ARTICLES

A Child’s Grief

How To Help

Why Grieve?

Sudden and Traumatic Grief

What People Need

Notes on How to Help a Traumatized or Grieving Person

Point of View

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A Child’s Grief

By Debbie Morrison Dyke, Ph.D

BCW Clinical Consultant

As the Clinical Coordinator of BCW, I get many calls from parents who are concerned about their children/s responses to death in the family of a friend. These parents are usually asking for information about how their children are grieving and how they can help them heal. My hope in this short space is to tell you a bit about children’s grief and how you can be available and supportive to your child as he/she finds ways to cope with a traumatic loss.

The first important point I would like to make is that all children grieve. Even babies respond to changes in the emotional climate of the home when a death has occurred. But children’s responses to a death do vary based on their developmental level and life experiences. Children younger than five years old typically do not understand that death is permanent and they may ask over and over when the person who died will return. They  will often express their grief through moodiness, changes in eating or sleeping patterns,  changes in toileting patterns, clinginess and nightmares. Children between the ages of five and nine are beginning  to understand the permanence of death. They now know that the person who died will not be coming back. They will usually express their grief similarly to the younger children just described. There is likely to be a greater ability for verbal expression of feeling and they may have more specific questions about the specific circumstances of the death as well as worries about themselves or other loved ones dying. From age ten through adolescence the understanding of death develops so that these young people now recognize that death is final, inevitable and universal. Their grief is often expressed through difficulties with motivation and concentration, increased isolation in general or distancing from family and tendency to spend most of their time with friends, expressions of sadness and anger, and misbehavior at home and/or school. Any significant changes from your child’s behavior prior to the death can be interpreted as a grief reaction.

Children of all ages are likely to express their grief through physical symptoms so you may hear many complaints of stomachaches, headaches, dizziness, fatigue and more. School problems may develop when a death has occurred in a child’s life. School-age children will need help reentering school after a loss, as well as support from teachers, administrators and guidance staff in creating a safe and secure environment. The ability to concentrate in class, to care about grades or to complete the required work is often difficult for a grieving child. Speaking to staff members and helping them to understand your child’s needs can be effective in addressing these difficulties.

Though there is healing that occurs after a loss, grieving is a lifelong process which is likely to be revisited at different points throughout your child’s life as he/she passes through carrying developmental stages of life events (e.g. graduation, marriage). Being aware of the typical responses to grief can help both you and your children to better cope with the feelings and behaviors that emerge and re-emerge after a loss.

HOW TO HELP:

By Debbie Morrison Dyke, Ph.D

BCW Clinical Consultant

LISTEN: Avoid the impulse to provide trite, “shut-down” responses such as, “It’s O.K.” (it’s not O.K. that his/her loved one has died), or, “Don’t cry.” (crying is an important expression of his/her sadness). It is O.K. for your child to have his/her feelings so allow the expression of emotion, provide realistic reassurance and a supportive, open state of mind.

Be direct and HONEST: Don’t be afraid to share your own feelings. You will not cause your child to feel worse than he/she already does and you may find an opportunity for closeness through providing comfort for each other.

Ask questions and, more importantly, make yourself available: Ask to hear stories about the deceased, favorite times together, regrets, funny memories, etc.

Provide suggestions for outlets: Journal writing, letter  writing to the deceased, reading books, music, artwork.

Allow humor and lightness: Children need to be children. It is important for them to laugh and play and spend time with their friends (this goes for you too!).

Take care of yourself: You cannot be truly available and supportive to your children if you are not attending to your own grief. Don’t be shy about reaching out to others when you need to. You have an opportunity to serve as a role model to your children about how to take care of themselves during a time of need.

Keep in mind what your children need most is: (1) a safe environment; physically, emotionally and psychologically; (2) the presence of a caring adult other than a parent (teacher, family friend, priest, rabbi, etc.).

Remember, all children are unique and express grief in their own way, so keep your eyes and ears open and listen to your own child as he or she moves through his or her grief towards and hope and healing.

