Note: All names have been changed to protect confidentiality.

By L.B. (LeslieBeth) Wish, Ed.D, MSS

Introduction

Sally had been a soldier’s wife for all twelve years of their marriage. She endured separations while her husband, Tom, was called to duty, and she toughed out raising twin boys alone. Sally said Tom loved her because, in his words, she was a “team player.” But ever since Sally learned that Tom was killed in a roadside bomb in Iraq, Sally doubts whether she can be a team of one. “I’m really not that strong,” Sally said. “It’s just a good act.”

When Rolanda was shot out of her helicopter, her husband Ray said he had no choice but to “pull himself together.” He had to focus on his job and raising his stepdaughter. “I only cry at night, and then only for a second or two. We were practically newlyweds. I don’t even know what I’ll be missing.”

“At least the kids are grown.” It was the first thing that came to Linda’s mind when she heard that her husband was killed in an ambush. But the relief was short—depression set in, and Linda felt “ashamed” for falling apart.

These stories provide a glimpse into the plight of many of the American families of downed warriors in Iraq. Each family’s grief is unique, but most share issues that are familiar to mental health professionals–adjustment, loss, grief, and anger.

Some families rely on friends, the Armed Forces community, and supportive family for help. But one of the issues that many (certainly not all) of these families also share is their reluctance to use the mental health services available to them.

Why? What makes providing counseling to these families so different from non-military families in mourning? And how can mental health professionals serve these families’ needs?

Let’s start with learning a little more about some of these families. Bear in mind, that there are many reactions to the loss of a family member and that not all families of downed warriors react the same. Yet, a constellation of beliefs, fears and adjustment issues does exist amongst many of these families, and it is important to become familiar with them.

Current Issues of Some American Military Families

At first, it seems that the most common issues of military families do not differ from the problems of families not in the military. People are people, as some say. After all, humans share common problems. Yet, military families often add elements to these issues that are unique to them.

Fear of Being “Found Out”

Many families worry about being seen in counselors’ halls and waiting rooms and about being judged and “found out.” They also worry about confidentiality. They believe that no matter what the organization, if it’s affiliated with the armed forces, it will keep records that could easily be shared with other branches and departments.

Non-military families may have similar feelings, but military families carry with them an extra dose of shame of being “found flawed.” They also say they “have had it” with the power of military and government rules. They long for privacy, and they have far higher doubts that their insurance can protect them.
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Mary Lee Carroll, LCSW Los niños Jonathan tenía seis años cuando murió en 1988. La trabajadora social Mary Lee Carroll, LCSW lo acompañó como voluntaria de hospice. El trabajo que ella hizo con él, y su espíritu inspiraron a la Sra. Carroll a desarrollar un programa de duelo pediátrico para un hospice en Conneticut. En 1994, el Júnior League de Waterbury hizo un donativo a la organización para patrocinar el Campamento Jonathan. En 1999 el Campamento Jonathan fue incorporado y ya no depende de ninguna organización. El Campamento apoya a las necesidades de las personas en duelo de Conneticut en la región de Watertown. Cada verano, el Campamento Jonathan patrocina un campamento diurno de una semana para niños que están en proceso de duelo por la muerte de una persona significativa en sus vidas. A continuación ofrecemos una lista de comentarios acerca del duelo y de tener una pena hechos por los niños que asistieron al programa de apoyo de una semana en julio del 2005. La pena es… Dura y pesada Triste Enojo y locura Única Vacío Soledad No es divertida, es guácala Confusión Dolorosa Difícil Mala No me deja concentrarme Siento mi corazón hecho pedacitos Difícil Muy triste y depresiva Nada divertida Algo que te quita mucho tiempo Como orillas sin limar Te deja con los nervios de punta Como usar ropa que te queda chica Agotadora Abatimiento Como si estuvieras en otra dimensión Amarga Cruel, malo, gacho Algo malo Algo que te fortalece Algo que nunca olvidarás Un hoyo negro Algo que les sucede a todos Muy triste y asusta Perder algo que querías Como tratar de correr con zapatos que te quedan grandes Enfrentar tus miedos Una carga que es pesada al inicio y que luego se aligera Como un incendio forestal De entrada acaba con todo. Pero luego todo empieza a crecer de nuevo de manera gradual y constante, con algunos topes. Pero: Algunas vidas ya se acabaron Puede que ya no encuentres la luz, pero depende de qué tan bien puedes ver en la oscuridad. Usar todo el día unos tenis que te quedan apretados. Cuando hace mucho calor y estás incómodo. Cuando usas shorts y hace mucho frío. La oscuridad cuando no tienes una linternita, y le tienes miedo. Cansada y frustrante Depresiva. De lo peor Además del apoyo que se da a niños y jóvenes durante una semana experiencial en el verano; el Campamento Jonathan ofrece grupos de apoyo durante todo el año para niños y padres, y sólo para niños y jóvenes. En noviembre de cada año, la organización también lleva a cabo un retiro para mujeres en duelo. El Campamento Jonathan, dirigido por un equipo de orientadores pediátricos en duelo, terapeutas y voluntarios entrenados, ofrece apoyo terapéutico individual o en grupo tanto a niños como a adultos en duelo. Los orientadores utilizan terapias creativas para contactar las emociones, como terapias de movimiento, arte, poesía y psicodrama para procesar el duelo y enfrentarlo de manera más exitosa. Hay otros programas disponibles en el país parecidos al Campamento Jonathan y, a menudo, son gratis para familias como la de ustedes. Si sabe usted de un Campamento así y lo recomendaría, por favor contáctenos a la siguiente dirección de correo electrónico: info@childrenshospice.org. Estamos haciendo una lista de Campamentos para que las familias puedan elegir entre ellos y la publicaremos en esta página de Internet. ### Traducción español examinada por Maribel Quiala, MSW, LCSW, miembro del Comité NASW Nacional sobre los Asuntos de la Mujer (MCOWI).

