Understanding Child and Adolescent Grief

Supporting Loss and Facilitating Growth

Carrie Arnold

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138740877
• eBook ISBN: 9781351673587
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Understanding Child and Adolescent Grief incorporates theory, clinical applications, case studies, and current research on contemporary models of grief pertaining to children and adolescents. The integration of developmental perspectives, attachment theory, and neurobiological implications provides a thorough summary of the many factors that can affect a child's growth and development, and the subsequent influence on grief expression. Chapters explore relevant social topics rarely addressed in other texts, such as the death of African American men, suicide among Aboriginal youth in Canada, death/suicide among LGBTQ youth and social media's influence. Also included are practical tips for helping professionals who want to better understand how grief and loss affect children and teens, as well as a meditation guide that provides concrete opportunities for growth and healing.

1 Introduction

Carrie Arnold

Several years ago, a colleague told me a story about a 10-year-old boy, named Sam¹, who had experienced the death of his best friend. At this young boy’s wintry funeral, Sam was making a snowman. This activity was deemed “inappropriate” and “disrespectful” by many at the funeral and Sam was admonished for “playing” at such a sombre time. Some time later, within the context of grief counseling, the therapist asked him why he was making a snowman at his best friend’s funeral. Sam replied that one of the favorite activities for him and his friend was to make snowmen, and he wanted to leave a really good one at his friend’s grave.

This story highlights several key aspects of how children make sense of death, process their grief, and the importance of adults understanding and appreciating the different ways that children make meaning of such events. While it is understandable that the adults in Sam’s life were overcome with their own anguish at the death of a child, their inability to understand Sam’s actions likely turned what could have been a beautiful tribute to his best friend into something where Sam was made to feel ashamed. Had the adults in Sam’s life been curious enough to ask, or to recognize that 10-year-olds tend to be quite concrete in their thoughts and actions, there may have been the opportunity for others to join with Sam and support him in his tribute to his best friend.

The goal of this volume is to highlight the fundamental need for adults to understand and support bereaved children and adolescents in their unique ways of grieving. There are many insightful and accomplished books written from various perspectives on the topic of children’s experiences with death, grief, and loss. This particular book has arisen from the contributors’ collective work as clinicians, educators, researchers, and consultants in the field. Our hope is to contribute to the ongoing conversation about bereaved children and youth and offer suggestions for facilitating growth and transformation amidst the pain of loss. We emphasize that the way children grieve is naturally embedded in the ways that they live. While various theoretical perspectives and clinical applications advance our capacity to offer support and assistance, the writings in this book add to these perspectives a holistic and multidimensional framework, exploring contemporary perspectives on grief and loss in addition to developmental considerations; interpersonal neurobiology; the political, social, and cultural realities in Canada and the United States; the influence of social media; and the potential benefits of attending to the mind–body connection for children who are bereaved, as well as for those who care for these children. Our collective effort is one that we hope contributes a unique and meaningful dialogue within the field.

Overview of Chapters

Beginning with an overview of developmental considerations, Chapter 2 provides the foundation for central concepts that will be noted throughout the book. The significance of attachment, its influence in the expression of loss, current perspectives on development stages, and the role of caregivers are presented. A potentially unique feature of this chapter is the integration of contemporary thinking from the field of interpersonal neurobiology, where the significance of somatic regulation and the implications for bereaved youth are discussed. The importance and applicability of developmental information is then explored further in Chapter 3, which includes an overview of typical grief responses for each age group based on developmental stages. There is an emphasis on holistic assessment processes including medical, physical, and spiritual dimensions, as well as family and social support, within the context of the child’s relationship with the deceased.

One of the more influential perspectives within thanatology is Doka’s (1989, 2002) conceptualization of disenfranchised grief. Chapter 4 begins with an explanation of this framework and its implications for young grievers. The chapter includes ways that children’s grief can be acknowledged and supported through open communication, modeling, and engagement in ritual. The significance of acknowledging children’s grief is central in Chapter 5, as it provides an overview of the relational bonds that exist between children and parents, along with typical responses of children and adolescents to the death of a parent. Additionally, there is an insightful commentary on the losses that can occur within the context of divorce, adoption, or placement in foster care.

Chapter 6 reviews the characteristics of sibling bonds and current research regarding the prevalence of childhood deaths and the subsequent responses of bereaved siblings. Typical reactions, types of support, and developmental considerations are included, as well as possible negative outcomes and the potential for growth. The benefits of therapeutic support are presented in Chapter 7, which focuses on the use of art and play therapy with bereaved children and adolescents. By highlighting grief that occurs after the death of a friend, this chapter describes the use of various creative modalities to facilitate the grief process due to their intrinsic alignment with development stages of children. This chapter provides information about the research behind, and the use of, expressive arts therapies for bereaved youth in clinical practice.

