Home May / June 2022 Volume 21, No. 3

PERSPECTIVES

Supporting Children Through Their Grief Journey

Nancy L. Kriseman, MSW and Lane Pease Hendricks, MS

An estimated 1 in 14, or 5.3 million, children in the U.S. will experience the death of a parent or sibling before they reach the age of 18 (Edelman, 2020). This estimate does not reflect deaths from COVID-19, as the analysis will not be released until sometime in 2022. No doubt, many more children and their families will need support.

After the death of a significant adult caregiver or sibling, the life of a child changes suddenly and forever. The family system changes as well. Family therapists can be a great support to children as death impacts the entire family system. Adults in the family often need help understanding how to best support their children, while coping with their own grief. Children need help navigating through all the emotional ups and downs that come with the death of a significant person(s). Yet, with staggering COVID-19 deaths staring us in the face every day, we are often ill equipped to talk about death and grief, especially with children. Knowing that each family member will grieve differently, family therapists will need to help the family navigate through all their different feelings. Additionally, family therapists will want to find out whether there is a children’s grief organization, like Kate’s Club (www.katesclub.org), that provides a safe space where social, recreational, and therapeutic programs are offered to grieving children and their families, as well as family programs to help build communication around grief.

Children’s grief is different

We know that children grieve differently than adults. Their age, developmental stage, life experiences, nature of the death, along with how adults around them model mourning, impacts how children grieve. Children move in and out of grief (called grief spurts) and process their grief in small doses. It is not unusual for young children to express sadness about losing a parent and then minutes later go out to play with their friends. Surprisingly, some children may not show their grief until one or two years later. They may be reluctant to express their feelings because they notice how much their parent or grandparent is grieving and they do not wish to upset the adults. However, if they do not express their grief, a variety of issues can result, such as depression, anxiety, problems at school or behavioral problems at home (Kaplow & Layne, 2014). When bereaved children have the opportunity to be with other children who have also experienced death, they can feel less alone. In fact, children in our program often share that their friends don’t understand how they feel, but their program peers do. Thus, when possible, we suggest a combination of family therapy and grief programs can be an important way to help children and their families best cope with their grief.

Differences between old grief and new old grief

Our society has a difficult time with children and adults who are still grieving after a year or two. They believe that it is not normal to still experience grief years later. Grief is a journey and will change overtime. It can come back throughout children’s lifetimes, even 20 or 30 years later. As children grow older and can process more, their unexpressed grief can come back. We try to educate our families and children to help them understand this.

Edelman (2020) calls this “after grief.” After grief can be a new grief which is grief that didn’t exist before. It can be acute, very painful, sudden, and can make it difficult for children and adults to function. If the new grief was unexpected or because of a suicide, overdose, or homicide, this type of grief can wreak havoc within the family system. Or, it can be an old grief, which is a grief that was not ever expressed and went underground. We recognize that many of our children and their families struggle with after grief. When there has been a recent death in the family, new grief can bring the family into therapy. The following are two case examples of working with children and after grief.

Case example: New grief

“Tommy,” a 12-year-old, was very close with his grandfather. They shared many of the same interests and spent a lot of time together through the years. Unfortunately, his grandfather was hospitalized with COVID-19 and died. Tommy was not able to say goodbye. After his grandfather died, he refused to talk about his feelings about his grandfather’s death. He isolated himself in his bedroom. He only came down for meals and refused to go to school. His parents were worried about him. Tommy’s pediatrician suggested the family seek out family therapy. The family therapist believed that it would be important to engage with Tommy by himself before she had a family session. She conducted two virtual sessions with Tommy, because he refused to come to her office. Knowing Tommy’s resistance to talking about his grandfather’s death, she utilized a strategic therapy intervention, telling him that he didn’t need to talk. She then asked him if their first session could be with him sharing some of his favorite music with her instead. She knew from his mother that he loved to listen to music. He agreed and chose three songs. They just listened to the music.

