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Running head: CHILDHOOD GRIEF 1 An Examination of Childhood Grief A Literature Review Presented to The Faculty of the Adler Graduate School ___________________ In Partial Fulfillment of the Requirements for The Degree of Master of Arts ___________________ By: Katey Lindell July 2013

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Page 1: Running head: CHILDHOOD GRIEF 1 - alfredadler.edualfredadler.edu/sites/default/files/Lindell MP 2013.pdf · Running head: CHILDHOOD GRIEF 1 An Examination of Childhood Grief ... Developmental

Running head: CHILDHOOD GRIEF 1

An Examination of Childhood Grief

A Literature Review

Presented to

The Faculty of the Adler Graduate School

___________________

In Partial Fulfillment of the Requirements for

The Degree of Master of Arts

___________________

By:

Katey Lindell

July 2013

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CHILDHOOD GRIEF 2

Abstract

Grief is a natural part of life and a shared experience by all human beings at one point or another.

Children’s experience with grief is a unique, subjective experience as it is for all humans.

However, societal myths continue to perpetuate a cycle of misunderstandings surrounding

children and their experiences of loss. Grief is a complex subject, therefore, it is necessary to

explore its history through its definition and associated grief theories. It is also a necessity to

understand the various kinds of grief and explore different associated examples. Children are

influenced by different kinds of grief and the developmental level of a child also influences the

way he or she copes with grief. Finally, Adlerian theory holds a connection to grief work through

the components of life tasks, lifestyle, social interest, and subjectivity.

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CHILDHOOD GRIEF 3

Acknowledgments

As I look back on my journey both before and during graduate school I realized my

personal experiences make me who I am today as a person and therapist going out into the world.

I am thankful to have so many wonderful people in my life dedicated to helping me stay strong

and continue to grow. A special word of thanks to my mom for always pushing me to follow my

dreams, being a friend, and giving me help when I have needed it most throughout the years. To

my sister, you are my other half, a best friend and have been a role model to me guiding me to

help others. To my grandma, thank you for being a second mom and showing at any age you can

do what you want and speak your mind. To my dad, you gave me my inventiveness, my love of

writing and have taught me the value of laughing at myself. To the rest of my family and friends

thank you for continuing to give me motivation to follow my dreams and recognition I have the

abilities to do wonderful work in this field.

In addition, this paper would not have been possible without Trish Fitzgibbons Anderson.

I have had the pleasure to look up to her as a teacher, mentor, clinical supervisor, master’s

chairperson, and artist in this field. Second, to Solange Ribeiro, thank you for taking on the task

of being my reader and sharing your wisdom and creativity.

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TABLE OF CONTENTS

ACKNOWLEDGMENTS .............................................................................................................. 2

ABSTRACT .................................................................................................................................... 2

TABLE OF CONTENTS ................................................................................................................ 4

The Various Sides of Grief ............................................................................................................. 6

Task Based Grief Theories .............................................................................................................. 7

Stage Based Theories of Grief ........................................................................................................ 9

Societal Beliefs about Childhood Grief ........................................................................................ 13

Developmental Stages and Grief Responses to Death of a Family Member ................................ 14

Infancy ....................................................................................................................................... 14

Toddlerhood and Preschoolers .................................................................................................. 15

School Aged Children ............................................................................................................... 15

Teens ......................................................................................................................................... 16

Types of Grief ........................................................................................................................... 17

Disenfranchised Grief ............................................................................................................... 17

The loss of pets. ..................................................................................................................... 17

Ambiguous Loss ........................................................................................................................ 19

Anticipatory Grief ..................................................................................................................... 22

Collective grief .......................................................................................................................... 25

Traumatic Grief ......................................................................................................................... 27

Adlerian Components and Grief ................................................................................................... 29

Lifestyle ..................................................................................................................................... 29

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Life Tasks .................................................................................................................................. 29

Subjectivity................................................................................................................................ 30

Social Interest ............................................................................................................................ 31

Encouragement .......................................................................................................................... 32

Other Important Implications of Childhood Grief ........................................................................ 33

Impact of Spousal Grief on Children ........................................................................................ 33

The Therapist and Grief ................................................................................................................ 36

Summary and Conclusions ........................................................................................................... 38

References ..................................................................................................................................... 40

AFTERWORD .............................................................................................................................. 46

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CHILDHOOD GRIEF 6

An Examination of Childhood Grief

Grief is an inevitable part of life and one all human beings share. Even children are no

exception to this rule and often are forced to face complex realities such as losing a parent or

other loved ones, losing a sense of family through divorce, or disease. As adults, the grief

process is unique for each individual and this is also the case with children. For years society has

made assumptions about the grief process for children and the importance of recognizing and

changing those assumptions is essential to help children work through their grief.

The Various Sides of Grief

Defining grief is a complex task and one which continues to be a source of controversy

and research. First, Ober, Granello, and Wheaton (2012) suggest grief is “the emotion, generated

by an experience of loss and characterized by sorrow and/or distress and the personal and

interpersonal experience of loss” (p. 150). Second, it has been suggested grief has at least four

dimensions. These dimensions include feelings such as anger and anxiety, physical sensations

including headaches, cognitions such as doubt and disbelief, and behaviors like crying or

patterns in sleeping (Gilbert, Grief is section, para. 2, 2009). Third, it is important to recognize

grief can occur for life events other than just death. Freud was the first to identify this concept

and suggested “mourning can occur for things/values and statuses” (Walter & McCoyd, 2009, p.

4). In societies around the world, people may grieve any type of loss from losing a beloved job to

a pet goldfish. The most essential thing to remember about grief is each person experiences it

differently and it is a natural reaction to loss experienced by all human beings at one point or

another. Factors “including age, family structure, circumstances of bereavement, previous

bereavements, concurrent stressors, relationship to the deceased, previous crises, social support,

and culture” make each experience unique from one individual to the next (Breen, 2011, p. 289).

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Besides identifying different ideas related to grief it is essential to understand various theories

related to grief.

Task Based Grief Theories

Freud’s understanding of mourning paved the way for future theories of grief including

task based theories. Erich Lindemann was the first to develop a task based theory in 1944 as he

looked at responses after a tragic fire which killed four hundred and ninety-two people in the

Cocoanut Grove nightclub in Boston in 1942 (Walter & McCoyd, 2009, p .)). While studying

people’s reactions he coined the term anticipatory grief and suggested knowing about a person’s

death in advance may influence the grieving process. In addition, Lindemann allowed four to six

weeks to accomplish three tasks he outlined including “emancipation from bondage to the

deceased, readjustment to the environment in which the deceased is missing, and formulation of

new relationships” (Walter & McCoyd, p.6). Another important impact of Lindemann’s work is

he was the first to set forth the idea humans are social beings where the environment around

them influences grief. As Lindemann was anticipating his own death he continued to share these

ideas as he stated, “Health is so much more than the absence of illness. It is learning how to

respond with one’s whole being. It is learning how not to die in one’s body by holding back, and

not fully expressing the excitement of one’s life. It is living what one is, not just inside of one’s

self but part of something larger: a family, a community, a large environment” (Duel, 1975, p.

301). Lindemann was a pioneer in understanding grief and expected symptoms, however, failed

to recognize the grief people may experience after his four to six week window.

