Working with Bereaved Children and Young People

Brenda Mallon

• Publisher: SAGE Publications Ltd
• Year: 2010
• Print ISBN: 9781849203715, 9781849203708
• eBook ISBN: 9781446246788
• Edition: 1
• Topic: Psychologie
• Subtopic: Conseil en psychothérapie

This book offers a fresh insight into working practices with children and young people who are experiencing the death of a family member, friend, school peer or in their social network. Bridging the gap between theory and practice, the book?s practical skills focus is informed by the latest research findings on children and young people?s experience of grief. The wide-ranging content includes:

- a comprehensive review of theoretical approaches to bereavement

- the impact of different types of grief on children

- working with children who have been bereaved in traumatic circumstances, such as through criminal behaviour

- skills development.

The list of resources, case studies and exercises encourage critical engagement with the counselling theory and promote reflexive practice. Trainees in counselling, psychotherapy and social work, as well as teachers and mental health workers, will find this an invaluable resource for working with this vulnerable client group.

1

Early Attachment and the Building of Resilience: The Theoretical Basis of Bereavement Counselling

‘When I’m trying to hide the sadness it makes my throat hurt more. I cry because I don’t feel like myself, I’m completely different. A big chunk of me has gone, it’s like I‘ve got a big hole inside me. My Dad shouts at me to go to school but I need him because I feel dizzy and so sad every morning. My heart feels weak.’ T., aged eleven. His mother died after a long illness.

There have been many changes in the theoretical foundations of bereavement counselling over the past century that, in many ways, reflect the changes in society. From Freud’s ‘Mourning and Melancholia’ in 1917, Bowlby’s seminal work on attachment theory, through Elisabeth Kubler-Ross, Colin Murray Parkes and William Worden to the most recent work of Kari and Atle Dyrgrov (2008). From linear tasks and stages of mourning we have moved to the development of Continuing Bonds from Klass, Silverman and Nickman (1996) and the dynamic Dual Process model of Stroebe and Schut (1999). Life and death in the twenty-first century is underpinned by family, society and cultural factors which play a part in our work with bereaved children and young people (Klass, 1999b). As in all bereavement, whilst we recognise the importance of theories which form the foundation of our knowledge, each child and young person has their own unique response to bereavement (Alexander, 2002).

Early writers, such as Freud, were of the psychoanalytic tradition which focused on the individual and his response to grief and its impact on his inner psychic world. More recent theories are influenced by systems theory, which focuses less on the individual perspective. The inter-relationships of the bereaved person, their family, friends and wider community are all seen to play an integral part in our response to death. This is exquisitely summed up in the words of John Donne:

No man is an island, entire of itself. Every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as is a manor of thy friend and mine were. Any man’s death diminishes me, because I am involved in mankind and therefore, never send to know for whom the bells tolls, it tolls for thee. (‘Meditation XVII’)

Donne believed that everyone was connected by their community bonds as well as spiritual bonds. When misfortune happens to one person, it impacts on all those who take part in the same society or who are interconnected by the same system.

Attachment Theory

John Bowlby (1907–1990), a British psychiatrist, was a pioneer in recognising the significance of child–mother attachment or child–care-giver attachment in the development of the child. He may have been influenced by his own experiences as a child. He grew up in an upper middle-class family and his beloved nanny, his primary care-giver, left when he was four years old. He later described this as being as tragic as if his mother had died. This experience, compounded by being sent to boarding-school at the age of seven, may account for his deeply felt concern about loss in children’s lives.

Working with Mary Ainsworth, Bowlby recognised that if we are to understand the child’s behaviour we need to understand his environment (Wiener, 1989). He showed how the early family environment influenced the emotional and physical development of the child and he brought the idea of attachment theory to prominence in the early 1950s. ‘The mother is the most important person in a baby’s life for its physical and psychosocial care, and the psychosocial interaction between baby and mother is as important as the physical feeding and contact and babies become distressed when their mother does not respond to their signals.’ (Graham and Orley, 1998: 272)

After World War II, the WHO invited Bowlby to write a report on the fate of children made homeless by the conflict. Maternal Care and Mental Health was published in 1951. In it he concluded that ‘care in a family was the most appropriate form of care for children and much preferred to living in an institution’ (Graham and Orley, 1998: 268). He concluded that emotional deprivation and frequent separations were a major contribution to delinquency and to psychiatric disorders, which is relevant for children and young people in public care, and this is expanded in Chapter 4. He revealed how early separation from the mother, main care-giver or significant attachment figure, produced adverse reactions in babies and young children and, against the popular view of the time, he advocated that mothers should visit their child in hospital to maintain the attachment. In passing, the practice of separating babies from their mothers at the time of the birth in hospital was roundly condemned. Bowlby emphasised the fact that each child needs to have a secure base from which to explore.

