grief counseling groups in a medium-security prison

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Grief Counseling Groups in aMedium-Security PrisonMargaret J. Olson a & Margaret A. McEwen ba University of Wisconsin Oshkoshb Thrivent Financial for LutheransPublished online: 12 Aug 2010.

To cite this article: Margaret J. Olson & Margaret A. McEwen (2004) Grief CounselingGroups in a Medium-Security Prison, The Journal for Specialists in Group Work, 29:2,225-236, DOI: 10.1080/01933920490439392

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Grief Counseling Groups in aMedium-Security Prison

Margaret J. OlsonUniversity of Wisconsin Oshkosh

Margaret A. McEwenThrivent Financial for Lutherans

The authors discuss their facilitation of four grief counseling groups with maleinmates in a state prison over a two-year period. Worden’s Tasks of Mourning wereused as a guide for the group process. Disenfranchised grief and gender and cul-tural issues in grieving are explored. Catalytic exercises are described, and writtenfeedback from inmates is included. The authors also describe the impact theseexperiences had on themselves as counselors and facilitators of the groups.

Keywords: grief counseling groups; prison inmates; tasks of mourning;disenfranchised grief

According to a report by Bureau of Justice Statisticians Beck andMaruschak (2001), significant attention has been directed toward gen-eral mental health needs of incarcerated individuals across the UnitedStates by federal, state, and private correctional facilities. Beck andMaruschak described mental health policies, screening procedures,and treatment plans as well as numbers of inmates receiving 24-hourcare, counseling or therapy, and psychotropic medications. Of the1,558 facilities reporting, 1,055 screened new inmates, 1,073 providedcounseling or therapy, and 1,115 distributed psychotropic medications.

The authors’ state has experienced severe budget cuts in recentyears (as have many others’ states) with resulting discussions onappropriate placement for inmates convicted of nonviolent crimes.Proponents of community-based treatment programs have encouragedthe state to reduce costs through changes in the criminal justice sys-tem, including prevention efforts. Mental health needs of inmates in

Margaret J. Olson is a professor in the Department of Counselor Education at theUniversity of Wisconsin Oshkosh. Margaret A. McEwen is the manager of employeehealth for Thrivent Financial for Lutherans, Appleton, Wisconsin. Correspondence con-cerning this article should be addressed to Margaret J. Olson, Department of CounselorEducation, University of Wisconsin Oshkosh, Oshkosh, WI 54901; phone: (920) 424-1475; fax: (920) 424-0858; e-mail: [email protected].

THE JOURNAL FOR SPECIALISTS IN GROUP WORK, Vol. 29 No. 2, June 2004, 225–236

DOI: 10.1080=01933920490439392

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general have been recognized, but resources for adequate treatmentare limited (Ebert, 2003).

While state prisons provide educational, vocational, and religioustraining and intensive treatment programs for anger managementand cognitive restructuring, they have fewer resources to offer assist-ance with loss and bereavement (Personal communication, S. Clark,September, 2000). Inmates have experienced many losses in additionto the deaths of loved ones. In a workbook specifically developed forincarcerated men, Welo (1999) lists loss of possessions, jobs, control,freedom, relationships, childhood, spirituality, and dreams and goals.

Disenfranchised Grief

Bereaved persons are excluded from the mourning process in manyways, as Doka (1989) has shown with his work on disenfranchisedgrief. Relationships, losses, and grievers all may be disenfranchised;that is, not recognized or supported by society. Prison inmates andtheir relationships often are not well regarded by others. They maybe considered disenfranchised grievers, because they are removedfrom their natural support systems. The secondary losses resultingfrom their incarceration, such as loss of freedom, privacy, and familycontact, are disenfranchised losses. Very little information can befound in the literature on bereaved prisoners, and it appears that theirgrief may not be of great concern to others. When grief is not recog-nized as valid, feelings of anger, guilt, and powerlessness can resultin a complicated grief response. (Rando, 1993).