Another pioneer in task-based grief theory is William Worden. First, the tasks he outlines

to work through the grief process include to “accept the reality of the loss, experience the pain of

the grief, adjust to a world without the deceased and find an enduring connection with the

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deceased while embarking on a new life” (Walter & McCoyd, 2009, p. 6-7). To accomplish the

task of acceptance time is needed; however, traditions such as attending a funeral may help to

start the acceptance process. In addition, to work through the remaining tasks Worden suggests

such things as being vulnerable to feelings of loss, role management changes, and reorganizing

one’s world to go on living without the person (Moos, 1995, p. 340). Worden says it best when

he stated grieving persons “must find an appropriate place for the dead in their emotional lives—

a place that will enable them to go on living effectively in the world” (Moos, p. 340).

Furthermore, Worden coined the term emotional ventilation, today known as grief-work

hypothesis. He suggested emotional ventilation, defined as crying, mourning, and anger, needs to

be conveyed to begin the healing process (Walter & McCoyd, p. 7). Emotional ventilation may

continue to be a source of controversy; however, Worden’s idea the relationship to a deceased

person continues to some extent has moved the understanding of grief forward. One final

important influence of Worden’s grief work has been his descriptions of four classes of

complicated grief (exaggerated grief, masked grief, chronic grief, and delayed grief).

Complicated grief occurs when individuals either avoid or deny grief or refuse to let go of grief

(Gilbert, 2009, an illness section, para. 4).

Like Worden, Goldenberg is another task based grief theorist. Goldenberg’s theory was

conceptualized in 1973 and it encompasses family grief tasks to be achieved. While Worden

focused on the individual, Goldenberg focused on the family and developed four familial grief

tasks. First, a family must allow mourning to happen by actively sharing and talking about their

emotions related to the loss. If a family, on the other hand, refuses to acknowledge emotions

such as crying by ignoring or changing the subject from talking about the loss, family members

may not be able to resolve the loss (Moos, 1995, p. 340). Second, the family must come to the

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understanding the deceased person cannot “play an active role in the family” and “the person

must release [him or herself] from attachment to the dead individual” (Moos, p. 341). In other

words, as a family unit they must adjust to life without the person lost. The next task outlined by

Goldenberg is the task of realigning intrafamilial roles. For instance, if a father dies and he was

the main source of income the mother may have to get a job or get an additional job to

supplement the lost income. If other family members do not accept this new role the transitions

become more stressful rather than smooth. Goldenberg’s final task comes in the form of

readjusting extrafamilial roles. With this task the needs of each family member which were met

by the deceased person need to be met in a new way (Moos, 342). For instance, when a child

loses a sibling it is very traumatic and the child needs to have the needs the sibling met fulfilled

by someone else; either another sibling or parent. Perhaps, Goldenberg’s greatest

accomplishment related to grief work was the idea he helped to shape that grief is both an

intrapersonal and interpersonal experience.

Stage Based Theories of Grief

In addition to task based theories another group of theories exist which suggest an

individual coping with loss move through stages of grief. One such classic grief theory is

associated with Kübler-Ross. This theory was developed in 1969 as part of a research seminar

where she and her students interviewed individuals experiencing terminal illness (Walter &

McCoyd, 2009, p. 7). As cited by Cordaro (2012), in the book On Death and Dying: What the

Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families, Kübler-Ross first

introduced five grief stages including denial, anger, bargaining, depression, and acceptance (p.

284). Another connection Kübler-Ross introduced in her original book was the importance of

hope in one’s life. As cited by Walter and McCoyd (2009), Kübler-Ross stated, “No matter what

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we call it, we found that all our patients maintained a little bit of it and were nourished by it in

especially difficult times. They showed the greatest confidence in the doctors who allowed for

such hope- realistic or not- and appreciated it when hope was offered in spite of bad news” (p. 8).

More recently, in 2005, Kübler-Ross coauthored a new book with David Kessler entitled

On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss. This

book was written with several purposes in mind. First, it serves as a resource on grieving for

persons grieving and others in their support system. Second, it outlines and gives descriptions of

the five stages from the perspective of a person who has experienced loss. The first stage of

denial refers to a person’s understanding their loved one is deceased, however, continued

disbelief. Anger, the second stage, is characterized by anger toward self or the deceased. The

third phase, bargaining, is outlined when people experiencing loss believe they may have been

able to prevent the loss. Depression is another phase of grief where it is normal to feel depressed

and to recognize it as part of the healing process. One last phase of grieving entails acceptance

where an individual is able to understand their new life without their loved one (Bolden, 2007).

Today the Kübler-Ross theory is also the most widely recognized grief model, but it is important

to recognize “this universal approach to grief serves as a guide to identifying patterns of grief

and loss and individuals may experience these stages in a different order or skip stages

altogether” (Cordaro, 2012, p. 284). Finally, this book outlines grief from different viewpoints on

grief. For instance, “they talk of how children grieve and how death may be explained to and

interpreted by them” and the “shame often associated with a suicide death is also explored”

(Bolden, p. 236).

John Bowlby, famous for his attachment theory, also conceptualized a four stage based

grief theory. The first stage, numbing, involves difficulty understanding the loss and emotional

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outbursts of panic attacks, anger, and other emotions. The second stage Bowlby coined is

classified as yearning and searching. This phase is “characterized by intense pining and duress,

with concomitant restlessness, insomnia, and rumination” and “there is a propensity to sense the

object’s actual presence; environmental stimuli trigger a feeling that the loved one has returned”

(Furst, 2007, Bereavement, Mourning, and Grief section, para. 3). In this stage, a grieving person

may have vivid dreams of the deceased. The next stage is disorganization and despair marked by

recognizing the loss, hopelessness, easily becoming distracted and withdrawing from others. The

final stage, reorganization, entails separating oneself from the deceased and creating new

patterns and goals (Furst, Bereavement, Mourning, and Grief section, para. 3). In addition,

Bowlby suggested “news of a death leads to activation of the attachment system goal of which is

to re-establish physical proximity to the deceased” and “resolution of mourning is marked by

termination of search behavior in recognizing the impossibility of finding the lost figure and

reorientation to everyday life and its tasks” (Field, 2006, p. 742). If an individual fails to do so

Bowlby also outlined three categories of pathological mourning. If one becomes stuck in the

numbing phase, chronic mourning occurs, where the person experiences prolonged grieving

accompanied by severe distress which does not decrease over time (Furst, Bereavement,

Mourning, and Grief section, para. 4). Another subtype is pathological denial. It is similar to a

delayed grief reaction and is considered a prolongation of yearning and searching or

disorganization and despair (Furst, Bereavement, Mourning, and Grief section, para. 4). The final

category of pathological mourning is “a euphoric response that shares similarities to a manic

episode, characterized by the refusal to accept the death combined with a vivid sense of the

deceased’s presence, or an unusually increased level of activity combined with latent tension and

anxiety” (Furst, Bereavement, Mourning, and Grief section, para. 4).

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Another important component of Bowlby’s grief work demonstrates how different early

attachment styles can influence the way individuals grieve. First, as children those who form

secure attachments to caregivers will be upset when the caregiver leaves, seek comfort from the

caregiver when scared, and prefer parents to strangers. Securely attached adults have “high self-

esteem, [enjoy] intimate relationships, [seek] out social support, and [have] an ability to share

feelings with other people” (Cherry, 2013, Characteristics of Secure Attachment section, para.

