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Statistically there appears to be a growing demand for bereavement counseling, and officially admittedly very poor training in it. Mourning, grieving, bereavement.. the loss of someone dear so painful, that it has found its way to lay dream interpretations as symbolizing predicted sorrow. (1987) Death’s pain has always moved the specialist alike literarily as well as academically and professionally. There is varying from culture to culture, traditions and theories places are named after the dead and investigations carried into of out of body experiences whether death is considered sad or joyous, physical or spiritual, grows whether the bond is broken with the dead or not those left behind are affected by a need to adjust to the changes caused. There agrees that when a human life comes to an end before the child’s eyes as the question of the meaning and worth of life never becomes impossible to happen (1987).
Considerations for Counseling with Children
Bereavement, the experience of the loss the vacuum felt and necessity for struggle to re-organize personally and socially chores and bills, cultural expectations and friends avoiding not to upset, when one realizes uncontrollable behavior, be it identifiable such as moodiness or as ‘something wrong’ (1987 ) affecting adversely personally and/or sociably, one may need counseling help and in cases requiring medical attention, learning changes the structure of the cells within the nervous system within the brain cell learning and biological processes are joined; biology influences behavior, but behavior affects biology (1985). A client seeking counseling can be helped not only if he is defensively seeking to reject his grief and to attribute his problem to something else, but even if he is seeking to displace his grief onto other persons sometimes, including the counselor because having sought help he is ready to be helped. Most human emotional behavior consists of intentional behavior in the restricted voluntary sense. It is behavior prompted by outcome expectations and to a large extent, by conscious anticipation of those outcomes and that emotional action tendencies is states of readiness to achieve or maintain a given kind of relationship with the environment. (1985)
The client having exercised that will, “the will therein lieth, which dieth not – who knoweth the mysteries of the will, with its vigor?”.. (1985 ) if the counselor applies her skills to his learning and development to those bereaved children. Thus, not all affected by grief seek specifically grief counseling that sometimes no emotion of fear is conscious of as having to do with grief: they may lead to tears and to despair, but in between, life is filled with other things; actions to feel the emptiness or seek contact with the lost person by arranging flowers before her portrait or dusting his clothes in the closet. (1985) Evidently the absence is continually present and reacted to; there is no continues grief, but in some other sense an action-readiness change and only the counselor’s skills can discover grief as the underlying cause of the problem as the bereavement counseling approaches differs as it is now person-centered and it is about loving”: a ‘companion’ -congruent, non-judgmental, empathic..’loving’… (1985)
There consider the optimum in relation to the creation of the core-conditions of congruence, positive-regard and empathy and say that the client must be the primary reference-point and it is very much advocated and most popularly, in the person-centered approach, that the counselor must grow herself to be able to deal with her own feelings first, so that she can better understand the feelings and emotions of her client it is generally recognized that “the anguish of another touches, on the whole personality of the individual called upon to help,” (1998) and the counselor’s training does not seek to make her inhuman and incapable of feeling and emotion she knows, at first consciously and later habitually, also to protect herself from harmful or self-injurious non-discrimination between sympathy and empathy, in seeking to understand bereaved children. A child needs to be understood and he does in problem-solving way to be helped to understand himself. Feelings that the counselor works with, must be those of the bereaved client himself and he is capable being taught to express his own feelings. (1998)
The bereaved children’s perceptions have much to do with his feelings, and, while there are generally recognized stages to the process of mourning, even on the basis of gender men and women grieve differently and special attention may require a client whose pain is coupled with stigma or shame to do with crime or an unsociable disease, or whose pregnancy is coupled with miscarriage or still-birth with no memories to cherish or when the client is children with no adult perception of death; or when the client is terminally ill and has it’s onset long before actual death. (1998 ) Moreover, this often shows itself in peculiar changes of personality which may precede death by quite a long time. The person-centered approach, in its interpretation that “the self-concept is unalterable” (1980 ). but that attitudes or behavior can be modified or transformed, in its task “to create new conditions of relationship where the ‘growth-process’ can be encouraged and the stunting or warping can be remedied”, demands most the consideration that “everyone experiences grief in his own way” (1980).
