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Adolescent Responses to Death and Grief Counseling

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Title: Adolescent Responses to Death and Grief Counseling


1
Adolescent Responses to Death and Grief Counseling
  • Marty Slyter, Ph.D.
  • Program Director Counselor Education
  • Eastern Washington University

2
Adolescent Responses to Death
  • The daily context crucial- parent resources
    life circumstances communication between parents
    and children previous traumatic events in the
    family support within the family and how
    adolescents are initially supported by their
    peers, school and other social networks.

3
Factors that interfere with the grief process
(Worden, 1991)
  • Relational what type of relationship did the
    person have with the deceased?
  • Circumstantial what was the circumstance that
    surrounded the death? Such as a person who is
    missing and is there evidence that the person is
    dead?

4
Factors that interfere with the grief process
(Worden, 1991)
  • Historical did the bereaved person have
    complicated grief reactions in the past?
  • Personality the bereaved persons character and
    how he or she copes with emotional distress.
  • Social if the nature of the death has any social
    stigma, such as suicide (complicated
    bereavement). If the bereaved person and those
    around him or her acts as if the loss did not
    happen. If the bereaved person does not have a
    support system.

5
Common death losses
  • Grandparents Grief responses will vary according
    to the relationships closeness (Webb, 1993).
  • Closeness was significantly related to grief
    intensity. Closeness, not kinship, is the salient
    indicator of grief intensity (Servaty-Seib and
    Pistole, 2007).

6
Common death losses
  • Peers
  • Top three leading causes of death in the 15
    through 24-year-old range are accidents,
    homicide, and suicide (Minino and Smith, 2001).
  • It is relatively rare for an adolescent to die
    from a life-threatening illness.

7
Common death losses
  • Peers coping skills are seriously tested by the
    trauma associated with sudden and tragic losses
    of peers
  • Such deaths usually lead to an acute and intense
    high grief reaction
  • Traumatic grief greater functional
    impairment, poorer physical health, and more
    suicidal ideation that those without traumatic
    grief, even after control for comorbid
    psychopathological conditions, such as anxiety
    and depression (Melhem, Day, Shear, Day, Reynolds
    Brent, 2004).

8
Complicated Bereavement
  • Sudden or unexpected death
  • Violent death
  • If death involved mutilation
  • If it is a child who dies
  • Result of a prolonged illness
  • Ambiguous losses
  • Traumatic losses
  • Social stigma such as suicide, AIDS, and
    abortions or psychosocial death such as several
    mental illness (Karaban, 2000).

9
Complicated Bereavement
  • A trauma experience can be a huge blow to the
    adolescents self esteem and sense of
    exhilaration. It reminds them they can be
    powerless and helpless (Aronson, 2005).

10
Traumatic Grief and PTSD
  • What they share symptoms of intrusive thoughts,
    emotional numbness, detachment from others,
    irritability, and anger.

11
Traumatic Grief and PTSD
  • How they are different
  • Traumatic grief includes a prominent component of
    separation distress characterized by searching
    and yearning and frequent bittersweet
    recollections of the person who died.
    Adolescents with traumatic grief often believe
    that grief keeps them connected to the deceased
    and/or that to grieve less would be a betrayal of
    the person who died. These symptoms are not seen
    with PTSD

12
Traumatic Grief and PTSD
  • How they are different
  • Hypervigilance in traumatic grief refers to
    searching the environment for cues of the
    deceased, whereas in PTSD, it refers to fears
    that the traumatic event will be re-experienced
  • Sadness is the predominant effect in traumatic
    grief, whereas fear is foremost in PTSD
  • While PTSD diagnostic criteria include sleep
    disturbance as one of the symptoms, no evidence
    of hyper-aroused sleep is found among subjects
    with traumatic grief.

13
Reactions to Homicide
  • May create disruptive grieving caused by
  • Survivor anger
  • Lack of closure
  • Feelings of victimization and unfairness
  • The search for meaning
  • Obsession and rumination
  • The need to assign blame and mete out punishment
  • Attempts to regain control
  • Significant violations of the assumptive world in
    which survivors live

14
Reactions to Homicide
  • More complicated, exaggerated and severe
  • Coping with the unfairness of someone killing a
    loved one results in confusion that can lead to
    behavioral manifestations and emotions that may
    be internalized, resulting in self-destructive
    behaviors or depression, or externalized,
    resulting in agitation and aggression (Vigil and
    Clements, 2003).