While the majority of this book explicates research and praxis related to bereaved youth, Chapter 8 offers an overview of palliative care and the children who benefit from this type of support. Related factors, such as symptom burden, maintaining quality of life, open communication, and decision making, are also featured. A poignant case study in this chapter highlights the central role of a palliative care team in providing compassionate care and support to an ill child and his or her family.

One emerging area of thanatology is the intersection between trauma and grief. Schuurman (2017) explained that the use of appropriate language is imperative when discussing these overlapping phenomena. Stating that “Death is a life-altering event but grief is not a pathological condition,” (personal communication, April 6, 2017), Schuurman cautioned against being overly diagnostic with respect to the natural distress that accompanies loss. Within this context, Chapter 9 presents contemporary conceptualizations and clinical implications for grief and trauma. This chapter also integrates Porges’ (2011) polyvagal theory of trauma within the framework of bereavement. This interdisciplinary approach helps to address these overlapping phenomena while transcending the various conceptualizations and terminologies that may not be helpful within a clinical setting.

Understanding the significance of both trauma and grief is essential within the context of suicide. Whether bereaved by suicide, or experiencing suicidal ideation, it is necessary for those working in the field to be adept at recognizing a young person’s distress and to provide effective interventions. An overview of the prevalence of suicide amongst youth in Canada and the United States is the focus of Chapter 10, along with research findings and clinical implications when working with children and adolescents.

The realities of suicide or homicide cannot be divorced from the socio-political realities of contemporary culture. In an effort to address issues of social justice and to highlight the political and societal realities that affect bereaved youth, Chapter 11 skillfully draws parallels between the types of traumatic and disenfranchised losses that are experienced by First Nations youth (Canada) and African American youth (United States). By including information about the current suicide crisis in Attawapiskat in Northern Ontario and the high-profile deaths of Trayvon Martin, Tamir Rice, and Michael Brown in the United States, the authors depict the emotional, social, and cultural losses that are embedded within the historical oppression and dehumanization of First Nations and African American communities. The chapter includes implications for future research and an outline of how to engage youth in culturally conscientious practice.

Continuing with the theme of social and political change, Chapter 12 presents information regarding the ways in which gender and sexual minority (GSM) youth are at increased risk for mental-health issues and suicide, and how they often experience numerous losses that are nonfinite and often disenfranchised. Typically referred to as LGBTQ, the term gender and sexual minority (GSM) helps to convey a more inclusive way of acknowledging how both gender and sexual orientation exist along continuums. This topic has received greater attention in both Canada and the United States due to the increased visibility of transgender youth, public advocacy for political and legal changes for those in the GSM community, and the need to have greater inclusivity and representation in grief-and-loss literature.

An additional contemporary societal phenomena related to grief and loss is the ubiquitous use of social media, particularly among youth. Chapter 13 contains current findings with respect to social media usage and the ways it may influence grieving teens. The chapter offers current statistics and skillfully illustrates the ways in which social media use can have profound effects on the transmission of emotional support and information among teens when someone dies. With examples of public tragedies and their representation on Facebook, Twitter, and text communication, the chapter explores the ways that social media can assist with the formation of continuing bonds, helpful memorialization, and survivor advocacy.

Chapter 14 includes current conceptualizations, research, and practice regarding resilience and the potential that exists for growth and transformation within the context of grief. Citing poignant examples from children’s art work, this chapter outlines the characteristics of resilient children, as well as ways that caring adults can promote this aspect of development within an increasingly complex and global society.

Being immersed as helping professionals in the complex and multifaceted communities in which bereaved children reside requires solid theoretical knowledge, strong clinical skills, self-awareness, and the responsible and ethical use of self. Chapter 15 contains an overview of key ethical principles and decision-making models that guide service sector care in Canada and the United States. Research and practical applications will be featured in this chapter, along with an exploration of the ethical practice implications that accompany self-care and attention to one’s well-being in this area of practice.

Lastly, this volume includes a brief meditation guide for children. There are several breathing exercises designed for youth to assist them in recognizing how the mind–body connection can help in times of sadness, fear, or worry. The inclusion of a meditation guide for children was done thoughtfully. While perhaps not the norm in many texts, there is a growing awareness of the benefits of acknowledging the mind–body connection and its relationship to overall health and well-being. While this book does not advocate that one ought to actively engage in this type of practice, it does offer an invitation for children and families who may wish to embrace the benefits of some form of contemplative practice, particularly when living in the midst of loss.

