DEATH & GRIEF

G505Andrea DavasherKassy Franchville

Chris Kempf

What Is Grief?

“Grief is the emotion people feel when they experience a loss. There are

many different types of loss, and not all of them are related to death. For example, a person can also grieve over the breakup of an intimate

relationship or after a parent moves away from home.”

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

“Grief is a natural reaction to the loss of someone important to you. Grief

is also the name for the healing process that a person goes through after someone close has died. The

grieving process takes time, and the healing usually happens gradually.”

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

*“Although everyone experiences grief when they lose someone, grieving affects people in different ways.”

*Depends on relationship with person.

*Circumstances under which they died.

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

Cont.

*Knowing someone is going to die can give us time to prepare.

*If they were suffering, it can mean a sense of relief.

*If the person that died was young, we may feel it was unfair.

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

“Losing someone suddenly can be extremely traumatic, though, no

matter how old that person is. Maybe someone you know died unexpectedly

- as a result of violence or a car accident, for example. It can take a

long time to overcome a sudden loss because you may feel caught off guard by the event and the intense feelings

that are associated with it.”

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

*Grief can make us feel guilty.

*Some people might blame themselves or think they could have done something to stop the death.

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

“Others might think if only they had been better people, than their loved

ones might not have died. These things aren't true, of course - but

sometimes feelings and ideas like this are just a way of trying to make sense

of something that's difficult to understand.”

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

Coping With Grief

“The grieving process is very personal and individual - each person goes through his or her grief differently. Some people

reach out for support from others and find comfort in good

memories.”

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

Coping cont.

*Throw selves into activities to take mind off loss.

*Become depressed and withdraw from activities, peers, family.

*Everyone handles grief in different ways.

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

“For some people, it may help to talk about the loss with others.

Some do this naturally and easily with friends and family, others talk to a professional

therapist.”

1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html

Do children experience grief?

“Yes, if children are old enough to love, they are old enough to grieve. Many times in our

society children are the forgotten grievers. For instance, when a parent dies, whom do we expect to help the child with their grief? The

surviving parent. That parent not only has their own grief to deal with but they are learning for the first time how to be a single parent. They,

like their child, can use support in their grieving.”

Excerpt from David Kessler’s website “On Grief & Grieving”By Elisabeth Kübler-Ross & David Kesslerhttp://www.davidkessler.org/html/qa_grief.html#9

Example

“Joey's friends expected he'd be really upset at his mom's funeral, so they were surprised

that he was smiling and talking with people as if nothing had happened. When they asked him about it, Joey said that seeing his friends

at the funeral cheered him up because it reminded him that some things would still be the same. Joey was able to cry and talk about how he felt when he was alone with his dad

after the funeral.”

Reviewed by: D'Arcy Lyness, PhDDate reviewed: April 2004KIDS/TEEEN.ORG

Counselors should keep in mind: “Children don’t grieve the way we do.

They don’t openly talk about how they are feeling. A death in their life

usually causes them to feel even more different than usual.”

Bereavement groups can be a helpful tool for children.

KESSLER

DSM IV V62.82 Bereavementalong w/diagnosis of Major Depressive Disorder

“This category can be used when the focus of clinical attention is a reaction to the death of a loved one.”

Can be linked with a “Major Depressive Episode (e.g., feelings of sadness and associated symptoms such as insomnia, poor appetite, and weight loss).”

Symptoms must still be present 2 months after loss. Can’t be considered “normal” grief reactions.

DSM IV, p 740-741, V62.82*Very limited information

What are the Five Stages of Grief and Do They

Always Occur in the Same Order?

The five stages:

Denial Anger

Bargaining Depression Acceptance

Elisabeth Kübler-Ross

Youtube video clip

Summer expresses her grieving for Marissa in five stages. From episode 4x04 "The Metamorphosis".

http://www.youtube.com/watch?v=iIfg2wXv6vk

Stages (cont.)

The stages are tools to help us frame and identify what we may be feeling.

Different for everyone.Doesn’t always happen in exact order,

may revert before moving forward.

KESSLER

Typical Physical Symptoms of Grief

difficulty going to sleep, or waking in the middle of the night

weight loss or gain; over- or under-eating

low energy or fatigue

headaches, chest pain, or racing heart

upset stomach or digestive problems

hair loss

Grief or Depression? Grief

Experienced in waves

Diminishes in intensity over time

Healthy self-image Hopelessness Response to support Overt expression of

anger Preoccupation with

deceased

* * Excerpts from Therese A. Rando (1993). Treatment of Excerpts from Therese A. Rando (1993). Treatment of Complicated Mourning. Research Press, Champaign, Complicated Mourning. Research Press, Champaign, IL.IL.

Depression Moods and feelings are

static Consistent sense of

depletion Sense of worthlessness

and disturbed self-image

Pervasive hopelessness Unresponsive to support Anger not as

pronounced Preoccupation with self

There are many ways people who are grieving can help themselves:

– Attending support groups– Therapy with a psychologist or other

licensed mental health professional– Journaling– Eating Well– Exercising– Getting enough rest– Antidepressants such as Zoloft, Paxil,

Wellbutrin, Lexapro, Celexa, Prozac and can be very effective to those who become clinically depressed

(continued)

