GRIEF AND LOSS – INTERVENTIONS WITH CHILDREN

1. GRIEF AND LOSS – INTERVENTIONS WITH CHILDREN SMH Intern Training October 17, 2012 CyndyLum, LCSW

2. Definition- Grief and Loss Grief is an inevitable, never-ending temporary disruption in a routine, a separation, or a change in a relationship that may be beyond the person’s control. This disruption, change, or separation causes pain and discomfort and impacts the person’s thoughts, feelings, and behaviors. Although loss is a universal experience, the causes and manifestations of it are unique to each individual and may change over time. (Fiorini & Mullen, 2006, p. 10)

3. Major Losses Other Losses • 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 • 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

4. Grief Stats: • Kenneth Doka, Editor of OMEGA • Journal • 1 in 5 children will experience the death of someone close by the age of 18 • 1 in 20 children will experience the death of a parent by the age of 18 Michelle A. Post, MA, LMFT , (310) 927-5611 , Email: michpost@ca.rr.com

5. Early Theoretical Models 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 John Bowlby and Colin Parks, 1970 Elizabeth Kubler-Ross, On Death and Dying, 1969

6. William Worden’s 4 Tasks of Mourning 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

7. Exploring Your Own Grief And “Listen” A C T I V I T Y

8. CODENAME: SIMON He’s an undercover agent. You have to keep his secret. DVD available for purchase grahamtallman@yahoo.com Michelle A. Post, MA, LMFT , (310) 927-5611 , Email: michpost@ca.rr.com

9. How do children perceive death?

10. Normal Grief Responses and Reactions – 0 to 2 years • WAYS TO HELP • Have a consistent, nurturing caregiver • Consistency in routines and affection • GRIEF REACTIONS • Irritability and crying • Changes in sleeping and eating patterns • Bowel/bladder disturbances • Reacts/responds to parental grief

11. Ages 2 to 5 Ways to Help Simple, honest words and phrases Emphasize 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 Grief Reactions Believes death is reversible Can become withdrawn, depressed Nightmares, agitated at night May ask questions over and over Separation anxiety – can’t sleep alone, over clinging May seem unaffected in their play

12. Ages 6 to 9 Ways to Help Help children cope by giving simple, accurate info. Be aware there may be confused thinking Offer physical outlets (punching bag, pillows) Include in funeral rituals Give reassurance about the future and surviving parent Encourage regular routines Grief Reactions Beginning 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

13. Ages 9 to 12 Ways to Help Needs encouragement in discussing their concerns Offer honest and direct answers Allow child to draw, use physical outlets Do not avoid questions the child may have Create opportunities to talk as a family Grief Reactions Understands death is final Difficulties concentrating Curiosity 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

14. Adolescents Ways to Help May feel vulnerable, allow them to talk Reactions 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 Grief Reactions Shock, denial, anxiety, distress, anger, depression Difficulties concentrating Decline in school work May complain of physical pains, fatigue, drowsiness Become withdrawn, isolated Increased risk taking, drug or alcohol use Difficulties controlling mood

15. 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 death Materials: 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 activity Share the project with your other group members From: Week 3 Grief Curriculum by Michelle Post

16. Interventions with Children who are Grieving Individual and family therapy Group counseling or support groups Use of art - drawing, collage Bibliotherapy Writing – poems, stories, memory book Music – listening or composing Dance – movement therapy Faith based – prayer, meditation Cultural practices Being a caring adult who listens and cares

17. How to Comfort the Bereaved TeenCircle of Life, Phoenix, Arizona • Be present to them with loving compassion • Permit teens to own their own pain. To empathize is one thing; to interfere is another. • Listen with your heart. Allow their sorrow to surface so they can heal. • Accept all expressions of grief • Permit the teen to talk about the deceased. Talking is therapeutic. • Be available to comfort during bouts of intense grief and loneliness. • Encourage rest, nutrition and exercise. • A simple “thinking of you” note promotes healing • Be willing to listen again and again. Discussing the deceased is important to healing. • Mention the deceased by name. It encourages communication.

18. Closing Ceremony: Releasing the Balloons

20. RESOURCES Michelle A. Post, Happenings: 8-9 Week Grief Group for Children and Parents Our House, www.ourhouse-grief.org – support groups for children, teens and surviving parents (310) 475-0299 The Compassionate Friends, South Bay Chapter (310)368-6845 For bereaved parents and siblings Survivors after Suicide – contact Sam and Lois Bloom (310)377-8857 New Hope Grief Support Community – grief support and education groups for children and adults (562) 429-0075 The Gathering Place – support groups for loss of a child and support groups for children and teens. (310) 374-6323