4). In addition, securely attached persons would move without maladaptive coping through the

experience of grief (Stroebe, 2002, p. 135). A second attachment style is ambivalent attachment.

Ambivalently attached children are highly suspicious of strangers, become extremely upset when

the caregiver leaves, and are not comforted with the return of the caregiver. As adults,

ambivalent attachments lead to such characteristics as worrying their partner does not care for

them and hesitant to get close with others (Cherry, Characteristics of Ambivalent Attachment

Section, para. 3). Ambivalently attached adults may demonstrate more chronic forms of grief.

Another type of attachment style is avoidant attachment. Children with avoidant attachment do

not seek comfort from caregivers and hold no preference between a caregiver or stranger. In

addition, some characteristics of avoidant attachment in adulthood include problems with

intimacy, inability to share feelings with others, and little emotion in interpersonal relationships

(Cherry, Characteristics of Avoidant Attachment Section, para. 2). To cope with grief avoidant

individuals may delay or try to prevent their grief. Disorganized attachment is the final

attachment style. Children with disorganized attachment may have a lack of attachment behavior

and their responses to caregivers are a mix of behaviors of confusion, avoidance, and possible

resistance (Cherry, Characteristics of Disorganized Attachment Section, para. 1). The

disorganized individual would “have a more disturbed, less coherent manner oscillating between

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orientations” of grief (Stroebe, 2002, p. 135).

Societal Beliefs about Childhood Grief

In the United States, death is taboo, “It has become a mystery to most Americans because

we have so little direct contact with it,” and people “avoid talking about sadness or any kind of

negative emotion as much as possible (Moos, 1995, p. 347). In addition, “children develop a

distorted view that death is temporary after they have spent hours watching cartoons on

television, where characters die one day and come back to the screen the next” or watch “nightly

news reports with graphic descriptions and pictures of murders, fatal accidents, and other

disasters” which depersonalize death (Norris-Shortle, Young, & Williams, 1993, p. 739).

Therefore, it becomes the role of parents, teachers, and caregivers to promote and model healthy

ways to grieve. Children also become the forgotten ones in a society where death and grief are

almost silenced. Johnson (2004) suggests in several families children observe “three important,

albeit flawed, life lessons: do not talk about death or acknowledge grief; be strong and put on a

smile no matter what; and get over it and move on as fast as possible when someone dies” (p.

435). These beliefs perpetuate a cycle of illusion that childhood grief may not even exist.

In addition to what seems a vow of silence, societal myths continue to be passed from

generation to generation. First, the idea children do not grieve is false. Children in all stages of

development grieve in different ways and these vary widely from those of adults. Children may

not express their grief in the same ways as adults, however, “this does not mean that [grief] is

any less painful and potentially pathologic” (Kaufman, p. 62). Second, the losses children

experience are more than the death of a close family member (Dyer, 2002, Myths about Children

and Grief section, para. 2). Children can experience grief with the loss of pets, changes in

friendships, or having to move due to his or her parent’s divorce. Family members may also

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share the idea children should be safeguarded from loss and not attend funerals or see the bodies

of their loved ones. If children are not given the choice and information to cope with childhood

loss it may lead to difficulties as adults. One final myth is the best way to help children deal with

loss is by talking openly. While giving children the chance to verbally express his or her feelings

is important; artistic approaches such as art or writing can be just as expressive and useful (Dyer,

Myths about Children and Grief section, para. 7).

Developmental Stages and Grief Responses to Death of a Family Member

Infancy

During infancy, there is a significant amount of change physically and psychologically.

During this time, infants are in Erikson’s stage of trust versus mistrust. Infants develop trust if

care is provided on a regular basis or mistrust if care is not given. The first attachments to

caregivers provide a foundation for relationships in the future (Walter & McCoyd, 2009, p. 70).

If a family experiences a significant death of a close family member a grief response can be seen

in the baby to those around them. “The infant responds to the changes in the schedule, the

tension he or she feels in his or her loved ones, and to the disruption in the home” (Kirwin, 2005,

p. 68). In addition, Bowlby suggested a link between separation anxiety and grief when

attachment is interrupted by long-term separation. He described a “three-step sequence of

grieving behaviors through which infants process such a loss: (1) protest- the outrage and

anguish over the loss, (2) despair- the realization of no hope, and (3) detachment- the separation

from people in general” (Norris-Shortle, Young, & Williams, 1993, p. 737). With the idea in

mind, it becomes clear interventions to help infants overcome the grief response include a

consistent routine and caregiving.

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Toddlerhood and Preschoolers

Erikson’s second stage of development is autonomy versus shame and doubt. Like in

infancy, tremendous development occurs during this stage. Although the child has not yet

entered the school atmosphere he or she is able to develop important attachments, such as

friends. Cognitively children in this age group are egocentric and lack the skills necessary to

understand death and other complex concepts. During this age range, death is not seen as

permanent and often the child will ask when the deceased person is coming back. The child’s

grief response at this age may entail regressing to a younger stage of development including

clinging, whining, and bedwetting (Kirwin, 2005, p. 68). In addition, older preschoolers, three to

five years old, enter another of Erikson’s stages known as initiative versus guilt. Initiative versus

guilt is the idea children either gain confidence in experiencing new things in a bigger world or

do not. These children may go through a process known as magical thinking where he or she

may believe they caused the death with angry thoughts of the deceased person. Another grief

response may be the development of questions over months since children lack the

understanding of death and to “unknowing parents young children’s questions about death may

appear to be insensitive, callous, or uncaring” (Norris-Shortle, Young, & Williams, 1993, p.

740). To care for children going through grief at this stage it is important to keep a set routine,

accept regression, and let the child attend the funeral to see the body. Finally, “clear explanations

grounded in concrete realities provide important ways for children to begin to understand the

death and what it means” (Walter & McCoyd, 2009, p. 79).

School Aged Children

During the school years, two of Erikson’s stages of development take place. First, as

already mentioned above, initiative versus guilt takes place around the ages of three to five. In

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later elementary school years the stage of industry versus inferiority occurs around the ages of

six to eleven years old. Industry versus inferiority is classified by the idea a child gains a sense of

autonomy and confidence in his or her social and academic endeavors or if unable to master

these things feels inadequate (Walter & McCoyd, 2009, p. 104). Concepts of death in this age

range may include such things as being fearful death is contagious, fear of dying or having others

die, or fear of abandonment. In addition, grief responses with this age group include regressive

behaviors, academic issues, withdrawing, anxiety, and somatic complaints (Kirwin, 2005, p. 69).

Finally, some positive interventions with school agers include asking the child what he or she

understands about death, let them know he/ she did not cause the death, talk about fears, involve

the child in the memorial service, and be honest (Kirwin, p. 71). Other outlets of expression may

also be useful including drawing, writing, or play to demonstrate feelings surrounding the loss

(Schoen, Burgoyne, & Schoen, 2004, p. 145).

