Discussion on Grief and Bereavement

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CHILDREN and LOSS
Discussion on Grief and Bereavement in young
people
Doug Ennals, RSW INCTR Annual Meeting Chennai,
2005
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Every deathhas a life of its own
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We enter the conversation with our own knowledge,
experiences and beliefs about death, grief and
bereavementOpportunities for reflection, asking
questions, exploring, and creating dialogue in
everyday practice
Local Knowledge
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Language of Loss
Bereavement the state of having experienced
loss Grief subjective, personal feelings and
reactions to loss Mourning the private and
public processes, rituals and practices to loss
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Models of Grief
Historical
Many western models have attempted to help
understand the processes of bereavement

• linear
• series of stages
• tasks to be completed
• re-investing of emotional energy
• processes of letting go of attachment to the
• deceased

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Models of Grief
Emerging Perspectives

• Through continued bonds, people find places for
  the deceased in their ongoing lives
• Grief is a condition of the human spirit
• Constructing relationships with the deceased
• Ongoing construction of self and relations to
  the
• world we live in

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Dual Process Model
Restoration Oriented Dealing with the many life
changes and new roles that are brought about by
the death
Loss Oriented Involves the emotional and reactive
processing of the loss
Oscillating between these stressors
(Reference Stroebe and Schut, 1999)
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Perspectives

• Multiple, dynamic processes whereby people find
• meaning in loss
• Moving between the grief and day to day life
• adjustments
• Continual process of coping, adapting, building
• capacity to move forward
• Traumatic grief survival issues take priority
  over grief
• Political, economic, social, cultural, spiritual
  and other
• considerations

(Reference Parkes, Colin M. Mortality Virtual
Themed Issue, 2003)
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Perspectives
restoring the fit between the world that is and
the world that should be
(Reference Parkes, Colin M. Mortality Virtual
Themed Issue, 2003)
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Children and Loss

• Death touches the lives of children regularly
• What may seem normal or abnormal for adults may
  be quite the opposite for children
• Childrens expressions of grief are both similar
  and different from adults
• Adjusting to the reality of illness, death, and
  loss is complicated by
• - childrens developing conceptual
  understanding of death and dying
• - lack of or distortion of information they
  receive

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Developmental Considerations
Younger Children

• Think in more connected
• ways
• Live in the moment
• Magical thinking
• Belief that thoughts and
• behaviors are cause for events
• Anxiousness, distress
• Repetitive and physical in their
• grief

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Developmental Considerations
Children

• Developing a better understanding of cause and
• effect
• Detect feelings of others
• Building capacity for
• expressive language
• May have many questions
• and a need for detailed
• information

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Developmental Considerations
Adolescence

• Time of dramatic physiological, cognitive,
  emotional,
• spiritual, and social change
• Increased sense of self
• Quest for knowledge, understanding,
• awareness of place in the world
• Search for meaning and purpose
• Increased understanding about significance and
• realities of dying and the death experience

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Social and Cultural Considerations
Influences

• Child-rearing practices
• Nature of attachments
• How children acquire their
• understanding of death
• Religious and spiritual beliefs
• about death and bereavement
• Age, gender, family position

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Social and Cultural Considerations
Influences

• Cause and nature of death
• - stigmatization?
• Roles during illness
• Previous loss experiences
• Rituals attending death, bereavement and
• mourning practices
• Influences rites of passage, and the norms for
• appropriate grief

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Perspectives
Childrens grief experiences are influenced over
time, embedded in developmental, social and
cultural contexts in which all experiences exist
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Windows to Grief

• Entering into the grief journey with children
  requires an embracing of their spirits
• Magical, curious, unpredictable, observant,
• perceptive, spontaneous
• Live in metaphor
• Need spaces to see, experience, accept, reject,
  
• and try on feelings and reactions

• Loss of ones right to be born into a safe world
  
• that makes sense

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Windows to Grief

• Companioning children on their grief journey
• means using theory as a framework and
• your heart as the guide
• No formulas
• Observant, flexible, patient
• Honest
• Courage to stay out of the way
• Courage to companion
• Prepared to be surprised

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Windows to Grief

• Children understand more that they are given
• credit for
• Adults are one of the biggest barriers
• Grieving children dont need to be fixed
• Expressions of grief take many paths
• Children need, want, and deserve honesty truth,
  
• and choices
• The best gift is the capacity to listen

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Into the Circle of Care
Ourselves and the team
What are my beliefs about grief and bereavement?
What are my beliefs about how children should
be involved / not involved in end-of-life care
conversations? What does the team need to know
from the patient and family? What are my comfort
levels in sharing information and talking with
children? Who on the team could assist in the
process?
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Into the Circle of Care
Family and caregivers
What does the child(ren) already know? What are
the cultural, religious and social practices for
this family? How has ritual been
practiced? What is the relationship between the
child(ren), patient, family and other
caregivers? What would be helpful? Invite
conversation
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Into the Circle of Care

• Preparation
• What to expect
• Misconceptions
• Expressions of emotion
• Providing developmentally appropriate information
  
• Asking children what they understand, how they
  are
• making sense of what is happening

With children
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sadness
confusion
anger
protest
guilt
fear
SEARCH FOR MEANING
pain
hope
shock
explore
invest
loneliness
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What is dead?
Am I going to die too?
Did I cause it?
SEARCH FOR MEANING
Who will take care of me?
Who am I now?
How will I remember?
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Reflections
Children as experts
All children are different and their view of the
world is unique and shaped by different
experiences. When working with a grieving
children, we are witness to a profound
journey.
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Reflections
Children as experts
In our everyday practice, how can we support
children as experts and storytellers of their own
knowledge and loss experiences?
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Every deathhas a life of its own
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Thank you
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