Why Grieve?

by Debbie Morrison Dyke, PhD

BCW Clinical Consultant

Most people  know, either from personal experience or through contact with others, that the grief following the death of a loved one can be painful and overwhelming. Many do not know, however, just how important it is that we allow ourselves to experience this grief, despite every impulse in our bodies and minds to move away from the pain. Grief is a normal and NATURAL response to the death of a loved one. Healing from this loss and reinvesting in life may often take a good deal of time. It is critical that we allow ourselves and others the time necessary to work through this process in order to move toward health and healing ( a very PERSONAL experience, by the way, which does not lend itself to the expectation of how fast other THINK one should be healed) 

Grief is, in part an expression of the depth of our love for and connection to this other human being who has died. As such, the experience of the feelings which make up our grief is constructive, and in fact, life-affirming . As Roberta Beckman so beautifully puts in Children Who Grieve: A manual for Conducting Support Groups. "If no person's life were significant enough to cause weeping and if the measure of our years on earth were nothing, then we would not be real human beings. Profound grief is preceded by deep love which gives life meaning." Though understanding that grief is important and even constructive and may not alleviate the pain we feel when someone we loves dies, it can help us to tolerate that pain, and help others in this situation to do the same. Allowing ourselves this healing process will eventually enable us to learn ways of maintaining a connection with our deceased loved one and holding the memories of our time together in life.

This is a memo written to help anyone dealing with the aftermath of Sept.11, 2001...as well as those managing other traumatic deaths that have impacted them. While grief following the death of a loved one is always intense, the grief that follows traumatic death is particularly confusing and frightening for those who have had direct contact with the situation or people who have died;  for family members and caregivers who are trying to understand and help each other with traumatic grief; and even for those who may not know anyone who died but have witnessed the events on television and may be worried about their own or other’s safety. We hope that the following will guide you in helping yourself and others during these extraordinarily stressful times. 

Jane Bradley Cameron, MA, M. Ed

SUDDEN AND TRAUMATIC GRIEF  

By Jane Bradley Cameron, MA, M. Ed

BCW School Outreach and Curriculum coordinator

What it consists of and how to help.

The grief that follows disasters and traumatic death is often overwhelming
and disabling and includes reactions at all levels of our beings. Please
bear in mind that each person will comprehend and react to crisis in their
own way, at their own developmental level and at their own pace. Be mindful
of the fact that many people will have delayed reactions that won’t be
evident for days and weeks after the event. Children are especially
vulnerable not only because their grieving patterns are often misunderstood
but because they may not yet have learned, or put into practice good coping
techniques.  These post-traumatic stress reactions are normal but need to be
monitored and they might include:

Behavioral/social responses such as:
            shock, numbness, disorientation, bewilderment
            disbelief, denial, detachment
            crippling inertia, withdrawal, listlessness
            crying, screaming, whimpering
            clingingness, excessive touching or hugging
            hyperactivity, regressive

behaviors such as bedwetting, thumbsucking, clinginess, 

aggressive behaviors such as hitting, verbal attacks, fighting

Physical symptoms such as:
            nausea, trouble breathing, tightness in chest or throat
            fatigue, listlessness, muscle weakness adrenalin rush,

            hyperventilation, heightened startle reaction
            dizziness, shaking, chills, sensitive skin, hot or cold flashes

Thought patterns such as:
            intensified rage, thoughts of retaliation, feelings of victimization
            nightmares, recurring flashbacks, intrusive memories
            the need to give or receive punishment
            inability to concentrate; to follow or to  make coherent conversation

Feelings such as:
            rage, anger, hysteria
            guilt or self-hate about having survived or not coping better
            confusion, powerlessness,
            utter hopelessness, profound loneliness, existential anxiety
            feeling overwhelmed and out of control
            feelings of panic and intense anxiety

WHAT PEOPLE NEED:

 -children and adults need the facts.  Explain  simply and accurately what
has happened and don’t speculate beyond what you are sure is true.  Ask them
if they have any questions or particular worries about the disaster; if there
are particular people they are concerned about. Do your best to obtain the
information they need. 

 -children and adults need opportunities to share feelings and experiences.
 Ask them how they are feeling about what has happened and bear in mind that
sharing some of your own feelings will help them talk about their own
feelings and concerns. Remember that children may express their feelings
through behaviors rather than words so be alert for behaviors that indicate
they might be worried and not talking about it.  Inviting children to make
drawings, a clay sculpture or playing with puppets are other ways of helping
them get at unexpressed feelings.  Remember that children typically deal with
grief in short spurts and can seem very upset one minute and unconcerned the
next;  also remember that children will differ in their pace and style of
grieving....for example some will act out angrily, others will withdraw sullenly.

