Helping Children & Teens Following Death in the Family Dr. Laura Brown, C.Psych. Norfolk Psychological Services Hospice Wellington
Outline Description of relevant Hospice Wellington Groups Factors influencing children s grief and how to talk with them about death Factors influencing teenagers grief and how to support them What teens say about their grieving process and how to help them
Hospice Groups Families Grieve Together Services children and parents Provides children a space to grieve Gives parents support and education about helping their children grieve
Hospice Groups Teen 2 Teen Provides teenagers with peer and expert support when facing loss Gives them opportunities to talk as well as to experience challenge activities and support one another
Hospice Groups Teen Focus Groups Teenagers who have lost a parent provide information about support that would have been helpful
Factors influencing children s response to death Must take into consideration: 1. Developmental level of the individual 2. Temperament 3. Family coping rituals 4. Relationship child had with the deceased
Factors influencing children s response to death Must take into consideration: 1. Developmental level of the individual
Developmental Level: Young Children Young children cannot understand logic, cannot mentally manipulate information, and cannot take the point of view of other people They experience death as reversible and temporary When will she wake up?
Developmental Level: School-Age Children Begin to think logically, understanding of abstract concepts begins to develop Death is permanent and irreversible Can happen to others as well as themselves May seek specific details of death and what happens to the body after death Range of emotions including guilt, anger, shame, anxiety, sadness, and worry about their own death
Developmental Level: Adolescents Teenagers gain a deeper understanding of abstract concepts such as death, Heaven, Hell Experience death as permanent, certain, and unchanging Have likely has some sort of contact with it
Commonalities in coping with grief across age spans regression to an earlier age temper tantrums exaggerated fears physical symptoms (stomachaches, headaches) lack of concentration mood swings withdrawal aggression poor school performance keeping the death a secret from friends sleep problems puddle jumping
Puddle jumping Children experience grief differently to adults. For adults, it feels like having to wade through rivers of grief, and they may get stuck in the middle of a wide sea of grieving. For children, their grieving can seem more like leaping in and out of puddles. First reactions may range from great distress to seeming not to be interested. One minute, they may be sobbing, the next they are asking: What s for dinner? It does not mean they care any the less about what has happened.
Factors influencing children s response to death Must take into consideration: 1. Developmental level of the individual 2. Temperament
Temperament Temperament refers to children s natural style of interacting with or reacting to people, places, and things. It s the way they re wired.
Dimensions of Temperament Activity Level Rhythmicity Approach/Withdrawal Adaptability Intensity Mood Persistence and attention span Distractibility Sensory Threshold
Temperament Protective factors of temperament with respect to grief: Higher adaptability Reasonable mood Lower intensity Higher sensory threshold Risk factors of temperament with respect to grief: Lower adaptability Lower mood High intensity Lower sensory threshold
Factors influencing children s response to death Must take into consideration: 1. Developmental level of the individual 2. Temperament 3. Family Coping Rituals
Family Coping Rituals Healthy practices: Generally healthy, functional family Family practice of acknowledging feelings outwardly Rituals to mark family deaths (e.g., funeral, wake, memorial, etc.) Providing space for grieving Support for relocating the deceased person in the child s life
Relocating children don t give up the relationship with the deceased person (they don t let them go ) they find a new place for them in their emotional lives that allows them to move forward with their lives
Factors influencing children s response to death Must take into consideration: 1. Developmental level of the individual 2. Temperament 3. Family coping rituals 4. Relationship child had with the deceased
Relationship with the deceased Close relationship often tied with better coping whereas troubled relationship is a risk for complications of grief Being around others who had close relationships with the deceased person helps child to remaining connected Having a village of attachment to rely upon throughout grieving assists children with grieving
Most important points children who are highly connected with the deceased person seem better able to show their emotional pain, to talk to others about the death, and to accept support from family and friends children who remain connected after the loss are better able to talk about the deceased person both inside and outside the family
Talking with Children About Death Tasks of the Mourning Process: 1) To Accept the Reality of the Loss must believe the deceased will not return to life
Common Questions Why is Mommy (Daddy, Grandpa, etc.) sick? What is [fill in illness here, e.g., cancer]? Does it hurt? Is it my fault she s sick? (Did I cause it?) Will you get sick too? Are you going to die? Am I going to die? (Is it contagious?) Who will take care of me? Where do people go after they die? What is Heaven? Where is Heaven? Did Mom go to Heaven? Can Mom still see me (or talk to me) after she dies?
Do s and Don t s of Answering Don t compare death to going to sleep Don t avoid using the words sick, death, died or dying Don t give too many details or traumatize the child Don t feel obligated to talk or answer questions at that moment if you re really not able or prepared.
Do s and Don t s of Answering Do keep language simple and direct Do explain death by saying something like, her body got sick and couldn t work anymore or his body was broken and couldn t be put back together Do tailor the words to the child Do encourage the child to ask questions and try to answer them honestly and directly; if you don't know the answer to a question, help find the answer.
Do s and Don t s of Answering Do be clear that the person is not coming back Do be yourself as much as possible and forgive yourself for fumbling, stumbling, and not always having the best answers at the right time Good way to start: What do you think? and build on their answer
Talking with Children About Death Tasks of the Mourning Process: 1) To Accept the Reality of the Loss must believe the deceased will not return to life 2) To Experience the Pain or the Emotional Aspects of the Loss acknowledge and work through the emotions associated with the loss children need to approach this task gradually and in ways that don t overwhelm their coping capacity
By paying attention to feelings we show kids that grief is a normal and natural response to loss we teach them how to label and understand their emotions we show them that it s okay to feel pain, anger, fear, and sadness and that these feelings are not too scary we prepare them to feel grief in their lives at another time
By paying attention to feelings we teach them life skills in handling strong emotions we model how to share feelings in an open and honest way we earn their trust by not lying to them and therefore help them feel security in their lives we show them the importance of sharing compassion to those who are hurting we teach them that their thoughts and feelings are important to us
Initial Factors to Consider Nature of the death (e.g., sudden vs expected) Relationship to the individual (e.g., primary caregiver vs more distant family member) and, therefore, impact on the teen s daily life Emotional relationship between the teen and the deceased person (e.g., close vs distant) Support individuals in the teen s life (e.g., other parent, grandparents, aunts & uncles, etc.)
