grief and loss – interventions with children

GRIEF AND LOSS – INTERVENTIONS WITH

CHILDRENSMH Intern Training

October 17, 2012Cyndy Lum, LCSW

Grief is an inevitable, never-endingtemporary disruption in a routine, aseparation, or a change in a relationship thatmay be beyond the person’s control. Thisdisruption, change, or separation causes painand discomfort and impacts the person’sthoughts, feelings, and behaviors. Althoughloss is a universal experience, the causes andmanifestations of it are unique to eachindividual and may change over time.(Fiorini & Mullen, 2006, p. 10)

Definition- Grief and Loss

Death of parent or primary caregiver

Death of close friend Death of family

member Death of classmate Serious illness of

parent or loved one Divorce of parents Incarceration/separation

Move to new home Change of schools Death of pet Illness, loss of health

for self or family member

Loss of peer friendship Breakup of

relationship Birth of a sibling Military deployment of

parent

Major Losses Other Losses

• Grief Stats:

Michelle A. Post, MA, LMFT , (310) 927-5611 , Email: [email protected]

Kenneth Doka, Editor of OMEGAJournal

o 1 in 5 children will experience the death of someone close by the age of 18

o 1 in 20 children will experience the death of a parent by the age of 18

Early Theoretical Models

John Bowlby and Colin Parks, 1970

Elizabeth Kubler-Ross, On Death and Dying, 1969

4 phases of young child’s separation response

Numbness Yearning and protest Disorganization and

despair Reorganization

5 stages of grief

Denial Anger Bargaining Depression Acceptance

1. To Accept the Reality of the Death – to accept that the deceased will not be a part of everyday life

2. To Experience the Pain of the Death – to experience the intense feelings of grief and work through them

3. To Adjust to an Environment in which the Deceased is Missing

to work through the struggles of practical everyday life where the deceased is no longer there

4. To Relocate the Dead Person within One’s Life and Find Ways to Memorialize the Person – to reinvest one’s energies in life and integrate the memories of the deceased in a new relationship

William Worden’s 4 Tasks of Mourning

Exploring Your Own Grief

A C T I V I T Y

And “Listen”

He’s an undercover agent. You have to keep his secret.

DVD available for purchase [email protected]

CODENAME: SIMON

Michelle A. Post, MA, LMFT , (310) 927-5611 , Email: [email protected]

HOW DO CHILDRENPERCEIVE DEATH?

GRIEF REACTIONS

Irritability and crying Changes in sleeping

and eating patterns Bowel/bladder

disturbances Reacts/responds to

parental grief

WAYS TO HELP

Have a consistent, nurturing caregiver

Consistency in routines and affection

Normal Grief Responses and Reactions – 0 to 2 years

Grief ReactionsBelieves death is reversibleCan become withdrawn,

depressedNightmares, agitated at

nightMay ask questions over and

overSeparation anxiety – can’t

sleep alone, over clingingMay seem unaffected in their

play

Ways to HelpSimple, honest words and

phrasesEmphasize death is

permanent and can be understood

Explain that the child did not cause the death and death is not a punishment

Listen to the child’s feelings, thoughts and concerns

Ages 2 to 5

Grief ReactionsBeginning to understand

that death is final but won’t happen to them

Magical thinking – feels responsible for the death

Lacks verbal ability to express strong feelings of grief

May act as though nothing happened (defense mech.)

Death is represented by monsters and ghosts

Ways to HelpHelp children cope by giving

simple, accurate info.Be aware there may be

confused thinkingOffer physical outlets

(punching bag, pillows)Include in funeral ritualsGive reassurance about the

future and surviving parentEncourage regular routines

Ages 6 to 9

Grief ReactionsUnderstands death is finalDifficulties concentratingCuriosity about what

happens when someone dies

Identifies with deceased – imitates mannerisms

Has the vocabulary to express grief but may choose not to

Begins to search for their own philosophy of life and death

Ways to HelpNeeds encouragement in

discussing their concernsOffer honest and direct

answersAllow child to draw, use

physical outletsDo not avoid questions the

child may haveCreate opportunities to talk

as a family

Ages 9 to 12

Grief ReactionsShock, denial, anxiety,

distress, anger, depressionDifficulties concentratingDecline in school workMay complain of physical

pains, fatigue, drowsinessBecome withdrawn, isolatedIncreased risk taking, drug or

alcohol useDifficulties controlling mood

Ways to HelpMay feel vulnerable, allow

them to talkReactions similar to adults

but they have fewer coping skills

Ask who they are talking with about the death, encourage them to express themselves

Include in funeral and memorial rituals

Encourage regular routines

Adolescents

Group Activity: What Happened?Purpose: Have members do a drawing/writing activity to share memories of how the person died, how they were told, and their reactions to the deathMaterials: paper, markers, crayons, colored pencils

Include in the drawing or writing activity how the person died, who told you about the death, what did you remember feeling, seeing, hearing, tasting, smelling, or touching. Were you in the hospital? Were you able to say goodbye? Did you see the body?What was the most surprising thing about the death? Add a title to the activityShare the project with your other group members

From: Week 3 Grief Curriculum by Michelle Post

Individual and family therapyGroup counseling or support groupsUse of art - drawing, collage BibliotherapyWriting – poems, stories, memory bookMusic – listening or composingDance – movement therapyFaith based – prayer, meditationCultural practices Being a caring adult who listens and cares

Interventions with Children who are Grieving

1. Be present to them with loving compassion2. Permit teens to own their own pain. To empathize is one thing; to

interfere is another.3. Listen with your heart. Allow their sorrow to surface so they can

heal.4. Accept all expressions of grief5. Permit the teen to talk about the deceased. Talking is therapeutic.6. Be available to comfort during bouts of intense grief and

loneliness.7. Encourage rest, nutrition and exercise.8. A simple “thinking of you” note promotes healing9. Be willing to listen again and again. Discussing the deceased is

important to healing.10. Mention the deceased by name. It encourages communication.

How to Comfort the Bereaved TeenCircle of Life, Phoenix, Arizona

Closing Ceremony: Releasing the Balloons

RESOURCESMichelle A. Post, Happenings: 8-9 Week Grief Group for

Children and ParentsOur House, www.ourhouse-grief.org – support groups for

children, teens and surviving parents (310) 475-0299The Compassionate Friends, South Bay Chapter (310)368-

6845For bereaved parents and siblingsSurvivors after Suicide – contact Sam and Lois Bloom

(310)377-8857New Hope Grief Support Community – grief support and

education groups for children and adults (562) 429-0075The Gathering Place – support groups for loss of a child and

support groups for children and teens. (310) 374-6323

http://www.ourhouse-grief.org/