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1 Slide 2 Lauren W. Schneider, LCSW Clinical Director of Childrens 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 2 Slide 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 3 Slide 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 80s. 4. Cohen & Mannarino 2000- first appearance of Childhood Traumatic Grief in the literature. 4 Slide 5 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 5 Defining Trauma and PTSD Slide 6 The Human Brain and Trauma 6 Slide 7 Impact of trauma on the brain 1. Brain Morphology 2. Neurological factors 7 Slide 8 Childhood Traumatic Grief A condition in which both unresolved grief and PTSD symptoms are present. The trauma symptoms interfere with the childs ability to go through the mourning process (Wordens Tasks) 8 Slide 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 9 Slide 10 Is the child ready to join a group? Assess childs ability to answer questions: How did your person die? 10 Slide 11 Teach Language of Feelings 11 Slide 12 Feelings Soup 12 Slide 13 Feelings Soup 13 Slide 14 1. Stress Management B. Relaxation: deep breathing and progressive muscle relaxation (belly breathing) 14 Slide 15 1. Stress Management C. Thought Stopping 15 Slide 16 2. Cognitive Triangle 16 Thoughts Feelings Behaviors Slide 17 A. Construct the narrative B. Share it with parent alone C. Discuss with parent and child in session D. Identify Cognitive Distortions 17 3. Trauma Narrative Slide 18 Sensory Prompts for Narrative 18 Slide 19 4. Cognitive Processing Address faulty cognitions connected to the Traumatic event 19 Slide 20 5. Parental Involvement A. Honest, age appropriate information B. Do you have any questions? C. Strengthen Parent system 20 Slide 21 21 Slide 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 22 Slide 23 What is this thing called Natural Grief? Behavioral Reactions Emotional Reactions Cognitive Reactions Social Reactions Spiritual reactions 23 Slide 24 Wordens 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. 24 Slide 25 TASK 1: To Accept the Reality of the Loss NOT IN DENIAL! Have to first understand what death is! 25 Slide 26 26 Slide 27 Helping child with Task 1- LANGUAGE Death is when a persons body stops working and they no longer breathe, think or feel anything and we will never see them alive again 27 Slide 28 28 Slide 29 29 Slide 30 Slide 31 Explaining Homicide Homicide is when someone hurts another persons body so badly that their body stops working and they die. 31 Slide 32 Explaining Suicide Suicide is when a person ends their own life. 32 Slide 33 TASK 2: TO PROCESS THE PAIN OF GRIEF 33 Slide 34 5 PRIMARY EMOTIONS SADNESS ANGER FEAR RELIEF OR HAPPINESS GUILT 34 Slide 35 Task 2 Activities Feelings Pie My Memory Sun Feelings Ball Angry Bags Feelings Charades 35 Slide 36 36 Slide 37 37 Slide 38 TASK 3: To Adjust to a World without the Deceased 38 Slide 39 Slide 40 Slide 41 41 TASK 4: TO FIND AN ENDURING CONNECTION WITH THE DECEASED IN THE MIDST OF EMBARKING ON A NEW LIFE Slide 42 42 Slide 43 TASK 4 ACTIVITIES Memorial Run 4 Hope Plant a tree Dedicate a plaque Volunteer 43 Slide 44 44