GRIEF MANUAL: HOW TO HELP CHILDREN AND ADOLESCENTS TANYA M. PRICE-WRIGHT Bachelor of Social Work, University of Regina, 1997 A Project Submitted to the School of Graduate Studies of the University of Lethbridge in Partial Fulfillment of the Requirements for the Degree MASTER OF COUNSELLING FACULTY OF EDUCATION LETHBRIDGE, ALBERTA October 2010 Abstract The grief manual on how to help children and adolescents is intended as a grief resource for parents, teachers, and other community members. The manual includes a historical review of families and death and dying. The literature review indicated that the Western world has changed how families deal with death and dying. Medical institutions and care facilities have replaced the family role and responsibility of caring for aging family members. The shift in care has resulted in what the literature refers to as an avoidance society. As a result adults may feel a lack of confidence in explaining death and in supporting children and adolescents through the grieving process. The grief manual uses Bowlby’s attachment theory (Bloom, 1985; Bretherton, 1992; McCormick, 1997), Piaget’s cognitive development theory (Bloom, 1985; Broderick & Blewitt, 2003), and Erikson’s stages of social development (Bloom, 1985; Broderick & Blewitt, 2003) as a lens to view childhood social, emotional, and cognitive maturity. Insight into these theories is useful for understanding how children form attachments, cognitively understand, and behave when the death of a loved one occurs. The grief manual includes a literature review, working definitions, the grieving process, themes in childhood grief, developmental stages, parental and other supports, and how the media can affect a child’s understanding of death. The developmental stages presented are ages: (a) 0 to 5 years, (b) 6 to 12 years, and (c) 13 to 18 years. Each developmental stage includes children’s understanding of death, their common reactions to death, and how to reduce the hurt and suffering caused by the death of a loved one. iii Acknowledgement I would like to thank my project supervisor, Lynn Davis, and my committee member, Tanya Beran, for their support, patience, and commitment to my learning process throughout this project. I would also like to acknowledge the countless hours that my children stood by me with encouragement and love to complete this endeavour. I am truly grateful to all the people in my life, past and present, for their strength, words of wisdom, and gentle encouragement throughout my life journey. iv Table of Contents Abstract..............................................................................................................................iii Acknowledgement.............................................................................................................iv Table of Contents.................................................................................................................v Chapter 1: Introduction........................................................................................................1 Purpose of this Project...................................................................................................2 Importance of this Project..............................................................................................4 Structure of the Project..................................................................................................6 Chapter 2: Literature Review...............................................................................................8 Working Definitions....................................................................................................10 Grief.......................................................................................................................10 Loss........................................................................................................................10 Mourning................................................................................................................11 Bereavement..........................................................................................................11 Grieving.................................................................................................................12 The Grieving Process...................................................................................................12 Themes in Childhood Grief.........................................................................................14 Awareness of death................................................................................................15 Egocentricity..........................................................................................................16 Maintaining order...................................................................................................16 Fear and abandonment...........................................................................................17 Euphemisms...........................................................................................................17 Social and Emotional Development.............................................................................18 v Developmental Perception of Death............................................................................23 Chapter 3: Method.............................................................................................................28 Chapter 4: Implications......................................................................................................30 References..........................................................................................................................31 Appendix............................................................................................................................34 vi 1 Chapter 1: Introduction The thrust of this project is to provide a resource for parents, teachers, counsellors, and other community members to support children and adolescents through the grieving process following the loss of a loved one. This project outlines the current themes in the literature for adults focused on helping children and adolescents through their grief. It is not the intent of this project to produce a clinical therapeutic manual, but rather to produce a resource that can be used in its entirety or in individual sections when a death occurs. Current literature on children and adolescents and the grieving process is amalgamated to identify pertinent areas that are necessary to consider for a healthy healing process. The project includes the following sections: (a) purpose of this project, (b) importance of this project, (c) structure of the project, (d) literature review, (e) working definitions, (f) the grieving process, (g) themes in childhood grief, (h) social and emotional development, (i) developmental perception of death, (j) method, and (k) implications. In addition, the relevant themes in the literature are presented as a proposed manual titled Grief Manual: How to Help Children and Adolescents in the Appendix. The proposed manual includes the literature themes on children and adolescent grief in Chapters 1 through 8. Chapters 1 through 4 include a literature review, working definitions, the grieving process, themes in childhood grief, social and emotional development, and a developmental perception of death. The manual also includes a chapter on developmental stages ages 0 to 5 years, 6 to 12 years, and 13 to 20 years. There