Teens

Adolescents are faced with many conflicts during the teen years and how to cope with

grief is no exception. They are caught at the crossroads of trying to be independent while still

depending on the family for money and experiencing changes both psychologically and

physiologically. Teens try to determine whether to deal with grief as a child or adult and typical

grief responses will can include “anger, depression, withdrawal, acting out, noncompliance,

frustration, and confusion” (Schoen, Burgoyne, & Schoen, 2004, p. 143). The grief interventions

which will work with adolescents may vary, however, could include such things as “open

discussions with trusted adults and peers, exploration of questions of life and death, permission

to mourn, appropriate assignment of role responsibilities for the age, models of healthy coping

behaviors, and toleration of acting out behavior” (Schoen et al., p. 144).

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Types of Grief

Disenfranchised Grief

Disenfranchised grief may be defined as “grief that is not recognized, validated, or

supported by the social world of the mourner” (Walter & McCoyd, 2009, p. 18). This type of

grief may be difficult to cope with since one may feel guilt for having feelings peers may not

agree with or understand. Some examples of disenfranchised grief include pet loss or death by

AIDS, alcohol, or crime. These types of losses lead individuals to mourn undercover which

indicates the person “does not have a healthy social support network or does have a social

support network but is choosing not to access it” (Cordaro, 2012, p. 288). For children these

types of losses are no less painful.

The loss of pets. For many children in the United States pets become a piece of the

family identity. It is apparent pets play an integral role in a child’s life since “over three fourths

of children in the United States live with pets- more than those living with both parents” (Walsh,

2009, p. 482). Especially for children whose parents work long hours, who live with one parent,

or do not have siblings pets provide security, unconditional love, and companionship. Children

who are able to have pets as a part of his or her life form a strong attachment to a pet and learn

skills such as responsibility, empathy, and caring for other living things. This attachment is

evidenced by the fact that children will often include pets in their drawings of family pictures

(Clements, 2003, p. 491). In addition, the child has a unique perspective as he or she is able to

grow and age with the family pet. Since a pet’s lifespan is shorter than a human’s this provides

the opportunity for a child’s first sense of loss to come in the form of a pet (Duffey, 2005, p.

290).

It becomes a therapist’s job to be sensitive to the feelings surrounding the loss of the pet

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which may be similar to those feelings experienced during other losses, such as anger and

sadness. In addition, if therapists fail to help their clients normalize the feelings related to the

loss of a pet they may unintentionally “minimize the experience or attempt to redirect sessions

when their clients encounter these experiences” leaving the client “feeling more isolated and

alone” (Duffey, 2005, p. 292). Besides recognizing the feelings of loss associated with the pet it

is important to include the pet within a family’s assessment including depicting the pet on a

genogram. By doing so, the therapist could gain clues to the family’s communication styles and

coping strategies to situations causing stress. For instance, through a client’s stories of pets a

therapist may learn “about deliberate harm to pets, or [may see] their neglect in home visits,

which may suggest risk or undisclosed abuse or neglect of family members, because they so

often coexist” (Walsh, 2009, p. 492). Even after the death of the pet this information can be a

useful way to spark conversation within sessions about the pet and allow family members,

including children, to share memories. Finally, therapists should use interventions to understand

the daily changes that come with the loss of the pet as well as look for ways to find closure with

the loss. Clements, Benasutti, & Carmone, (2003) suggest various ideas including buying items

on a local shelter’s wish list in memory of the pet, planting a tree as a living memory of the pet,

volunteering at a shelter or, when ready, adopting a shelter pet (p. 53). All of these interventions

could be done as a family where both adult and child alike are getting support from one another.

Parents on death row. Another type of disenfranchised grief experienced by children

and their families is the loss of a loved one on death row. Families coping with a family member

lost to death row have “pain exacerbated by social isolation or rejection with little support (if

any) provided” due to the stigma associated with it (Walter & McCoyd, 2009, p.18). There has

been little investigation into the grieving process of family members who have a loved one on

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death row. These families present a unique case of grief and the grief they experience needs to be

recognized and validated by society at large. Death row family members give the best example

of disenfranchised grief since it relates to the three classifications including “when the

relationship is not recognized, the loss is not acknowledged, or when the griever is excluded”

(Jones & Beck, 2007, p. 292).

The public often views death row inmates as monsters; however, it must be recognized

these individuals have family members who love them. In 2007, three thousand three hundred

and sixty-six people were on death row in the United States (Jones & Beck, p. 283). Family

members of these inmates do not want to share their pain with those in the community because

of the stigma but also out of fear of being viewed in a negative light themselves. Unfortunately,

these individuals are forced to live in a society where their loss is not recognized and their

feelings of loss are not taken seriously. Another way these families face disenfranchisement is

during the execution itself. While the inmate’s family may console each other outside they may

be met with cheers from other people in the community in favor of the death of their family

member (Jones & Beck, p. 293). With the above idea, it becomes clear society needs to change

its thoughts regarding the family members of death row inmates. Instead of treating them as

though they committed the crime and are on death row, they should be respected and given their

chance to grieve.

Ambiguous Loss

Perhaps the most devastating type of loss is ambiguous loss. It occurs in two ways

including where a person “is physically present but psychologically absent –for instance, a loved

one with Alzheimer’s” or “physically absent but psychologically present- such as when someone

is kidnapped or missing in action during war” (Walter & McCoyd, 2009, p. 20). Individuals

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experiencing this type of loss are left confused and uncertain about how to adjust to the existing

circumstances. In addition, ambiguous loss can create “depression, anxiety, psychic numbing,

distressing dreams and guilt” like PTSD, however, it is also “a rollercoaster ride [where families]

alternate between hope and hopelessness” (Boss, 2000, p.24). Those who are left with the job to

support these individuals are left confused about whether to stay strong or be sympathetic to the

situation.

Foster care. The world of a foster care child is one of disconnect and uncertainty and

several aspects of his or her life fit into the category coined ambiguous loss. In the foster care

system three types of ambiguous loss may occur. The first case is where parents or primary

caregivers “were physically present but did not consistently provide love, nurture, and

protection” (Lee & Whiting, 2007, p. 418). One of the most important aspects during childhood

is knowing one’s basic needs are cared for and for these children this is not the case. In this case

there is no psychological presence of the caregivers and children are left facing confusion about

reasons for being in foster care and what will happen in the future (Whiting & Lee, 2003, p.

288). Another type of ambiguous loss faced by children in foster care occurs when family

members are not living in the same household, but continue to hold a psychological place in the

family. For instance, children may remain loyal to their family and this can continue to impact

the child’s daily life events (Lee &Whiting, 418). Finally, loss can occur when relationships are

in a state of limbo or transition. Children do not see their place as permanent in any family

system and “do not know if they ever again will see the individuals- birth parents, siblings,

relatives, and foster parents- who have been removed by order of the court” (Lee & Whiting, p.

418). In this situation the child is met with multiple losses where the future remains unclear.

Children placed in foster care will experience the manifestation of loss through a variety

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of emotions including anger, self-blame, and fear. With this in mind, practitioners working with

children in foster care need to take all of these different unique types of loss into consideration

when working to find interventions to help these children through the grief process. First,

therapists should validate and be sensitive to each child’s unique experience in foster care. By

doing so, the child is more likely to feel comfortable to sort through the emotions and situation

he or she is experiencing. Second, practitioners should make every attempt to be honest and not

withhold details of a child’s placement or knowledge about the future. If information is kept

from children due to “wanting to prevent emotional upset” this “can keep them in a state of

limbo where they cannot process their grief or pain or form attachments to new caregivers”

(Whiting & Lee, 2004, p. 294). Finally, these children need continued encouragement they are

not to blame for being in foster care and need to be given various outlets to tell their stories such

as art or writing.

