Working with Grieving Children Deborah Weisberg, LMFT, LPCC

Clinical Coordinator of Children’s Programs

Introduction to OUR HOUSE Grief Support Center

• Largest non-profit grief support center with two locations in California

• Non Sectarian, non profit

• Age and relationship specific groups

• Only grief support center serving children as young as 2 1/2 and adults across the life span

• Core Belief: Grief is a natural reaction to a life cycle event

Our Services

• Grief Support Groups (Adults and Children)

• Camp Erin ( 2 sessions June and August)

• School Program- several different districts including

LAUSD as well as charter and magnet schools all over the

city, especially in high risk, low income areas

• Spanish Satellite Program for Adults Only

• Grief Workshops throughout the year

• Professional Trainings (CEU’s)

• On Site Community Grief Response

Universality

• Taboo subject in our society

• Hospice Movement- more people are dying at home surrounded by friends and family

• National Average in our society is 30 days in Hospice.

• Hospice means facing death.

• Many doctors view death as a failure so they avoid talking about it

• Our group members often say they wished their doctors would have been more open about death

• Our discomfort shapes the way we approach grievers

Universality (cont.)

• 1:5 children have experienced the death of someone close before the age of 18. (Kenneth Doka)

• Grief takes longer than most people think. The most significant changes in the DSM V are that there is no time frame and that a category has been added, called Persistent Complex Bereavement Disorder (PCBD). This disorder is characterized by severe persistent grief and mourning reactions.

Facilitating Healing

• Direct, Truthful, Age-Appropriate language

• Better for them to hear news from someone they trust

• Avoid Euphemisms

Definition of death for younger children: “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.”

J. William Worden’s Task Model

• Four Tasks of Grief

• Non-Linear Model- Circular Model

• Outlines tasks grievers undertake while moving through the grieving process.

• Goals for Children/Teens

Worden’s Four Tasks of Mourning: 5 Goals for Children

To Accept the reality of the loss

To Process the Pain of Grief

To Adjust to a World Without the Deceased

To Find an Enduring Connection with the deceased in the midst of embarking on a new life.

Task 1: To Accept The Reality of the Loss Goal: For the child to understand what happened to their person who died

• Requires the ability to understand what the meaning of death is

• Child’s ability to do task 1 is dependent on:

Developmental level

Age of the child

Previous history of loss

INFANT

• React to separation from their attachment figures

• Sensitive to changes in the responses of caregivers

• Physical manifestations of Grief:

Changes in eating

Changes in sleep patterns

Vocalizations

Irritable

Heightened separation anxiety

TODDLER (until age 4 or 5)

• Magical Thinking makes it impossible to understand death. Regress to earlier stage of development

• Cognitively unable to understand death related concepts:

Irreversibility

Unpredictable

Universality

Causality leading to non-functionality

School Aged ( 6-10 years)

• Concrete thinkers

• Death is permanent

• Somaticize or “act it out” their grief

• May not look like their grieving “Short sadness span” (Nancy Boyd Webb)

• Can’t tolerate intensity so take breaks to play

Pre-Adolescent and Teens

• Lack emotional maturity to process grief like adults • Ego- centric • Magical thinkers Magical thought is a child’s inaccurate conclusion (s) regarding loss experience, resulting in the child believing that he or she is responsible for the loss experience and needs to fix the loss experience.

Dr. James Fogarty, The Magical Thoughts of Grieving Children

• Controlled by moods • Depressive symptoms • Changes in patterns of eating, sleeping • Trouble concentrating • Impulsivity or poor judgment-risk taking behaviors

Teens (Cont.)

• Social problems due to feeling different

• Separation-Individuation process impacted

• Ex: Hailey

• May take on adult roles, worries prematurely

Interventions: Task 1

• Reading Books : Brave Bart; My Memory Book for Grieving Children, Teen Journal

• Write or Draw about the day of death; day of the funeral or memorial service

• Write or Draw where your person is now.

• The 5 Senses –see, hear, taste, smell, touch

Task 1 Activity

Task 1 Drawing

Task 1 Drawing

Task 1 Drawing

Explaining Suicide to Children

• Define Suicide in simple terms

• Give honest, age appropriate information about what actually caused the death

• Answer questions honestly or by saying

“I wish I could answer that question”.

• Ask children to identify who they would go to for help if they ever felt so depressed they wanted to die

Definition of Suicide & Homicide

• Suicide: The act of killing yourself so that your body won’t work anymore.