The bereaved child “needs to be understood in the darkest corners of his experience” as he needs to talk and grieve and he must be made to feel safe, he must be empowered to do so, encouraged to perform or complete what Worden calls ‘the tasks of mourning’ – accepting the reality of the loss, experiencing the pain of grief, adjusting to the new environment, looking ahead and investing in the future. ( February 2004) When someone is bereaved, they usually experience an intense feeling of sorrow which includes grief. Children grieve in order to accept a deep loss and carry on with their life and that experts believe that if they do not grieve at the time of death, or shortly after, the grief may stay bottled up inside the child and will cause emotional problems or physical illness later on and it is often necessary to ensure the child’s future emotional and physical well-being. ( February 2004)
There is no single way to grieve as the children are aware when a loved one dies and they feel that loss in much the same way as adults do. Children go through similar stages of grief, although they may progress through them more quickly. Understandably, some people try to protect children from the death and grieving process. (1993 ) and that, it is better to be honest with children about grief, and encourage them to talk about feelings of pain and distress in their turn. The grieving process can take time and should not be hurried although, it takes years to recover from a major bereavement. Sometimes, the bereaving counseling process is difficult and some people may find it impossible to acknowledge its relevance, which can mean that their feelings are not worked through properly as others may be unable to move on from their grief, making it impossible to rebuild their lives. (1993)
Certain factors can make a difficult bereavement more likely: (1993)
Ø being male
Ø several previous bereavements
Ø a history of mental illness
Ø a dependent relationship with the person who has died
Ø low self-esteem
Ø a lack of support from family and friends
Thus, inappropriate bereavement counseling with children can cause particular problems for the bereaved in certain circumstances around the death. (1993)
These can include:
Ø a sudden or unexpected death
Ø the death of a parent
Ø a death involving murder, legal proceedings or media coverage
Ø deaths where the bereaved may be responsible
Ø situations where a post mortem or an inquest is required
Ø more than one death at once
In response to the process, there are useful bereavement counseling and psychotherapy for children as well as support groups where children can meet with other people who have been bereaved. (1985)
Helping family or friends
If somebody in the family or a friend has been bereaved, the best thing a child can do is spend time with them and listen to them work through their grief. Offer practical help, such as cooking dinner or shopping for food – when a person is grieving, it is usually hard to focus on everyday tasks. Finally, if the child is reacting in extreme ways for a prolonged period, encourage him or her to seek professional help. (1985 ) Although everyone’s personal reaction to a bereavement is different, most children experience some of the following emotional responses when someone close to them dies: (1985)
Ø Disbelief
Ø Shock
Ø Anger
Ø Sadness
Ø Relief
Ø Guilt
Ø Depression
Ø Anxiety
Ø Longing
These emotions normally occur and some of these responses may be experienced for differing lengths of time, depending on the individual. The main initial responses to a death even one that has long been expected are disbelief, shock and anger. (1985) These may lessen in time and can be followed by a sense of guilt, depression anxiety and despair. Children may also feel an acute sense of longing for the dead person, hopelessness at the thought of their absence, loneliness and sadness at their loss or even a sense of relief that they are gone. (1985)
Some physical symptoms experienced after bereavement can be quite acute and distressing. It is important to realise that these are normal parts of the grieving process and will pass in time. Physical reactions may include: (1978)
Ø loss of energy and interest in life
Ø an inability to sleep or constant tiredness
Ø poor concentration and forgetfulness
Ø loss of appetite or compulsive comfort eating
Ø inability to cry or a tendency to continuously burst into tears
Ø nausea
Ø headaches and unexplained body pains
In addition, toddlers and young children, react to death very differently. It can be very important to tell children about a death in a way that they can handle at that particular age. (1978 ) There are many bereavement services and support groups throughout the country, both public and private, professional and voluntary, religious and secular. If you are religious, there may be pastoral care available through your local priest, order, minister, rabbi or congregation. You should make contact through the relevant place of worship. (1978) Children do not come into the world as empty slates but bring with them complex behavioral systems. One system that hasbeen well studied protects the child from danger during the longperiod of extra-uterine immaturity. It involves the developmentof mutual attachment behavior which ensures that the childdoes not stray far from guardians. These children are active partnersin the development of this behavior, using instinctive behaviorsto engage bereavement counselors in protecting them includes smiling, vocalizing, crying and returning frequently to the securebase of the adult after exploratory forays. (1986 ) Child attachmentis at its height at about three years of age and then becomes increasingly diffused by the development of other relationships, but it remains important throughout life, with relationships echoing the earlier ones. For optimal emotional, social and psychosexual development to occur, children need warm, secure, affectionate, individualized and continuous experience of care from guardians who interactwith them in a sensitive way and who can live in harmony witheach other. (1986)