Unlike other analysts of his time, Bowlby believed, after long-standing research and observation of children, that excessive separation anxiety was the result of adversive family experiences including threats of being abandoned, rejection by parent(s), illness of parents or siblings or death of parents or siblings. He recognised that children often blamed themselves for these family events. He was influenced by a series of films made by Joyce and James Robertson, who studied the effects on young children who were briefly separated from their mothers. They filmed children in nurseries and those placed in foster care and concluded that, although separation from a mother (or mother-figure) provoked anxiety, children adapted to foster placements where a nurturing substitute mother was present (Shapland, 1976). One of the films, A Two-Year-Old Goes to the Hospital, documented the impact of loss and suffering by the young child separated from her primary care-giver and influenced a change in policy allowing parents to stay with their children in hospital.

Bowlby’s views are powerfully reflected in the work of Camila Batmanghelidjh, founder of Kids Company, a charity that works with violent, rejected and disenfranchised young people. As she says, ‘If the attachment is inconsistent and unpredictable and is not in tune with the infant’s needs, the child develops an ambivalent or insecure attachment’ (Batmanghelidjh, 2007: 25).

Attachment is essential to the development of emotional well-being and resilience (Frayley and Shaver, 1999; Huertas, 2005; Machin, 2009). Without attachment to a significant person, usually a parent or constant carer, a child may fail to thrive, fail to relate to others and be unable to feel empathy for others. If the attachment relationship is robust and sensitive, the child gains a sense of security which can sustain him in the face of adversity.

Bowlby and Parkes (1970) defined four main stages in the grieving process:

1 Numbness, shock and denial which may cause the bereaved to feel a sense of unreality.

2 A phase of yearning and protest in which grief may come in waves of crying, sighing, anxiety and the child or young person may sense the presence of the dead person.

3 Disorganisation, low mood and hopelessness.

4 Re-organisation involving letting go of the attachment and investing in the future.

This model was interpreted as by many as linear, which did not allow for the way in which the bereaved move backwards and forwards in their responses.

Recent research by Linda Machin (2009) has extended our understanding of attachment and its role in relationships in adult life as well as its role in resilience or vulnerability, security or insecurity, when faced with bereavement. Though there is ongoing research into the links between early attachment and response to bereavement, Machin states, ‘What is clear is that relationships, their meanings and consequences for self-perception are key to the nature of grief responses’ (2009: 39).

Elisabeth Kubler-Ross (1926–2004)

Watching the peaceful death of a human being reminds us of a falling star; one of a million lights in a vast sky that flares up for a brief moment only to disappear into the endless night forever. (Kubler-Ross, 1969: 276)

Swiss born physician and psychiatrist, Elisabeth Kubler-Ross was the first person to carry out extensive research with terminally ill patients. Her seminal work, On Death and Dying (1969), describes how those who are dying pass through a number of ‘stages’.

• Denial – the patient does nor accept that he has a terminal illness.

• Anger – anger towards self because their body has let them down; anger towards others including medical staff because the patient feels they have been failed in some way.

• Bargaining – the patient may bargain with God or another unseen force, for extra time to live longer or become well again.

• Depression – the patient may feel low and dejected as they face their mortality.

• Acceptance – given the chance to grieve, the patient may come to accept their forthcoming demise and go through a period of contemplation, reflection and accept the inevitability of their situation.

Kubler-Ross went on to apply these stages to people who had been bereaved.

Kubler-Ross (1975) added greatly to our understanding of terminally ill patients and bereavement and her model was widely accepted and used to explain the pattern of grief, and was included in the training of medical personnel. In fact, it became so widely known it featured on the TV programme ‘The Simpsons’ as DABDA (Denial, anger, bargaining, depression and acceptance) (DeSpelder and Strickland, 2002). However, the model later lost favour. Subsequent researchers found no evidence to support these stages and found conflicting reactions among the dying and bereaved (Stroebe and Schut, 1999). As with the Bowlby’s and Parkes’ model, Kubler-Ross’s was interpreted as a linear model and did not allow for the fluidity of most people’s experience of bereavement. People may alternate between these stages and may never feel resolution or acceptance.

William Worden’s Task Model

J. William Worden, psychologist and grief specialist, was, with Phyllis Silverman, co-director of the Harvard Child Bereavement Study. The longitudinal study, which began in 1987, revealed that for many bereaved children the negative consequences of the death of a parent do not appear until after the end of the second year following the death. His book based on the findings of the study, Children and Grief: When a Parent Dies (1996), changed the way we think of children and bereavement.

J. William Worden’s four-stage Task Model is based on the idea that following bereavement there are a series of psychological tasks that have to be undertaken (Worden, 1991). In this way he continues Freud’s concept of grief as a job of work that the bereaved must accomplish. The stages are:

• Accepting the reality of the loss.

• Working through the pain of grief.