Grief Support Groups For Disenfranchised Grievers

Pesek (2002) suggested that support groups benefit disenfranchisedgrievers ‘‘because they provide the opportunity for the griever to makepublic what he or she feels must remain private elsewhere’’ (p. 92).Many prison inmates have experienced significant losses prior to aswell as during their incarceration. Perhaps they are not consideredto be ‘‘entitled’’ to grieve, because they are being punished for breakingsociety’s laws. Even the basic privilege to mourn a lost loved one maybe taken away from them.

Pesek also discussed advantages and disadvantages of professionalleaders and self-help groups, open-ended and time-limited groups,structure and screening, and facilitator qualifications. She empha-sized the importance of support for all relationships, losses, and grie-vers, noting that even in well-run groups, members may not feel safein sharing specific details of their relationships with the people theymourn.

226 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / June 2004

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Gender Issues in Grieving

Doka and Martin (2002) provided insight into the much-discusseddifferences between ways women and men are thought to grieve. Theycited Zinner (2000) on the disenfranchisement of men who do not ap-pear to grieve openly, even though male socialization with regard toemotional expression is a well-known phenomenon. They also sum-marized their observations that people in general grieve differentlyand can be considered to be on a continuum between ‘‘intuitive’’(affective) and ‘‘instrumental’’ (cognitive, physical, or behavioral)grievers. These patterns are not necessarily sex-typed. A man maybe inclined to share openly but afraid to do so; a woman may preferto engage in physical activity rather than to talk about her feelings.

Winterowd, Morgan, and Ferrell (2001) studied facilitator goals andtraining for group work with male prison inmates. They noted ‘‘Forinmates, group may be their place to learn how to share or releasepent-up thoughts and feelings in socially and therapeutically appropri-ate ways without hurting themselves or others in the process’’ (p. 414).

Cultural Issues in Grieving

It is critical in a grief support setting to consider cultural differ-ences with regard to religious beliefs, spirituality, and ritual. By ex-ploring with group members some ways in which bereavement isaddressed in different cultures, facilitators can demonstrate that thereis no one ‘‘right way’’ to grieve. Sharing beliefs in a supportive, respect-ful group setting can be enriching for everyone, including the facilita-tors (Doka & Martin, 2002).

A prison represents a small community, and as such has its ownculture. In any group meeting within a prison, it is important forthe facilitators to become acquainted with the culture of that parti-cular setting. Prisons are unique in programming as well as in waysin which inmates relate to each other, approach their work or edu-cational assignments, worship, and so forth. Each new inmate mustbecome accustomed to the ‘‘way things are done’’ in that particularenvironment. This acculturation can lead to feelings of disenfranchise-ment in prisoners. Often their own cultural belief systems aredeferred, not recognized, and leave a void in the manner in whichthe prisoners view the world.

Tasks of Mourning

Worden’s (1991) work with bereaved persons resulted in a movefrom looking at grief as a stage or phase framework to what he

Olson, McEwen /GRIEF COUNSELING GROUPS 227

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considered a more practical approach. Rather than focusing on whereclients might be in the grieving process, he encouraged counselors andtherapists to assist them in approaching grief as a series of tasks to befaced.

Task 1. From Worden’s perspective, the first task challenging thebereaved is To Accept the Reality of the Loss. When someone dies,there is always a sense that the death really did not occur. Wordenmade a distinction between accepting the loss and accepting thereality of the loss. Persons who are unable to face the reality of theloss may have great difficulty with the remaining tasks.

Task 2. The second task is To Work Through the Pain of Grief.Facing the pain of loss is hard work, and often people avoid normal,but intense grief reactions, placing the pain deep within themselves.According to Worden, pain that is not fully experienced, felt, andworked through may manifest at some point as illness or depression.Grief can become complicated if there is a less than supportive socialsystem to endorse open mourning.

Task 3. Working through the pain of grief is followed by the thirdtask, To Adjust to an Environment in Which the Deceased is Missing.Worden distinguished between ‘‘acceptance’’ and ‘‘adjustment.’’ It isnot necessary to accept the loss of loved ones; however, the bereavedeventually must learn to cope without the loved ones in their dailylives.