-children need to feel safe.  Stay with your children if  possible;  try
not to  leave them alone or with strangers .  Keep assuring them of what is
safe and stable in their lives. Many children will become very anxious about
being separated from their parents and family members and this may last for a
number of weeks.  Assure children that they will be cared for and implement a
buddy system if you are in charge of a classroom or a large group of children.

-children need to feel a sense of control.  Keep to your regular routine
if at all possible;  give children specific tasks to do that they are sure to
succeed in;  this not only keeps them productively busy but gives them a
sense of mastery and control.  For ex: cleaning out a drawer, setting a
table, tidying a room.  If appropriate include them in decisions and plans
that follow the tragedy.

-children and adults need to learn their own coping techniques for
dealing with the crisis.  Remember to allow for different understandings of
and reactions to the situation.  Traumatic grief reactions are natural and
normal - and remember that most people can manage their own reactions best if
they get some rest, good food, exercise and have access to people who can
listen, who can tolerate their pain without trying to make it go away
prematurely, and don’t criticize their coping techniques.

-children and adults need to slowly, and in their own way, be allowed to
absorb the range of losses that trauma can cause.    These include loss of
control, loss of trust, loss of security and safety, loss of  innocence, loss
of assumptions about the world, loss of a sense of fairness, loss of personal
belongings, loss of  relationships. 

-children and adults deserve to have their pain validated.   If our own
issues with grief and trauma are causing us to deny, prejudge, or wish 
another’s pain away it can eclipse their healing.  Their pain is real and
true even if it frightens or angers you;  to deny their pain is to deny them.
 

Notes on How to Help a Traumatized or Grieving Person

-unconditional, supportive listening:  this is the ESSENTIAL SKILL.

-self-awareness regarding personal issues with trauma.  Try to be aware of
and process your own issues so you don’t prejudge what is emotionally real
and conceptually true for others.

-tolerance of others’ pain:  staying present to and accepting of the depth
and range of pain that is there, rather than ignoring, or trying to talk or
wish it away.

-be the learner:  let them guide you towards their own ways of expressing and
help them teach you about what is going on inside them.

-tolerance of different modes of expression:  whether in identifying,
expressing, &/or handling feelings and issues.

-creativity: provide opportunities for esp. young  children but also others 
to express their beliefs and feelings through ‘expressive media’ - ranging
from clay, drawing, poetry, journal keeping, letter writing, dance,
photography, music listening or music making, to sand play and quiet time.

-honesty: use real language (‘he died’...) not euphemisms such as ‘gone
away’, ‘taken to heaven’, etc.  and tell the truth.

-patience:   encourage them to tell the same stories again and again until
they don’t need to anymore...at least for now.

-alertness and flexibility:  stay alert and open to serendipitous, opportune
times for listening, comment, quiet presence and intervention.

-trust their feelings:  be willing to surf with the range of emotions and
behaviors they present...from huge and roiling to a need for solitude or a
quiet presence.  Remember that your job is not to help them ’to get ‘over
it’ or ‘around it’ but to honor their journey ‘through’  trauma and grief
as they find their own style and pace.... in the direction of hope and healing.

-sense of perspective:  remember that everyone needs and deserves to be
encouraged to take ‘downtime’ from traumatic grieving and this is especially
true for children who literally need to play in order to absorb and pace
their grieving.

Point of View

A grief survivor’s journey

By Emily Laitmon, CSW

Recently a  neighbor lost their 15-year old daughter to cancer. We only knew them through common friends but we felt compelled to contact them to help them cope with their loss. A family that has lost a child can truly understand what another family goes through in dealing with this loss. Regardless of how well-meaning people can be, often words meant in support and care can have just the opposite effect. This is our story and what we’ve had to learn.

It’s been 5 years since our son Daniel died of a sudden, catastrophic asthma attack. Our family began a journey that day to cope with an unimaginable loss from which we never thought we’d recover. We sought professional help and found our way to the Tree House Program in the spring of 1998. My husband Steve and I participated in a child loss group and our daughter Rebecca joined a “Middles” group with other who lost a sibling or parent. Although a few months had passed since Daniel died, we were still numb, confused, drained and suffered from relentless pain; symptoms which I now understand are components of the normal process of grieving.