He told his parents how bad he felt about not saying goodbye to his grandfather or telling him he loved him.

The songs he chose were recordings of famous jazz singers and musicians. At the end of the session, she decided to see if he would be willing to share why he chose those songs. She started to ask him why he chose those songs and then she said, “Oh, I forgot that I told you, you didn’t have to talk.” But he didn’t hesitate one bit, and said his grandfather loved jazz. He mentioned that his grandfather introduced him to jazz, and they often would listen to it together. He said he felt bad because he didn’t tell his grandfather that he loved him before he died. He then burst into tears. The therapist just held that space while he cried and then once he stopped, she told him that she bet his grandfather knew he loved him. She reminded Tommy of all the special time he spent with his grandfather. “Love doesn’t have to be talked about; it can also be felt” the therapist told Tommy. Tommy then shared how much he would miss his grandfather. She asked Tommy to share some of his special memories of his grandfather. At the end of that session, she asked him if he would be willing to bring a few of his songs that he and his grandfather enjoyed to a family session. He agreed. In the family session, he and his family listened to those songs, and then the therapist asked if Tommy would be willing to share his feelings. He told his parents how bad he felt about not saying goodbye to his grandfather or telling him he loved him. This session was eye opening for his parent and helped them recognize the feelings of regret and shame Tommy harbored. They were able to tell him that his grandfather knew Tommy loved him. The therapist also helped the family create some rituals to honor and remember Tommy’s grandfather. One example of honoring his grandfather’s memory was to listen to jazz on his grandfather’s birthday and at Christmas. And when Tommy turned 16, he and his family would go to the New Orleans jazz festival.

Case example: Old grief

“Jordyn” an 11-year-old girl, was referred to a family therapist because she had panic attacks every time Mother’s Day approached. The therapist found out she told her peers that she “hates Mother’s Day.” Her mother died several years ago, yet every year at school she is asked to make a Mother’s Day card. She feels horrible, watching everyone in her class writing cards, while she just sits and watches. This experience brings her old grief feelings back again. Unfortunately, many bereaved children may face this situation at school. Regrettably, most teachers do not receive training in how to support a grieving child in the classroom. They aren’t aware of the importance of continuing bonds. In situations like this, the family therapist will want to find ways to help Jordyn stay connected to her mother. The therapist gives her some ideas about how to cope with Mother’s Day, such as, write in a journal about how much she misses her and share a few of her special memories. She could also write about the things she would like her mother to know about her now. The idea of continuing bonds and staying connected to her mother was a great source of comfort for Jordyn.

Traumatic loss

Traumatic loss is a topic that family therapists are unfortunately seeing more of in their practices (Bernstein, 2022). Traumatic loss usually results from a suicide, homicide, murder, or overdose death. Children can also experience traumatic grief after watching a parent or sibling die from a long illness. With traumatic grief, adults may hide how the death occurred from children as to not upset them. However, children can sense when an adult is hiding something from them. Not telling children the truth about a death can be confusing and can make their ability to grieve and heal more difficult, as well as prolong their grief process. Therapists should advocate for telling children the truth in age-appropriate ways and then support the adults in the process.

We have found in our program that children who experience traumatic grief usually require therapeutic help and support. Family therapy can offer significant help in facilitating the very difficult grief conversations and feelings in families. Once they have had family therapy and dealt with very difficult emotions, then peer group support can be invaluable, as children feel that their peers understand what they are going through.

Ideas for family therapists: Encouraging continuing bonds with the person who died

Walsh and McGoldrick (2004) note that loss can be viewed as a transactional process involving the deceased and the survivors in a shared life cycle that acknowledges both the finality of death and the continuity of life. It is important to make sure children understand the finality of death, but also realize they can still stay connected to the person(s) who died. We call this maintaining continuing bonds. By maintaining continuing bonds, children and families know it is okay to stay connected to their loved one(s) who have died and still find ways to move forward in their lives. Family therapists can help facilitate creating continuing bonds by having families look at photos, read old letters or cards, share family stories or recipes, wear clothing of the person who died, or appreciate having their special possessions.