Loss in the military. During war children are faced with military deployment bringing

about a newer category of loss and uncertainty. First, children are surrounded by uncertainty.

The “uncertainty about whether and when the parent will be deployed, uncertainty about the

potential for danger during deployment, and uncertainty about the deployed parent’s return”

(Pfefferbaum, Houston, Sherman, & Melson, 2011, p. 293). Second, once the parent leaves for

military deployment the child is met with the reality of a parent who will no longer be available

in his or her daily lives. Finally, these children may have to cope with a parent who returns with

a brain injury or any other type of devastating injury. The parent may be present physically, but

comes back changed from the parent who existed before deployment (Walter & McCoyd, 2009,

p. 113). These children may lose the support and attention from the parent suffering from a brain

injury. In other words, leading to an overall change in the relationship between parent and child

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as well as altering the familial unit.

In addition to the children, the entire family system must develop and adapt to the

changes presented by the departure and return of a primary caregiver. In a study by Huebner,

Mancini, Wilcox, Grass & Grass (2007), these adaptations were discussed by one hundred and

seven adolescents who had had a parent deployed in some branch of the military. First, roles and

responsibilities shift. For instance, children may be asked to help more around the house.

Second, there may be changes in a daily routine. For example, if a family went from two parents

to a single parent there is not as much time in the schedule for after school activities. Finally, the

question becomes what to do and what can go back to normal when the parent returns from

active duty. As one adolescent interviewed described it “We can’t go back to being who we were

because we’re not that anymore. We have to move forward, but it’s also something you have to

do as a whole family” (Huebner et al., p. 117).

Anticipatory Grief

Anticipatory grief is a unique grief experience “that occurs when there is an opportunity

to foresee the death of a loved one (or oneself)” (Gilbert, 2009, Lecture section, para. 1). This

type of grief also has several distinctive characteristics. First, anticipatory grief entails working

through losses of the past, present, and future including things such as looking forward to the

future, security, level of functioning, shared history, etc. Second, anticipatory grief can be

experienced from two viewpoints including the view of the person dying and the view of people

who care for him or her. Gilbert (2009) suggests of particular concern is the idea family

members may detach from the dying person leaving the person who is dying feeling abandoned

and alone (Costs of Anticipatory Grief section, para. 1). In addition, time is an important

component of anticipatory grief as “it is a factor, of course, over which the dying person,

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caregivers, social workers, and medical personnel have no control” (Walker, Pomeroy, McNeil

& Franklin, 1996, Phases of Chronic Illness section, para. 1). Finally, there are a set of

adaptational tasks or phases which need to be completed by the family before the death of the

dying person. These include “acquisition of information, the expression of emotion, the

maintenance of open communication, the acceptance of the needs and new roles of caregivers,

and the opportunity to say goodbye” (Walker et al., phases of chronic illness section, para. 4).

Chronic disease. When a child is diagnosed with a serious, life-threatening illness it

impacts the family and community, but most importantly the child. Currently, figures suggest

“ten to twenty percent of children in the Western world under the age of sixteen years are living

with chronic illness” (Heath, 2011, p. 772). For the child, his or her entire life is turned upside

down. The quality of life may decrease as he or she comes to term with changes in being able to

go to school, changes in being able to play with friends, or participate in other hobbies or

activities. In addition, in a study by Patterson, Holm, and Gurney (2003), four themes related to

children’s responses to a cancer diagnosis were found. The parents reported “(1) strong

emotions, such as fear and anxiety, (2) self-consciousness about other’s reactions, (3) loss of a

normal life activities, and (4) worry about the expense of treatment” (p. 396). This is evidence of

a clear feeling of loss of a “normal” childhood for the child with the diagnoses. Caregivers,

doctors, friends, and community members bear the responsibility of helping the child cope with

his or her condition by explaining it according to the child’s developmental level.

For the family a child’s chronic illness also creates a sense of loss as the family

transitions through the stages of diagnosis, evaluation of treatment options, and coming to terms

with possible outcomes of the disease (Heath, 2011, p. 772). First, family members may grieve

over the family identity they had before the child’s diagnosis. In particular, parents may

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experience problems balancing family needs including time with one’s spouse, other children,

and being at the hospital. Families coping with cancer describe the diagnosis at a turning point in

their lives as “if the cancer had a life of its own that forever changed the families’ life course”

(Woodgate, 2006, p. 16). Second, family members (especially parents) may grieve the child’s

pain and experienced losses such as hair or ability to continue with a normal life (Patterson,

2004, p. 397). Finally, the family experiences a loss of money and security as they struggle to

find sources to pay for the treatment services for their child (Patterson, p. 398).

AIDS. Like other chronic illnesses, AIDS is considered an example of anticipatory grief

as the circumstances surrounding the illness complicate the grief process for the patients,

caregivers, and families. First, the social stigma of AIDS influences the grieve process for both

the individuals diagnosed with AIDS or HIV and the people who care about them. Walker,

Pomeroy, McNeil, and Franklin (1996) state, “Stigma attaches to the social groups into which

many people with HIV/AIDS fall (that is gay men and IV drug users), the physical disfigurement

associated with AIDs, the cognitive decline of people with AIDS, the lack of a known cure, the

often unrealistic fear of contagion, and some people’s perceptions of immorality associated with

the disease” (HIV Infection, AIDS, and Anticipatory Grief section, para. 1). In addition, the

caregivers or loved ones of the person diagnosed with HIV/AIDS are faced with stigma

including not having their relationship validated by society and because of the shame and

embarrassment they must grieve secretly. Additionally, the grief process for all involved persons

is complicated since AIDS like other chronic diseases have phases of the illness. The first phase,

the crisis phase, provides the starting point of anticipatory grief and is characterized by the pre-

diagnosis where the person has symptoms and right after the diagnosis where the focus lies on

things related to the disease. Chronic phase is the second phase of chronic illness. This period “is

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often the longest and most unpredictable, is filled with ambiguity for all involved because there

is no definite end point, leaving people in limbo” and caregivers “become exhausted and their

financial, physical, and emotional resources deplete making it all the more difficult to effectively

grieve” (Walker et al., 1996, Phases of Chronic Grief section, para. 3). Finally, caregivers face

multiple losses which continually complicate the process of anticipatory grieving watching their

loved one’s decline in front of their eyes in physical and mental appearance and losing feelings

of control over life events and the future.

Collective grief

Collective grief is another type of grief defined as a group of people coping with a public

tragedy. Within the idea of collective grief it is also necessary to understand the public should be

defined as a “group of people with shared interest” (Doka, 2003, How does a traumatic event

become a public tragedy section, para. 2). In essence, the public event will gain attention and

trigger societal responses and collective actions. In addition, there may be several publics related

to one significant event and each is influenced by the event differently (directly or indirectly).

Another important concept related to collective grief is the role of the media. “The news media

[plays] a critical role in defining public tragedy” as they “report what happened, describe its

significance, and suggest social action” (Doka, Role of the news media section, para. 1). It is also

important to recognize different types of events which can be categorized with collective grief as

a response including natural disasters, deaths of famous individuals, and terrorist attacks. In

addition, collective grief often entails mourning rituals by public groups to contribute to recovery

by affirming solidarity of community and to help regain a sense of control for survivors (Pivar &

Prigerson, 2004, p 282).

