Helping Children with Loss

A Guidebook

Margot Sunderland, Nicky Armstrong

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000538847
• Edition: 2
• Topic: Bildung
• Subtopic: Bildung Allgemein

Now in a fully updated second edition, this professional guidebook has been created to help adults provide emotional support for children who have experienced the loss of somebody they know, or something they loved.

Written in an accessible style and with a sensitive tone, Helping Children with Loss provides adults with a rich vocabulary for mental states and painful emotions, paving the way for meaningful and healing conversations with children who are struggling with difficult feelings. Practical activities provide opportunities for conversation and will empower the child to find creative and imaginative ways of expressing themselves when words fail.

Key features of this resource include:

• Targeted advice for children who defend against feeling their painful feelings by dissociating from grief

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• Tools and strategies for helping children cope with loss, including engaging activities to help children explore their feelings in a non-threatening way

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• Photocopiable and downloadable resources to help facilitate support

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Written by a leading child psychotherapist with over thirty years' experience, this book will support children to develop emotional literacy and connect with unresolved feelings affecting their behaviour. It is an essential resource for anybody supporting children aged 4-12 who have experienced loss.

1. Helping grieving children with their painful feelings

DOI: 10.4324/9781003214113-2

That moment of loss when someone the child has loved deeply leaves or dies can herald a complex mix of agonising feelings: despair, futility, anger, fear, shock, emptiness, to name a few. The strength of the feelings and the pain of the grief can, at times, feel too much to endure. Oh, to feel just the comparative sweetness of sadness rather than this acute ache, this searing, screaming pain. Because of the intensity of grief, children and adults can at times feel almost crazy and/or that they cannot go on.

So, when working with children who are suffering the pain of loss, we need to be very aware of the whole range of feelings and mental states they may be experiencing. This knowledge will inform our empathic responses, which are key to healing (Gottman et al., 1996). We will fail grieving children if we just talk to them about being sad. With traumatic loss, so many more feelings are involved, all needing to be spoken about and addressed.

This chapter is designed to support you in your work, with an exploration of some of the commonest emotional responses to loss in order to inform your empathic statements.

Helping grieving children with shock

'The awful thing had happened, and no-one had stopped it.' These were the words of Gemma, aged eight, talking about the death of her mother.

It is easy to begin to think that your life will carry on down the same path, with roughly the same people. Then one day something happens that changes everything. This happens with loss: loss of a loved one; loss of a school friend; loss of your home or school (when children experience multiple moves). And so often these losses lead to other losses: loss of so much that is safe and known in your life; loss of trust; loss of self-esteem. Things are literally never the same again. When a child suffers a traumatic loss, it is in effect the ending of his life as he has known it.

Terrible shocks are something most of us have to manage at some time in our life. Yet the parenting and education we receive provide us with few, if any, resources to know how to cope well with shocks. Without help to feel, think about and work through shock states, negative reverberations can cause long-term psychological problems. Also, when it is denied, shock can get locked in the body, resulting in all manner of illnesses and physical symptoms. As Bessel van der Kolk (2015), a famous researcher in traumatic stress states, writes, ‘The body keeps the score. Shock states can also badly affect the ability to concentrate at school, to make good decisions, and to function well on all levels. In traumatic stress we become frightened unthinking animals. Shock is so often experienced as a body blow. The child may literally feel 'shattered' by it.

The child's bodily response to the shock may include loss of appetite, bed-wetting, nightmares, and wanting to shake and scream.

How you can help

1. Offer children repeated times with an emotionally available adult who will be alongside them with their outpouring of grief in a totally non-judgemental way. Children lucky enough to have such a trusted and emotionally available adult after traumatic loss can be supported to release the shock trapped in their body.
2. Give psychoeducation. Children who understand can benefit from knowing that it is emotionally and physically healthy to let shock out of your body. So, give the child permission to let the shock out by crying and shaking. Tell them about animals. When, for example, a wildebeest is carried in the mouth of a lion but gets away, it will shake afterwards to release the fear and shock from its body. Humans often fight against this, which is not good for their physical or mental health. As Maudsley (founder of the London hospital of that name) said many years ago: ‘The sorrow that hath no vent in tears makes other organs weep' (cited in McDougall, 1989). It may help to talk to children, when appropriate, about the cost to emotional health of bottling up feelings of shock, and to praise them hugely for their courage in expressing it.
3. Help children with words to use. Use the word shock.' Often children are in shock and don't realise they are. It really helps them to know about shock, as it makes sense of what they are experiencing. They then need to be able to talk about the feeling of shock. In this endeavour, it is often useful to use the exercise in Chapter 3 called Shock states. This exercise aims to help children to address their shock states, and to find words for their feelings, so that their pain can begin to be modified. For some children, the exercise may be the first time they have acknowledged to themselves the power of the shock, and awareness is a vital stage in the healing process.
4. Encourage children to find their power again. Shock often leaves children feeling helpless and impotent, so encourage them to take their power back by finding an angry response to what happened. Drums are ideal for this, as is writing angry words on paper. So rather than the retreating and withdrawing of powerlessness and hopelessness, you are encouraging the child to feel the energy of aggressing on the world. Martha, aged 11, for example, found it particularly healing to draw 'Cancer, I hate you. How dare you take my mum.’

• 5) Offer quotes like the following, which may help.

