Lisa Kynvi NER 2011 Children's Bereavement Slides

8/7/2019 Lisa Kynvi NER 2011 Children's Bereavement Slides

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Lisa Kynvi, MA, MT-BC, LMHCMerrimack Valley Hospice

Lawrence, Mass.

1Sunday, April 3, 2011


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OUTLINE

1. Central Concepts

a. Loss

b. Bereavement

c. Grief

d. Mourning

2. Types of Loss

3. Important Factors4. Prominent Issues

5. Bereavement Needs

6. Four Tasks of Mourning

7. Continuing Bonds

8. Development &Bereavement

9. Case Example:

Pre-Bereavement10.Case Example:

Stand By Me project



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FOUR CENTRAL

CONCEPTS

Loss

Bereavement

Grief and Grieving

Mourning



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LOSS

Primary Loss

Separation from lost person, object, status,

relationshipSecondary Loss

Follows from primary loss

Meaning

Depends on what is involved & childs

interpretation



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BEREAVEMENT

Situation of having experienced loss. The child:

has a relationship with a person who is valued

experiences the lossending, termination,

separationof that relationship

is deprived of the valued person by the loss



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GRIEF

Reactions to the loss

Internal & external

Experienced, but may or may not be expressed

outwardly

Many types of reactions...



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GRIEF: TYPES OFREACTIONS TO LOSS

Feelings (i.e. sadness, anger, guilt, self-blame)

Physical sensations (i.e. lump in throat,hollowness in stomach, dry mouth,exhaustion)

Cognitive responses (i.e. disbelief, confusion,preoccupation, difficulty concentrating,dreams of deceased)



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GRIEF: TYPES OFREACTIONS TO LOSS

Behaviors (i.e. sleep or appetite disturbances,regression, bedwetting, loss of interest in

activities, crying)

Social difficulties (i.e. fighting, problems atschool)

Spiritual dimensions (i.e. searching for asense of meaning, hostility toward God)



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GRIEF

Most grief in children & adolescents is healthy,

normal, appropriate reaction to lossSome grief reactions can become excessive,

complicated, unhealthy

Although unusual for a child, does NOT meanabnormal or alien, like disease is to health



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GRIEF

Generally avoid use ofsymptoms in bereavement

Symptoms are indicators of disease

Thinksigns, manifestations of grief

Honest reactions to loss are real, cannot be turned on& off at will

Developmental situation & individual personalitywill influence grief



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GRIEF

Usually grief reactions come from:

Realization someone loved & valued is gone

Recognition that child has been left behind

Simply realistic human reactions

Griefis reactions to loss,grieving is process ofexperiencing those reactions...



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MOURNING

Mourning is childs responses to, and processes

of, coping with loss & grief

Childs efforts to manage his/her experiences

in bereavement, and

To incorporate them into ongoing living



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MOURNING

Mourning two complementary aspects:

Internal, private (intrapersonal) process childsinward struggle to cope with both loss & griefreactions to loss

Outward, public (interpersonal) processchildsovert, visible, shared expressions of grief,together with efforts to obtain social support



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MOURNING

Mourningis childs capacity to move toward, workwith her/his loss & grief

Hopeful child can eventually find solace orcomfort, perhaps even grow through managing

experiences in bereavement



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MOURNING

Mourning is one of the most profound human

experiences that it is possible to have. . . . The deepcapacity to weep for the loss of a loved one and to

continue to treasure the memory of that loss is one

of our noblest human traits.

Shneidman, E. S. (1995). Voices of death. New York: Harper & Row



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MOURNING

The way we deal with loss shapes our capacity to

be present to life more than anything else. The way

we protect ourselves from loss may be the way in

which we distance ourselves from life.

Rachel Naomi Remen (2010) on the American Public Mediaradio program Speaking of Faith



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TYPES OF LOSS

Typical types of death children & adolescents encounter

Grandparents

Parents

Significant adults: extended family, teachers, neighbors,parents of friends

Peers, friends, classmates

Cherished pets

Adolescents can experience death of own offspring



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IMPORTANT FACTORS

What was the nature of the relationship between thechild and the person who died?

Were there complications to consider?

Were there mixed feelings?



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IMPORTANT FACTORS

The way the death occurred

Natural & expected?

Sudden & unexpected?

Human element in causation?

Trauma?

Violence or multiple deaths?

How it is shared with the child?



