Running Head: COUNSEING GRIEVING CHILDREN 1

Counseling Grieving Children

Phillip Fentress Mobley

Liberty University

COUN 611 B04 201230

COUNSELING GRIEVING CHILDREN 2

Abstract

Grief is a mature and healthy emotional process. One in which everyone has or will have experienced at

some point in life; just as adults grieve, so do children and adolescents. Grief in children is nothing new.

It may manifest itself in the loss of a loved one or an unforeseen and uncontrollable circumstantial event.

Much is known empirically of how grief affects the lives of adults, however, little is known about the

psychological and emotional effects that grief has on children and adolescents. The reality of death can

only be understood by children who are psychologically mature enough to understand the finality and

irreversibility of death. In order for children to gain an understanding of what death is, they need the

support of a loved one to help them cope with the inevitable absolution of death. This paper will

illuminate the subject of grief and bereavement in children and how it shapes their perception of reality.

Keywords: grief, bereavement, loss, trauma, crisis, depression.

COUNSELING GRIEVING CHILDREN 3

Counseling Grieving Children

On the subject of death and dying, most adults tend to shy away from the inevitability

and finiteness of the topic of death. Adults simply do not want to be reminded about their own

mortality. Bereavement and death are synonymous with grief. In a child’s world, death is

understood in stages of psychological development. How well a child accepts the reality of

death depends on their understanding of loss and finality. More so now than ever, children are

being exposed to traumatic grief and bereavement not only due to the loss of a loved one, but

acts of terrorism and violent wars across the globe. With the current state of affairs in foreign

governments and military deployment of soldiers in hostile territories throughout the world; grief

and loss are becoming a part of the mainstream societal and cultural environments. Much of

what is seen in the media concerning wars and the consequences of war, many children are left

wondering about their own care and safety. According to Cohen, Mannarino, Greenburg, Padlo,

& Shirley (2002) “childhood traumatic grief refers to a condition in which characteristic trauma-

related symptoms interfere with children’s ability to adequately mourn the loss of a loved one.

Empirically, researchers have found that the concepts of childhood traumatic grief

suggest that it overlaps with but is distinct from uncomplicated bereavement, adult complicated

grief, and posttraumatic stress disorder” (p. 307). Brown, Amaya-Jackson, Cohen, Handel,

Bocanegra, Zatta, Goodman and Mannarino (2008) found that every year, approximately 4% of

children experience the death of a parent (Social Security Administration, 2000). By 21 years of

age, over half of all participants in a representative inner-city sample had experienced the sudden

unexpected death of a close relative or friend; traumatic death was the most frequent traumatic

experience reported by this cohort (Breslau, Wilcox, Storr, Lucia, & Anthony, 2004) (Brown et

al., 2008). Although most children cope well even after sudden death, some research has

COUNSELING GRIEVING CHILDREN 4

indicated that children bereaved by parental death experience increased rates of psychiatric

problems in the first two years after the death (e.g., Cerel, Fristad, Verducci,Weller, &Weller,

2006). However, empirical research is limited concerning what are considered ‘‘normal’’

children’s grief reactions, and, at what point their reactions enter into a range that could be

considered ‘‘pathological’’ (i.e., severe enough to warrant clinical intervention) (Cohen,

Mannarino, Greenburg, Padlo, & Shirley, 2002). Developmentally, children cope with grief and

loss in life stages. From infancy to adolescence, children experience death and loss in varying

ways.

Infants and Toddlers

Infants and toddlers (babies 0 to 2-years-old) experience a sense of “gone-ness” or

absence when someone dies (Emswiler & Emswiler, 2000; Wolfelt, 1996) (Cohen, et al., 2002).

Children at this stage typically present systemically with separation anxiety due to being

separated from an attachment figure; sleep deprivation; changes in eating habits; fussiness,

bowel and bladder disturbances, or difficulty being comforted (Black, 1998; Emswiler &

Emswiler, 2000; Grollman, 1995; Wolfelt, 1996) (Cohen, et al., 2002). According to

Himebauch, Adam, Arnold, Robert M., & May, Carol. (2008) “children at this age have no

cognitive understanding of death. However, grief reactions are possible and separation anxiety is

a concern. Behavioral and developmental regression can occur as children have difficulty

identifying and dealing with their loss; they may react in concert with the distress experienced by

their caregiver. There is a need to maintain routines and to avoid separation from significant

others” (p. 242).

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Early childhood (Preschoolers)

Preschoolers; ages 2 to 6 do not understand the finality of death. According to

Henderson and Thompson (2011) they regard it as temporary and reversible. They explain away

the death of a loved one as being on a trip or being asleep (Henderson & Thompson, 2011). The

concept of death is a “magical thought” construct; meaning, they believe that their thoughts can

make things happen. Preschoolers believe that the death of a loved one is somehow their fault or

if they are “good enough” that the deceased person will return (Henderson & Thompson, 2011).