Death of a celebrity. The death of a celebrity is one example of collective grief as they

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“touched an entire generation through their accomplishments and were symbols of attractiveness,

success, and talent” (Hayslip, 2009, para. 4). In Hayslip’s article he discussed the impact

Michael Jackson and Farrah Fawcett’s deaths had on fans. First, for those persons who were not

fans of either Fawcett or Jackson their lives were totally unaffected by the deaths other than

maybe thinking it was sad and hearing about it in the news. On the other hand, for fans that grew

up listening to Michael Jackson’s music or watching Farrah Fawcett on Charlie’s Angels the

influence the deaths had on their lives may have been significant. In other words, the more a

person identifies with the celebrity the more grief the person may experience. To cope with the

loss, fans of Michael Jackson around the world mourned together in various ways. For instance,

some fans chose to put flowers outside of his home and gather together, while others started

online tribute pages.

911 terrorist attacks. The terrorist attacks which occurred on 9/11 provide another

example of collective grief. The 9/11 attacks changed the lives of many public groups including,

victims, rescuers, survivors, airlines and personnel, families, New Yorkers, Americans in

general, and others around the world. Each of these groups has a distinct perspective of the

attacks and may have been directly or indirectly involved (Doka, 2009, How does a traumatic

event become a public tragedy section, para. 2). In addition, public interest was huge with this

tragedy as Americans were able to view the tragedy on television as it took place, were able to

hear firsthand accounts of survival and rescue, and controversy flared over what should be done.

Another characteristic demonstrated about collective grief during the terrorist attacks came in the

form of how communities and the nation came together to understand and help support everyone

impacted by the event. One example comes in the form of musicians writing music to help with

the healing process and promote a community feeling of togetherness (Gengaro, 2009). For

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instance, Springstein wrote the song “The Rising” in 2001 after the attacks. As Gengaro points

out, “What is most powerful about that song is not just that Americans share in the mourning, but

that it’s a call to emerge from the ruins, to be reborn and phoenix-like, rise from the ashes” (p.

30). Another example came in the form of the community establishing different resources to

provide support for residents located in the areas of the attacks. For instance, “in October 2001,

the Federal Emergency Management Agency and the Community Mental Health Service

establish Project Liberty, the largest disaster counseling effort ever with one hundred and thirty

two million in funding” (Waizer, Dorin, Stoller, & Laird, 2005, p. 501). Another community

support group, “Time to Share,” was also established after local residents in lower Manhattan

stated they wanted to talk to neighbors not therapists (Waizer et al., p. 501).

Traumatic Grief

Traumatic grief is a type of grief which is “event-focused and refers to loss experienced

under externally traumatic circumstances, which may elicit shock, disbelief, horror, or

helplessness, and there is evidence that such grief remains unresolved over time” (Pivar &

Prigerson, 2004, p. 278). Furthermore, traumatic grief can occur from events including homicide,

suicide, natural disasters, or war. Another unique aspect of traumatic grief is that it can cause a

diagnosis in children labeled Childhood Traumatic Grief or CTG. This is defined as “a. a grief

caused by a death that is either objectively or subjectively perceived to be traumatic, b. the child

has significant posttraumatic stress disorder symptoms including loss and change reminders that

segue into trauma reminders that bring forth avoidance and numbing tactics, and c. the PTSD

symptoms prevent the child from completing the tasks of bereavement” (McClatchy, Vonk, &

Palardy, 2009, p. 307). Finally, to help individual cope with traumatic grief “the ultimate goal is

to enable the [person] to reframe the traumatic experiences so that the memory becomes a

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resource for resilience versus a trigger for terror” (Kuban & Steele, 2011, p. 43). For instance,

therapists would work to restore a sense of safety and decrease the arousal level.

Parental suicide. Unfortunately, suicide is very prevalent in today’s society as it is “the

fourth leading cause of death among twenty-five to forty-nine year olds in the United States” and

“an estimated thirty thousand children are left behind to grapple with the suicide of a parent or

close relative” annually (Hung & Rabin, 2009, p. 782). In addition, suicide is misunderstood and

this is even more so the case when surviving children are involved. First, “the loss of a parent at

an early age informs and becomes incorporated into a bereaved child’s personality, identity, and

world-view” (Hung & Rabin, p. 791). Children continue to re-experience the grief as they mature

in different ways and the focus may shift as the child moves through developmental stages.

Second, there is a societal stigma associated with suicide which makes it difficult to receive

support. Oftentimes, families coping with suicide are left feeling isolated from the surrounding

community. Another important component of suicide occurs when negative legacies of the

deceased parent influence the family atmosphere. One negative legacy involves the child

identifying with the suicidal parent often exhibiting suicidal behaviors or feelings they will

someday repeat the suicidal act committed by their parent. Another negative legacy relevant to

suicide bereaved children is a legacy of blame which involves feelings of guilt and thoughts that

one could have prevented the suicide (Hung & Rabin, p. 791). Finally, it is necessary for the

surviving family members to understand the need for open communication to help the child

understand the whys surrounding the parental suicide and to emphasize suicide is not a viable

option to cope with life’s struggles.

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Adlerian Components and Grief

Lifestyle

The lifestyle is a basic core concept within Adlerian therapy. Adler believed as a child

each person creates a sense of reality and identity of where he or she belongs in the familial unit.

In turn this schema of apperception including one’s “individual personality, emotions, behaviors,

and identity” becomes “the response set for an individual and is the mechanism by which an

adult’s thoughts, feelings, and actions coalesce into a coherent pattern” (Peluso, Stoltz, Belangee,

Frey, & Pelus, 2010, p. 153). In addition, the lifestyle is stable throughout the lifespan.

Therefore, grief responses one uses as a child or sees modeled from parents whether effective or

ineffective may continue to be utilized as an adult. For instance, if as a child one believes he or

she cannot cry and must appear to have moved on fast from the loss, future losses as adults will

be coped with in a similar manner. If the feelings of the loss are not dealt with in a healthy

manner the feelings could manifest in different ways including anxiety and depression. In

addition, the lifestyle can give insight into familial views on death. For instance, one person

dealing with loss could view it as a place where courage and optimism are necessary while

another person may view anger as a necessity. Finally, familial values, rituals, and traditions

surrounding death may become apparent through the lifestyle. For instance, families may choose

cremation versus burial based on their cultural or ethnic background.

Life Tasks

Adler suggested there are three basic life tasks including work task, community/ social

task, and love task. Each of these tasks is influenced by the experience of grief in various ways.

First, the work task may be influenced by grief in the form of individuals in the family taking on

new roles. For example, if a dad dies and he was the main source of income another family

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member will have to step up and take on the role of provider. Another way the work task may be

influenced by grief comes with the fact people may have to be absent from work to cope with

ailing family members, to attend funerals, or to cope with the feelings related to the loss. Next,

the love task may be influenced when a bereaved person tries to find a way to stay connected to

the deceased person or attempting to have the needs that were met by that person met by

someone else. The family is a systemic unit where “loss cannot be studied only as an individual

phenomenon because the family system affects and is affected by the grief of its members”

(Moos, 1995, p. 342). For instance, if a family loses a child the parents and other siblings will try

to stay connected to the deceased person in differing ways. Finally, the social/ community task is

also changed by grief. Since “humans are social beings and have always found strengths in

community” to a “certain extent humans will be influenced by the beliefs and values of the

community and social definitions of appropriate grief and mourning” (Hartshorne, 2003, p. 147).

