the Church Context: A Family Life Ministry Model in an Inner-City Church
• The Tasks and Skills of the Social Worker Across Stages of Group Development
• Group Work and the Environment: A Systems Approach
• A Social Group Work Model for Latency-Aged Children from Violent Homes
• Feedback, Role Rehearsal, and Programming Enactments: Cycles in the Group's Middle Phase
• Small Group Dynamics and a Dialectic Discourse
• Not Just One of the Gang: Group Workers and Their Role as an Authority
• Group Empowerment Through Learning Formal Decision Making Processes
• The Social Worker in Politics as a Multi-Role Group Practitioner
• The Telephone Group: Accessing Group Service to the Homebound