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PROMINENT ISSUES

Issues likely prominent in experience of bereaved

children:

1. Did I cause it (death or other form of loss)?

2. Is it going to happen to me?

3. Who is going to take care of me?



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BEREAVEMENT NEEDS

Reassurance they are not to blame

Careful listeningsomeone who will hear them out & notminimize their concerns

Validation of feelingsrespect for & safe ways to expressindividual reactions in their own ways

Help with overwhelming feelingsespecially intensesadness, anger, anxiety, guilt



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BEREAVEMENT NEEDS

Involvement & inclusionbefore & after death, withpreparation, without being forced to join in

Continued routine activitiesage-appropriate activities,play & school

Modeled grief behaviorsadults who can share their owngrief & mourning, show how to experience & express in

constructive ways

Opportunities to rememberboth after death & throughoutlife



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4 TASKS OF MOURNING

Worden (1996)

1. To accept the reality of the loss

The death may seem unreal to many bereaved children &adolescents

Involve children in making losses real, acknowledging &accepting reality of the death



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4 TASKS OF MOURNING

2. To experience the pain or emotional aspects of the loss

Find ways of experiencing the pain encountered duringbereavement in a manner that is not overwhelming



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4 TASKS OF MOURNING

3. Adjust to an environment in which the deceased is missing

Requires child to determine significance of now-severedrelationship,

to identify each of the various roles that the deceasedplayed in the relationship,

and to adjust to the fact that the deceased is no longeravailable to fill such roles



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4 TASKS OF MOURNING

4. Relocate the dead person within ones life & find ways to

memorialize the person

Change or restructure a cherished relationship in light ofthe new realities brought about by death,

Even as memorialization activities honor and treasure thelegacy of the deceased persons life



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CONTINUING BONDS

Developed from research on childhood bereavement (Silverman,Nickman, & Worden, 1992)

For bereaved children, important to maintain form ofsymbolic connection to loved one who has died

Rather than disengaging, breaking bonds, putting the pastbehind them, getting over it, orforgetting the deceased,

Bereaved children often work to alter their relationship todeceased & develop a set of memories, feelings, actionsthat keep them connected to that individual



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DEVELOPMENT &BEREAVEMENT

All stage-based theory is flawed:

Resist treating in overly rigid way

Resist drawing sharp lines between stages

Resist applying in fixed, mechanical ways

All aspects of development in childhood are complex & highlyindividualized

Particular children are organic, living beings with multipledimensions

Children dont move in mechanical ways through preordainedlevels



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Hungarian psychologist Maria Nagy

Children Under 5

Recognize death, but not as irreversible, final or definitive

Consciousness attributed to the dead

Death may be understood as

departure, kind of continued life elsewhere

sleep, diminished form of life



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Children Ages 5 to 9

Accept existence & definitiveness of death, but think ofdeath as a reality that is remote from them

Death conceived of as final, but avoidable, not inevitable& not universal

Not satisfied with fact of loved ones disappearance; wantto know where & how deceased continue to live



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Children Over Age 9

Recognize death is a process operating within us

View death as final & universal, inevitable & not

avoidable



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Sub-concept SubordinateComponent

Typical Questions from a Child

UniversalityIs it true that all living things must

eventually die?

All-inclusiveness Does everyone die?

Inevitability Does everyone have to die?

Unpredictability Is the timing of death certain andpredictable?

IrreversibilityOnce you are dead, can you come

back to life again?

Non-functionality What do you do when you are dead?

CausalityWhy do living things die? Whatmakes them die?

Non-corporealcontinuation

What happens after death? Where doesyour soul or spirit go when you die?

SUB-CONCEPTS



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1:1 time, small private room

Question: If I were a friend at school who

came to you at recess & I was having a hard

time because someone I loved had died, howmight you try to help me?

Almost regardless of what question we ask,

what arises is what the child needs to talkabout.

Great therapy, processing opportunity



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I listened to individual recordings manytimes

I typed & printed key quotations from

recordings, no names attachedHanded out quotations to the group (no one

knew whose was whose)

During group, took turns reading them aloudKids had quotes as they wrote song verses,

for inspiration; no one quoted directly



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Do you miss them? What happened?

Are you okay?If its in school, tell the teacher, Can I go to

the bathroom or can I go somewhere else?

Think about what youve done with her.

I ask my family to come to me and tell me,

Calm down. Calm down. They wait for me

to stop crying.

Basketball, soccer, football.

We pray all night and we know that theyre

in our corazn, that means heart.



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Stand by Me Original Song by Ben E. King

When the night has come, and the way is darkAnd the moon is the only light we'll see

No, I won't be afraid, No, I - I - I won't be afraidJust as long as you stand, stand by me.

Chorus: So darlin' darlin' stand by me, Ooo stand by me Oh stand, Stand stand by me, C'mon stand by me

If the sky we look upon should tumble and fallAnd the mountain should crumble to the seaI won't cry, I won't cry, No, I won't shed a tear

Just as long as you stand, stand by me.