Intended Audience and Purpose

This book is intended for educators, clinicians, and students, as well as for caregivers of bereaved children. One goal of this volume is to offer an integrated conceptualization of childhood grief and bereavement, as well as ways of facilitating growth and transformation. For many adults, it can be unbearably painful to accept the reality that it is not possible to shield children from pain, and, as such, witnessing this anguish can be utterly devastating. That said, the grief process can also be an opportunity for growth, connection, and resilience if there is a willingness to lean into it, despite the natural inclination to avoid grief’s accompanying thoughts and feelings. Healing can unfold within a context that is guided by developmental awareness, understanding the unique needs of each child, the willingness of adults to be sensitively attuned, and the ability to be compassionately present towards oneself and others.

It may also be useful to remember that interactions with children and adolescents can involve elements of play, lightheartedness, and fun. Many years ago, in a conversation with a mentor, I was expressing concern about the devastating realities that some children experience and was looking for guidance. This mentor replied, “Remember that they are children first.” This simple message has remained with me and beautifully highlights that our focus on who this child is remains the priority, alongside his or her story of loss. While the pain and sadness that accompanies grief is reflected in these chapters, we also provide guidance regarding potential ways to foster growth and transformation. Each one of us could share stories of anguish that we have witnessed during our experience in the field, yet we could also share countless stories of healing, hope, and strength.

Lastly, it may also be wise to remember that healing can happen in moments of levity, particularly with respect to children and adolescents. A story that demonstrates this type of spontaneous humor occurred when I was teaching a class regarding the ways in which children’s age and stage of development affects their ability to make sense of death. One student shared a story of how, at the age of 7, she learned about her grandmother’s impending death. Growing up on a farm, it was the norm to take sick animals out behind the barn and euthanize them. When her mother told her that Grandma was ill and would die, she replied, “So, do we need to take Grandma out behind the barn and shoot her?” While some might find this to be a shocking response from a child, it is quite accurate when we apply the fundamental principles of how 7-year-olds make sense of death. Because the students in this class had developmental insight into how children understand such issues, they responded with uproarious laughter.

Although the focus of this book is to share knowledge regarding grief and loss among children and adolescents, there is also an opportunity for all of us, as adults, to perhaps think critically about the diverse types of losses (i.e., both death and non-death) that are all too often present in the lives of our youth. Alongside contemporary grief theory and our collective ability to respond in sensitive, informed, and attuned ways are the social, political, and cultural realities that directly shape how our young people make meaning of their experiences. It seems necessary to equip ourselves more fully in order to foster healing, resilience, and growth in children who have experienced significant losses.

Thus, we invite you to read these pages as we share an integrated perspective of children’s development and the ways in which these multidimensional processes influence their understanding, expressions of grief, and growth. We also invite you to be mindful of the need to ask a child or teen about his or her experiences, be patient enough to listen, and be willing to honor the ways in which a child makes sense of his or her losses, as well as recognize that adult discomfort with grief and loss will directly influence how youth are able to understand and live within their own experience of grief and loss.

Note

1.Name has been changed to protect privacy.

References

Doka, K. (Ed.). (1989). Disenfranchised grief: Recognizing hidden sorrow. New York, NY...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of Illustrations
• Series Editor’s Foreword
• Acknowledgements
• About the Editor
• About the Contributors
• 1 Introduction
• 2 Developmental Considerations for Grieving Youth
• 3 Assessing Grief and Loss in Children and Adolescents
• 4 Disenfranchised Grief Among Bereaved Youth
• 5 Death of a Parent in Childhood or Adolescence
• 6 A Lifetime Loss: Death of a Sibling
• 7 Using Expressive Arts Following the Death of a Friend
• 8 The Unique Needs of Children with Life-Limiting Illnesses
• 9 Understanding Trauma and Grief Complications
• 10 Suicide in Children and Adolescents: An Overview
• 11 Grief and Loss Among First Nations and African American Youth
• 12 Loss and Resilience in Gender and Sexual Minority Youth
• 13 Grief, Adolescents, and Social Media
• 14 Supporting Resilience in Grieving Kids in Today's World
• 15 Ethical Practice and Maintaining Well-Being
• Appendix: Just Keep Breathing! Mindful Breath Awareness: A Brief Manual for Kids of All Ages
• Index