Discussion on Grief and Bereavement in young people Doug Ennals, RSW INCTR Annual Meeting Chennai, 2005 CHILDREN and LOSS

Every death 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 Knowledge

Language 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 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 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 Model Loss Oriented 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

Perspectives Multiple, 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)

Perspectives …restoring the fit between the world that is and the world that should be…

Children and Loss Death touches the lives of children regularly What may seem normal or abnormal for adults may be quite the opposite for children Childrens expressions of grief are both similar and different from adults Adjusting to the reality of illness, death, and loss is complicated by: - childrens developing conceptual understanding of death and dying - lack of or distortion of information they receive

Developmental 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 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 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 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 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

Perspectives Childrens grief experiences are influenced over time, embedded in developmental, social and cultural contexts in which all experiences exist

Windows to Grief Entering 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 ones right to be born into a safe world that makes sense

Windows to Grief Companioning 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 Children understand more that they are given credit for Adults are one of the biggest barriers Grieving children dont 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 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 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 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?

Reflections 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

Reflections In our everyday practice, how can we support children as experts and storytellers of their own knowledge and loss experiences? Children as experts

Every death has a life of its own…

Thank you…