Task 4. The fourth task is To Emotionally Relocate the Deceasedand Move on With Life. The mourner who has accomplished this taskrealizes that the loss can be integrated into the here and now. The re-lationship with the deceased has changed, but it has not been obliter-ated. Bereaved persons can learn to find ways to hold on to thememories of their loved ones without being prevented from developingor pursuing significant relationships with the living.

Worden (1991) believed that bereavement work in a group contextcould be very effective (pp. 54–55). Grievers could benefit greatly fromthe emotional support inherent in the group process, because theyoften feel alone in their pain.

GRIEF COUNSELING GROUPS AT THE OSHKOSHCORRECTIONAL INSTITUTION

This article will report on four grief counseling groups for medium-security prison inmates using Worden’s tasks of mourning as aframework. Although each group was based on the tasks of mourning,the facilitators attempted to modify their approach as appropriatefor each group and with the results of informal feedback assessments.


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The groups were similar to Corey and Corey’s description of counse-ling=interpersonal problem-solving groups (1997).

Setting

The Oshkosh Correctional Institution (OSCI), located on the out-skirts of a city of 62,000 residents and university students, housednearly 2,000 inmates. Its charge from the state of Wisconsin was‘‘the dual responsibility of protecting society and equipping the menwho are entrusted to its care for their return to society’’ (OSCI,2000, p. 3). Educational, vocational, and rehabilitation programs werewell established, and volunteers were invited to assist with classesand groups. Inmates’ spiritual needs were served by Roman Catholicand Lutheran chaplains who offered pastoral support, organized Biblestudies, and arranged for religious services of all faiths.

Although the chaplains were well aware of the many types of lossesassociated with imprisonment, their primary reason for hoping to pro-vide grief support groups was to provide help for inmates who experi-enced significant losses while incarcerated. The chaplains werepermitted to view videotapes of funeral services with individualinmates, but they recognized the need for further support in assistingthe bereaved inmates. Additionally, the chaplains were concerned thatpersons outside of the inmates’ families often did not validate inmategrief. Because they did not have the necessary resources to providegroup work, the chaplains requested volunteer counselors to facilitatethe groups.

Participants

The groups were limited to nine members. The chaplains publicizedthe groups and met with each interested inmate to determine his ap-propriateness for group work. In each group all but one or two mem-bers were Caucasian. The men’s ages ranged from the early twentiesto the mid-sixties. Nearly all participants had experienced the deathsof close persons prior to, during their incarceration, or both. The facil-itators were not given information on individual participants’ criminalhistories, but many of the inmates had completed or were concurrentlyparticipating in treatment programs for anger management, sexualoffense, and substance abuse.

Facilitators

The groups were co-facilitated by the authors. One is a professor ofcounselor education; the other is a nurse practitioner. Both were


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members of a local pastoral counseling agency board. Both hadconsiderable group leadership experience, but neither had worked ina correctional setting prior to facilitating the first group.

Structure

The groups were closed-ended and time-limited with either six,seven, or eight sessions, depending on the time of year and the facili-tators’ schedules. The first group met eight times, the second metseven times, and the third and the fourth met six times each. Eachgroup session lasted 90 minutes. Members were expected to attendeach session and were required by the prison to sign in. They also wererequired to return to their units immediately after a session ended.Worden’s tasks of mourning (1991) were used as a guide for thesessions.

Materials

Copies of Metzgar’s (2000) A Time to Mourn, A Time to Dance wereprovided by the second author’s employer and checked out to eachmember for the duration of the group. The book was used to give themen information on the grieving process as well as support in theirown grief reactions. The facilitators distributed a series of handoutson various aspects of bereavement during the first group, and thismaterial was developed into a booklet used by later groups.

Group Sessions

The door to the room had a window to the hallway, enabling prisonguards to monitor the inmates without hearing session content. Forthe first group, two large tables were moved to one end of the roomso that the group members could sit in a circle with nothing betweenthem. Later groups were arranged so that the members and facilitatorscould sit around a table. On one occasion a group session was held in achapel with carpeting and soft lighting, but the chapel was not avail-able for regular use. This was unfortunate, because the atmospherethat evening seemed especially conducive to optimal group process.

