Living With Grief: Children,
Adolescents, and Loss
HFA's Year 2000
Initiative to help children and
adolescents cope with loss
During the live broadcast of our teleconference we receive hundreds of call-in questions. Due to time constraints, we cannot answer all of them over the air. The questions here are representative of the questions asked during Children, Adolescents, and Loss and have been answered by panelists Nancy Boyd Webb, Charles Corr, and Ken Doka. For further information on these and other subjects, see our teleconference book.
Death-Related Losses
Funeral Rituals
Non-Death Related Losses
Counseling Issues
Providing Support in Special Situations
Schools
Death-Related Losses
Q. Is there value in helping to maintain a connection between the living child and the deceased parent, sibling, or friend?
A. Continuing bonds are important because they recognize and respect the important place that a deceased person has occupied in a child’s life, as well as the significance of some type of ongoing connection with the deceased person. Helping to maintain healthy continuing bonds can be a source of great solace to a bereaved child. Adults should be careful that these bonds do not fail to recognize the harsh realities of death. As Anderson wrote in his play “I Never Sang for My Father,” death ends a life, but it does not end a relationship.
-Charles Corr
Q. Should a child be told that his or her parent is going to die? Who should tell--the other parent, a relative, or a counselor?
A. Barring unusual circumstances, a child should be told about reasonably anticipated important events in a family. Often children will be anxious about changes they observe in the family and concerned about what they may not properly understand. Bringing things out into the open in a pro-active, honest, and caring way can defuse the demons of a child’s imagination. When a child does need to be told about an anticipated death, the choice of the person to do so should be carefully considered. The person should be someone whom the child trusts, who can offer support at the same time, and who is prepared to explore implications and concerns with the child. Generally, that means that a parent or close, trusted relative. A professional might guide or empower this person before or during such an interaction. Only in relatively rare circumstances, and when asked to do so, would it be desirable for the professional to assume this responsibility directly. Read The Garden Is Doing Fine, The Eagle Kite, Mama’s Going to Buy You a Mockingbird, A Season In-Between, or With You and Without You, all books for young readers on this subject.
-Charles Corr
Q. What do you say to a child who refuses to accept that a parent is dead? She keeps insisting that Dad will return or that she is not being told the truth.
A. Until we know the details it is difficult to know how to answer. How old is the child? For a younger child this response might not be unusual. How long ago was the loss and what were the circumstances? Disbelief is not uncommon as an early response to traumatic loss. Was there a funeral and was the child given the option to attend? Participating in rituals assists in accepting the reality of the loss. The question here is to understand what factors are complicating the child’s willingness to acknowledge the loss. Only when that is understood, can we effectively intervene.
-Ken Doka
Q. Please address the grief issues involved when it is the child or adolescent who is dying.
A. This is a large request. Anticipatory grief and mourning, i.e., reacting to and trying to cope with losses that occur prior to death (whether the loss has already occurred, is still in process, or is yet to come), are well-recognized experiences among those who are coping with dying. In the case of children and adolescents, these experiences will occur in a context of what may be a young person’s limited life experiences and coping resources, along with the developmental challenges that he or she is simultaneously confronting. Hence, we can learn from this wise observation from Danai Papadatou: It could be argued that seriously ill adolescents experience a “double crisis” owing to their imminent death and the developmental age. A dying adolescent is simultaneously coping with losses that have already occurred, that are in process, and that are expected, as well as the normative challenges associated with the developmental processes of achieving separation from parents, developing personal competencies, and reestablishing intimacy. Helpers should be especially sensitive to the possibility of double crises when death and development come together in the experiences of a young person. Hunter in the Dark is one book about a boy confronting these types of challenges.
-Charles Corr
Q. What would you recommend to say to a family where the father died when the boy was young and as he gets older, the boy is not allowed the opportunity to discuss his father?
A. This question implies that the child has a need to discuss his father. In that case the family should be reminded that it is quite normal for children to revisit losses at varied points in their development. Stress the value of communication and remind them of ways such as viewing photos, mementos, videos or home movies that this can naturally be done. If it too painful for them or they are otherwise unwilling, perhaps other people can be identified to help the child have safe opportunities for discussion.
-Ken Doka
Q. What would you say to counsel adults about the effect on children of having a dying person in their home?
A. In the past, dying was a natural part of the experiences of a family and of its children. In many societies, it still is. Caring for a dying person in the bosom of his or her family was a last difficult, but loving, gesture. From this perspective, children may be strengthened and encouraged, not harmed, by being permitted to participate in such experiences when the events are explained to them in a loving way. Still, the goal of home care in dying is to achieve as much quality in living and dignity as is possible, not merely to insist that the death take place in a home. Many circumstances might make this type of home care impossible or undesirable, just as it might be disproportionately difficult for some children.