You've survived 100 per cent of your worst days. (unknown)

At any given moment, you have the power to say: this is not how the story is going to end. (Christine Mason Miller)

One bad chapter does not mean your story is over. (unknown)

• 6) Make empathic statements about shock states. Examples include:
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    Everything got smashed up that day.
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    It was like your world ended that day.
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    Because you are in shock, you need to be very kind and gentle to yourself, and other people need to be kind and gentle to you too.
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    You may feel disorientated, because you are. You are now in a different world than before - a world before the bad thing happened - so it’s a very disorientating world.
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    When you lose someone you have deeply loved and they are not ever going to come back, it’s always a terrible shock and your life is changed for ever. It is changed but not destroyed, although at first it may feel as though it is destroyed.
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    After a big shock, you can feel very different inside.
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    After a big shock, your whole body is in a state of alarm.
• 7) Consider PTSD (post-traumatic stress disorder). If a long time has passed since the child experienced the event and yet he is still suffering from persistent hyperarousal, hypervigilance, flashbacks, generalised anxiety, startle reactions, problems sleeping, etc.; then he is probably suffering from PTSD. In PTSD, core arousal and stress response systems in the brain can be affected, making the body unable to regulate its internal systems properly; this can result in problems with sleeping, eating and digestion, and the immune system doesn't work well, which can cause physical ailments. If the child has any of the above-mentioned symptoms, refer him to a PTSD specialist (unless you are one yourself, of course). EMDR (eye movement desensitising reprocessing) or CBT (cognitive behaviour therapy) are particularly successful in treating PTSD (Khan et al., 2018).

Helping grieving children cope with the awful pain

What happens to the brain chemistry of children who love someone deeply?

When an attachment bond between two people is deeply loving, then at times of intimacy - shared delightful play states, when comforting distress, or in moments of real emotional connection - the brain’s emotion chemicals and the body’s hormones, released in both people, feel exquisite. When flowing strongly, it is these chemicals and hormones that make a child feel warm and tender, deeply content, and that all is well in his world. This is far more than just a state of calm that you might get from looking at the sea, for example. It is a far richer response, and results in feeling expansive, potent and very loved.

These powerful natural chemicals, released in interactions with a loved person, are oxytocin and opioids. As Panksepp, founder of affective neuroscience, and with over 40 years in a laboratory studying emotional systems in the brain, says, 'Brain oxytocin and opioids systems appear to be the key participants in these subtle feelings that we humans call acceptance, nurturance and love and warmth.’ Panksepp states that optimally activated opioids and oxytocin in the brain's CARE system are 'nature's gifts to us' (Panksepp and Biven, 2012).

The language of loss is the language of pain.

Panksepp also says,

When this feeling of normalcy is suddenly disrupted by the undesired loss ... or the unexpected death of a loved one, we find ourselves plunged into one of the deepest and most troubling emotional pains of which we, as social creatures are capable. The psychic pain informs us of the importance of those we have lost.

(Panksepp, 1998)

When a child loses someone he loved deeply, the wonderful hormones and brain chemicals described above are no longer dominant in his brain, and other painful neurochemical systems take over. This results in acute psychological pain. Hence the child who loved someone deeply will suffer terribly if that person dies or leaves. There is no getting away from this - it is how the human brain and body are genetically programmed.

The natural brain opioids released when a child deeply loves a parent are addictive. As Panksepp says, 'Social bonds are to some extent mediated by opioid-based, naturally occurring addictive processes within the brain’ (Panksepp and Biven, 1998). Losing a loved one is, therefore, as painful and as powerful as conning off heroin. (Heroin activates the opioid system in our brains or, looked at vice versa, opioids mimic the action of heroin in our brains.) We are all familiar with films of people coming off such drugs - the agony, the torment. The same emotions are experienced by the child who has lost a loved one.

For the grieving child, the intensity of the pain can feel unbearable. Scientists have found that loss of a loved one triggers the same pain centres in the brain as when we are in physical pain (Eisenberger, 2012). The neurochemicals of painful loss block all pleasure and wellbeing chemicals such as opioids and dopamine; hence, in grief, some children feel no pleasure in anything. ‘Psychological pain and loneliness are promoted by high levels of stress-promoting corticotropin-releasing factor [CRF] and a dearth of soothing opioids. When opioids are low, and CRF is running high, people and animals feel lonely, distressed, and miserable' [Panksepp and Biven, 2012).

How the pain of loss can hit children in fits and starts

Sometimes he is seemingly playing happily, and adults worry that he is denying his grief. Then suddenly he is overwhelmed by grief: 'I just want my mummy, I want my mummy I want my mummy ...' he howls and howls, as if forever. Adults in his life may worry that they themselves will not be able to stand the agony of his calling, it is so raw and terrible. All too often, it screams an intensity that makes them remember things in their own lives they have been trying to forget.

Loss of a deeply loved person is one of the most intensely painful experiences we can suffer. It can bring torment and anguish. It can feel as if nothing but the return of the lost person could bring comfort. And yet many people think that children do not feel grief as intensely as adults. This is not the case, as we know from the neurobiology of grief. In fact, because children fall deeply in love with their parents, they are just as vulnerable as adults to the agony of lost love.

Children often give the impression that after the loss of a loved one, life resumes as normal. This is partly because of their limited language skills, and partly because young children are genetically programmed with powerful motoric impulses that cannot yet be inhibited. So, ...