Running Head: COUNSEING GRIEVING CHILDREN

Counseling Grieving Children Phillip Fentress Mobley Liberty University COUN 611 B04 201230

COUNSELING GRIEVING CHILDREN

Abstract Grief is a mature and healthy emotional process. One in which everyone has or will have experienced at some point in life; just as adults grieve, so do children and adolescents. Grief in children is nothing new. It may manifest itself in the loss of a loved one or an unforeseen and uncontrollable circumstantial event. Much is known empirically of how grief affects the lives of adults, however, little is known about the psychological and emotional effects that grief has on children and adolescents. The reality of death can only be understood by children who are psychologically mature enough to understand the finality and irreversibility of death. In order for children to gain an understanding of what death is, they need the support of a loved one to help them cope with the inevitable absolution of death. This paper will illuminate the subject of grief and bereavement in children and how it shapes their perception of reality.

Keywords: grief, bereavement, loss, trauma, crisis, depression.

COUNSELING GRIEVING CHILDREN Counseling Grieving Children On the subject of death and dying, most adults tend to shy away from the inevitability and finiteness of the topic of death. Adults simply do not want to be reminded about their own mortality. Bereavement and death are synonymous with grief. In a childs world, death is understood in stages of psychological development. How well a child accepts the reality of death depends on their understanding of loss and finality. More so now than ever, children are being exposed to traumatic grief and bereavement not only due to the loss of a loved one, but acts of terrorism and violent wars across the globe. With the current state of affairs in foreign

governments and military deployment of soldiers in hostile territories throughout the world; grief and loss are becoming a part of the mainstream societal and cultural environments. Much of what is seen in the media concerning wars and the consequences of war, many children are left wondering about their own care and safety. According to Cohen, Mannarino, Greenburg, Padlo, & Shirley (2002) childhood traumatic grief refers to a condition in which characteristic traumarelated symptoms interfere with childrens ability to adequately mourn the loss of a loved one. Empirically, researchers have found that the concepts of childhood traumatic grief suggest that it overlaps with but is distinct from uncomplicated bereavement, adult complicated grief, and posttraumatic stress disorder (p. 307). Brown, Amaya-Jackson, Cohen, Handel, Bocanegra, Zatta, Goodman and Mannarino (2008) found that every year, approximately 4% of children experience the death of a parent (Social Security Administration, 2000). By 21 years of age, over half of all participants in a representative inner-city sample had experienced the sudden unexpected death of a close relative or friend; traumatic death was the most frequent traumatic experience reported by this cohort (Breslau, Wilcox, Storr, Lucia, & Anthony, 2004) (Brown et al., 2008). Although most children cope well even after sudden death, some research has

COUNSELING GRIEVING CHILDREN indicated that children bereaved by parental death experience increased rates of psychiatric problems in the first two years after the death (e.g., Cerel, Fristad, Verducci,Weller, &Weller, 2006). However, empirical research is limited concerning what are considered normal childrens grief reactions, and, at what point their reactions enter into a range that could be considered pathological (i.e., severe enough to warrant clinical intervention) (Cohen,

Mannarino, Greenburg, Padlo, & Shirley, 2002). Developmentally, children cope with grief and loss in life stages. From infancy to adolescence, children experience death and loss in varying ways. Infants and Toddlers Infants and toddlers (babies 0 to 2-years-old) experience a sense of gone-ness or absence when someone dies (Emswiler & Emswiler, 2000; Wolfelt, 1996) (Cohen, et al., 2002). Children at this stage typically present systemically with separation anxiety due to being separated from an attachment figure; sleep deprivation; changes in eating habits; fussiness, bowel and bladder disturbances, or difficulty being comforted (Black, 1998; Emswiler & Emswiler, 2000; Grollman, 1995; Wolfelt, 1996) (Cohen, et al., 2002). According to Himebauch, Adam, Arnold, Robert M., & May, Carol. (2008) children at this age have no cognitive understanding of death. However, grief reactions are possible and separation anxiety is a concern. Behavioral and developmental regression can occur as children have difficulty identifying and dealing with their loss; they may react in concert with the distress experienced by their caregiver. There is a need to maintain routines and to avoid separation from significant others (p. 242).

COUNSELING GRIEVING CHILDREN Early childhood (Preschoolers) Preschoolers; ages 2 to 6 do not understand the finality of death. According to

Henderson and Thompson (2011) they regard it as temporary and reversible. They explain away the death of a loved one as being on a trip or being asleep (Henderson & Thompson, 2011). The concept of death is a magical thought construct; meaning, they believe that their thoughts can make things happen. Preschoolers believe that the death of a loved one is somehow their fault or if they are good enough that the deceased person will return (Henderson & Thompson, 2011). Caregivers should provide straight forward and simple explanations, being careful to avoid euphemisms, correcting misperceptions, and reminding them that the loved one will not return are important strategies (Himebauch, Arnold, & May, 2008). Middle Childhood At the age of 9 and up, children know that death is final and irreversible. Children at this age tend to see death as something tangible or physical (i.e., a spirit, angel, or ghost). They come to the realization that everyone eventually dies, they began to recognize that their own existence is fragile and finite. They fear their own demise. They may struggle with the concept of how the deceased could be buried in the cemetery and be in heaven at the same time (Saravay , 1991) (Cohen, et al., 2002). For children who have been raised in a fundamentalist Christian home, their knowledge and understanding of this concept is clear; they believe that the physical body is finite, but the soul is immortal. According to Sciarra (2004) children after the ages of 11 or 12 may have trouble concentrating on their school work, may withdraw from friends and family, and may seem angry and sad, as well as being tired and drowsy (Sciarra, 2004) (Henderson & Thompson, 2011).