-Charles Corr
Q. How do I counsel a child who has ambivalent feelings toward the dead parent?
A. Ambivalent feelings are common in all relationships. Sometimes, when a parent has been abusive or neglectful toward the child, the child’s anger will cause him to wish the parent dead. Then, if the parent dies, the child may feel guilty or responsible. The younger child (pre-school – age 9) is most likely to believe that her death wishes caused the death. The older child usually is more rational, but he still may feel strong guilt about the wishes.
Normalizing and universalizing these feelings is most important in reducing a child’s sense of self-blame. The next step is to gently, but persistently, challenge the idea that anybody’s wishes can make things happen. This may have to be repeated many times, especially if the child still believes in magical thinking. The older child may respond to the suggestion that he “let go” of these feelings, and try to substitute some happy memories of the parent.
-Nancy Boyd Webb
Q. What level of intervention is appropriate when a child is observed to be withdrawing from a dying parent?
A. The question of intervention here mainly has to do with encouraging self-awareness and self-reflection, and with offering support and constructive opportunities. One might first discuss this with the parent, and then talk about it with the child in a gentle, caring way. What are the concerns involved? Do they have to deal with dying or with the disease process, such as physical changes in the parent’s appearance or personality changes associated with increasing pain or weakness? Whatever their origins, how could the child’s concerns be addressed, minimized, or even resolved? It could be helpful to point out to the child positive benefits that might result from drawing closer, instead of withdrawing. But we should not force children to do what they do not want to do, against their wills, in the face of what frightens or threatens them, merely because we judge it to be better for them.
-Charles Corr
Q. What are some of the grief issues for young people when someone they love chooses physician-assisted suicide?
A. As always, in speaking with a child about the death of a loved one, the age of the child, and his/her relationship to the person who died should serve as guidelines in our response. The younger the child, the simpler and more direct should be the response: “You know that Grampy was in a lot of pain, and the Drs. didn’t have the right kind of medicine to take the pain away. They told Grampy that they knew that people with his kind of sickness always die. So Grampy asked the Dr. to help him die soon, so he wouldn’t have to be in any more pain. The doctors agreed to help, and they gave Grampy a special drug [avoid using the term ‘medicine’] to help him die peacefully.”
With older children, emphasize that this was the choice of the person. Also emphasize that the doctors will assist only when they know that the person is going to die soon.
It’s always hard when a person dies. When we know about it in advance we can say ‘Goodbye’ and tell the person how much we love them, and that we will always remember them.
-Nancy Boyd Webb
Q. What do I say to my 13-year-old friend who lost both parents in a car crash when she says, “No one knows how I feel”?
A. Say, “You are right. How do you feel?” Then listen.
-Ken Doka
Funeral Rituals
Q. Do you feel that a funeral for a pet is helpful for a child dealing with loss?
A. With sensitive adult support, mimicking adult rituals like this can be an important element in healthy socialization by teaching children how to cope in constructive ways with loss and sadness, and how to manage difficult moments in life. Of course, such rituals need to be adapted in form and length to the needs and capacities of the child, and to the nature of the deceased. Read The Tenth Good Thing About Barney or another of the many stories of children and pet funerals.
-Charles Corr
Q. What do you think of taking young children to visitations or funerals when the deceased is an adult that the child never knew?
A. This can be a useful way of introducing children to loss, grief, and funeral rituals in a manner that is relatively safe or non-threatening. As in any case in which children are involved in funeral ritual, it would be important to prepare the child ahead of time for what he or she might reasonably expect to experience. This allows the child some degree of choice as to whether he or she wishes to take part in these events.
-Charles Corr
Q. How can you explain cremation to a child?
A. Explanations are most effective when they are proportioned to what the child wants and needs to know and to his or her life experiences and cognitive capacities. To explain cremation, one might stick to simple, biological facts, such as “dead people feel no pain,” or “the extreme heat in the crematory essentially reduces the size of the body to bone fragments and ash which are then prepared and placed in an urn for disposition in various ways.” Aids to explaining cremation include simple story and coloring books like Jessie Flynn’s What Is Cremation, or Karen Carney’s Our Special Garden: Understanding Cremation (Book 4 in the Barklay and Eve series).
-Charles Corr
Q. How do you help the child deal with a death when there is no service for the deceased?
A. If there is no formal service following a death, one can always work with a child to organize some sort of informal memorial service to commemorate the life that is now over. Have a few private moments together with the child while thinking about the person who died. You may also want to read a poem, plant a tree, create a scrapbook, or just share memories. In all of this, one should involve the child in planning such events.
-Charles Corr
Non-Death Related Losses
Q. How can you help a handicapped child deal with the losses he or she must face? What issues might children face in foster care? Adoption? Sexual Abuse?