Children who are bereaved may be vulnerable to psychiatric disorder later in life, forewarning can help children to prepare for bereavement and they usually benefit from viewing a dead parent and attending funerals and other rituals and family support meetings can reduce morbidity after bereavement. Thus, infants and toddlers react to separation from an attachment figure by protesting vigorously. (1985) If their cries are not successfulin restoring the adult, protest eventually gives way to despairand if they are not restored to their attachment figure,pathological states of detachment and indifference may ensue. They probably have little concept of death and the disappearanceof a parent, whatever the cause, will evoke similar reactions. (1982) Moreover, a parent away for a few hours and one absent for longer bothevoke the same separation anxiety in infants and toddlers olderthan a few months. (1985) Even very young children can mournfor a lost parent, although the form of their grief differs fromthat of adults and older children their reactions tendto be bodily ones such as feeding difficulties, bedwetting, constipation,and sleeping difficulties. (1985)
Children from five to eleven years are likely to understand the physical changes that death brings and are helped by seeingthese changes for themselves. They should be told what to expect,and they should be allowed to view the body if they wish. Exceptionsmay arise if the body is severely mutilated or if the child or parents have a strong aversion to the idea of viewing. In suchcases additional support may be needed, (1982) because of their need for parenting, children who lose one parent often become anxious about the survival of the other, and they may protect that parent from knowing of their distress and the difficulty of sustainingmood states in childhood, may lead the parent or teacher to believethe child has recovered from bereavement. (1982) Children who lose their mother suffer a reduction in the quantity as well as quality of care, and this may account for thefinding of differential effect according to the sex of the deceasedparent. (1982)
Helping and counseling bereaved children
Children are rarely prepared for the death of a parent or a sibling, and yet we know from studies of bereaved adults thatmourning is aided by a foreknowledge of the imminence and inevitabilityof death. Children who are forewarned have lower levels of anxiety than those who are not, even within the same family. When death occurs, young children in particular may need the concrete experience of seeing the parent after death. Bereavedadults find it particularly difficult to help a child in thisway, and the general practitioner could offer to accompany thechild. Similarly, children benefit from attending the funeralbut need some protection from the raw expressed grief that maybe shown at that time. Attending in the company of someone lessaffected by the death than the immediate relatives is desirable.This could be the child’s teacher or someone from the family practicewith whom he is familiar. The monitoring and help with practical matters – applying for a home help, mobilizing family support, ensuring adequate income, needs to be accompanied by specific bereavement counselingfor both the child and the surviving parent. (1982)
A controlled trialof family therapy with children bereaved of a parent showed thatthe post bereavement morbidity of 40 percent at one year could be reducedto 20 percent by six sessions of family meetings which focused on promotingshared mourning within the family and encouraging communication about the dead parent. Preventive counseling is properlythe responsibility of the primary care team, utilizing the resourcesof bereavement counseling services as necessary. Henceforth, the bereavement counselors needs to be aware of the small number of children who may need more specialized help in recoveringfrom depressive or other symptoms that may be associated withbereavement. These will include children who may have beeninstrumental in causing death, those who have gone through sudden and particularly traumatic bereavements, children who have suffered more than one bereavement, adolescentswho express suicidal ideas, and children who do not respond tothe initial preventive interventions. School behavior, interest in school, peer involvement, peer enjoymentand self-esteem were similar for bereaved and normal children. (1986 ) Bereavedchildren functioned significantly better than depressed inpatients. As agroup, the bereaved children from stable families did not experience significant, acute psychosocial dysfunction. The recentlybereaved children endorsed depressive symptoms. Thirty-seven percentof them met the DSM-III-R criteria for a major depressive episode. The depressed children had more depressive symptoms on average thanthe bereaved children. (1986 )
Thus, a considerable number of the bereaved children developed theclinical symptoms of a major depressive episode immediately after the deathof a parent. The relation of these symptoms to the subsequent course ofgrief and to major depressive disorder remains unknown and should bestudied further. In a desire not to intrude and also a protection for themselves, relatives and friends may think it is best to say nothing and sidestep the issue. Many bereaved people are ignored by others and quickly learn that to hide their feelings is more acceptance in society and generally people then feel more comfortable with them. However, it is by acknowledging the loss and finding ways of accepting the reality that helps the bereaved to express their painful feelings and allows them to grieve for the person who has died. In older children, a bereavement can cause a regression to a younger, more dependent stage in their development. Emotions may be suppressed, resulting in a display of apparent indifference or lack of feelings. In a search for love and affection, they may develop premature new sexual relationships. Some young people start truanting, turn to petty delinquency or begin shop-lifting as a general protest against the upheaval in their family life.
