The Art of Listening to Children Who Have Experienced Loss through Bereavementby Helen Culhane

My interest and commitment to this topic is based on my professional social work experience with bereaved children and young people since 2001. I felt so passionate about the importance of listening to bereaved children that I established the Children’s Grief Project in Limerick city in 2009, in association with my Congregation of the Sisters of Mercy. This project supports children and young people who have experienced loss through separation/divorce or bereavement. The project is unique in that it is volunteer-led. The majority of the volunteers are from a counselling/play therapy or art therapy background.

I worked for thirteen years with the HSE in the areas of child protection and subsequently worked in a hospice setting for seven years. In the course of my work with bereaved children, I noted that some children felt their grief was not recognised and they did not feel listened to. Children like adults do not always show their emotions. Dyregrov (2008) stated:

There is still a strong tendency in many western countries to try and protect young children from many of the unpleasant or difficult aspects of life rather than prepare children to understand and cope with these (p9).

In Ireland, it is estimated that between 36,000 and 60,000 young people have experienced a significant bereavement (McLoughlin, 2012). Research by the ESRI (Economic and Social Research Institute: ‘Growing up in Ireland’) demonstrates that 2.2% of nine year olds have lost a parent, 1.1% a sibling, 7% an aunt or uncle and 6% a close friend. By the age of nine, 28% of Irish children have lost a grandparent.

A Personal Account

My brother Martin died when I was five and a half years old. To this day I have vivid memories of his small white coffin been removed from our home and placed in the back seat of our neighbours’ car. To my mind he was whisked away. The memory of his death surfaced for me some forty years after his death when I went to work in the Milford Hospice. Unresolved feelings surfaced and I was taken by surprise.

These feelings prompted me to take a different career path and I decided that I would like to undertake a course of training to become a psychotherapist, so that I could help the many children I knew were suffering loss through bereavement, separation or divorce. Therefore in 2012, I enrolled in a professional training course in counselling and psychotherapy with the Dublin Counselling Centre.

Children’s feelings are often inaccessible at a verbal level. They are more inclined to act out when distressed. In some cases they are referred on to a counsellor or therapist for counselling, as if they have a serious problem.

From my experience of working with bereaved children, when given space and time, they can express their grief through many interventions. This expression is rarely with words, but more frequently through paint, music, workbooks, play, clay, games and story books.

I believe it is important that parents and professionals understand the power of listening to children. Listening to grieving children can reduce the negative effects that may occur following bereavement and last into adulthood. In this paper, my hope is to highlight the value of listening to bereaved children and that they don’t always need professional help.

Listening

Epictetus, the Greek philosopher, believed we have two ears and one mouth so that we can listen twice as much as we speak. Listening has been defined in a variety of ways. However, it is posited that listening is the most important of all communication skills (Hunt & Cusella, 1983). It is at the heart of all communication. To listen literally means ‘to gather’. From my experience, parents and professionals can gather so much information from watching and listening to children as they engage with them.

Torrie (1978), writing on bereaved children, advises that: “the young child has not mastered the art of communication and it is rare for him to be able to say what he feels” (p5).

In my opinion, children often experience isolation and confusion following bereavement because people can pressure them ‘to put it behind you and move on’. The feeling of been heard is essential to a child’s growth and development. If a child fails to process thoughts and feelings associated with loss and grief, the child cannot move through the healing process.

Parents and professionals can listen, not only with their ears, but through the many interventions that I have mentioned. Oaklander (2007) has noted through her work, the power of listening to bereaved children. She believes “Kids desperately need someone to listen, validate and support them in a non-threatening safe place” (p102).

How I work

When a child is referred to the Project, I meet with the parent or guardian of the child in the first session. The purpose of the meeting is to listen to their reasons for the referral and this gives an insight into where the parent or guardian are at in relation to their own grieving. In the second session, I meet with the child and the parent together for the first ten minutes of the session. These meetings, with the parent or guardian present, are important in establishing a rapport with the child. All of the sessions with the child take place in the art room. The parent waits in a waiting room opposite the art room. The child knows their parent is immediately available to him or her should they get upset. At the end of each session, the child has the option of inviting mum or dad into the session.

Tom

The following case study is taken from my case load. I am using a pseudonym for the purpose of this article and permission for this story and artwork has been given by the child and his mother. Tom was an eight-year-old boy whom I worked with for eleven sessions. One of the hardest losses for a child to experience is when a parent dies as a result of suicide.

Tom was six years old when his father died by suicide. In my experience, children manifest their grief at home, at school, and with their peers. Tom’s mum stated in our first meeting that he had become more aggressive towards his older siblings since his father’s death. In school he had become withdrawn but his grades had remained good. He had become aggressive towards his peers and uncooperative at home. From my experience of working with bereaved children, they often communicate their grief by misbehaving.