15
Reactions to Homicide
  • Many adolescents express fears that another
    family member will be murdered or that the
    perpetrator will return and kill them as well
  • Many feel shame and embarrassment when they
    return to school
  • Many describe teachers never talking about what
    happened, and their peers speaking about it too
    often
  • Many describe feeling as though they are treated
    differently, express having trouble with memory
    and concentration, and find it difficult to keep
    up with schoolwork (Vigil and Clements, 2003).
  • It is critical that school counselors and other
    mental health professionals educate teachers and
    other school personnel about the response of
    adolescents to this specific trauma and other
    death related traumas.

16
Reactions to loss of a famous personality or hero
  • Many adolescents first experience with grief
    resulted from the fatal crash of Princess Diana,
    the murder of John Lennon, etc.
  • What happens to the adolescent to whom the larger
    than life personality was an influence in his or
    her daily life?
  • Societys grieving rules may not sanction the
    adolescents grief over such figures so the
    sadness is kept locked away from peers and family
    (Bull, Clark Duszynski, 2002).

17
Secondary life adversities
  • Secondary life adversities that may follow a
    trauma, such as family displacement and financial
    hardships are distractions and can serve as
    defensive functions.
  • By focusing on these secondary life adversities,
    adolescents can avoid or even deny the impact of
    trauma.

18
Grief Counseling
  • Grief work is a journey because the death of a
    loved one changes lives forever
  • Adolescents heal over time as they proceed
    through their grief journey with the guidance of
    companions, which can be a counselor or
    therapist, a parent or an adult caregiver

19
Grief Counseling
  • Few resources are available for grieving teens
    who often must grieve alone or with very limited
    support
  • Death may affect adolescents in later adulthood
    if the loss is not given proper attention and
    adolescents are not provided grief support and
    the opportunity to express their pain

20
Grief Counseling
  • Adolescents grief experience profoundly personal
    in nature. They grieve more intensely than
    adults, but the grief may be expressed in short
    outbursts, or there may be a concerted effort to
    control emotions. They may retreat into
    themselves by reading, writing, listening to
    music, or exercising, or to enact angry or
    antisocial behavior (Worden, 1996).

21
Grief Counseling
  • Grief may follow a life-long developmental path.
    The loss may be continued to be felt throughout
    the lifespan, as he or she graduates from high
    school and college, finds a job, gets married,
    and grows older than the parent, sibling or
    friend who has died (Silverman, 2000)

22
Grief Counseling
  • Adolescents need to be given information, be
    included in discussions about illness and
    memorial preparations, and be reassured that
    those who are also grieving will not abandon
    them.

23
Grief Counseling
  • Counselors can encourage adolescents to express
    their grief through creative arts, maintaining
    tangible connections with the person who has
    died, and engaging in rituals (Silverman and
    Nickman, 1999)

24
Grief Counseling
  • Counselors need to support the adolescents needs
    for further independence and maturity. These
    needs can be encouraged by helping the adolescent
    set appropriate limits, aiding the adolescent in
    overcoming feelings of helplessness, and by
    connecting him or her with professionals when
    grief is prolonged and self-destructive.

25
Grief Counseling
  • With music being an agent of peer socialization
    during adolescence, music therapy designed
    specifically for adolescents may be especially
    helpful in promoting emotional expressions and
    peer support.

26
Grief Counseling using music in a grief support
group
  • Grief Song Writing Process-adolescents create
    music and write original lyrics to songs that
    focused on five grief process areas
    understanding, feeling, remembering, integrating
    and growing (Dalton and Krout, 2006).

27
Understanding
  • Understanding the cause of their loved ones
    death, their reactions to the death, and if
    knowing if they were normal in what they were
    experiencing.

28
Feeling
  • Lyrics that pertained to the area of feeling
    allowed adolescents to express a variety of
    emotions related to their experience of their
    loved ones death.

29
Remembering
  • Reflections for memories and times spent with
    their loved one, including the unique
    relationship with their loved one

30
Integrating
  • Lyrics describing a concern about how they would
    be able to go on with their lives while
    experiencing emotional pain and the changes that
    resulted from the loss. These lyrics also
    described how the adolescents were re-defining
    their relationship with their loved one and
    maintaining a connection with them as they
    continued with their lives.

31
Growing
  • Lyrics describe adolescents concern with finding
    some sense of meaning or personal growth through
    the loss.

32
Support Groups
  • Helps ease sense of isolation and creates a sense
    of belonging and identity. Tedeschi (1996) has
    excellent advice as how to form, facilitate, and
    structure support groups for bereaved
    adolescents.

