Discussion on Grief and

Bereavement in young people

Doug Ennals, RSWINCTR Annual Meeting

Chennai, 2005

CHILDREN and LOSSCHILDREN and LOSS

Every deathEvery deathhas a life of its own…has a life of its own…

We enter the conversation with our own knowledge, experiences and beliefs about death, grief and bereavement

Opportunities for reflection, asking questions, exploring, and creating dialogue in everyday practice

Local KnowledgeLocal Knowledge

Language of LossLanguage of Loss

Bereavement – the state of having experienced loss

Grief – subjective, personal feelings and reactions to loss

Mourning – the private and public processes, rituals and practices to loss

Models of GriefModels of Grief

Many western models have attempted to help understand the processes of bereavement

linear

series of stages

tasks to be completed

re-investing of emotional energy

processes of ‘letting go’ of attachment to the deceased

Historical

Models of GriefModels of Grief

Through continued bonds, people find places for the deceased in their ongoing lives

Grief is a condition of the human spirit

Constructing relationships with the deceased

Ongoing construction of self and relations to the world we live in

Emerging Perspectives

Dual Process ModelDual Process Model

LossOriented

Involves the emotional and

reactive processing of the loss

Restoration Oriented

Dealing with the many life changes and new roles that

are brought about by the death

(Reference: Stroebe and Schut, 1999)

Oscillating between these stressors

PerspectivesPerspectivesMultiple, dynamic processes whereby people find meaning in loss

Moving between the grief and day to day life adjustments

Continual process of coping, adapting, building capacity to move forward

Traumatic grief – survival issues take priority over grief

Political, economic, social, cultural, spiritual and other considerations

(Reference: Parkes, Colin M. Mortality: Virtual Themed Issue, 2003)

PerspectivesPerspectives

(Reference: Parkes, Colin M. Mortality: Virtual Themed Issue, 2003)

“…restoring the fit between the world that

is and the world that should be…”

Children and LossChildren and Loss Death touches the lives of children regularly

What may seem normal or abnormal for adults may be quite the opposite for children

Children’s expressions of grief are both similar and different from adults

Adjusting to the reality of illness, death, and loss is complicated by:

- children’s developing conceptual understanding of death and dying

- lack of or distortion of information they receive

Developmental ConsiderationsDevelopmental Considerations

Think in more connected ways

Live in the moment

Magical thinking… Belief that thoughts and behaviors are cause for events

Anxiousness, distress

Repetitive and physical in their grief

Younger Children

Developmental ConsiderationsDevelopmental Considerations

Developing a better understanding of cause and effect

Detect feelings of others

Building capacity for expressive language

May have many questions and a need for detailed information

Children

Developmental ConsiderationsDevelopmental Considerations

Time of dramatic physiological, cognitive, emotional, spiritual, and social change

Increased sense of self

Quest for knowledge, understanding, awareness of place in the world

Search for meaning and purpose

Increased understanding about significance and realities of dying and the death experience

Adolescence

Social and Cultural ConsiderationsSocial and Cultural Considerations

Child-rearing practices

Nature of attachments

How children acquire their understanding of death

Religious and spiritual beliefs about death and bereavement

Age, gender, family position

Influences

Social and Cultural ConsiderationsSocial and Cultural Considerations

Cause and nature of death - stigmatization?

Roles during illness

Previous loss experiences

Rituals attending death, bereavement and mourning practices

Influences rites of passage, and the norms for ‘appropriate’ grief

Influences

PerspectivesPerspectives

Children’s grief experiences are influenced over time, embedded in developmental, social and cultural

contexts in which all experiences exist

Windows to GriefWindows to GriefEntering into the grief journey with children

requires an embracing of their spirits

Magical, curious, unpredictable, observant, perceptive, spontaneous

Live in metaphor

Need spaces to see, experience, accept, reject, and try on feelings and reactions

Loss of one’s right to be born into a safe world that makes sense

Windows to GriefWindows to GriefCompanioning children on their grief journey

means using theory as a framework and your heart as the guide

No formulas

Observant, flexible, patient

Honest

Courage to stay out of the way

Courage to companion

Prepared to be surprised

Windows to Grief Windows to Grief

Children understand more that they are given credit for

Adults are one of the biggest barriers

Grieving children don’t need to be fixed

Expressions of grief take many paths

Children need, want, and deserve honesty truth, and choices

The best gift is the capacity to listen

Into the Circle of CareInto the Circle of Care

What are my beliefs about grief and bereavement?

What are my beliefs about how children should be involved / not involved in end-of-life care conversations?

What does the team need to know from the patient and family?

What are my comfort levels in sharing information and talking with children?

Who on the team could assist in the process?

Ourselves and the team

Into the Circle of CareInto the Circle of Care

What does the child(ren) already know?

What are the cultural, religious and social practices for this family? How has ritual been practiced?

What is the relationship between the child(ren), patient, family and other caregivers?

What would be helpful?

Invite conversation

Family and caregivers

Into the Circle of CareInto the Circle of Care

Preparation

What to expect

Misconceptions

Expressions of emotion

Providing developmentally appropriate information

Asking children what they understand, how they are making sense of what is happening

With children

What is dead?

Who will take

care of me? Who am I now?

Did I cause it?Am I going to die too?

How will I remember?

ReflectionsReflections

All children are different and their view of the world is unique and shaped by different experiences.

When working with a grieving children, we are witness to a profound journey.

Children as experts

ReflectionsReflections

In our everyday practice, how can we support

children as experts and storytellers of their own

knowledge and loss experiences?

Children as experts

Every deathEvery deathhas a life of its own…has a life of its own…

Thank you…Thank you…