Course 4 - Chevra Kadisha: Nechama Outline

Gamliel

I. Introduction to Nechama

A. Definition

1. Hebrew Roots

2. Example of Torah Reference

B. Comfort along the continuum

1. Before death

2. At death

3. After death

C. Whom do we comfort

1. The one who is dying

2. The family and friends

3. The community

4. The Chevra

D. Possibilities and Limitations of Nechama

1. What we can provide

a. Being present, listening, providing support

b. Assessing other resources needed

i. Assessing psychological or spiritual needs outside our scope

ii. Assessing physical resources needed that are outside our scope

iii. Special Requests

c. Requesting referrals to address issues

2. What we can't provide - the limits

a. Difference between nechama and counseling

b. Creating appropriate boundaries

E. Designing a Nechama Plan

1. Where do we get guidance in this area?

2. What resources are available to us?

3. What people/volunteers are appropriate and available?

4. Time frame?

5. Can it be sustained?

6. Fixed vs evolving model

7. Standard vs adaptive

8. Having the conversation with the recipient

a. Initial contact

b. Community representation

c. Responses to refusal

d. Follow-up

II. Texts

A. Traditional texts

1. Biblical sources

a. Torah

i. God's comfort

(a.) Gen 17:23 - 18:2 - Abraham and the Angels

(b.) Gen 25:11 - God appears to Isaac after death of Abraham

(c.) Husband comforted

ii. God's lack of comfort

(a.) Death of Aaron's sons

(b.) Death of Miriam - lack of comfort to Moses

b. Writings - Wisdom Literature

i. Job 1:21

(a.) friends visiting

(b.) blaming

ii. Psalms of comfort

iii. Kohelet

(a.) Death is natural

c. Prophets

i. Isaiah

(a.) Haftorah of Consolation

2. Talmud

b. Sotah 14a

c. Pirkei Avot 4:23 - shock of loss

B. Contemporary texts

1. Grief literature

2. Personal stories

III. Responsa

A. Mourning

IV. Historical evolution

A. Sources and Background

1. Bikkur Cholim (visiting the sick)

2. Chevra Kadisha including Tahara

3. Nechama

B. Jewish Hospital

1. Sick-care in the German Ghetto - CK to Jewish Hospital

C. Pastoral Care

1. Clergy

2. Chaplaincy as a profession

D. Hospice

1. why started

2. when started

3. how started

4. Jewish community

5. free standing vs home

6. Jewish certification

V. Essential Skills

A. Active listening and responsiveness

1. Empathy vs sympathy

2. Building the capacity for compassion

B. Aspects of Responsiveness

1. Preparing one's self

2. Not knowing what to say

3. Coping with discomfort - Dealing with one's own grief & reaction to other's pain

4. Blending compassion with reality

C. Learning from the mourner

1. Learning the mourner's style and needs

2. Adapting to the mourner's pace

3. Attuning to what is helpful for the mourner

D. Self-care

1. Finding support

2. Continued learning

3. Sustaining practices

a. Debriefing

b. De-compression

c. Re-centering - Physical and spiritual

E. Identifying need for outside help

1. For the mourner

2. For the comforter

F. During the Nechama course year

1. Readings about active listening and other topics covered at the conference

2. Debriefing from the conference

3. Sharing experiences as the giver

4. Sharing experiences as the receiver

VI. Role Involvement

A. Issues

1. normal role

2. no one in that role

3. flexing roles

4. what if the person in the normative role doesn't have the skills

5. what if they are unresponsive

B. Roles to examine

1. definitions

a. volunteers

b. thanatologist

c. chaplain

d. doctor

e. therapist

f. rabbi

g. funeral director

h. cemeterian

i. chevra first responders

j. Chevra Kadisha

2. cross-over

VII. Preparing the Family and the Community

A. Pre-need Issues

1. life review

2. ethical will

3. physical will

4. advance directives

5. funeral and burial planning

a. ground burial

b. funeral

i. graveside

ii. synagogue

iii. funeral home

iv. hesped (eulogy)

6. Issues around Jewish traditions

a. cremation

b. embalming

c. organ and tissue donation

7. Differing values and opinions within the family

B. Providing comfort pre-need

VIII. Nichum - Providing comfort

A. Bikkur Cholim

B. Home Care

C. Hospital

D. Hospice

E. Viddui

F. Aneinut - mourners before the burial

1. accompanying the family

2. helping with logistics

3. k'riah

4. funeral

5. hesped

6. burial

G. Aveilut - mourners after the burial

1. Meal of Comfort

2. Kaddish

3. shiva

a. Shabbat during shiva

b. Getting up from shiva

4. shloshim

5. yahrtzeit

6. yizkor

IX. Healing

A. Organized formal programs

B. Informal care

X. Challenging situations

A. Differing values and opinions within the family

B. Delayed burial

1. Military

2. Family choice

C. Burial in Israel

D. Non-Jewish

1. parents

2. spouse

3. children

E. Suicide

F. Accidents

G. Disasters

1. No Body found

H. Child Death

I. Divorce

J. Cremation

K. Embalming

L. Sudden death