This is more likely in adolescents who have lost their mother, particularly girls. Others become silent, withdrawn and self critical. Many young children will grieve privately and shed their tears in the solitude of their own rooms, maintaining a brave face in society. In an attempt to numb the pain, some youngsters develop self destructive behaviour such as excessive drinking or drug taking. (1986 ) Reaction to the fear of death may cause some young people to take unnecessary chances with their lives. By confronting death they try to overcome their fears and demonstrate their control over their own mortality. Some young people will assume the role of a parent, taking on heavy responsibilities causing them to mature rapidly and denying themselves the opportunity or permission to grieve. Others will take this experience in their stride. It is not uncommon for many of us to experience feelings of inadequacy in the face of someone’s grief. (1996) The sense of not knowing what to say or do, the fear of saying or doing the ‘wrong’ thing, and the underlying knowledge that this is something we simply can’t ‘make better’ often leads people to avoid bereaved friends and relatives.
This serves to increase their isolation. Most families express the feeling that it helps when people acknowledge the significance of their loss, whatever that might be. Practical support can also be invaluable to families – the friend or neighbour who cooks a meal or takes a basket of clothes to iron is often greatly appreciated. It is important, in supporting bereaved families that we take our lead from them, and do not assume that we know best what will help them. People’s needs are very different. It may be tempting to think it helpful to clear out a nursery, for example, after a baby has died, but it is crucial that this kind of decision is made by the parents when they feel ready. It may well be that this is the right decision for them, but it needs to be their decision those who have been bereaved have been robbed of so much – it is vital that in our helpfulness we do not inadvertently rob them of even more. (1986) Children are more likely to act out their distress then speak about it, often because they don’t have the vocabulary to explain how they feel. So a person can expect children to be more irritable or aggressive. People can help by encouraging them talk about how they feel and giving them the language to describe their feelings.
Drawing and painting are therapeutic activities in themselves but they can also help children describe how their feeling. If the person who has died has taken their own life it can feel impossible to know how to explain this to children as it can help to break the process down into five stages, which may happen in the space of minutes, hours, days, weeks, months or even years, depending on when questions are asked or the likelihood of the child finding out by other means. (1986 )
These stages are:
Ø Explaining that the person has died
Ø Giving simple details about how they died
Ø Saying that the person chose to take their own life
Ø Providing a more detailed description of how the person died
Ø Exploring possible reasons why the person chose to kill themselves
General management and advice to patient (1991)
Ø If attending a parent with a terminal illness, consider with the family when and what to tell the child and who should do it
Ø Explain directly to the child what is happening or has happened to their parent or other family member and answer questions they may have
Ø Anticipate that young children may have distorted or immature thinking
Ø Ascertain child’s worries about the health of the remaining parent and any siblings and reassure
Ø Encourage participation in the funeral, as appropriate
Ø Encourage the family to talk about the dead person, share their sorrow together and remember good times. They should help children keep mementos of the dead person
Ø Discourage families from giving explanations to the child that are developmentally inappropriate. If a religious explanation is desired, it is better to say ‘Mummy’s soul having gone to be with God in heaven
Ø Advise the family to maintain child’s normal routines as far as possible
Ø Reassure the family that most bereaved children recover from the loss with good support; children are resilient
Ø Ensure that the child’s school is aware of their bereavement and is supportive
Ø Anticipate anniversary reactions – the first Christmas, birthday and anniversary of the death. Monitor the child’s progress for the next year
Ø Bereavement support or counseling for child and family should be considered in each case as a preventive intervention
Ø Some charities run groups and/or camps for bereaved children
Ø If the bereavement was a violent, traumatic one, watch for post-traumatic stress symptoms and arrange appropriate referral if these persist
Furthermore, there needs to have an effective bereavement counseling program designed for bereaved children in helping them cope and accept the reality of life bringing them hope that life is beautiful despite shadows of sadness. The program may develop an intensive child bereavement program and prepare them for the loss of loved ones, thus building resilience in order to train volunteers in child care and counseling and assist identified families to retrieve their family histories. The aim was to help children and their families create memory boxes to keep alive memories of the family, thus facilitating the bereavement process. (2002)
