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Mark de St.

Aubin. , LCSW, FT. College . of Social Work, University of . Utah. Lorene de St. . Aubin. , Chaplain. mark.lorene@gmail.com. Working with the Grief of Children and Adolescents. Idaho School . Counselor .

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Mark de St.

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Mark de St. Aubin, LCSW, FTCollege of Social Work, University of UtahLorene de St. Aubin, Chaplainmark.lorene@gmail.com

Working with the Grief of Children and Adolescents

Idaho School



Fall Conference – October 3


, 2014



Let’s talk about GriefSome essential concepts and terms:Grief - "a multi-faceted response to loss that includes psychological, behavioral and physical reactions combined with cognitive, emotional, behavioral, social, spiritual and somatic elements." Stroeb ,M, Stroeb, W and Schut, H. Bereavement

- an objective state of

having lost someone or something. The term is generally used to describe the state of having suffered a loss due to death. Mourning - the process by which people adapt to loss; the public expression of grief, which is shaped by social and cultural expectations. It is how a person tries to incorporate the loss into life and keep living.Slide3

First, let’s review what “normal grief” looks likeFeelingsPhysical SensationsCognitive Behavioral





YearningEmancipationGuilt and Self-reproach


Material adapted from William Worden,

Grief Counseling and Grief Therapy: A Handbook for

Mental Health Practitioner

, 4th edition, pp. 18-31,Springer Publishing, 2009Slide5

Physical SensationsHollowness in stomachTightness in the chestTightness in the throat

Oversensitivity to noise

Sense of depersonalization


Weakness in the muscles

Lack of energy

Dry mouthSlide6

DisbeliefConfusionPreoccupationSense of presenceHallucinations


BehaviorsSleep disturbancesAppetite disturbancesAbsentminded behaviorSocial withdrawalDreams of the deceasedAvoiding reminders of the deceasedSearching and calling out


Restless hyperactivity


Visiting places or carrying objects that remind one of the deceased

Treasuring objects that belonged to the deceasedSlide8

Spiritual Can lead to a spiritual crisis. The tough questions – “Why did this happen?”; “Why did it happen this way?”; “How could God let this happen to me?”Causes us to question our beliefs (‘assumptive world’ ) which form our world viewMay bring feelings of emptiness, meaninglessness, disconnection from our source*Wolfelt, A. “The Journey Through Grief”, www.centerfor loss.com, 2007Slide9

Some examples of loss across the life spanChildhoodDeath of a petAbuse/abandonment/Foster care/adoptionDivorced parentsDeath of sibling or parentMoving/relocationAdolescentDeath of a friendAbortionUnwanted pregnancyAdulthoodLoss or death of childMiscarriage/SIDS babyChild with disability

Chronic illness/health

Death of friend or parents

Divorce/death of partnerRetirement/career transitionDementia/Alzheimer’sLoss of dreams/hopes/plansSlide10

How can we help others along their journey of grief?Slide11

From Grief Counseling and Grief Therapy: A Handbook for Mental Health Practitioners, 4th EditionBy J. William Worden, Springer Publishing Co., 2009One Model “The Four Tasks of Mourning”Slide12

THE FOUR TASKS OF ADAPTING TO LOSS - Just as healing is necessary in the physiological realm in order to bring the body back into physical health, a period of healing is likewise needed after a loss to return to a similar state of emotional well-being. There are four tasks of adapting to loss which are an essential part of the healing process. They do not always follow a specific order, but still must each be worked through during the time of grieving.How do we heal from grief?Slide13

Task 1 - To Accept the Reality of Loss To come full face with the fact that your loss is real and will not return, i.e. that immediate reunion or regaining it is impossible, that the loss is permanent.Obstacles: Denying the facts of loss.Denying the meaning of the loss, e.g. It wasn’t a good job anyway, or I don’t miss him, or I’m just as healthy as I ever was. Minimizing the loss.Denying the fact that the loss is irreversible. Belief and disbelief alternate. Adaptive denial.THE FOUR TASKS OF ADAPTING TO LOSSSlide14

Task 2 – To Process the Pain of Grief It is impossible to lose something or someone you have been attached to without experiencing some level of pain. Society often feels uncomfortable when you show this pain, and often will give you the subtle message of “You don’t need to grieve”, or “Please don’t be so emotional around me.” They will often try and distract you from your feelings.Obstacles: Not allowing yourself to feel.Cutting off your feelings and denying that pain is present.Avoiding reminders of the loss – e.g., trying to find a ‘geographic cure’ by moving to another location, removing all pictures/reminders of the deceased.


Task 3 - To Adjust to a World Without the Lost Person, Ability, etc. Coming to terms with being without (maybe raising children alone, facing future unemployment or handicap, redefinition of self, etc.). This often requires the learning of new skills and functioning in a new set of roles. This adjustment may also include a redefining of some life goals. A. External Adjustments – how the loss affects your everyday functioning in the world B. Internal Adjustments

– how the loss affects your sense of self


Spiritual Adjustments – how the loss affects your beliefs, values and assumptions about the worldObstacles: Promoting your own helplessness.Not developing the skills you need to cope.Withdrawing from the world. Refusing to see yourself or the world differently.


Task 4 – To Find an Enduring Connection With the Deceased in the Midst of Embarking on a New Life To find a place for the deceased that will enable us to remain connected with them but in a way that will not keep you from going on with life. We come to realize that there are still areas in life left to become involved in or other people to be loved.Obstacles: Withdrawal from others and life. Not living. Holding onto the grief as a way to honor the deceased.Unwillingness to risk; making a vow to never love again.Holding on so tight to the past that you’re unable to form new relationships or develop new skills.