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Adolescence Cognizance of grief is much more concrete among adolescents. They are capable of understanding the process of death and dying. As with younger children, adolescents are unsure of how to express their emotions. They may experience deep fear, guilt, helplessness, and grief in varying ways (Henderson & Thompson, 2011). At this phase of development, teens will rely more on their friends for support instead of parents or primary caregivers. Within the past 3 years a study was done with Searles Mcclatchey, Vonk and Palardy(2009) founded by UCLA and the University of Georgia, Athens on the prevalence of childhood traumatic grief (CTG) and posttraumatic stress disorder (PTSD) symptoms in parentally bereaved children (McClatchy, Vonk, & Palardy, 2009). The purpose of this study is to examine the occurrence and interplay of grief and post-traumatic stress disorder symptoms among parentally bereaved children, both for those children who have been bereaved by a violent/sudden death and for those children who have been bereaved by an expected death, such as that due to chronic illness. METHODS Sample Three weekend bereavement camps were held in April, May, and October of 2006 in a metropolitan area in the southeastern United States. A purposive sample was used for this study which was part of a larger quasi-experimental study. The total sample of 158 children ranged in age from 6 to 16 (M = 10.8, SD = 2.31). The length of time since death ranged from 1 to 48 months with an average of 13.48 months (SD = 12.54). Eighty-three (52.5%) of the children were female, 98 (62%) White, 50 (31.6%) African American, 9 (5.7%) Latino, and 1 (0.6%) Asian. Sixty-two (39.2%) children had lost a mother. Sixty-three (39.9%) children had lost a

COUNSELING GRIEVING CHILDREN parent to an expected death such as cancer, end-stage kidney and heart disease, and multiple

sclerosis (McClatchy, et al., 2009). Most of these deaths occurred on hospice care. As such, this study addresses the following research questions: 1. Do children who experience an expected death of a parent suffer from Childhood Traumatic Grief to the same extent as those children who lose a parent to a sudden and/or violent death (McClatchy, et al., 2009) 2. Do children who experience an expected death of a parent suffer from PTSD symptoms to the same extent as those children who lose a parent to a sudden and/or violent death (McClatchy, et al., 2009) 3. To what extent do parentally bereaved children experience CTG and PTSD symptoms (Searles Mcclatchey, Vonk and Palardy, 2009, p. 309) To assess exposure to trauma and PTSD symptoms in children ages 7-18., researchers used the UCLA PTSD indexing tool which consists of three parts, but only the third part, the frequency of occurrence of re-experiencing, avoidance, and arousal symptoms over the month prior to the administration of the scale, was used for this study (McClatchy, et al., 2009). This third part is a 20-item paper-and-pencil self-report instrument on which the participant has an option of five frequencies, ranging from 0 (none of the time) to 4 (most of the time) (McClatchy, et al., 2009). Validity of previous versions of the UCLA PTSD Index has been supported by many studies (Steinberg, Brymer, Decker, & Pynoos, 2004) and the latest scale version used in this study has shown to have good convergent validity (0.70) with the PTSD Module of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Epidemiologic version (Steinberg et al., 2004) (McClatchy, et al., 2009). The UCLA PTSD Index also has good convergent validity (0.82) with the Child and Adolescent Version of the Clinician-administered

COUNSELING GRIEVING CHILDREN PTSD Scale. Researchers have demonstrated support for the internal consistency of the latest scale version of the UCLA PTSD Index with a Cronbachs alpha of 0.90 (Roussos, Goenjian, Steinberg, Sotiorpoulou, Kakaki, Kabakos et al., 2005). A test-retest reliability coefficient of 0.84 was recently reported (Roussos et al., 2005). Scoring for this study was calculated by summing the scores for each symptom (re-experiencing, avoidance, arousal) (McClatchy, et al., 2009). The empirical findings of this study concluded that the frequency of CTG and PTSD symptoms, as measured by the EGI and UCLA PTSD Index respectively, did not differ in children who had experienced an expected loss of a parent compared with children who had experienced a violent or sudden loss (McClatchy, et al., 2009). Concurrently, every subsequent lost was impactful and devastating to the children. There was no greater devastation due to the degree of trauma or tragic loss. A child losing a parent to a sudden violent car accident was just as devastated as a child whose parent was slowly dying in a hospice center from a terminal disease. Intervention methods are varied when seeking professional assistance with grieving children. The most influential is behavior therapy. Behavior modification therapy is the key to changing

the way a child processes the idea of death and dying. A childs methodology for understanding death is magical thinking. This is the area of psychopathology that needs to be addressed when helping the child mentally process the finite reality of death. According to Pauline King, director of children's programs at the OSU James Cancer Hospital "They may look like they are coping well, because they are playing - and adults equate playing with being carefree - but they may actually be involved in a complicated and unhealthy process of mourning ("Behavior Therapy; Grief counseling reshapes children's thoughts of death," 2005)." Kings therapeutic methodology for dealing with grieving children is art therapy; giving children a voice for their