Caregivers should provide straight forward and simple explanations, being careful to avoid

euphemisms, correcting misperceptions, and reminding them that the loved one will not return

are important strategies (Himebauch, Arnold, & May, 2008).

Middle Childhood

At the age of 9 and up, children know that death is final and irreversible. Children at this

age tend to see death as something tangible or physical (i.e., a spirit, angel, or ghost). They come

to the realization that everyone eventually dies, they began to recognize that their own existence

is fragile and finite. They fear their own demise. They may struggle with the concept of how the

deceased could be buried in the cemetery and be in heaven at the same time (Saravay , 1991)

(Cohen, et al., 2002). For children who have been raised in a fundamentalist Christian home,

their knowledge and understanding of this concept is clear; they believe that the physical body is

finite, but the soul is immortal. According to Sciarra (2004) children after the ages of 11 or 12

may have trouble concentrating on their school work, may withdraw from friends and family,

and may seem angry and sad, as well as being tired and drowsy (Sciarra, 2004) (Henderson &

Thompson, 2011).

COUNSELING GRIEVING CHILDREN 6

Adolescence

Cognizance of grief is much more concrete among adolescents. They are capable of

understanding the process of death and dying. As with younger children, adolescents are unsure

of how to express their emotions. They may experience deep fear, guilt, helplessness, and grief

in varying ways (Henderson & Thompson, 2011). At this phase of development, teens will rely

more on their friends for support instead of parents or primary caregivers. Within the past 3

years a study was done with Searles Mcclatchey, Vonk and Palardy(2009) founded by UCLA

and the University of Georgia, Athens on the prevalence of childhood traumatic grief (CTG) and

posttraumatic stress disorder (PTSD) symptoms in parentally bereaved children (McClatchy,

Vonk, & Palardy, 2009). The purpose of this study is to examine the occurrence and interplay of

grief and post-traumatic stress disorder symptoms among parentally bereaved children, both for

those children who have been bereaved by a violent/sudden death and for those children who

have been bereaved by an expected death, such as that due to chronic illness.

METHODS

Sample

Three weekend bereavement camps were held in April, May, and October of 2006 in a

metropolitan area in the southeastern United States. A purposive sample was used for this study

which was part of a larger quasi-experimental study. The total sample of 158 children ranged in

age from 6 to 16 (M = 10.8, SD = 2.31). The length of time since death ranged from 1 to 48

months with an average of 13.48 months (SD = 12.54). Eighty-three (52.5%) of the children

were female, 98 (62%) White, 50 (31.6%) African American, 9 (5.7%) Latino, and 1 (0.6%)

Asian. Sixty-two (39.2%) children had lost a mother. Sixty-three (39.9%) children had lost a

parent to an expected death such as cancer, end-stage kidney and heart disease, and multiple

COUNSELING GRIEVING CHILDREN 7

sclerosis (McClatchy, et al., 2009). Most of these deaths occurred on hospice care. As such, this

study addresses the following research questions:

1. Do children who experience an expected death of a parent suffer from

Childhood Traumatic Grief to the same extent as those children who lose a

parent to a sudden and/or violent death (McClatchy, et al., 2009)

2. Do children who experience an expected death of a parent suffer from PTSD

symptoms to the same extent as those children who lose a parent to a sudden

and/or violent death (McClatchy, et al., 2009)

3. To what extent do parentally bereaved children experience CTG and PTSD

symptoms (Searles Mcclatchey, Vonk and Palardy, 2009, p. 309)

To assess exposure to trauma and PTSD symptoms in children ages 7-18., researchers used the

UCLA PTSD indexing tool which consists of three parts, but only the third part, the frequency of

occurrence of re-experiencing, avoidance, and arousal symptoms over the month prior to the

administration of the scale, was used for this study (McClatchy, et al., 2009). This third part is a

20-item paper-and-pencil self-report instrument on which the participant has an option of five

frequencies, ranging from 0 (“none of the time”) to 4 (“most of the time”) (McClatchy, et al.,

2009). Validity of previous versions of the UCLA PTSD Index has been supported by many

studies (Steinberg, Brymer, Decker, & Pynoos, 2004) and the latest scale version used in this

study has shown to have good convergent validity (0.70) with the PTSD Module of the Schedule

for Affective Disorders and Schizophrenia for School-Age Children, Epidemiologic version

(Steinberg et al., 2004) (McClatchy, et al., 2009). The UCLA PTSD Index also has good

convergent validity (0.82) with the Child and Adolescent Version of the Clinician-administered