Chorus~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~When _____________________________________And _______________________________________Then ______________________________________Just _______________________________________

Chorus

If__________________________________________And _______________________________________Then ______________________________________Just_______________________________________

Chorus____________________________________________________________________________________________________________________________________

____________________________________________



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Shifting plans for the recording:

A. Record kids singing their ownlyrics.

(none of them agree to sing)

B. Ok, record kids playing aninstrument, multi-track, over

me singing their lyrics.

(missed session due to snow)

C. Fine, Ill sing their lyrics, but

will also mix in their spokenwords (recorded in individualsessions).



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Like I know more stuff for my age than a lot of people do.

(original verse)

When the night has come, and the way is dark,And that moon is the only light you see.No I won't be afraid, no I-I-I won't be afraidJust as long as you stand, stand by me

Chorus:

So darlin' darlin' stand by me, Ooo stand by me Oh stand, Stand stand by me, C'mon stand by me

That its going to be okay, and that hes probably in a better placenow... or she. And I would hug you.

(original verse)If the sky we look upon should tumble and fallAnd the mountain should crumble to the seaI won't cry, I won't cry, no, I won't shed a tearJust as long as you stand, stand by me.

Chorus52Sunday, April 3, 2011


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I miss my mom, and I love her, and I wish she could hold me. Its okay.

When you went away, I criedAnd I felt all aloneThen the memories, they made it okayJust remember: I will see you again some day

Chorus

There is no worrycause mostly your mother can be in your head,your heart and even in your soul, either way if it isnt or if it is. Yes.

When Im sad, I dont need to worryI dont need to worry every time I cryBecause I- I- I am bein protectedI just be calm and play with my friends

Chorus


I l ith f i d Lik l i b k tb ll


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I play with my friend. Like playing basketball. Read a book or watch TV. Basketball. Soccer. Football. Batten ball.

A color might make me feel betterAnd remembering all the animals that we coloredThen looking out the window, seeing birds & treesJust stand, stand by me

Chorus

My meme she used to like always color with me when I slept overthere.

Well, sometimes she tells me stories about her. Tell like your mom that if she has any, like, videos of her and you

together or something.

When I hear stories about herAnd I, I feel sadThen I cry, then I cry, oh then I cryI just feel her hold me

Chorus



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Hug her. Pray to God that I love you. Maybe like say, I want you to stay with me tonight. When I was never born, my dad died in an accident. I lost my grandfather, my dad, then my uncle. 2009 and 2010. Well, Id talk about how great he was, or what he might have that he

couldnt have down here.

When I am trying to go to sleepAnd laying there in bed all aloneThen I think of my dad, oh I think of my dadJust laying, laying there with me

Chorus

Shell always be there with you in your heart. Do you miss your dad? What happened? You okay? Pray to them every night, and you should always love them, and

theyre always- theyre always with you.



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If I am having a bad dayAnd I am fighting with my sisterThen I go outside and play basketballJust having fun, that is all I need

Chorus

Its gonna be okay, and maybe you will be fine in like the last couple,couple of few days.

When I am mad, and when I need helpAnd when I am having troubleThen I need a hug, oh then I need a hugJust give me a hug and Ill be fine

Chorus

Sometimes- I know with me, you start thinkin about her one day, andthen you just like break down. I yell. Sometimes I cry, sometimes I justtake a little walk or jog around my block and just talk to myself. Itskind of lettinyour emotions out and then you dont feel as bad lateron.



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I ask my family, come to me and tell me to calm down, calm down

and for me to stop crying. And I told my grandma that my dad is- andmy, and my uncle-is in your heart. And I saw her stop crying, and shestarted believing me. Because we pray all night and we know thattheyre in our corazn, that means heart.

When Im having a bad day

And sittin- sittin there cryingThen I hope youll be there, then I hope youll be thereJust waitin, waitin just for me

Chorus

They didnt want me to feel like sad. So they like- they would just- they

would just like not say nothin. And that kind of like made me feel likedo they not even care? But my friends told me that they just didn twant to make me sad, so they didnt say nothing.



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When I am mad- I cryAnd I dont want to talkThen everything goes round, everything goes round

Just like, just like the world

Chorus

Well always be there for you. Talk to somebody in your family, or do something like what your

brother did.

If- if I, if I tell why and I - I will cryThen I take a deep breathOh I take a deep breathAnd just, just calm down

Chorus

Maybe you should think about what youve done with her, or look atpictures of her and you, or share stories about what, what were greatdays you had with her.



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The things youve loved or the things that are sad or happy or silly. To think of happy things instead of bad things. And that everything

would be okay. So that they would feel okay.

(original verse)

When the night has come, and the way is darkAnd the moon, is the only light you seeI won't be afraid, no I won't be afraidNot as long as you stand by me.

You know that the person that died to you is going to always be there.

And that its- theyre always going to be watching you. And that itsgoing to be okay if you believe that theyre there with you.



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Documents

Lisa Kynvi NER 2011 Children's Bereavement Slides