1. How to interact with teenagers who are experiencing a loss, specifically a death. April 17, 2009 Sara Karnes School of Social Work Baylor University Providence Hospice BSW Intern

2. Topics to cover today  Why this is important for you to know  What you may expect from a teen who is experiencing a loss  How to help a teen with the healing process after the loss  Tips on what to say/what not to say after the teen’s loved one dies. (Handout)

3. Why is this important?  Teens are struggling Trying to find their identity. Self-esteem can be affected May get confused  Most teens do not feel like they need professional services. People who tend to have more depressive systems are those who do not seek professional assistance.  If pain is not dealt with properly, it may cause more harm in their future.

4. Why is this important? (cont.)  Adolescence grief manifests as: Confusion Feelings of emptiness/or loneliness Sleep and eating disturbances Crying Exhaustion Usually express grief in short outbursts or suppress it-  “They don’t want to feel emotionally out of control.”

5. What could you expect teens to go through?  It’s different for everyone. There’s no perfect way to grieve.  Elisabeth Kübler-Ross’ 5 stages of grief Denial Anger Bargaining Depression Acceptance

6. Shock/Denial  A teen may say, “I don’t believe it. That’s impossible. I just saw her last night.”  They probably will show no tears. They may go on with their life- pretending as if nothing happened.  Do not push the issue. Tell them that you are there for them. In time, they will come to realize that their world has flipped upside down.  Necessary for the healing process.

7. Shock/Denial  World becomes overwhelming and meaningless. Life makes no sense.  It helps pace feelings of grief.  It’s a way of taking in as much as they can handle.  Denial will begin to fade and healing will start to take place. Eventually feelings will begin to come to the surface.

8. Anger  Do not tell them, “Don’t be angry!”  Anger is often necessary for the healing process.  Depending on the situation, a teenager may be angry with their parents, doctors, friends, a sibling, a teacher, or with God.  Psychological harm can actually be caused by unexpressed anger (Catharsis Theory)  Let them feel their anger. The more they express their anger in healthy ways, the more it will decrease, and then they will begin to heal.

9. Healthy Ways to Express Anger  Journaling  Punching bag  Punching a pillow  Playing sports or doing aerobic exercise  Playing or listening to music  Ripping up magazines  Screaming  Crying  Writing feelings out then burning the paper... Etc.

10. Anger (Cont.)  Try to find out if this person has someone to visit with- or if they want to talk to a chaplain.  Pain is underneath the anger.  Anger actually can be an indication of the intensity of their love.

11. Bargaining  A teen might even say, “God, if you heal my mom, I promise to go to church every Sunday.”  “What if…” or “If only…” They will want things to go back to how they use to be.  Guilt usually will creep up.  Let them know that these thoughts/feelings are normal.

12. Depression It’s not always an indication of a mental illness. Sign of great loss and is actually appropriate. Another step to healing. Also remember to be cautious and to use good judgment  They may need a counselor depending on the intensity of depression

13. Signs of Depression  Lack of sleep or getting too much sleep  Eating too much or not enough  Feeling worthless or hopeless  Difficulty concentrating  Repeated thoughts of death  Not partaking in things they used to like to do: Not wanting to hang out with their friends anymore, not wanting to play their guitar anymore, grades slipping, etc.

14. Acceptance  This does not mean that everything is “ok” with everything that has happened.  It’s accepting the reality that the loss happened and living with the consequences.  Let them know that it is okay to continue living their life.  Allow them to make new relationships, and new connections.  Let them know that they may have good days and bad days

15. Acceptance  It’s a time for growth.  In order for them to fully live again, they will need the time to grieve.  Try not to rush them into acceptance. They are masters of their own grief.

16. Remember!  Failure to complete any of these could lead to incomplete healing.  Stages of grief does not appear linear:  May go from shock → anger → denial → bargaining → anger → depression → acceptance → anger.  There’s no perfect model- There’s no right or wrong way.  We can’t put grief into a perfect box.

17. The way past the pain is to go all the way through it

18. Things to watch out for: Ways of prolonging healing: frantic busyness Overeating Compulsive drinking Allow the teenager to cry  Sometimes they may feel like they have to hold the tears in- they tighten throat and facial muscles.  You may need to have a box of tissues out  They are in pain- just like physical pain- they hurt

19. Healing  Our bodies are capable of healing itself. White blood cells will come and be warriors and fight off the illness and heal the body Inside is the power to heal him or herself emotionally. Sometimes we need other people’s direction. Even though our bodies can heal by itself- we may need the stability of a cast or stitches so it will heal properly

20. Healing You could be that support: the one who puts the “cast” on the teenager to help him or her heal properly.

21. Remember!  We do not have to have all the answers or be able to fix the circumstance.  We need to be able to: Listen Accept Acknowledge their grief *The more he or she experiences the pain, the faster he or she will begin to heal.

22. References  Bozarth, A. R. (1990). A journey through grief. Gentle, specific help to get you through the most difficult stages of grieving. Center City, Minnesota. Hazelden Foundation.  Feldbaum, R. B. (2008). What should I say, what can I do? How to reach out to those you love. New York, NY. Pocket Books.  Hooyman, N. & Kramer, B. (2006). Living Through Loss. Interventions across the life span. New York.  Five Stages of Grief Packet. Received from Providence Hospice.