Disclaimer: The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.

By Mary Raymer, MSW, ACSW

Introduction

The social work profession helps individuals, families, groups and/or communities enhance or restore their capacity for optimal psychological, emotional, spiritual, social and physical health. Social workers are a core service on hospice and palliative care teams. Their professional values and skills are a perfect match with hospice and palliative care programs, which are designed to treat the whole person in an interdisciplinary manner to enhance quality of life during challenging times. Social workers are strong advocates for self-determination and culturally appropriate care. They are trained in evaluating the strengths of individuals and families and understand that good medical care requires that the wishes and needs of the individuals being served are respected. When cure is no longer possible, a host of psychological, physical, and spiritual stressors arise that social workers are specifically trained to assist the individual and family to cope and manage.

Social Workers assist individuals and families in the following areas:

• Symptom Management. � Physical symptom management, such as relaxation exercises to help with nausea or pain, is just one example of the services that social workers provide.
• Psychological and Spiritual Stress.� Psychological/spiritual stressors such as anxiety, guilt, or depression can be addressed and managed through counseling (including emotional support), education, or short-term psychological techniques.
• Ethical Dilemmas. � � Ethical dilemmas (such as withdrawing or withholding treatment) may also arise, and social workers are adept at problem solving, advocacy and facilitating the proper resources to find solutions that are helpful for each family.
• Financial Stress. � Financial concerns are often an issue at the end of life, and this is another area where social workers are extremely knowledgeable and successful at helping people navigate resources such as health insurance coverage, medical costs, and bills, or accessing disability income.
• Advance Care Planning.� Assistance with advance care planning to ensure that all treatments meet the wishes of the people receiving care is also within the purview of social work intervention. Advance care planning entails making decisions about treatment in end of care and funeral planning, and communicating this with loved ones and in legal documentation.
• Grief and Bereavement.� Coping with loss and the ensuing grief process is another area in which social workers are well versed. Dealing with the intense emotions associated with grief can be overwhelming without the proper support and information. Social workers have information and skills that help facilitate grief and help people avoid obstacles that can lead to more complicated reactions like depression.

How Do� Social Workers Evaluate with Individuals and Families?

Social workers on hospice and palliative care teams make an initial psychosocial evaluation that is essential to making medical care effective and appropriate for each unique family. In this evaluation, questions include spiritual and cultural beliefs so that social workers can help educate other team members as well as themselves about what each family wants, and even more importantly, what they might not want.

Past history is also crucial, because social work takes into account past strengths of the family, and identifies coping skills and strengths people have already utilized. These skills and strengths are drawn upon and enhanced to help people during their current challenge. If there are special difficulties, such as multiple losses or financial stresses, social workers help make plans to provide extra interventions, support, and/or resources.

Social Workers Are Part of a Hospice Team

As a part of the interdisciplinary team, social workers will represent the individual/family’s wishes at every team meeting and advocate within other systems to enhance their responsiveness and insure that each family receives care that is hand tailored to fit their needs. After death, social workers provide bereavement information, education, and support to help survivors cope with the death and the subsequent adjustment (”new normal”) to a life without their loved one.

A recent study (Reese and Raymer, “Relationships Between Social Work Involvement and Hospice Outcomes: Results of the National Hospice Social Work Survey”, Social Work, 2004) showed, among other things, that there was higher client satisfaction and fewer nights of inpatient care when there was more frequent social work intervention on hospice teams. With about 2.4 million people dying each year in America, it is helpful to know that more and more social workers in the field are receiving even more specialized training to help people live the last days of life as fully as possible and to help survivors find a meaningful “new normal.”

### The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.