Initial session. Although the development of each group was unique,each progressed in approximately the same manner as described inthe group counseling literature. Initial sessions focused on introduc-tions, ground rules, expectations, and a description of the Wordentasks of mourning. Before closing the first meeting with a ‘‘go around,’’the facilitators invited the participants to bring to the next meetingcopies of obituaries or programs from funerals of their loved ones.


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They also asked the men to bring photographs of the deceased lovedones whenever they would like or would be able to do so. Frequentlythis required a letter or telephone call to a relative who then wouldprovide the photographs.

Because most of the men had been involved in other groups, theywere familiar with the basics of group work. In each group there weremen who were eager to share their stories and others who needed timeto develop trust in others and themselves. Without exception, every-one listened intently to each other.

Early sessions. A goal for the second session was to assess whetheror not the group members had completed Worden’s first task of mourn-ing, To Accept the Reality of the Loss. Examining each others’ funeralprograms and obituaries gave the men opportunities to remember andrelive the moment they learned about significant deaths. It also helpedthem to compare losses experienced while incarcerated with prior onesand funerals they were able to attend. A common statement was that adeath did not seem real if one could not visit the gravesite.

Middle sessions. The men generally seemed to find some relief indiscussing their progress in accepting the reality of the deaths. Fre-quently, several group members were ready to move on to the secondWorden task, To Work Through the Pain of Grief. At least two sessionsof each group were devoted to providing time for members to showtheir photographs and talk about their grief reactions. Opening one-self to the pain of loss is hard work, and some of the inmates weremore familiar with thought-stopping procedures. A great deal of re-spect was expressed to the speakers, though, and the facilitators wereimpressed with the ability of many of the men to empathize withoutthen taking the focus off the speaker.

After each group member had shared photographs or discussedphotographs they used to own or wished they had, the facilitatorsbrought in a basket of small objects chosen to elicit additional memor-ies and emotions about loved ones. One of the men in the first groupchose to hold a teddy bear while he talked about the two-year-old childhe and his wife had lost. Another chose a globe bank, because his par-ents had taken the family on many wonderful trips in the past. Otheritems included a small rag rug, a decorated box, a foam rubber heart,and a goose feather. These items served as metaphors for the men andseemed to help everyone understand each other more fully.

Music was an important part of these middle sessions. Initially, thefacilitators chose some vocal recordings and distributed the lyrics, ask-ing the men to choose songs that were meaningful to them. Groupmembers sometimes brought or sang favorite songs. Sometimes musicwas played quietly in the background. Often connections were madeamong members and facilitators who shared the same favorites.


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Worden’s third task, To Adjust to an Environment in Which the De-ceased is Missing, also was difficult, especially for group members whohad experienced ambiguous relationships with the deceased. Somewere unsure of what the world without the loved one would be likeafter their release from prison. The Metzgar book addresses, very sen-sitively, different types of death losses such as deaths from accidents,suicide, and disease. Each group member found something in the bookthat comforted him and helped him in his attempts to adjust to hischanged world. For some it was a particular photograph or poem,and for others it was a moving description of a loss similar to hisown. One of the men asked for information on ordering the book,because a relative wanted to buy a copy for him.

Later sessions. As the group sessions neared the ending dates, thefacilitators invited the men to write letters to their deceased lovedones. This was done to encourage them to work toward the finalWorden task, To Emotionally Relocate the Deceased and Move onWith Life. The power of this exercise was evident when the letterswere read aloud to members who listened in complete silence and thenoffered their appreciation and compassion to the writers.

Final session. The theme of reaching out to others was emphasizedin a closing exercise. Large note cards were distributed to the mem-bers at the end of the second-to-last session. The facilitators askedthe members to think of messages they would like to leave with eachof the other members and the facilitators, who also would prepare acard for each member. The last session began with the members tak-ing turns reading one card at a time and presenting it to another mem-ber or a facilitator. Some chose to write notes with feedback andencouragement, some selected poems or Bible passages, and somedrew pictures. After all the cards had been shared and each personthanked, the groups processed the messages, the entire group experi-ence, and their feelings about the group ending. This processingunfolded easily and naturally each time, taking approximately onehour. The facilitators then distributed feedback sheets, asking themen to complete and return them to the chaplain’s office.