Our group was led by a caring facilitator who had also survived a devastating loss of a son and therefore understood our needs. We shared Daniel’s story with the group and listened to others speak of their loss. We recalled memories and regrets. We cried and got angry with God and doctors for not preventing this. We shared photos and anecdotes. And we repeatedly questioned why this happened to us. But most importantly questioned why this happened to us. But most importantly, we were with other parents whose children had died and we weren’t totally alone in our pain. We in turn could muster the strength to return the support.

We’d come home after these weekly sessions emotionally drained and often followed by sleepless nights. After eight meetings at the Tree House, as part of the closing ceremony we honored our children and parent loss with special memory pillows, joined a ritual circle of hand-squeezing and hugs, and prepared to move on with the next phase of our grieving. In many ways this was the most difficult part because we were without the constant support of friends and neighbors whose attention quite normally was on their lives. And we were without the anchor and security of the weekly Tree House meetings.

But it wasn’t good-bye because we were offered an opportunity to continue receiving support during the monthly Tree House with both the same families as well as additional families.. During the years that followed, we could see our own evolution from endless neediness to growing strength.

After five years without Daniel, we have accepted that the loss is forever. The sadness remains as we have learned that one doesn’t “recover or get over it”. The BCW, however has helped us redefine ourselves as a smaller family and we are now able to lead lives that can bring us joy and satisfaction despite our ongoing grief. And we in turn have tried to help others, such as our neighbors, to deal with their tragedy. As part of the journey I have devoted more of my practice to bereavement. Patients often speak of double losses; the loss of a loved one and then the loss of friends and family members who just don’t know what to say or how to treat them. So for fear of doing the wrong thing they disconnect.

Below are some suggestions on how you can help a grieving family. Much of this can be found In greater depth in Tear Soup, by Schwiebert and DeKlyen.

If a relative or friend is grieving:

You can comfort others through LISTENING and laughing and crying.

Send cards, notes, e-mails or even a telephone message saying, “I’m thinking of you” The thoughts don’t need to be long, but they’ll know you haven’t forgotten them. This continues to help us even years after Daniel’s death.

Grief takes time. If a spouse, child or parent dies, it may be a year before the bereaved begins to gain a sense of stability.  Don’t try to push her through grief. (i.e. Never say you should be OVER it by now.)

Say the name of the deceased and recall memories and anecdotes with the family. The fear of forgetting a lost loved one is like a double loss, both the physical being and their legacy.

Avoid offering easy answers and platitudes; this only invalidates grief.

In facilitating bereavement groups, I learned most poignantly that we all grieve differently. And one’s grief cannot be compared to another’s/

He/She may be having a good day which doesn’t imply one is over a loss. She may be fine one minute and the next hit bottom.

As a good friend or relative, try to anticipate their needs. Bereaved persons sometimes don’t know what to ask for or are unaware of what helps. After a traumatic loss, one is typically numb, in shock or disoriented for a varying period of time.

Nighttime can be particularly tough (getting to sleep, staying asleep, not wanting to wake up). If you’re available in the wee hours, you may want to give your loved one permission to call.

Stick close, defend their right to grieve, and be present even if you don’t understand.

Give them permission to mourn in front of you. “I’m here for you and have nothing more important right now.”

Invite them to attend events or exercise class with you as your would normally. They’ll decide if they cannot; accept their decision without debate.

Be mindful of holidays, birthdays, and anniversaries.

We can all provide bereavement support to those we love. There is no magic to being a caring neighbor, community member, or friend. However if you’re concerned that the family may require more professional help, individual or group, or may benefit from a Tree House program suggest a call to Patty or Mindy at 914-961-2818 (BCW) or feel free to email me with questions at laitmon@aol.com.

Finally, I would like to thank the dedicated staff and volunteers of BCW who continue to check-in, providing love and support as we still struggle to get through memorials, birthdays, bad days, frightening dreams, and anniversary dates. We thank you for your caring and kindness; we’re glad you’re there to guide us through the healing process.

Emily Laitmon, CSW is a psychotherapist in private practice in Larchmont and NYC. After participating in the Tree House program she completed volunteer training and is currently facilitation loss groups with the Center. She feels that “giving-back” is a rewarding and necessary piece of her healing process.

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