are three subsections: (a) cognition: understanding death; (b) effects of grief: common reactions; and (c) how to help: reducing the hurt. The second-to-last 2 chapter includes information on how parents and other supports can help children and adolescents through the grieving process, and the last chapter is a brief overview of the impact media has on children and adolescents grief. For example, the role media has on a child’s grieving process when graphic pictures and commentary of traumatic and natural disasters are viewed with no explanations. No matter where a child is in his or her journey through grief this manual can be used as a resource for adults to understand the social and emotional developmental stage of the child or adolescent. Purpose of this Project Children and adolescents require assurance and positive role modelling from adults to grow and develop healthy life-long coping strategies (Corr, 1998). For example, adults need to assure children that their feelings are natural and they are not crazy. Adults should also model how to express feelings and emotions in a way that fosters healing through the grieving process. A safe and healthy environment is essential for children and adolescents to process and make sense of the death of a loved one. “The manner in which children work through their grief depends a great deal on how family members, teachers, and friends reach out to them” (Grollman, 1995, p. 6). A common thread in the current literature asserts that adults are more likely to avoid the subject of death or any discussions about death or dying. The literature also stated that adults lack confidence and awareness of “how to” discuss death and dying with children and adolescents. Adults who feel a lot of anxiety when discussing death with children and adolescents often provide vague answers about death and dying (Grollman, 1995). Children then feel confused, vulnerable, and insecure when a death occurs (Grollman, 1995; Thompson, Rudolph, & Henderson, 2004; Wolfelt, 2004). 3 Children of all ages need support and encouragement through the grieving process. Adults can encourage and model positive coping strategies as well as provide the best support networks for life challenges facing children and adolescents. Children spend a large percentage of their day in a school setting and school staff can play an important role in a child’s support network. School staff can provide positive role modelling for cope with life’s challenges and death. School staff, parents, and other significant adults need to help children cope with their fears, anxieties, and insecurities. This can be achieved by providing children with simple, honest, and accurate information that is age appropriate. Grollman (1995) asserted that a child’s “ability to cope with their pain will be powerfully influenced by how parents and other adults understand their loss and express their grief” (p. 13). The literature indicates a number of key factors that are essential to understand when helping children and adolescents process their grief. First, the child’s developmental stage will determine the child’s ability to understand the finality of death. Second, having a working knowledge of the stages, tasks, or phases of the grieving process is critical in helping children and adolescents through their grief. Third, the significant supports that already exist in a child’s life such as parents, school personnel, and peers are significant to a child’s grieving process. Finally, an adult’s fears and anxieties about death and dying will influence the level of support available for helping children cope with the death of a loved one. Adults who are aware of their own comfort levels and coping strategies with death and dying are in a better position to provide support and understanding to children. As the literature states, effective grief work is not done alone and adults have a 4 significant role in a child’s grieving process (Deits, 1988). With accurate knowledge, adults are in the best position to model and teach healthy coping strategies that will facilitate healthy grieving for both themselves and the children around them. Importance of this Project Wright (2004) asserted that we live “in a culture that doesn’t like to acknowledge loss or talk about the impact, it’s difficult to grieve” (p. 1). Grief is a very painful process to experience and work through alone. In today’s western culture, adults who are uncomfortable with death are less likely to use teachable moments to teach children about the grieving process or the normalcy of grief (Grollman, 1995). In fact, most adults are uncomfortable discussing death and lack confidence to teach children about life, death, and how to grieve the death of a loved. Dyregrov (2008) asserted, “There are more similarities than dissimilarities between adults’ and children’s grief” (p. 85). Adults have more experiences in their lives to help them cope in difficult times, whereas children look to adults for guidance and support during difficult and confusing times. Children experience the same feelings of longing, confusing thoughts, and powerful emotions regarding death as adults do. Therefore, it is important for adults to be comfortable and prepared to discuss life and death with children. Knowledge of the grieving processes, what to expect, and how to cope is key to helping children and adults grieve the loss of a love one. The grief manual (see Appendix) offers evidence-based information to cultivate confidence in parents and other adults who are working with grieving children. With this resource adults will be able to help children develop healthy life-long coping strategies for effectively processing the 5 death of a loved one. As a result, adults’ feelings of inadequacy resulting from a child’s loss of a loved one, friend, and or colleague will be minimized. It is critical that any person in a supportive role also reach out to others for support and assistance for themselves. In difficult times families do not have to work through their grief alone. Care for the caregiver cannot be stressed enough, if you do not look after your own emotional, physical, mental, and spiritual needs you will not be able to help others achieve a healthy grieving process. The school environment provides a multitude of services to its staff, parents, and community members. Schools have a well-established network of supports for children and adolescents, as “schools for the most part provide a tightly knit sense of unity between the students, teachers and parents” (Deits, 1988, p. 111). Schools have an important role in providing an environment where students feel safe and supported by staff and peers. It is imperative that parents and schools work together, as they have an established relationship. Parents, significant friends, family members, and school personnel are often the first source of support for children faced with the death of a family member or friend. A caring and knowledgeable person can facilitate the understanding of the loss and expression of grief for children and adolescents. Children at a very young age have the capacity to feel the realities of death (Grollman, 1995) and, therefore, need adults to support, comfort, and answer their questions and concerns with age-appropriate answers. Children and adolescents learn how to deal with death by listening and observing the coping strategies (e.g., expression of feelings and showing emotions like crying when needed) of adults and close friends in their lives. Adults who fear death are more likely to