MEMBER OUTCOMES

Closing Messages

The cards presented to the members and facilitators during theclosing session provided direct, although not anonymous informationon member satisfaction with the groups. Many of the messages indi-cated appreciation for the opportunity to share with each other and


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the growth they experienced. The following was written to one of thefacilitators:

What a charm you are. You found the right music for several of us, butyou knew that was going to be a breaking point for some of us to open up.We talk, we cry, and we care about each other! When you shared aboutyour past and present griefs, it made sharing not just an ‘inside’ (theprison) program. Your knowledge of testing the waters of our emotionspaid off. We will go our ways, but we will remember each other inthought and prayers.

A particularly sincere note given to one of the facilitators illustrateswell the concept that the men appreciated being thought of as caring,hurting human beings.

‘Yet many will not believe there is any such things as a sympathy ofsouls.’

Isaak Walton, Life of Dr. DonneThis is a poem that really sticks out in my mind when I think of

our group sharing our grief. No matter where we come from or whatwe’ve done to get there, we still all have feelings and we still allgrieve the loss of our loved ones. Thank you for taking the time tocome in and lead us to where we need to go. . .healing our pain anddealing with our loss.

Another note that struck a chord with the authors follows:

I want to leave a message with you, sometimes we men in here have ahard time sharing with people from the outside community. But youhave a way of making that ice melt off, and you give the feeling of con-cern for our grief and feelings. Take with you in your heart that youmade a difference in my life of grief. I will always remember you. Keepteaching the best you can.

Structured Evaluation Forms

An evaluation tool based on the Worden tasks of mourning providedthe facilitators and chaplains with important feedback. The anony-mous evaluation form and sample responses to each question are pro-vided below.

How or in what ways has the group experience helped you to accept thereality of your loss?

‘‘Discussing past memories helped increase the acceptance of the un-seen. The group gave me a sense of relief from guilt I had carried, aheavy burden for years in my heart over the passing of my brother,and then losing my father as well.’’


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What might have helped more?‘‘Being aware of a group like this before. Hearing more examples of

the things people do or say to keep the hope alive.’’How or in what ways has the group experience helped you to work

through your pain?‘‘Talking about my mother, talking about the positive things and

allowing myself to cry and feel comfortable because I knew all the othermen were feeling the same thing.’’

What might have helped more?‘‘I liked hearing the music in the background a lot. It was soothing

and helped me to be in the right mood to express my feelings. I wouldlike to hear some poems or testimony on tape or more prayers.’’

How can you take some of your experiences from the group away withyou and use them in your life in the future, especially when you are out-side of the prison?

‘‘Now that I know that the feelings, emotions, and behaviors that Ithought were strange or weird and were mine alone, are common toall kinds of grief it will be easier to recognize what is happening andbe able to share them with friends and family.’’

What else might have helped?‘‘Having specific things to do each week, homework.’’Has the group experience helped you to find a special place in your

heart for your loved one so that you can reinvest in life?‘‘Yes, talking about all the things that my mother gave to me and

taught me, inspired me and loved me, I’ve already shared a lot of thethings from the group with my sister and my brother. I love that book,the soft pictures and quotes and poems.’’

What else might have helped?‘‘More time per group and not having to move the tables around every

week. Keeping people on track and discussing things related to our griefonly.’’

DISCUSSION

Most of the members of these groups had prior group experience inanger management or chemical dependency groups and were familiarwith group process as well as prison rules regarding appropriateconduct. In each of the four grief counseling groups, the memberswere respectful of the facilitators and empathic with each other.They listened carefully and thought about the group during the daysbetween sessions. The facilitators’ volunteer status may have beenan advantage with regard to acceptance and trust. The group contentseemed to lead naturally to the development of group cohesion whileold as well as new losses were shared.

