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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

  • CHILDHOOD GRIEF 2

    Abstract

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

    Childrens 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.

  • 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, masters

    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.

  • CHILDHOOD GRIEF 4

    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

  • CHILDHOOD GRIEF 5

    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

  • 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).

  • CHILDHOOD GRIEF 7

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

    related to grief.

    Task Based Grief Theories

    Freuds 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

    peoples reactions he coined the term anticipatory grief and suggested knowing about a persons

    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 Lindemanns 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 ones whole being. It is learning how not to die in ones body by holding back, and

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

    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

  • CHILDHOOD GRIEF 8

    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

    ones 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, Wordens idea the relationship to a deceased

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

    important influence of Wordens 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. Goldenbergs 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

  • CHILDHOOD GRIEF 9

    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. Goldenbergs 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, Goldenbergs 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 Kbler-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, Kbler-Ross first

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

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

    hope in ones life. As cited by Walter and McCoyd (2009), Kbler-Ross stated, No matter what

  • CHILDHOOD GRIEF 10

    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, Kbler-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 persons 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 Kbler-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

  • CHILDHOOD GRIEF 11

    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

    objects 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

    deceaseds presence, or an unusually increased level of activity combined with latent tension and

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

  • CHILDHOOD GRIEF 12

    Another important component of Bowlbys 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

  • CHILDHOOD GRIEF 13

    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 parents divorce. Family members may also

  • CHILDHOOD GRIEF 14

    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 Eriksons 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.

  • CHILDHOOD GRIEF 15

    Toddlerhood and Preschoolers

    Eriksons 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 childs

    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 Eriksons 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 childrens 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 Eriksons stages of development take place. First, as

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

  • CHILDHOOD GRIEF 16

    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).

  • CHILDHOOD GRIEF 17

    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 childs 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 pets lifespan is shorter than a humans this provides

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

    290).

    It becomes a therapists job to be sensitive to the feelings surrounding the loss of the pet

  • CHILDHOOD GRIEF 18

    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 familys assessment including depicting the pet on a

    genogram. By doing so, the therapist could gain clues to the familys communication styles and

    coping strategies to situations causing stress. For instance, through a clients 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 shelters 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

  • CHILDHOOD GRIEF 19

    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 inmates 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 Alzheimers or physically absent but psychologically present- such as when someone

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

  • CHILDHOOD GRIEF 20

    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 ones 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 childs 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

  • CHILDHOOD GRIEF 21

    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 childs 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 childs 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 parents 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

  • CHILDHOOD GRIEF 22

    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 cant go back to being who we were

    because were not that anymore. We have to move forward, but its 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,

  • CHILDHOOD GRIEF 23

    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

    childrens responses to a cancer diagnosis were found. The parents reported (1) strong

    emotions, such as fear and anxiety, (2) self-consciousness about others 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 childs developmental level.

    For the family a childs 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 childs diagnosis. In particular, parents may

  • CHILDHOOD GRIEF 24

    experience problems balancing family needs including time with ones 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 childs

    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 peoples 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

  • CHILDHOOD GRIEF 25

    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 ones 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

  • CHILDHOOD GRIEF 26

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

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

    Michael Jackson and Farrah Fawcetts 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 Jacksons music or watching Farrah Fawcett on Charlies 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

  • CHILDHOOD GRIEF 27

    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 its 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

  • CHILDHOOD GRIEF 28

    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 todays 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 childs 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 lifes struggles.

  • CHILDHOOD GRIEF 29

    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 ones individual personality, emotions, behaviors,

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

    adults 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

  • CHILDHOOD GRIEF 30

    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,

  • CHILDHOOD GRIEF 31

    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 childs perception of the loss must be taken into consideration rather

    than generalizing interventions that may work.

    Social Interest

    Adlers 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.

  • CHILDHOOD GRIEF 32

    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.

  • CHILDHOOD GRIEF 33

    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 womens pre-bereavement

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

    navigating the terrain of his childrens emotional world (p. 344). It seems men in particular

    need to be in tune to his childrens 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

  • CHILDHOOD GRIEF 34

    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 parents ability to parent children through the grief process also holds

    implications for the childs 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

  • CHILDHOOD GRIEF 35

    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 childs surrounding environment. It is these routines that provide a backbone of

    the childs environment, and are pivotal to a childs 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, Dagostino, 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

    childs 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 siblings 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

  • CHILDHOOD GRIEF 36

    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

    clients 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 therapists 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 ones 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 ones 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

  • CHILDHOOD GRIEF 37

    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 clients views. First, it is important to utilize ones actual client

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

  • 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 therapists 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 bereaveds

    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 therapists 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 clients 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

  • 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.

  • CHILDHOOD GRIEF 40

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