General Guidelines for Caregivers Many teens feel a great deal of anger when dealing with grief Many rely primarily on friends for support instead of family Focus on the relationship, not the behaviour Keep the structure in place but build in flexibility Don t force conversation but keep doors open for conversation (balance between avoidance and confrontation)
Teen Focus Group We asked the question: How have you survived the loss you have experienced? What helped you? What didn t? These are some of their responses.
Things that help Having an open environment to talk about the death Having trustworthy people available to talk to Being given real information instead of sugar-coating Being given specific information rather than generalizations Having something tangible to hold onto and be with you constantly (e.g., a piece of jewelry or clothing) Fine line between support and smothering
Trustworthy people Having trustworthy people available to talk to Brenda: My dad gave me space when I needed it and hugged me when I needed it. He knew me well enough to know what I needed. My aunt is like a second mom. Having her there was a comfort
No competition! Having people around who don t need to compare their grief to yours Caitlin: worst fight I got into was with my cousin when she said, well, she was MY aunt, you know. As if that could compete with losing your mother. Nathanial: It affects the people who live in the house the most. People who put their grief on an equal level as yours should step back.
Real information Being given real information instead of sugar-coating Brenda: Mom s impact as a person helped me. Who she was changed me into someone who could handle things She was very open about the illness which helped.
Specific information Being given specific information rather than generalizations Not assuming the individual knows what is going on without direct information Norma: I never knew my mother had cancer. When I did find out, I didn t know what cancer was. I didn t know my mother was going to die until she died.
Genuine Support Support for the loss without turning it around so the teen is taking care of the other person Brenda: People want you to support them and you should make them feel better. They want the attention away from you to them instead. Consuela & Jacklyn & Caitlin: everyone wants you to say sorry or it s alright to all the people coming to the funeral.
Genuine Support Support for the loss without turning it around so the teen is taking care of the other person Nathanial: I dreaded standing in the receiving line and hated all the people saying sorry and meeting all these new people. Then a friend kidnapped me to take me to DQ for a break.
Funerals All expressed that they were glad they were at the funeral but some things were hard: having people come up to them who they didn t know being in the spotlight having there be expectations on them about how they should be acting and feeling
Forbidden words All had words that they hate hearing now after their experiences Coping Condolences Sorry Lost
School Personnel Having key people at school know but not being treated differently Nathanial: My teachers didn t expect anything of me anymore, like I was some sort of stunned potato. Norma: On the first day back to school after Mom died, my teacher gave me a hot chocolate [something he did to acknowledge exceptional students anyway]. It wasn t weird because he knew of my mom and it was a nice gesture without being too much.
Anniversary Dates It s helpful if people are sensitive to anniversary dates without being too obvious about it Nathanial: date matters to me, the accomplishment that I made it this far because I remember the day so clearly Caitlin: the 8 th of the month is physically draining and mentally, realizing it is another month without her. I don t know why I am so bitchy and then I realize it is the 8 th of the month
Anniversary Dates It s helpful if people are sensitive to anniversary dates without being too obvious about it Nathanial: I m extra sensitive around the date and more quiet. If I am being quiet please don t play counselor.
Other changes Caitlin: I have an irrational fear that if I get close to someone that person will die on me. Nathanial: I deal with change much differently than previously. i don t want to let people in because if they leave will then be another change. Brenda: I won t talk about my mother unless I m forced to. My tattoo sparks questions and I will answer them honestly but not in detai.
Teen services? We also asked the questions: If we were to offer something to help other teenagers who have experienced a loss like yours, what should we know? How should we approach teens? What should we watch out for? Here are some of their answers.
Labels The words therapy, support group, counselor are loaded and fraught with associations: Weak Death Discomfort Vulnerable Something is wrong with you
Timing The timing of the help is important: if too rushed or too late it isn t helpful maybe 6 months to a year after the death
Group demographics With respect to how many in each group: group size should be less than 10, that way everyone gets a chance to speak Who should be included is more about personality than gender. It s important to feel comfortable with one another. Best to include people from different schools so lowers the risk of personality/social strata conflicts that take place during school hours
Approach Being approached by a stranger is weird; has to be someone the teenager would know Word-of-mouth is best being approached by another teenager or adult that you know If an adult, maybe someone from the school that you know like a special teacher, child and youth counsellor, social worker
Setting Not a hospital or hospice too many bad associations Not a school too public and other people might find out A home is good or a neutral setting like a group room in a building Warm and welcoming
Atmosphere A more informal meeting rather than a therapy session helps participants relax Brenda: a lot of attitude to therapy has to do with how you approach it, with this kind of approach is more comfortable, if make something feel more casual but has the same objective as individual therapy (support, help, talking about it) is better, gives a more open atmosphere
Atmosphere A more informal meeting rather than a therapy session helps participants relax Nathanial: It s nice that it s in your home because you re offering a bit of yourselves. I like that you and Erin are casual as well and don t dress business-like Including food is nurturing, relaxing and makes it feel less like a therapy session
Group stigma? We may be more open to talking in a group based on experience with this group (but still suspicious of whether any group could be like this one) Brenda: so long as I knew that people were more caring and not just curious
Remember a death of someone close begins a lifelong conversation about death... and life