grief in-service
TRANSCRIPT
Grief and the
Family
Child Life Intern Molly
Pearson
Summer 2014
GR
IEFThe normal process of
reacting to a loss.It
is a process that helps us
adapt to change so that we
can return to life with
vitality and hope.
MedicineNet.com
Sta
ges o
f Grie
f
Eliza
beth
Küble
r-Ross
Denial: A
defense
mechanism
that buffers the
initial shock
Anger: When
reality and its
pain re-emerge
Bargaining:
Often the need
to regain
control
Depression:
The reaction to
practical
implications
relating to the
loss
Acceptance:
Coping with
the loss
Who Deals with
Grief & Who Can
We Help?
The Whole Family
Who D
eals w
ith G
rief
& W
ho C
an W
e H
elp
Patients with disabilities
AmputationsSpina Bifida
Cerebral Palsy
Osteogenesis Imperfecta
Scoliosis
Muscle Dystrophy
Juvenile Arthritis
Other Orthopedic
Conditions
Who D
eals w
ith G
rief
& W
ho C
an W
e H
elp
Parents; single, divorced,
step, adoptive parentsSiblings
Grandparents
Other relatives and
community members
Grie
f Resp
onse
Facto
rs
Age
Stage of mental and emotional
development
Patterns of interaction and
communication within his/her
family
Grief can be reoccurring and in
doses
Show grief through play/activities
rather than tell their grief- may
appear unaffected
A loss may interrupt a child’s
developmental tasks
Children are sensitive about
being different
Children have a difficult time
putting their feelings into
words.
Children are quick to blame
themselves
Young children may not
understand that a loss is final,
irreversible or certain: grief
may be delayed into later
developmental years.
Children lack experience and
social skills.
Children may sacrifice their
personal needs.
Com
mon R
eactio
n
Afte
r Dia
gnosis o
r loss
Anguish
Envy
Self-blame
Sadness
Anger
Anxiety
Isolation
Bitterness
Self-image/
Self-esteem
issues
Sleeping
problems/nigh
tmares
Change in
appetite
Nader & Salloum, 2011
Shear, 2012
Oth
er G
rievin
g
Resp
onse
s
Mental reactions to grief
Thinking that the loss didn’t really
happen
Difficulty in making decisions
Thinking everyone is watching you
Thinking you are different from
everyone else
Self-destructive thoughts
Oth
er G
rievin
g
Resp
onse
s
Physical reactions to
grief
Headaches
Tightness of the throat
Shortness of breath
Fatigue
Loss of appetite and sleep,
Types o
f
Grie
vers
Intuitive Griever:
heightened experience
and expression of
emotion
Instrumental Griever:
use cognitive behavioral,
problem-solving
approach
Nader & Salloum, 2011
Developmental Grieving
InfantsNader & Salloum, 2011
No cognitive understanding of
loss, but can grieve.
Difficulty identifying or dealing
with loss.
Crying excessively, fretting
persistently, separation anxiety,
and irritability.
Changes in feeding, bowel
movements, and sleeping
patterns
Developmental Grieving
ToddlersNader & Salloum, 2011
Egocentric
Mirror caregiver reactions
Separation anxiety,
nightmares/fear of sleeping
Regression and irritability
May have trouble
concentrating
Behavioral outburst
Developmental Grieving
Preschool AgeNader & Salloum, 2011
Magical Thinking
May experience grief reactions
of toddlers
Self-blame- causes the loss
Regression and aggression
Behavioral issues:
internal/external
Developmental Grieving
School AgeNader & Salloum, 2011
Anger, anxiety, depression
Fear about safety for self and
other loved ones
See self as different from other
children; stigmatized
Feel of loss of control
Concerns with isolation
Developmental Grieving
Pre-AdolescentNader & Salloum, 2011
Intellectualize the loss,
curiosity to understand the
details of the loss
Interest in religion
Difficulty identifying and
dealing with feelings
Aware that they are different
from other children
Developmental Grieving
AdolescentNader & Salloum, 2011
Abstracting thinking/reasoning.
Develop understanding of meaning
and/or greater effect of loss
Preoccupied with own thought
process.
Concerns about how others are
thinking and saying about them.
Feel different and that nobody
understands them.
May reject religion and adult
support.
Pare
nta
l Grie
vingCan re-experience
disparity between their
actual parenting
experience and their
idealized parenting
experience.
Whittingham, Wee, Sanders, & Boyd, 2013
Must deal with multiple
losses as their child will
not have a normal life
cycle nor will they, as
parents. Patrick-Ott & Ladd, 2010
Sto
ry“The hopes and dreams for the
life of my first some were dying
a slow death. The growing
realization that Josh would be in
my life, fully dependent on my
care for the rest of his life... I
was sad for Josh and his own
losses – skills, opportunities, and
milestones. No driver’s license.