PTSD Scale. Researchers have demonstrated support for the internal consistency of the latest

COUNSELING GRIEVING CHILDREN 8

scale version of the UCLA PTSD Index with a Cronbach’s alpha of 0.90 (Roussos, Goenjian,

Steinberg, Sotiorpoulou, Kakaki, Kabakos et al., 2005). A test-retest reliability coefficient of

0.84 was recently reported (Roussos et al., 2005). Scoring for this study was calculated by

summing the scores for each symptom (re-experiencing, avoidance, arousal) (McClatchy, et al.,

2009). The empirical findings of this study concluded that the frequency of CTG and PTSD

symptoms, as measured by the EGI and UCLA PTSD Index respectively, did not differ in

children who had experienced an expected loss of a parent compared with children who had

experienced a violent or sudden loss (McClatchy, et al., 2009). Concurrently, every subsequent

lost was impactful and devastating to the children. There was no greater devastation due to the

degree of trauma or tragic loss. A child losing a parent to a sudden violent car accident was just

as devastated as a child whose parent was slowly dying in a hospice center from a terminal

disease.

Intervention methods are varied when seeking professional assistance with grieving children.

The most influential is behavior therapy. Behavior modification therapy is the key to changing

the way a child processes the idea of death and dying. A child’s methodology for understanding

death is “magical thinking”. This is the area of psychopathology that needs to be addressed

when helping the child mentally process the finite reality of death. According to Pauline King,

director of children's programs at the OSU James Cancer Hospital… "They may look like they

are coping well, because they are playing - and adults equate playing with being carefree - but

they may actually be involved in a complicated and unhealthy process of mourning ("Behavior

Therapy; Grief counseling reshapes children's thoughts of death," 2005)." King’s therapeutic

methodology for dealing with grieving children is art therapy; giving children a voice for their

loss. Two graduate students and a professor/clinical supervisor from the art therapy department

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at New York University discuss their experiences in the wake of September 11, 2001. DiSunno,

Linton, & Bowes (2011) discuss their use of art therapy after the aftermath of the tragedy of

September 11th. “Images created by children suggested that symbol making after a public

tragedy can have universal meaning to others experiencing grief, that image making helps

process traumatic experiences so that they may be translated into words, and that therapists and

clients who have experienced a common public tragedy share in processing traumatic events

through artistic creations” (DiSunno, Linton, & Bowes, 2011, p. 48). DiSunno, Linton, & Bowes

(2011) feel that “because children respond to and cope differently with traumatic experiences,

the flexible use of art as a therapeutic tool is helpful for children who experience a variety of

grief responses” (DiSunno, Linton, & Bowes, 2011, p. 48). As described by DiSunno, Linton, &

Bowes (2011) “Camp Good Grief, located on the eastern end of Long Island, is a weeklong

summer day camp for children aged 4 to 15 who have experienced the death of a family member

or relative. The camp was founded in 1997 by East End Hospice’s multidisciplinary team who

identified the need for specialized work with bereaved children. Theoretical frameworks from

the disciplines of psychiatry, social work, art therapy, nursing, child development, and

psychology are the basis for the design of the children’s bereavement program” (DiSunno,

Linton, & Bowes, 2011, p. 48). The response was overwhelming, both for the counselors and the

children. Many of the camp workers described being emotionally moved to see the images that

were created by these grieving children. In retrospect, this was one of the most emotionally

draining, yet professionally rewarding experiences a counselor could have.

In summation, the Bible tells us in Isaiah 53: 3-4; “He is despised and rejected of men; a man

of sorrows, and acquainted with grief: and we hid as it were our faces from him; he was

despised, and we esteemed him not. Surely he hath borne our griefs, and carried our

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sorrows: yet we did esteem him stricken, smitten of God, and afflicted.” (KJV) Truly,

Isaiah’s words communicate the suffering of Christ as He was the propitiation for our sins.

Giving His life so that we would be reconciled back to God, the Father. Surely, God had no

greater grief than we shall ever know, because His only Son gave His life for us. It is for this

reason, that God understands our sorrows and grief; He Himself has experienced that same

heart wrenching grief that at some point in life all of us have or will experience in our

lifetimes. Yet, our hearts can be glad and still rejoice knowing that if we stay on the path of

righteousness, that one day we will see those whom we have lost again and on that day we

will rejoice and be exceedingly grateful that God prepared a place for us and we will find rest

for our souls in Him. Amen!

References

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(2002). Childhood traumatic grief. Trauma, Violence, & Abuse, 3(4), 307-327. doi:

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DiSunno, Rebecca, Linton, Kristin, & Bowes, Elissa. (2011). World Trade Center Tragedy.

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