Promoting Healing in Grieving Children and Teens After a Traumatic Death

1. Promoting Healing in Grieving Children and Teens After a Traumatic Death

2. Lauren W. Schneider, LCSW • Clinical Director of Children’s Programs • Lenna Lebovich, MFT • School Program Coordinator • OUR HOUSE Grief Support Center • 1663 Sawtelle Blvd., #300 • Los Angeles, CA 90025 • (310) 473-1511 • www.ourhouse-grief.org

3. Agenda I Introduction to Childhood Traumatic Grief II How Trauma impacts the Grieving Process III Treatment Considerations when working with Childhood Traumatic Grief A. What is Trauma-focused CBT B. Grief counseling - Age- appropriate Language to use when explaining death, homicide and suicide

4. Introduction 1. John Bowlby – Studied grief reactions of children 2. Harvard Child Bereavement Study – 1980, Worden & Silverman 3. Pynoos et al, Lenore Terr findings on PTSD in children also in ‘80’s. 4. Cohen & Mannarino 2000- first appearance of Childhood Traumatic Grief in the literature.

5. Defining Trauma and PTSD • PTSD - diagnosed when the child has specific symptoms that continue for a month or more following exposure to a traumatic event. Symptoms must include : 1. Re-experiencing/ intrusive thoughts 2. Avoidance/emotional numbing 3. Hyper-vigilance/physiological arousal

6. The Human Brain and Trauma

7. Impact of trauma on the brain 1. Brain Morphology 2. Neurological factors

8. Childhood Traumatic Grief • A condition in which both unresolved grief and PTSD symptoms are present. • The trauma symptoms interfere with the child’s ability to go through the mourning process (Worden’s Tasks)

9. Most Grief Experts Agree • Goal: alleviate the trauma symptoms so they can begin to resolve the tasks of grieving (Cohen, Mannarino & Deblinger) • Best practice: Trauma Focused Cognitive Behavioral Therapy (TF-CBT); GTI

10. Is the child ready to join a group? • Assess child’s ability to answer questions: “How did your person die?”

11. Teach Language of Feelings

12. Feelings Soup

13. Feelings Soup

14. 1. Stress Management B. Relaxation: deep breathing and progressive muscle relaxation (belly breathing)

15. 1. Stress Management C. Thought Stopping

16. 2. Cognitive Triangle Thoughts Behaviors Feelings

17. 3. Trauma Narrative A. Construct the narrative B. Share it with parent alone C. Discuss with parent and child in session D. Identify Cognitive Distortions

18. Sensory Prompts for Narrative

19. 4. Cognitive Processing • Address faulty cognitions connected to the Traumatic event

20. 5. Parental Involvement A. Honest, age appropriate information B. “Do you have any questions?” C. Strengthen Parent system

22. Natural Grief vs. CTG • Natural Grief Comforting to think about the deceased • CTG: Avoid thinking or talking about the deceased in order to minimize frightening feelings

23. What is this thing called Natural Grief? • Behavioral Reactions • Emotional Reactions • Cognitive Reactions • Social Reactions • Spiritual reactions

24. Worden’s TASK MODEL 1. To Accept the reality of the loss 2. To Process the Pain of Grief 3. To Adjust to a World Without the Deceased 4.To Find an Enduring Connection with the Deceased in the midst of embarking on a new life.

25. TASK 1: To Accept the Reality of the Loss • NOT IN DENIAL! • Have to first understand what “death” is!

27. Helping child with Task 1- LANGUAGE “Death is when a person’s body stops working and they no longer breathe, think or feel anything and we will never see them alive again”

31. Explaining Homicide • Homicide – “is when someone hurts another person’s body so badly that their body stops working and they die.”

32. Explaining Suicide “Suicide is when a person ends their own life.”

33. TASK 2: TO PROCESS THE PAIN OF GRIEF

34. 5 PRIMARY EMOTIONS SADNESS ANGER FEAR RELIEF OR HAPPINESS GUILT

35. Task 2 Activities • Feelings Pie • My Memory Sun • Feelings Ball • Angry Bags • Feelings Charades

38. TASK 3: To Adjust to a World without the Deceased

41. TASK 4: TO FIND AN ENDURING CONNECTION WITH THE DECEASED IN THE MIDST OF EMBARKING ON A NEW LIFE

43. TASK 4 ACTIVITIES • Memorial Run 4 Hope • Plant a tree • Dedicate a plaque • Volunteer