• Adjusting to a changed environment in which the deceased is missing.

• Emotionally relocating the deceased and moving on with life.

This model was later extended by psychologist Therese Rando, who adds that readjustment includes moving adaptively into the new world, without forgetting the old attachments, to form a new identity and to reinvest in life (Rando, 1993).

From the research of Worden and Silverman in the Harvard Bereavement Study grew the theory of ‘Continuing Bonds’, discussed later in this chapter, which is now a strong theme in bereavement. Continuing Bonds were clearly prevalent in the children they interviewed (Hospice Foundation, 2010).

Colin Murray Parkes

Colin Murray Parkes has been a highly important figure in bereavement research, as his many influential texts show. His most recent works concentrate on grieving as a reconstruction process in which the bereaved make a ‘psychosocial transition’ (1996). This grows out of his earlier concept which introduced the term ‘Assumptive World’ (1988). We each live in a world where we ‘assume’ life will carry on as it always has, without major transformations. Children assume they will live with their family, go to school, do their homework and have friends; however, this assumptive world may be shattered when a parent dies. Their security is split asunder, they may have to move house because of a change in financial resources, then move school and lose friends. Their world is turned upside down yet they have to learn how to negotiate their new world. This transition is the ‘work’ of grieving and mourning and children and young people will look to adults to find out how to move through this territory that has no map and to learn to make some meaning out of it (Neimeyer, 2005).

Continuing Bonds

The dead are an active, positive resource to be drawn on by the living.
(Riches and Dawson, 2000: 37)

The theory of Continuing Bonds was introduced by Klass, Silverman and Nickman in 1996 and was developed from findings of the Harvard Child Bereavement Study. It maintains that the bereaved keep links with the deceased person and these continue over time. The bonds move into the future life of the bereaved (Holland, 2001). This model encompasses what many feel is the reality of grief; that is, it is not something to be worked through or resolved because in reality grief is not so easily resolved. Previously, with the stage models of grief, people felt they were somehow inadequate because they could not get to the final stage of acceptance or resolution. The Continuing Bonds model, like the Dual Process Model, discussed later in this chapter, reflects the actual experience of the bereaved in which they incorporate the lost loved one in their ongoing life (Stroebe et al., 1995).

Children also maintain links with the deceased through memories, objects that they keep, photographs and so on (Silverman et al., 1995). Children also think about what their dead parent or sibling would advise them to do or behave in a way the deceased would have approved of. Many children do not want to forget or say goodbye. ‘You don’t have to say goodbye; say “See you later.” You always think about them but you do get over it,’ was the hopeful counsel of an eleven-year-old girl’ (Worden, 1996: 172).

In many cultures continuing bonds with the dead are woven into the fabric of the culture (Deeken, 2004; Valentine, 2009). In Japan the ancestral tradition, sosen suhai, fosters continuing bonds between the living and the dead through a complex system of rituals, which ensure the smooth journey of the deceased to the world of the ancestors. They include rites at the funeral, in memorial services, visits to the grave and the erection of a home altar, known as butsudan. ‘These attachments are based on reciprocity and mutual dependency, the living providing care and comfort to their dead who, in turn, look out for the living’ (Valentine, 2009: 7).

Continuing bonds are particularly important in Japanese culture (Ishii, 2008). Ishii describes four main aspects of grieving which include firstly, the custom of offering food daily at the home altar or shrine and yearly visits to the grave; secondly conversing with the dead person at the home altar and at the grave; thirdly the home altar and grave are for the extended family not only the immediate family; and fourthly the living attend Buddhist rites for the dead for many years after the death. These connections are maintained in traditional ways and ‘provide a safe way for bereaved Japanese, a people who are known for their reluctance to show their feelings, to express their emotions’ (Ishii, 2008: 11). This cultural tradition may influence the behaviour of bereaved Japanese children who may present with school-related difficulties, such as refusal to attend, rather than sadness, for example.

African beliefs about life involve continuity through ancestors, so death is viewed as a transition from one form of life to another and responsibility for the care of children is delegated through the extended family system (Richter, 2008). These kinship networks also give...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Introduction
• 1 Early Attachment and the Building of Resilience: The Theoretical Basis of Bereavement Counselling
• 2 The Impact of Bereavement
• 3 Core Skills for Bereavement Counselling
• 4 Understanding Death: Mental Health Issues in Vulnerable Children – AHHD, Autism and Children with Special Educational Needs
• 5 The Role of the School: A Whole School Approach to Bereavement and Loss
• 6 Creative Approaches in Working with Grief and Mourning
• 7 Interactive Support On-line
• 8 Traumatic Death and its Impact
• 9 Working with Dreams to Ease the Grieving Process
• 10 The Spiritual Dimension of Grief
• Appendix:Resources and Organisations for those Supporting Bereaved Children
• Reference
• Index