No first date. No first job
interview. No marriage and
children”Patrick-Ott & Ladd, 2010
Sib
ling G
rievin
g
Increase risk for emotional
and behavioral problems
Anger and jealousy
towards disable sibling
Scared for their
brother/sister and
themselves
Feel forgotten and not an
important part of the
family Sharpe, D., & Rossiter, L., 2002.
Gra
ndpare
nts
Initial reaction is similar to
those of parents
Place self-blame
Want to shoulder some of the
burden and help out
Fear and concerned about
grandchild’s future and
uncertainties Lee & Gardner, 2010)
Life
styl
e
Adapta
tions
Alterations/adaptions to
daily living activitiesMoving to first floor
bedroomRe-learn ambulationUsing assistive devices
Installing handrails and
ramps in the homeIncrease time to
complete tasks and travelRequired rest periods
Dietary modifications
Life
styl
e A
ltera
tions
Conti
nue
Decrease physical activitiesMedical expenses-
budgetingPreventions and precautionsEnvironmental changes
Extra time planning
outings
Pati
ent
Copin
g
Given honest, age appropriate information
and involved in decision
making processSupport groups and
campsPlay to learn, process
new information, and to
adapt.Keep open communication linesEdgar-Bailey & Kress, 2010
Pare
nta
l Copin
g
Adaptive coping strategiesCommunication with
health professionals &
school staffSocial supportOptimistic outlook/reframingSpending time with
spouseHaving a hobbyWhittingham, Wee, Sanders, & Boyd, 2013
Sib
ling C
opin
g
HonestInfo at age appropriate
levelOpen for questions and
to share feelingsOkay to cry with themSet time aside for them
each dayLet them visit sibling in
the hospitalReassure them they are
important and lovedWilliams et al., 2002
Fam
ily C
opin
g
Positive reinterpretation and growthInstrumental/emotional
social supportActive copingAcceptancePlanningSuppression of competing activitiesWang, Michaels, & Day, 2011
How
Can W
e
Help
?
ListenInclude the pt. and his/her
family in the treatment plan
processEducate about the disability/diagnosis and
beneficial resourcesAllowing them to grieve in
their own waySilence, but being present
Build rapport with the family
Believe in child’s ability to
recover and grow
Who C
an H
elp
?
Child life/Rec Therapy
Physical TherapyOccupational Therapy
TherapistDoctors/NursesSocial WorkCare Coordinator
Other Medical StaffTeachers/TutorsSchool Counselor Local Church
Refe
rence
s
Axelrod, J. (2006). The 5 Stages of Loss and Grief. Psych Central
Edgar-Bailey, M., & Kress, V. E. (2010). Resolving Child and Adolescent Traumatic Grief: Creative Techniques and Interventions. Journal of Creativity in Mental Health, 5(2), 158–176.
Harvey, J. H., & Miller, E. (1998). Toward a psychology of loss. Psychological Science, 9, 429.
Lee, M., & Gardner, J. E. (2010). Grandparents’ Involvement and Support in Families with Children with Disabilities. Educational Gerontology, 36(6), 467–499.
MedicineNet.com
Nader, K., & Salloum, A. (2011). Complicated Grief Reactions in Children and Adolescents. Journal of Child & Adolescent Trauma, 4(3), 233–257.
Patrick-Ott, A., & Ladd, L. D. (2010). The Blending of Boss’s Concept of Ambiguous Loss and Olshansky’s Concept of Chronic Sorrow: A Case Study of a Family With a Child Who Has Significant Disabilities. Journal of Creativity in Mental Health, 5(1), 73–86.
Sharpe, D., & Rossiter, L. (2002). Siblings of children with a chronic illness: A meta-analysis. Journal of Pediatric Psychology, 27(8), 699–710.
Shear, M. K. (2012). Getting Straight About Grief. Depression & Anxiety (1091-4269), 29(6), 461–464.
Wang, P., Michaels, C. A., & Day, M. S. (2011). Stresses and Coping Strategies of Chinese Families with Children with Autism and Other Developmental Disabilities. Journal of Autism & Developmental Disorders, 41(6), 783–795.
Whittingham, K., Wee, D., Sanders, M. R., & Boyd, R. (2013). Predictors of psychological adjustment, experienced parenting burden and chronic sorrow symptoms in parents of children with cerebral palsy. Child: Care, Health & Development, 39(3), 366–373.
Williams, P. D., Williams, A. R., Graff, J. C., Hanson, S., Stanton, A., Hafeman, C., … Sanders, S. (2002). Interrelationships Among Variables Affecting Well Siblings and Mothers in Families of Children with a Chronic Illness or Disability. Journal of Behavioral Medicine, 25(5), 411–424.