• People who kill themselves often do so because they are suffering from a disease called Depression.

• They can’t think clearly and feel very, very depressed.

• Sometimes they feel hopeless that things will never get better and that life is not worth living. They may feel there is no other way to solve their problems or to end the pain they are feeling.

• Homicide: is when someone ends someone else's life”

Task II: To Process The Pain of the Grief Goal: For the child to express their feelings of what happened

• Children and Teens lack the emotional capacity to

tolerate intense feelings for extended periods of time

• Naturally take breaks from their grief to play, socialize, study

• Often leads to the misconception that they weren’t grieving because they don’t appear sad

• When talking about normalizing feelings, try saying what was that like for you instead of how does that make you feel?

5 Primary Emotions

•Sadness

•Anger

•Fear

•Relief or Happiness

•Guilt

5 Primary Emotions (cont)

SADNESS:

•Child lacks social skills to verbalize sadness

•May cry “on the inside” for fear of being ridiculed

•May hide sadness out of concern for surviving family

5 Primary Emotions (cont.)

ANGER

Person who died

Doctors

G-d

Surviving family

Self (guilt)

5 Primary Emotions (cont.)

FEAR

• that they will die

• feel less safe in the world

• that someone else will die

•need to know who would care for them if their parent/guardian were unable to do so

5 Primary Emotions (cont.)

RELIEF OR HAPPINESS

• if deceased was suffering from a long, painful disease

• if deceased was abuser

• if child always had to be quiet

or other family members were unavailable because they were

caring for a person at end of life.

5 Primary Emotions (cont.)

GUILT

•Survivor guilt

•Relationship guilt – “should haves & could haves”

•Causation guilt

Guilt Drawing

Ways to Help with Guilt

Teens (and other kids too!)

• Identify thoughts

• Time travel intervention--Would’ves, Should’ves, Could’ves

• Identifies lots of thoughts—not just magical ones…sometimes regret.

• Intervention:

• Find the flaw in the thought

• Ask questions to help child arrive at another conclusion

• Don’t say “It’s not your fault!”

Interventions: Task II

•Feelings Pie: makes it visual not just verbal

•Feelings Ball

•Angry Bags(physical release from popping the bags)

•Feelings Jenga

Task II Drawing

Task II Drawing

Task III: To Adjust to a World without the Deceased Goal: For the child to find ways to get their needs met in the absence of the

• Also known as “secondary losses”

• Assist the child in finding ways to get needs met in the absence of the person who died. Children need help holding onto their memories of the person who died in their family

• Prepare child for special days: birthdays, holidays, anniversary dates, vacation days

Ex: who will they spend Christmas with now that mom has died

• Collaborate with school personnel to make sure they understand how long grief lasts

Interventions: Task III

•Holiday Projects

•Letters To and From the person who died

•Emergency Plan

Task IV: To Find An Enduring Connection with the Deceased In The Midst of embarking On A New Life Goal: For the child to be able to maintain the bond and find ways to honor the memory of the person who died person who died

• Families can engage in activities that will help the child maintain the bond with the person who died

• Engage in memorial activities

•People become more future oriented over time

•Pursue goals

Task IV (cont.’)

• Find ways to memorialize

• Commemorative activities also help with Task 1

• Encourage child to maintain the connection

• Engage in activities in honor or in the absence of that person

• Encourage child to engage in exploratory activities and pursue new goals

Interventions: Task IV

•Connected for Life

•My Patchwork Quilt of Memories

•Run 4 Hope

•Plant a tree

•Dedicate a plaque

•Volunteer

In the Classroom

• Provide accurate information

• Dispel Rumors

• Lead classroom discussion for expression of feelings

• Model appropriate responses including tears if appropriate

• Suggest ways to cope after school

• If a child is having difficulty concentrating, offer short break to speak to counselor

5th Goal for Children & Teens

Teach children coping strategies to help them cope

Deep breathing (candle/flower; spaghetti)

Air Punch

Journaling

Exercise

Talk to a trusted friend or family member

Listen to Music

Preparing Children for Mourning Rituals

• Offer age-appropriate explanations for burial and cremation

• Encourage children to participate : “Chance to say good-bye to grandma”

• Suggest ways can help with the preparations for the ritual:

make a collage of photos

Choose something to place in the casket

Select music to be played at the service

Self Care

Your reactions to a death will be affected by various factors:

• Your own history with death

• If you are actively grieving

• The nature of the death

• Your own personality