These tasks can be revisited and worked through again and again over time. Various tasks can also be worked on at the same time. When is grieving over? No time limit can be set. Mourning is finished when the tasks of mourning have been accomplished; when you are able to think of your loved one without fresh pain. This does not necessarily mean that the bereaved will no longer feel sad, it means that one is able to move on and continue living, even though they still may miss the deceased.


Task 1 – Helping the survivor actualize the lossHave them tell their story – Tell me how your friend/family member diedTell me about the funeralTell me about when you heard the news of his deathTell me about your visit to the grave of your loved oneThen listen, listen, listen. You may have to hear the same story over and over again. That’s OK, they need to tell it. Having them review the events of the loss assists them in coming to grips with the reality of the death Grief Counseling Interventions - - Slide19

Task 2- Helping them identify and experience feelings related to the lossHelping the client express the feelings they are experiencing and give them permission to feel these feelings – sadness, anger, guilt, anxiety, loneliness, fear, etcHave them bring a photograph of their family member/friend and tell you about them, their relationship, their memoriesEducate them about what normal grief looks and feels likeUse reflective and empathic listening skillsValidate their feelings and experience. This will assist them in feeling safe to express and explore these feelingsPerhaps ask them to write a letter to the deceased person to give voice to thoughts and feelings which may relate to ‘unfinished business’Interventions – cont’dSlide20

Task 3 – Assist them living without the deceasedExternal adjustments – A problem-solving approach, education and modeling may be most helpful learning the new skills needed to adapt and take on new roles - the cook, decision maker, home repairman, etc.You may ask What roles did your loved one perform?What changes has this required of you?How have you been able to change or adapt in the past?Interventions - cont’dSlide21

Internal/spiritual adjustments – You may ask:How has this loss changed your view of the world?How are you different because of this loss?How do you make sense of this loss - why has it happened to you? At this time?In what ways has this loss challenged your faith, or how you see the world?Is it important to you to find good or value or something learned from this loss?What good, then, has come of this loss?Task 3 interventions - cont’dSlide22

Task 4 – To Assist in Emotional Relocation of the Deceased (shifting from a relationship of ‘presence’ to a relationship of ‘memory’)Reminisce - What memories do you have of the deceased? Which memories do you want to keep? How do you want to remember and honor him/her?What ways/practices can help you keep them in your life? In your mind? In your memory?What things can you do to remember them on special days – anniversaries, holidays, birthdays?How can you symbolize the completion of this time of grief and mourning? (a ceremony or ritual may be performed)Interventions – cont’dSlide23

Listen with your heart – allow yourself to be touched by their loss. Your shared humanity allows them to feel safe and understood.‘Companion’ them, don’t try to ‘fix’ their grief. (see Wolfelt, A., The Handbook for Companioning the Mourner: Eleven Essential Principles, Companion Press, 2009) Avoid cliches – “They are in a better place.” “God needed them on the other side.” “At least you enjoyed 25 years of a good marriage with them.” These types of comments do not help the bereaved. Don’t try to ‘fix’ their grief so that they will ‘feel better’.Understand the uniqueness of grief – each person grieves in their own way and on their own time schedule. They will teach you what they need along the way, if you listen. Things to remember in

helping another in their griefSlide24

Answer the questions they ask, even the hard onesBe truthful and speak to their level of understanding. Children’s age and cognitive level affects their ability to understand death.Give the child choices whenever possibleDo they want to be involved in the funeral? Choosing the casket? Clothing of their family member of friend?Talk with them about and remember the person who diedUse the name of the deceased as you talk about the deceased.Talk about memories they have and things that matter to themIf they do not wish to speak, use drawing , clay or play as ways of expressionRespect differences in grieving stylesChildren grieve differently than their parents or siblings. Generally through play and through their behavior rather than through talk.*The Dougy Center: The National Center for Grieving Children and FamiliesThings to remember when working with children in griefSlide25

Listen without judgmentSimply reflect back to the child their feelings or experience without trying to judge, fix or direct them. Hold a memorial service and allow for saying goodbyeInform a child about the funeral and involve them, if they choose. If they don’t want to join you, invite them to create their own activity for saying goodbye – planting a flower or tree, holding a candle-lighting ceremony, drawing a pictureTake a break from griefChildren, like adults, need a break from grief. That’s OK. Having fun or laughing is not being disrespectful, this is how children process their feelings.Working with Children – cont’dSlide26

The sense of being out of control that is often a part of grief may overwhelm or frighten some teens. It may be an experience some teens resist and reject. Helping them accept the reality they are grieving allows them to do their grief work and to progress in their grief journey.Each teen’s grieving experience is unique. Adults can best assist grieving teenagers by accompanying them on their journey in the role of listener and learner, allowing the teen to be the teacher.Invite the teen to try helpful ways of expressing their grief – talking with a trusted friend, journaling creating art, and expressing emotion rather than holding it inside.*The Dougy Center: The National Center for Grieving Children and FamiliesThings to remember when working with adolescents in griefSlide27

Teens may mourn differently at different times – for example through talking, crying, or withdrawal. This can cause a great deal of tension within the already stressed family. Each person’s responses to the death should be honored as his/her way of coping in that moment. And this may change from day to day or even from hour to hour.Other factors which may impact the teen include:Social support availableCircumstances of the death – how, where and when death occurredWhether the teen unexpectedly found the bodyThe nature of their relationship with the deceased- harmonious, abusive, conflictual, unfinished supportiveThe emotional and developmental age of the teenThe teen’s previous experiences with death Working with teens – cont’d