– Reading and learning about death-related grief responses

– Seeking comforting rituals– Avoiding major changes in

residence, jobs, or marital status– Allowing emotions– Seeking solace in the faith

community

Factors that may hinder the healing process

Avoiding or minimizing emotions

Using alcohol or drugs to self-medicate

Using work to avoid feelings

Gender Differences Women

express their feelings early after loss

reach out for social support

are seen to express more sorrow, depression, and guilt

more willing to talk about the loss of a child

Men

more likely to take on a managerial role

intellectualize their emotions

indicate that they feel more anger, fear, and loss of control

use denial more more private about

grief

Developmental Grief Responses

Ages 2-4Concept of Death

– Death seen as reversible Grief Response

– Intensive response but brief– Very present oriented– Most aware of changes in patterns of

care– Asking questions repeatedly

Developmental Grief Responses

Ages 4-7 Concept of Death

– Death still seen as reversible – Feeling of responsibility because of

wishes and thoughts Grief Response

– More verbalization– Great concern with process. How? Why? – May act as though nothing has happened– General distress and confusion

Developmental Grief Responses

Ages 7-11 Concept of Death

– Still wanting to see death as reversible but beginning to see it as final

– Death seen as punishmentGrief Response

– Specific questions – Desire for complete detail– What is the right way to respond? – Starting to have ability to mourn and

understand mourning                      

Developmental Grief Responses

Ages 11-18 Concept of Death

– Ability to abstract– Beginning to conceptualize death

Grief Response– Extreme sadness– Denial– Regression– More often willing to talk to people outside of

family and peer support– Risk-taking

It's only when we truly know and understand that we have a limited time on earth -- and that we have no way of knowing when our time is up, we will then begin to live each day to the fullest, as if it was the only one we had.

~Dr. Elisabeth Kübler-Ross

Needs of the 2 – 5 year old

Kind and understanding tone of voice and demeanor

Encouragement to talk about how s/he feels in whatever way s/he can express it

Permission to “play about” death and the events surrounding the experience

Open and direct manner that says “I’m with you and you are with me. There are no secrets.”

Needs of the 2 – 5 year old(continued)

Sharing of how you feel or felt when a similar thing happened

Reassurance that remaining family members will take care of the child

Needs of the 5 – 9 year old

Clear answers in simple terms to the questions that they ask, no matter how improbable their fears seem

An accepting listener to the memories s/he has of the deceased

Explanations to refute the magical beliefs that feed their fears

Acceptance of play, artwork, songs, etc. about the events surrounding the death

Needs of the 9 – 12 year old

To be taken seriously, no matter how shallow his/her concerns seem

To be included in family discussions about the changes brought about by the death

To have his/her ways of grieving acceptedWhile this age-group may understand death

intellectually, they may have great difficulty understanding it emotionally.

Needs of the Teenager

To be included in planning & decision making

To be informed of what to expect in terms of events, ceremonies, rituals, etc.

To know what to expect from various relatives

To know what is expected of themTo witness adults grieving so they can

learn adult ways to grieve

Needs of the Teenager(continued)

To be encouraged to talk about what they think and feel and have their thoughts and feelings respected

What to Do

Act naturalShow genuine care and concernMake it clear that you are there to listenTalk openly and directly about the

person who diedKeep in mind that evenings, weekends,

anniversaries, and holidays can be extra challenging times

What to Do

Find a way to help children symbolize and represent the death

Pay attention to the way a child plays; this is one of the main ways that children communicate

Say that you are sorry about the lossSit next to a child that wants closeness

What NOT to Do

Try to shelter children from the reality of death; it can be a learning experience

Give false or confusing messages (“Grandma is sleeping now.”)

Tell a child to stop crying because others might get upset

Try to cheer the person up or distract from the emotional intensity (“At least he’s no longer in pain.” “She’s in a better place now.”)

What NOT to Do

Offer advice or quick solutions (“I know how you feel.” “Time heals all wounds.”)

Pry into personal mattersAsk questions about the circumstances

of the death

Grief Groups

By sharing feelings with one another, children find out that they are not alone and that others are also struggling to rebuild shattered lives. Grief

groups help children feel understood, accepted, and

supported.

How do you start a group?

1. Open-ended: new kids can arrive at any time, and group introductions will need to be made often. The advantage is that children will have more time to work on their grief, especially after sudden, violent, or traumatic deaths.

2. Walk-in: this format frees students from any commitment and fits into the busy routine of school life. The difficulty is not knowing who or how many kids will attend.

How do you start a group?

3. Time-limited: these groups work best in the school setting. School schedules often do not allow the flexibility for an on-going group. Students may also be more comfortable knowing there is a beginning and an end to the group. The number of sessions is usually 8 – 12, but shorter groups could be offered along with the opportunity for teens to request an additional session or sessions.

How do you select group members?

Group leaders have to decide on the parameters of the group. Is this going to be limited to students who have had a parent die, or will it be more general? Are there enough students to do a group focusing on parent loss? This type of focused group may work best, but grief groups that are broader in nature work well too.

Referrals may come from teachers, coaches, students, or parents.

The school newsletter or website can be a good place to advertise the group.

Group ActivitiesWriting or drawing spontaneously on mural

paper taped to the wallCreating a collage using pictures and words

cut from old magazinesWriting a poem, eulogy, or songConstructing a book that can be used as a

journal or a memory bookLaunching a balloon after writing messages

to the person who diedGoing on a field trip to a funeral home,

cemetery, etc.

Signs that Bereavement in Young People Needs Outside Intervention

If a young person pretends that absolutely nothing has happened

If school work takes a dramatic decline or the student develops a school phobia

If a young person threatens suicideIf a young person panics frequentlyIf a young person becomes involved with

alcohol or drugsIf a young person begins committing serious

socially delinquent acts

Signs that Bereavement in Young People Needs Outside Intervention

If news of a death or other significant loss was kept from the young person for a long time or if the young person was told lies about the death

If a young person frequently physically assaults others or is cruel to animals

If a young person had a difficult relationship with the deceased or behaves poorly with family members

If the young person is unwilling or unable to socialize with other young people