Overall, the study has revealed findings that are promising for child bereavement counseling. Children participated in the counseling program expressed appreciation about understanding their family tree and culture. Dealing with the stigma, shame, guilt and fear is difficult and produces anger in children and assisted with easing resentment toward deceased parents. The bereavement counseling program with children adheres in persuading families to participate in the study involved tedious discussions with the extended family as there are process of putting together the memory box can be very emotional for family members and volunteers – it is imperative that program coordinators should gain confidence and trust of the families involved as well as the broader community. (2002 ) Children often feel responsible for a person’s death, feeling guilty and afraid that their bad behavior caused the loss. Reassure them that nothing they ever said, or did or thought, could have resulted in someone dying. Children often find it difficult to remember what the person looked like. Show them that this is normal and give them a photograph to treasure. Having a Memory Box with items that belonged to their loved one, or remind them of that person or their pet can be a great source of comfort. Once the loss of a loved one has been experienced, children begin to fear that other close people might die and are afraid of what might happen to them if they do. If you suspect this is happening, make a list of all the people who love the child and will care for him/her so that s/he feels safe and secure. (2002 )
Bereavement counseling can provide an opportunity for the child to express their grief without feeling that they are burdening their family at what may be a distressing time for all. Counseling for children see if they offer a counseling service or can advise you of services available in your area. In addition to using a range of tried and tested counseling techniques, we have also designed and created a large number of therapeutic tools which use successfully in work with children. Face to face counseling for children and young people and behavior therapy is available in providing a relaxed, safe environment where children can spend time with a professional who is experienced in listening to and talking with children of all ages. (1996) Often it is easier for a child to discuss problems with someone outside their family who is not involved in the issues they are wrestling with. Of course, this is no reflection on the love and care given to them at home. Receiving support at an early stage can prevent a smaller problem turning into a major one. The ability to counsel people who have been bereaved or have suffered a devastating loss is of importance to all those in the helping professions, calling upon a whole array of skills and knowledge. Providing a practical, accessible guide to the area of counseling, this volume takes readers step-by-step through the counseling skills they need to work with their clients in a way which sensitively facilitates the process of grief, initiates healing and promotes a sense of growth. (2000)
Carefully chosen examples illustrate each step along the way, while specific attention is paid throughout the book to ethics and to the possible and realistic need for referral. Providing a firm theoretical base, the authors discuss the concepts and categories of attachment, loss and grief. Grief can influence behavior such as disturbed sleep, crying, changes in appetite and withdrawing from society and can change after bereavement. (1996) Children also experience grief, and you need to listen to their thoughts and feelings. If you do not tell them what has happened, they may become confused and anxious. (1996) Talking to them in words they will understand is important. Sometimes children may need professional help. (2000) Lastly, getting support from friends and family, and talking about your loss, can be very beneficial. This can be difficult and at times painful, but it is important to talk about the person you have lost and share memories of them with other people close to you. Family members and friends may also be grieving and finding it difficult to help. (1996) Sometimes, talking to someone unrelated and removed from the situation can be helpful. This may be face to face, over the phone or by e-mail. It may also help to talk to someone who has shared a similar experience. (1996)
Therefore, bereavement counseling with children is an opportunity to talk in confidence to someone experienced in listening to people in distress. It focuses on the emotional crisis and the life changes that you may be experiencing. The counseling team and our trained staff provide a listening and support service for as long as you need it. Please phone our helpline to find out more about our free counseling service. (2000)
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