COUNSELING GRIEVING CHILDREN loss. Two graduate students and a professor/clinical supervisor from the art therapy department

at New York University discuss their experiences in the wake of September 11, 2001. DiSunno, Linton, & Bowes (2011) discuss their use of art therapy after the aftermath of the tragedy of September 11th. Images created by children suggested that symbol making after a public tragedy can have universal meaning to others experiencing grief, that image making helps process traumatic experiences so that they may be translated into words, and that therapists and clients who have experienced a common public tragedy share in processing traumatic events through artistic creations (DiSunno, Linton, & Bowes, 2011, p. 48). DiSunno, Linton, & Bowes (2011) feel that because children respond to and cope differently with traumatic experiences, the flexible use of art as a therapeutic tool is helpful for children who experience a variety of grief responses (DiSunno, Linton, & Bowes, 2011, p. 48). As described by DiSunno, Linton, & Bowes (2011) Camp Good Grief, located on the eastern end of Long Island, is a weeklong summer day camp for children aged 4 to 15 who have experienced the death of a family member or relative. The camp was founded in 1997 by East End Hospices multidisciplinary team who identified the need for specialized work with bereaved children. Theoretical frameworks from the disciplines of psychiatry, social work, art therapy, nursing, child development, and psychology are the basis for the design of the childrens bereavement program (DiSunno, Linton, & Bowes, 2011, p. 48). The response was overwhelming, both for the counselors and the children. Many of the camp workers described being emotionally moved to see the images that were created by these grieving children. In retrospect, this was one of the most emotionally draining, yet professionally rewarding experiences a counselor could have. In summation, the Bible tells us in Isaiah 53: 3-4; He is despised and rejected of men; a man of sorrows, and acquainted with grief: and we hid as it were our faces from him; he was

COUNSELING GRIEVING CHILDREN despised, and we esteemed him not. Surely he hath borne our griefs, and carried our sorrows: yet we did esteem him stricken, smitten of God, and afflicted. (KJV) Truly, Isaiahs words communicate the suffering of Christ as He was the propitiation for our sins.

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Giving His life so that we would be reconciled back to God, the Father. Surely, God had no greater grief than we shall ever know, because His only Son gave His life for us. It is for this reason, that God understands our sorrows and grief; He Himself has experienced that same heart wrenching grief that at some point in life all of us have or will experience in our lifetimes. Yet, our hearts can be glad and still rejoice knowing that if we stay on the path of righteousness, that one day we will see those whom we have lost again and on that day we will rejoice and be exceedingly grateful that God prepared a place for us and we will find rest for our souls in Him. Amen!

COUNSELING GRIEVING CHILDREN References Behavior Therapy; Grief counseling reshapes children's thoughts of death. (2005). Science Letter, 78-78.

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Brown, E. J., Amaya-Jackson, L., Cohen, J., Handel, S., Bocanegra, H. T., Zatta, E., . . . Mannarino, A. (2008). Childhood traumatic grief: a multi-site empirical examination of the construct and its correlates. Death Studies, 32(10), 899-923.

Cohen, Judith A., Mannarino, Anthony P., Greenburg, Tamra, Padlo, Susan, & Shirley, Carrie. (2002). Childhood traumatic grief. Trauma, Violence, & Abuse, 3(4), 307-327. doi: 10.1177/1524838002237332 DiSunno, Rebecca, Linton, Kristin, & Bowes, Elissa. (2011). World Trade Center Tragedy. Traumatology, 17(3), 47-52. doi: 10.1177/1534765611421964

Henderson, Donna A., & Thompson, Charles L. (2011). Counseling Children (8th ed.): Brooks / Cole, Cengage Learning.

Himebauch, Adam, Arnold, Robert M., & May, Carol. (2008). Grief in children and developmental concepts of death 138. [Article]. Journal of Palliative Medicine, 11(2), 242-243. doi: 10.1089/jpm.2008.9973

COUNSELING GRIEVING CHILDREN McClatchy, Irene Searles, Vonk, M. Elizabeth, & Palardy, Gregory. (2009). The Prevalence of Childhood Traumatic GriefA Comparison of Violent/Sudden and Expected Loss. [Article]. Omega: Journal of Death & Dying, 59(4), 305-323. doi: 10.2190/OM.59.4.b

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