Individuals experiencing grief will grieve in ways considered appropriate or acceptable to the

group they are in. For instance, if a family member attends a support group where it is expected

people will cry and share memories the individual will feel good about expressing these things in

that environment.

Subjectivity

The Adlerian concept of subjectivity and grief overlap in several ways. Subjectivity may

be defined as an “individual [creating] his or her own reality, and [acting] as if that reality is

true” (Herrmann-Keeling, 2010, Subjectivity section, para. 4). Grief and loss is a unique,

subjective experience. First, each person has different needs when loss occurs. For instance, one

child may want to participate in a funeral as a way to gain closure while another child chooses

not to participate since he or she wants to remember the loved one from memories. In addition,

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“grief occurs on multiple levels” and is “a system wide event and yet is also a personal event for

each individual in the family” (Moos, 1995, p. 338). Each person coping with grief will

experience a different response and for children this response will depend on several factors

including the surrounding environment, developmental age, previous loss experiences, etc. This

idea is essential for parents to recognize, so he or she does not make assumptions about the state

of mind of their child. Finally, different coping strategies or interventions may work with one

child and not another. The child’s perception of the loss must be taken into consideration rather

than generalizing interventions that may work.

Social Interest

Adler’s social interest intersects with grief in numerous ways. Social interest “is

manifested in such attributes as empathy, cooperation, and other prosocial orientations toward

others” (Leak & Leak, 2006, p. 207). This idea can be linked to grief through the process of

holding compassion and helping someone while he or she is coping with loss. For instance, one

may demonstrate empathy by giving the person a card or allowing them to share their memories.

In addition, Adler saw social interest as “the foundation of mental health, and many intrapersonal

and interpersonal difficulties could be traced to an absence of social or community feeling”

(Leak & Leak, p. 208). Grief is a shared experience by all human beings, however, the

experience differs. In times of grief one should reach out for support from friends and utilize

other resources such as support groups. These support systems form a sense of community of

shared experience and serve as a reminder one is not alone in grief. If on the other hand one

chooses to withdraw from family and the community he or she may experience physical and

psychological symptoms such as anxiety, depression, or sickness due to lack of support.

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Encouragement

A foundational concept in Adlerian psychology is the idea of encouragement, which also

holds strong links in grief work. First, clients coping with loss need to know they have a safe

place where they can discuss their feelings, be actively listened to, and be respected.

“Encouragement begins through the basic process of focusing on the counselee” and when the

counselor “concentrates on listening not only to what is said but also to how it is said- and is

sensitive to verbalized or implied feelings as well as nonverbal cues, [they] inspire confidence”

(Dinkmeyer, 1972, p. 180). In addition, encouragement may serve as a way to help a client see

the possibility of moving beyond loss and creating new ways to reorganize their life by utilizing

their own strengths. A counselor can help a client who may be “pessimistic and discouraged

about the possibility of change” to “recognize [his or her] own creative capacity for interpreting

[the] life situation and for choosing to function in a different manner” (Dinkmeyer, p. 180). For

instance, if a mother dies in the family and her main role was caregiver the father will have to

find the encouragement to take on these new roles to keep life moving. In this case, the therapist

can encourage the father to take on new roles, accept new responsibilities, and make the choices

to keep life going for the rest of the family as hard as it may be. One final way encouragement

overlaps with grief is as a way to promote healing. Therapists can encourage clients so share

special memories of a loved one, develop support in the community, and find a way to stay

connected to their loved one while allowing themselves to move on. For instance, if a child loses

a friends it is important they are encouraged by everyone around them to share something about

their friend such as a favorite shared activity or special memento.

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Other Important Implications of Childhood Grief

Impact of Spousal Grief on Children

One unique aspect of the grief process for children is those who lose a parent and are left

with a surviving parent struggling with his or her own grief. The surviving parent must make

“painful adjustments in handling the tasks of family life: logistical, social, financial, and

parental” and parenting may be the most complex (Saldinger, Porterfield, & Cain, 2004, p. 332).

The surviving parent must be wary about his or her own feelings of grief and how they can

influence the relationship with his or her children. For instance, after the loss of a spouse the

surviving spouse may be numb, causing detachment from children, or become angry, possibly

causing decreased patience.

In addition to being aware of their own grief feelings, the surviving parent must

recognize the differences in parental relationships to the children before the death of one parent.

Saldinger et al. (2004) did a study interviewing forty-one families including the surviving parents

and children to determine parenting quality and child adjustment. They found tasks of affective

communication “fall within a domain typically more congruent with women’s pre-bereavement

parenting experience” while “a widowed father, by contrast, is likely to be less familiar

navigating the terrain of his children’s emotional world” (p. 344). It seems men in particular

need to be in tune to his children’s emotional needs, recognize the feelings, and validate them

with support.

Saldinger et al. also found gender differences in coping with environmental

responsibilities. Widowed fathers were committed to returning to prior levels of functioning

before the death in home environment and outside activities while mothers struggled with daily

tasks due to overwhelming grief. Werner-Lin and Biank (2012) further suggest “bereaved

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mothers are less likely to have occupied disciplinarian roles and may struggle with enforcing

limits” and bereaved fathers “are infrequently in primary nurturing family roles and may be in

greater need of, but find it more difficult to access, parenting support” (p. 4). With this

information, it appears both genders have parental strengths and hardships after the death of a

spouse and further investigation is needed regarding these differences.

The surviving parent’s ability to parent children through the grief process also holds

implications for the child’s physical, emotional, and cognitive development, therefore, parents

need to recognize healthy ways to help children cope. First, it is essential for surviving parents to

understand how children grieve and to recognize unique grief responses. For instance, “children

taking emotional cues from parents to support survival may mask grief and sadness to align

themselves with parents they see as recovered from the loss” (Werner-Lin & Biank, 2012, p. 11).

When this is the case parents need to recognize their child is not over the loss, but is utilizing

behaviors being modeled.

In addition, parents need to understand how the changing roles will impact the adaptation

to loss in everyday experiences for the family as a whole. For example, “families may struggle to

regain a sense of safety and security if the deceased parent was the emotional or nurturing parent,

responsible for maintain the daily emotional and instrumental functioning of the family”

(Werner-Lin & Biank, p. 4). The surviving parent needs to develop a plan to meet all the needs

of the family and utilize different resources of support to make sure needs are being met. Finally,

there are a few healthy ways the parent can utilize to help his or her child work through the grief

process. One way is to help the child maintain a healthy connection to the deceased parent

including such things as creating rituals to remember the deceased or actively sharing memories.

Another way to help children cope with loss is to talk openly with the child using appropriate

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developmental language and ideas to help the child make sense of the loss. In addition, the parent

should consider letting the child be an active participant in the funeral and wake of the deceased

parent as a way to help gain closure and put the experience into reality (Saldinger, Porterfield, &

Cain, 2004, p. 339). One final way for parents to help children process grief is to maintain

stability in the child’s surrounding environment. It is these “routines that provide a backbone of

the child’s environment, and are pivotal to a child’s sense of order and predictability” (Saldinger

et al., p. 340).