Tom was aware of how his Dad died. At his stage of development Tom understood the finality of death and saw death as permanent. He worked through each page of the workbook, ‘Someone I Love Died’. The workbook enabled Tom to develop his feeling vocabulary.

In the first session I asked Tom, why his Mum brought him to the Children’s Grief Project. He appeared nervous and said:

“To talk about what is going on in my head.”

On exploring further, Tom replied:

“It’s better for me not to think about it too much because when I think about my father, I know there’s nobody like him. Dad used to bring me to school. I have anger and other things going on in my head.”

I listened and repeated what he said. In a low tone he uttered:

“I’m afraid I’m upsetting Mum and she gets really upset. I worry about Mum. I worry when she cries and I wonder why she is crying.”

I repeated, “You worry when Mum cries”. He replied:

“I think it is about Dad. When I talk to Mum about Dad she gets upset.”

In page six of the workbook Tom read:

Sometimes love hurts and it hurts when someone your love goes away. It hurts a lot when someone you love dies. Draw a picture of how love hurts.

Tom shared:

“I feel the hurt in my heart and what hurt most is that Dad died”. Tom quickly said to me:

“Can I draw my heart?”

I explained to Tom that this was his space and he could say or write whatever he was feeling. He drew a heart.

As Tom looked at his drawing, I asked him what he was feeling. He replied:

“I am ‘heartbraking’. Can I write on my heart?”

He wrote:

“Sad, extremed, upset, angry, shocked, patience, terrible, not alive, anxious, and unhappy.”

Tom explained each of the feelings. He described sad:

“Do you know how you feel happy when you are alive and not sad? I miss Dad he was good to me.”

“I feel not alive when I miss dad. When I am sad I feel not alive.”

In explaining ‘extremed’, he extended his arms and said:

“I felt extremed because I felt shocked and upset. I feel shocked Dad died so suddenly and so young. My Dad was only forty two. I feel terrible myself.”

Worden (1996) states:

The loss of a parent to death and its consequences in the home and in the family change the very core of the child's existence. (p9)

In our conversations together, Tom shared ways he remembered his father. In session eight, he brought in two pictures he had painted of his Dad. One picture was of his Dad walking in the fields. He told me it was an activity he enjoyed doing with his father. The second picture was of his Dad out in the farm with the cows. With a smile on his face he shared:

“Dad used to walk in the fields and one time he slipped in a drain. I am happy that I have got Dad’s stuff. I have Dad’s tools, board game, wallet, and his hats. I have them in a box.”

As an intervention, the drawing of his Dad and himself is closely connected to the continuing bond theory of Klass and colleagues. According to Klass (1996), many people who have been bereaved maintain a bond with the deceased. In this exercise Tom was maintaining a bond with his father. Silverman & Worden (1992) identify five categories which represent children’s attempts to stay connected with the person who has died. They are locating the deceased, experiencing the deceased, reaching out to the deceased, waking memories and, finally, linking objects. Evaluation

At the last session with Tom, I asked him to complete an evaluation which is standard practice within the project:

What did you find helpful? “Talking about the person. I got used to it and it helped me to talk about it with my family.”

What did you most like about coming to the Project? “I liked writing about my Dad. Helen helped me by saying it was OK to cry.”

Did the sessions make any difference in your life? If so, can you describe the difference? “The sessions made a difference to me, I am not as worried as I used to be.”

Any other comments? “Thank you for helping me.”

At the end of each session the child is asked to name what they are feeling. A feeling face sheet is provided which has drawings of feeling faces and provides lists of feelings. In session nine Tom shared:

“I am happy. I am finding it helpful coming in here. You are helping me to understand what happened... I don’t like being asked questions.”

As I listened to Tom, he said:

“I’m happy you are helping me a bit. I learn what is going on. I sort things out. I understand my Dad is not alive. I was sad when I started here but I now feel good. I am able to get my words out.”

At the end of each session Tom invited his Mum in to view his work. I noticed on a number of occasions that Tom would not share with his Mum what he had planned to share. Research shows that children will hesitate to share what may be upsetting to their parents as they want to ‘protect’ them. This further highlights the importance of a safe place like the Children’s Grief Project where children can be open and where they can freely express their feelings and be helped to communicate in a meaningful way with their parents. In her research, Webb (2011) highlights the importance of family and parental involvement when working with bereaved children. Mum also completed an evaluation sheet and said:

“He is not as angry as he would have been 13 months ago and we have had no tantrums for the past five months. He’s able to express verbally better how he is feeling and has a better empathy/understanding of other family member’s feelings”.