A. In all of these questions there is a concern about non-death related losses. In each of these situations, it is important to validate the many losses that the child experiences, and to offer opportunities for the child to explore the ways that these losses affect him or her as well as ways to best adapt to these losses. It is difficult for two reasons to note the individual affects of each type of loss. First, there are constraints of space. But second, and more critical, each child will experience grief and respond in a unique way. The key issue is to assist the child in explaining what this loss meant for him or her. Remember that this can be done not only verbally but also through varied expressive therapies.
-Ken Doka
Q. How do you help a child when a family member is incarcerated?
A. Children and adolescents can be told that the person did something very bad, and that they are being punished by having to stay in prison. This basic information may be sufficient for the young child, but as children get older, they may want more details. It is appropriate to tell children in a general way what the person did (without giving excessive details). However, any accounting of the nature of the crime should be prefaced by a statement such as, “Mary made a BIG mistake”, or “she made a very BAD choice.” Distinguish this “bad” behavior from what the child does that is “bad.”
If appropriate, and the family wants to maintain a relationship with the incarcerated person, the child can be told that Mary still loves us, and misses us. We can send her a card or a drawing, and (if appropriate) we can visit.
-Nancy Boyd Webb
Q. Are there any connections between loss, anger and delinquency?
A. There clearly is a relationship, one that is supported by a fair amount of research. It is not unusual for children to act out their grief. This can be manifested in varied ways such as delinquent acts, sexual acting out, substance abuse, or other behavioral difficulties. Two cautions ought to be noted. First, the reason for the act ought to be assessed. It may be a result of anger to the loss or secondary losses that followed as well as a call for care. Second, acts that are self-destructive or destructive to others are a red flag that the child does need counseling.
-Ken Doka
Q. What are the issues surrounding the loss of ‘culture’ for the bi-racial child whose parent dies?
A. The culture will always remain part of the child in his/her racial identity. Focusing on this reality will help the child “internalize” the memory of the dead parent. The surviving parent should be encouraged to permit the child to maintain contacts with the relatives of the dead parent, and to participate with them in holidays and ethnic celebrations. If this is not possible, the child can be encouraged to develop or continue peer friendships with children of the dead parent’s culture. Also encourage the child to display photos of the dead parent in his/her room, and to keep a photo album of special times and memories together. If the surviving parent can help the child honor the memory of the child’s dead parent, the child will feel more comfortable about doing so.
-Nancy Boyd Webb
Q. What issues might an adolescent face whose parents divorced when she was much younger and who has not seen her father in some time?
A. Ask her! She might feel anger, abandonment or a range of other emotions. Or perhaps the absent parent has little effect on her. It is not unusual for young adolescents, as they struggle with identity, to have questions as they try to understand in what ways they are alike or different from their parent.
-Ken Doka
Counseling Issues
Q. How does one determine whether it is better for a child to be counseled individually or in a group setting?
A. It is often wise for the counselor to have a screening interview to make an initial determination of the child’s status, and to talk with him/her about the prospect of group counseling. For most children, a time-limited (8-10 session) bereavement group would be the treatment of choice. Exceptions to this include children whose bereavement involves either trauma or suicide. These children should be seen in individual counseling to help them with their traumatic memories or thoughts associated with the nature of the death.
-Nancy Boyd Webb
Q. How do I help a parent accept his grieving child’s need for group counseling?
A. Ideally, the group is time-limited, so the parent will not have to make a long-term commitment. State firmly that many teachers and professionals have found that children can benefit tremendously from group counseling following the death of a parent. The parent may be afraid that counseling implies that “there is something wrong with the child.” Try to present the counseling as for “normal” kids who have all gone through a similar experience.
-Nancy Boyd Webb
Q. How do therapists handle issues of confidentiality between the parent and the child?
A. The usual practice is to respect confidentiality except when the individual is in danger of hurting him/herself or others. As I mention in my book, Social Work Practice with Children (Guilford Press) I believe that young children do not expect nor understand the principle of confidentiality. In most cases it is more helpful for the therapist to help the parent and child communicate more openly with each other than to set up a situation that excludes the parent. So I may sometimes ask a child if he/she would like my help in discussing a sensitive matter with the parent, and then I will schedule a joint session.
On the other hand, when a parent wants to keep a matter secret from the child, such as the terminal illness of the other parent, I would work with that parent around the issue of when and how to communicate this, respecting the parent’s need to maintain some control. Usually attempting to keep secrets in a family doesn’t work and leads to added feelings of betrayal later.
-Nancy Boyd Webb
Q. Is there an appropriate age for play therapy?
A. Since play therapy is a form of communication, it can be useful whenever verbal approaches are not effective. Play therapy is most commonly used with preschool and school-age children up to about age 12, but adolescents also can benefit from play therapy techniques, such as drawing, using clay, and creating stories or poems. When the child or adolescent can talk, he/she should be encouraged to do so. However, bereavement concerns are difficult to verbalize, and children may be more comfortable showing how they feel through playing with a puppet or teddy bear rather than speaking directly in the first person.