Last but not least…A few activity ideas

As family therapists recognize, sometimes it is hard for children and families to talk about their feelings together after a loved one has died. Family therapists can remind families that doing activities as a family may offer a way for members to share their grief with one another. Examples include cooking and sharing the loved one’s favorite meal. They can create a memory collage of pictures or favorite saying of their loved one. They also might listen to music together that their loved one enjoyed, wear a favorite tie or shirt, etc. Family activities are safe ways to help families talk with one another. Activities are particularly helpful if families are having trouble talking and sharing.

An example of an activity that works well for children and families that can be utilized in a family session is called “sentence starters.” Sentence starters are utilized to help not only with starting conversation but helping individual family members find ways to stay connected to their loved ones. Sentence starters can reinforce that it is okay for them to leave messages for the person who died. These should only be used with school age children who can understand the permanency of death. Sentence starters that might be helpful for therapists to consider using are: “I want you to know…”, “I will never forget….”, “One thing I want you to know about me now is…”, “Thank you for …”

Another idea is to encourage family members to write letters to the deceased loved one and read their letters aloud to one another in the family session. They can also bring the letters or messages to the grave site or read them at the memorial service.

Children and families can heal well

Family therapy can be an incredibly powerful way to help children and families heal well. Death in our culture is not a topic that is comfortable to talk about, especially for children. Family therapists can create safe, affirming, compassionate sessions that encourage expression of feelings. Letting children and families know that its healthy to express their grief will give them hope and can eventually help them heal.

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Nancy L. Kriseman, LCSW, is an AAMFT Affilialte member and a licensed clinical social worker who has worked with older people and their families for over 35 years. She maintains a part-time private practice in the Atlanta area, in addition to presenting workshops across the country. Kriseman has written four books, We Come Together As One: Helping Families Grieve, Share and Health The Kate’s Club Way, (2021); Meaningful Connections: Positive Ways to Be Together When a Loved One Has Dementia, (2017); The Mindful Caregiver: Finding Ease in the Caregiving Journey, Roman and Littlefield publishers (2014) and The Caring Spirit Approach to Eldercare: A Training Guide for Professionals and Families, Health Professions Press (2005). Nancy has a master’s in social work and specialist in aging from the University of Michigan, 1982.

Lane Pease, MS, is the director of programs at Kate’s Club in Atlanta, GA. Pease oversees the quality of all programs offered to Kate’s Club members and their families. She also leads KC Connects, the outreach program of Kate’s Club. She trains professionals in Georgia and nationally on working with grieving children, young adults, and families. She is a National Training Associate with the Boys and Girls Club of America, serves on the editorial board of the American Cancer Society and on the Education Committee of the National Alliance for Grieving Children. She has worked with the Georgia Commission of Family Violence to create resources to be used with families around the state. Lane holds a BA in Philosophy from Georgia State University and a MS in Clinical Mental Health Counseling from Mercer University.

REFERENCES

Bernstein, L. (2022). This is why it’s so hard to find mental health counseling right now. The Washington Post. https://www.washingtonpost.com/health/2022/03/06/therapist-covid-burnout/

Edelman, H. (2020). The after grief: Finding your way along the long arc of loss. Denver, CO: Judi’s House/JAG Institute.

Kaplow, J. B., & Layne, C. M. (2014). Sudden loss and psychiatric disorders across the life course: Toward a developmental lifespan theory of bereavement-related risk and resilience. The American journal of psychiatry, 171(8), 807-810. https://doi.org/10.1176/appi.ajp.2014.14050676

Kate’s Club. (2017). Retrieved from www.katesclub.org

Walsh, F., & McGoldrick, M. (Eds.). (2004). Living beyond loss: Death in the family (2^nd ed.). New York: Norton & Company.