Conclusion

It is important for adults to listen empathetically when children come to them with issues of bereavement (Emswiler & Emswiler, 2000). As Tom worked through the workbook he began to talk more and more about his sadness and missing his Dad. He used tools such as drawing and writing to talk and express his feelings. His drawing of his heart gave him the space and permission to get in touch with his feelings. I gained an insight into Tom’s emotional wellbeing as well as his fears and worries as he worked through the workbook. The variety of interventions gave him the opportunity to communicate in a less threatening manner rather than talking face-to-face. The sessions with Tom resulted in his ability to express emotions through the workbook and painting that he could not express verbally. In listening intently to Tom, he appeared relieved when I told him “it is ok to cry”.

The work that I undertook in this case study illustrates the importance of listening to children and the use of various interventions to empower them to verbalise and understand their feelings of loss.

Final Thoughts

Bereavement in childhood can have a devastating effect on the life of a child. Children who are bereaved need their grief to be recognised and acknowledged so that they can mourn their loss in their own way. Creating a safe place for children to express their feelings is essential to their emotional well-being.

When children have difficulty finding words to express their thoughts and feelings, they are able to do so through various interventions, as outlined above. From my clinical practice, I have found that when bereaved children are given the opportunity to talk of their loss experiences, they gain an insight into and understanding of their pain.

As demonstrated by the case study, the technique of using a workbook and art materials aided Tom in his emotional expressions of his grief and loss. These interventions proved very effective and through my understanding, acceptance and listening ear, Tom felt supported. This resulted in Tom naming and facing his deep pain at the loss of his Dad. From my long experience of working with bereaved children, most children do not need counselling. They need adults in their lives to be well informed, in order to support them by listening as the children experience their feelings of pain and loss.

I have found that children who have the opportunity to talk of their experiences of loss with someone who takes them seriously are enabled to gain insight into and understanding of those experiences for themselves. From my experience, listening is the key to helping children communicate their feelings during times of bereavement. According to Hilliard (2001):

Providing children/adolescents with choices and opportunities to process grief through fun and creative mediums enable this population to learn healthy coping strategies to prevent emotional, behavioural, and/or psychological issues arising in their future” (p368).

Throughout this paper, I have talked about the vital role listening plays when working with bereaved children. If we can support children in their grief, they will gain the confidence to conquer other traumatic events later in life. It is crucial that adults generally develop the art of listening so that they will become more effective and supportive for bereaved children. The training I received through the psychotherapy course has greatly furthered my understanding of the power of listening.

In conclusion, this case study provides an insight into the role and value of listening to bereaved children. It is fitting that I conclude with words from Tom as he describes his experience of coming to the children’s Grief Project:

“I am able to get my words out.”

Helen Culhane is the founder and Director of the Children’s Grief Project, Ashbourne Avenue, South Circular Road, Limerick. Tel: 061 224627. Mob: 087 9851733. www.childrensgriefproject.ie.

References:

Dyregrov, A. (2008). Grief in children: A handbook for adults (2nd ed.). London, Antenaeum Press. p9.

Deaton, W. (1994). Someone I loved Died. Hunter House Inc, Publishers, Alameda CA 94501-0914.

Emswiler, M.A. & Emswiler, J.P. (2000). Guiding your Child through Grief. New York, NY: Bantam Books.

ESRI (2012) Williams, J and Morgan, M Adverse Childhood Experiences – Their effect on behavioral outcomes http://www.esri.ie/docs/CLSCIWilliams.pdf accessed November 4th 2012

Hilliard, R. (2001). The effects of music therapy-based bereavement groups on mood and behaviour of grieving children: A pilot study. Journal of Music Therapy, 38(4), 291-306.

Hunt, G.T., & Cusella, L.P. (1983). A Field Study of Listening Needs in Organisations. Communication Education, 32(4), 393-404.

Klass, D., Silverman, P.R., & Nickman, S.L. (1996). Continuing bonds; New Understandings of Grief. Phil. PA, USA: Taylor & Francis.

McLoughlin, K. (2012). Establishing a Children’s Bereavement Support Network in Ireland: a scoping study. Ireland: Irish Hospice Foundation.

Oaklander, V. (2007). Hidden treasure: A map to the child’s inner self . London: Karnac Books. p102.

Worden, J. W. (1996). Children and grief: When a parent dies. New York: The Guildford Press. p9.

Silverman, P.R., & Worden, J.W. (1992). Children’s reactions to the death of a parent. In: Stroebe, M.S., Stroebe, W. & Hansson, R.O., (Eds.). Handbook of bereavement: Theory, research, and intervention. New York: Cambridge University Press; pp. 300–316.