-Nancy Boyd Webb
Providing Support in Special Situations
Q. What are some suggestions for ways to help children deal with a loved one’s long-term illness, like Alzheimer’s?
A. As much as possible, help the children to be involved with the loved one in ways that are safe and non-threatening for the child. They might do small chores for that person, or share a story or an event from their life with that person. In these ways, the child can witness the chronically-ill person’s long decline and gradual loss of abilities, while also maintaining loving contact for as long as possible. That can be accompanied by occasional discussions or sympathetic exchanges with a supportive adult to provide needed information, explore concerns, and reinforce insights.
-Charles Corr
Q. What are some special issues concerning counseling bereaved mentally handicapped children?
A. Often mentally handicapped children cannot comprehend the concept of death. Like very young children, they may not understand that death is irreversible. We should try to explain in very simple terms that when a person is “dead”, their body stops working and they don’t feel anything any more. It is helpful for the child to see the dead body, if the circumstances and religious practices permit this. They should be encouraged to “say good-bye” to the person, because they won’t be seeing him/her again. Relatives can be sure that the child has a picture of the dead person, and perhaps an article of clothing or jewelry to keep.
It is important for counselors to understand that grieving occurs when the survivor realizes that the dead person is “gone forever”. This concept may be very difficult for a mentally handicapped child to grasp. Therefore a lot of patience and gentle repetition may be necessary.
-Nancy Boyd Webb
Q. What value should counselors place on a child’s beliefs in the afterlife, heaven, eternity, and reunion?
A. Robert Coles calls children “spiritual pioneers,” in that they are often constantly seeking and exploring their spirituality. Counselors should place great value on these concepts as they are critical in assisting young people in making sense of loss as well as offering comfort in the midst of grief. The critical role for the counselor is to help the child or adolescent understand the ways that spirituality may influence his or her response to loss.
-Ken Doka
Q. How can I help a child whose sister has died and whose parents are now separated?
A. This is a situation of “complicated bereavement.” First, expect a lot of anger (and this is justified). Validate the child’s feelings: “THIS ISN’T FAIR!!” Then, depending on the age of the child, look for ways to ensure that the child doesn’t think that it is her fault. Encourage each parent to reassure the child that he will continue to love and have frequent contact with him.
Unfortunately, the stress of a death of a child frequently leads to marital conflict and separation. The parents should be referred to a bereavement counselor before moving rapidly into divorce proceedings. I describe my counseling with a family in somewhat similar circumstances in my book, Helping Bereaved Children (Guilford Press).
-Nancy Boyd Webb
Q. How do I respond to my four-year-old daughter who says she wants to be with her brother in heaven?
A. This is a difficult question to answer. Your child’s response may just be a reflection of her grief and confusion. In that case reassuring her that you too miss her brother but that you are so glad she is there may help as would honestly addressing her grief and patiently understanding her attempts to understand her faith in the midst of the loss. However, it might be well to meet with a counselor so you can clearly make an assessment as to whether there is any danger that the child may act on her wish.
-Ken Doka
Q. What sort of assistance can a ‘Far-away’ grandparent provide to a grieving child?
A. Telephone, letters, and e-mail (for the older child) can be useful in communication with distant relatives. It might be helpful to consult the children’s librarian in your community to identify some children’s books, appropriate for your grandchild’s age, and for the specific bereavement situation. If you feel comfortable with the book, buy a copy and send it to your grandchild, and then follow-up with a phone call. The most important thing you can do is to maintain contact. Tell the child that you are thinking about her/him, and try to plan a visit in the near future.
-Nancy Boyd Webb
Schools
Q. What ages of children can be grouped together when running a grief support in a school setting?
A. The general rule is to group children within two years of the same age or grades. If the spread gets too big, the older children may tend to dominate, and the group members will feel less in common with one another.
In certain circumstances it is ok to group children with a wider spread of ages. When children have experienced a traumatic event together (such as a school bus accident or a bomb scare) the impact of their shared experience takes precedence over age considerations.
-Nancy Boyd Webb
Q. Is it appropriate for teachers to use books that deal with the subjects of death and grief?
A. There are many wonderful books related to death that are appropriate for classroom use. If a teacher is aware that a child has suffered a recent loss, it would be appropriate for the teacher to speak to the child prior to using the book, and prepare the child for the contents. The book could be potentially helpful to the child, but it would not be helpful for the child to be taken by surprise about the teacher’s plan to use it. At some later time (in private) the teacher could ask the child what it was like to listen to the story, and if he/she wants to share any of his/her experiences with the teacher. It is important for the teacher to feel comfortable about doing this (both talking to the child individually and reading the story to the class). If the teacher feels nervous or hesitant about doing it, it would be better to substitute another reading.
-Nancy Boyd Webb