33
Support Groups
  • Group is a secure base that can establish a
    broader base of support, helping re-entry into
    normative, age-appropriate activities.
  • Important to instill a sense of hope
  • Adolescents internalizing of the healing
    elements of the group will allow them to proceed
    with development and with life

34
Support groups for those also dealing with trauma
  • May help them feel that their reactions are not
    abnormal, but rather methods of coping.
  • Repeated re-telling of the trauma experience in a
    safe environment can help the adolescent cope
    with trauma and begin to more clearly gain a
    sense of what happened

35
Support groups for those also dealing with trauma
  • Group members write journals between sessionsthe
    use of words provides a structure to make the
    trauma more tolerable and manageable. Writing
    helps to develop a sense of perspective.
  • Drawing and/or
  • Writing a play provide opportunities for
    creativity and mastery over overwhelming
    traumatic experiences connected with death of a
    loved one.

36
Growing Through Loss Program
  • Emphasizes value of support, therapeutic and
    educational groups
  • Program has information that covers values,
    beliefs, antisocial attitudes, interpersonal
    skills, dangers of alcohol and drugs, and dealing
    with adverse family circumstances.

37
Growing through Loss Program
  • 12 session curriculum uses several strategies
    such as hands-on activities and role playing
  • It combines sessions of forgiveness, grief and
    loss, attitudes, friendship, developing a healthy
    conscience, life mapping, and leadership.

38
Growing through loss program
  • Art therapy create a memorial wreath which
    communicates that the loss is a permanent and
    real aspect of the persons life history
  • Family genograms are used along with encouraging
    participants to become the generation of change
    in their families
  • Memory books provide avenues for creative and
    artistic expressions of pain

39
Growing through loss program
  • Program concludes with a Letting Go ceremony.
    Participants light a candle symbolizing their
    commitment to make a difference in the live of
    others in an effort to find meaning to the
    painful loss experienced.
  • Approximately 5,000 adolescents have completed
    this program in correctional facilities,
    alternative and traditional schools, residential
    treatment centers and community centers. This
    program has been successful in reducing levels of
    depression among incarcerated youths in 88
    percent of program participants (Walker and
    Shaffer, 2007).

40
Web sites of interest
  • Counseling for Loss and Life Transitions
    http//www.counselingforloss.com Helpful
    information for counselors and parents
  • The National Center for Grieving Children and
    Families http//www.dougy.org Helpful
    information on grief for parents,
    children/teenagers and counselors

41
References
  • Aronson, S. (2005). A war that had come right to
    them Group work with traumatized adolescents
    following September 11. International Journal of
    Group Psychotherapy, 55(3), 375-390.
  • Bull, M.A., Clark, S., Dyszynski, K. (2002).
    Lessons from a communitys response to the death
    of Diana, Princess of Wales. Omega, 46, 35-49.

42
References
  • Dalton, T.A., Krout, R.E. (2006). The grief
    song-writing process with bereaved adolescents
    An integrated grief model and music therapy
    protocol. Music Therapy Perspectives, 24(2),
    94-103.
  • Karaban, R. (2000). Complicated losses, difficult
    death. California Resource Publications, Inc.

43
References
  • Melhem, N.M., Rosales, C., Karageorge J.,
    Reynolds, C.F., Shear, M. K., (2004). Comorbidity
    of axis 1 disorders in patients with traumatic
    grief. Journal of Clinical Psychiatry, 62,
    884-887.
  • Minino, A.M. Smith, B. L., (2001). Deaths
    Preliminary data for 2000. National Vital
    Statistics Reports, 49(12). Hyattsville, MD
    National Center for Health Statistics.

44
References
  • Servaty-Sieb, H. L. Pistole, M. C. (2006).
    Adolescent Grief Relationship category and
    emotional closeness. Omega, 54(2), 147-167.
  • Silverman, P. R. (2000). Never too young to know.
    New York Oxford University
  • Silverman, P. R. Nickman, S. L. (1996).
    Childrens construction of their dead parents. In
    D. Klass, P. R. Silverman S. L. Nickman (Eds.).
    Continuing bonds New Understandings of grief
    (pp. 73-86). Washington D.C. Taylor Francis.

45
References
  • Tedeschi, R. G. (1996). Support groups for
    bereaved adolescents. In C. A. Coor D. E. Balk
    (Eds.), Handbook of adolescent death and
    bereavement. (pp. 293-311). New York Springer.
  • Vigil, G. J. Clements, P. T. (2003). Child and
    adolescent complicated grief and altered
    worldviews. Journal of Psychosocial Nursing
    Mental Health Services, 41(1), 30-39.

46
References
  • Walker, P., Shaffer, M. (2007). Reducing
    depression among adolescents dealing with grief
    and loss A program evaluation report. Health
    Social Work, 32(1), 67-68.
  • Webb, N. B. (1993). Helping bereaved children A
    handbook for practitioners. New York Guildford.

47
References
  • Worden, J., (1991). Grief counseling and grief
    therapy. New York Springer Publishing Company.
  • Worden, J. W. (1996). Children and grief When a
    parent dies. New York Guilford.
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