Given the national and state demographics for prison populations,the facilitators were concerned with the small numbers of persons ofcolor in the groups. The Native American and African Americanmembers participated fully in the groups and did not discuss race-related concerns in their experiences in the institution. Perhaps this


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was because most of the staff and the community volunteers wereCaucasian.

Tasks of Mourning

The men reflected on the reality of their losses and worked throughthe pain of their grief. These tasks are difficult for anyone, but theymay be even more so for persons who also have lost their freedom.Most of the men were not able to say good-bye to a dying parent,attend a funeral, or visit a grave. They were socialized not to cry,especially in front of other males. The third task of mourning, to adjustto an environment without the deceased, at first seemed nearlyimpossible to those in prison. The fourth, finding a special place inone’s heart for the deceased and reinvesting in life, seemed especiallychallenging to men who were separated from loved ones and leery ofdeveloping relationships inside the institution.

Facilitator Reflections

These group experiences taught the facilitators as much as themembers. The facilitators learned to monitor confrontation that mayhave been appropriate among members in other types of groups. Theylearned to deal with complaints about the prison that were not rel-evant to the group content. They also learned more about the univer-sality of grief, the collective pain of loss. They became aware that theright to grieve often is taken away when a person is incarcerated. Eachloss is unique, not only because causes, circumstances, and relation-ships vary, but also in the way the bereaved individual perceiveslosses. Yet death touches everyone, and the human soul seems to knowthat in sharing pain there is healing. The second author wrote thefollowing poem after leaving the prison at the end of the first group.

Within These Walls

Beyond the lockers, metal detectors, watchful eyesThe grayness permeates, the air is thick.Up, up, up the ramp the two go forward

Oblivious to the razor fence above their heads.No music here; no warmth or comfort.

The men wait outside the glassed-in roomTo talk about the ones they loved and lost

With others who do not want to know their crime.The circle forms and through the weeks evolvesInto a living, breathing, growing orb of grief.

My pain, your pain, lonely nights with pen in handSuch poetry and beauty I have never known.

McEwen, 2000


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REFERENCES

Beck, A. J., & Maruschak, L. M. (July, 2001). Mental health treatment in state prisons,2000. Bureau of Justice Statistics Special Report. U. S. Department of Justice.

Corey, M., & Corey, G. (1997). Groups: Process and practice. (5th Ed.). Pacific Grove, CA:Brooks=Cole.

Doka, K. J. (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA:Lexington.

Doka, K. J., & Martin, T. L. (2002). How we grieve: Culture, class and gender. InK. J. Doka (Ed.) Disenfranchised grief: New directions, challenges, and strategiesfor practice. Champaign, IL: Research Press.

Ebert, K. (February 9, 2003). Too many inmates, too few dollars. Deficit sparks debate onlow risk prisoners. Oshkosh, WI: Oshkosh Northwestern.

Metzgar, M. (2000). A time to mourn, a time to dance. Appleton, WI: Aid Association forLutherans.

Oshkosh Correctional Institution (2000). Program information booklet. Oshkosh, WI:author.

Pesek, E. M. (2002). The role of support groups in disenfranchised grief. In K. J. Doka(Ed.) Disenfranchised grief: New directions, challenges, and strategies for practice.Champaign, IL: Research Press.

Rando, T. A. (1993). Treatment of complicated mourning. Champaign, IL: ResearchPress.

Welo, B. (1999). Life before loss: A workbook for incarcerated men. Revised edition.Landham, MD: American Correctional Association.

Winterowd, C. L., Morgan, R. D., & Ferrell, S. W. (2001). Principal components analysisof important goals for group work with male inmates. The Journal for Specialists inGroup Work, 26, 406–417.

Worden, J. W. (1991). Grief counseling & grief therapy. New York: Springer PublishingCompany.

Zinner, E. (2000). Being a man about it: The marginalization of men and grief. Illness,Crisis, and Loss, 8, 181–188.


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grief counseling groups in a medium-security prison

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