Loss of a Sibling

Another unique type of loss experienced by some children is the loss of a sibling. This

type of loss is especially difficult since “for surviving siblings the death might represent the loss

of a role model, confidante, playmate, and friend and the impact of the death can still be felt

many years later” (Barrera, Alam, D’agostino, Nicholas, & Schneiderman, 2013, p. 26). Another

aspect of sibling bereavement is the continuing bond with their deceased sibling. This may

include “regrets, endeavors to understand the whys of the death, and attempts to catch up by

updating the sibling on events and reaffirming the importance of the deceased sibling” to his or

her life (Walter & McCoyd, 2009, p.140). Parents, caregivers, friends, and other people in the

child’s support network need to recognize the importance of letting the child share memories of

their sibling to promote healing and understanding. For example, the surviving sibling may want

to use the deceased sibling’s belongings. It is also necessary to recognize sibling bereavement

also entails multiple grief responses “emotional (sadness, depression, excessive crying, anxiety,

feelings of guilt), behavioral (acting out, sleep disturbances), social (loneliness, withdrawal)

intrusive thoughts, and deterioration in school performance” (Barrera et al., p. 26). Finally,

parents also need to continue to support the surviving sibling and not participate in the process of

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mislocation where there is failure to recognize the reality of the death. For instance, attempts

may be made “by parents to impose characteristics of a dead sibling on a new child” and these

“children are likely to grow up with a poorly developed sense of self and lacking self-esteem in

never being able to live up to the idealized image of their deceased sibling in their parents’ eyes”

(Field, 2006, p. 744).

The Therapist and Grief

As a therapist it is essential to be aware of personal issues which may overlap with a

client’s struggles and ultimately influence various aspects of the therapeutic sessions or

relationship. Self-awareness of unresolved conflicts is a key to help safeguard against unwanted

influences in therapy. Countertransference at times can influence therapy in unwanted ways and

is defined as a therapist’s reaction to a client promoted by unsettled conflicts. On the other hand,

personal history also may influence the therapeutic relationship in a positive way. For instance,

for a therapist has worked through his or her loss this can provide the opportunity for enhanced

empathy (Hayes, Yeh, Eisenberg, 2007, p. 346). These unsettled conflicts may lead a therapist to

“display avoidance behavior, engage in reactive as opposed to reflective thinking, feel anxious,

and be prone to distorted perceptions of clients (Hayes, Yeh, & Eisenberg, p. 346). In addition, a

therapist coping with one’s own feelings toward loss needs to be concerned not to overgeneralize

his or her experiences to those of a client. Each person has unique coping mechanisms and

feelings toward loss and it is imperative to keep distinctions between them. If a therapist were to

generalize and make assumptions about the way one’s client should grieve it may result in the

client feeling unheard or with the therapy not working at all.

Being self-aware is one piece of ethical practice when working with clients experiencing

grief. Another piece is keeping up to date with changes and new ideas surrounding grief. One

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way to maintain knowledge of new research is by researching journal articles. It is surprising

“despite journals containing the most recent empirical information and being the most popular

avenue for researchers to disseminate their findings, they have minimal practical relevance to

grief counselors” (Breen, 2007.p. 292). It appears counselors prefer to get their information from

courses or workshops, colleagues, books or the internet ahead of journal articles (Breen, p. 291).

This presents the issue there is a gap between grief research and practitioners which needs to be

addressed. Another important idea is the question of how therapists are supposed to be

competent in grief counseling if no adequate training is completed. One study surveyed one

hundred and forty seven members of the American Association of Marriage and Family Therapy

and International Association of Marriage and Family Counselors to find if they had taken grief

courses in graduate coursework. It was found at least fifty percent of those members surveyed

lacked this training (Ober, Granello, & Wheaton, 2012, p. 150). With this in mind, it appears

therapists may lack the specific skill set to help clients understand grief and work through it.

Finally, therapists can become more competent in grief by understanding their personal

experience with grief is not equal to professional understanding. Therefore, therapists should

seek out areas which provide specific knowledge “including theories of grief, definitions of types

of bereavement, identification of effective and ineffective coping skills, and applying a

developmental understanding of grief in work with clients” (Ober, Granello & Wheaton, p. 155).

Working as a therapist it is necessary to demonstrate competence in grief work as well as

recognize the significance of the client’s views. First, it is important to utilize one’s actual client

cases. First-hand experience is one of the best ways to learn and continue to develop one’s skills

as a therapist. As therapists one can ask clients whether or not the interventions being used work

for them or not. Second, as a therapist one should recognize the resilience of clients. For some

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CHILDHOOD GRIEF 38

clients grief work may not be necessary. To these clients “grief is a normal part of life and

something that can promote growth, even in the absence of professional assistance (Walter &

McCoyd, 2007, p. 26).

Finally, it is essential to remember the therapist’s role when working with a client

experiencing loss is to “(a) explore attitudes toward death and dying from a psychological,

sociological, and philosophical/religious perspectives; (b) explore and analyze the bereaved’s

constructions of life; and (c) explore the processes of adjustment to the world without the lost

entity” (Walter & McCoyd, 2009, p. 23). Clients experiencing loss are coping with life

transitions, new roles, and rebuilding his or her self from the rubble of the loss, therefore, it

becomes the therapist’s job to help the client negotiate this path.

Summary and Conclusions

Grief as a field of study continues to evolve and it is exciting to think about what the

future may hold. With this in mind, there exists a need to change societal beliefs surrounding

death and recognize myths specific to childhood grief. As a society we need to understand grief

is a shared experience no matter what age, however, the process is unique to each individual.

Furthermore, continued research needs to focus on interventions working with children facing

different circumstances of loss. In particular, the field of therapy “could benefit from a

comprehensive and diverse database of resources on grief counseling, including topics such as

studies on effectiveness, interventions, and community and professional resources” (Ober,

Granello, & Wheaton, 2012, p. 157). In addition, therapists “need to provide the appropriate

bereavement interventions and not over-pathologize a client’s experience” (Edgar-Bailey &

Kress, 2010, p. 159). Therapists need to continue to educate themselves to become competent in

grief work and conceptualize a better understanding of its history, theories, and diversity in this

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CHILDHOOD GRIEF 39

specialized area. By doing so, therapists can improve the understanding of teachers, parents, and

children themselves about the process through psychoeducation. While humans will never be

able to steer clear of grief with knowledge they may be able to cope with it in a more adequate

way.

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Afterword

As the writing of this paper and my chapter at Adler comes to a close I am excited about

the beginning of my new journey. As a child I never realized how my own grief experiences had

impacted my life. It has only been going through the graduate program at Adler I have come to

the conclusion to move forward using my grief experiences as a strength and source of empathy

for future clients. It is my hope to influence the lives of children coping with loss and help their

parents to understand the grief process through their children’s eyes. Society needs to recognize

and validate children’s feelings and experiences of loss no matter how trivial the loss may

appear. Armed with all the research I have done for this paper, projects for other classes, and my

personal experiences I feel I have fortified the groundwork to move forward and start working in

the field. I look forward and hope one day to specialize in the field of grief work and continue to

explore future ideas and interventions.