GriefPerspectives...Resources for Caregivers

September 2011

In this month's GriefPerspectives. . .

Supporting Bereaved Children and Teens

Upcoming Seminar Schedule 
Professional Bookshelf: Parent's Guide to Raising Grieving Children
Research that Matters

Supporting Bereaved Children and Teens
William G. Hoy

More than 1.3 million children across the United States currently receive Social Security Survivor Benefits following a parent’s death (Tamborini, Cupito & Shoffner, 2011, p. 5), and undoubtedly, this number can be doubled or tripled when adding children grieving the death of a grandparent, sibling or close friend. With such a large and ever-increasing number of bereaved children and teens, thoughtful consideration is required to develop the most effective programming and intervention strategies. Care for these grieving youngsters is undoubtedly most effective when assessment and intervention strategies are based on the best research and clinical practice experience. Here are some important keys to remember.
Help families communicate honestly. Parents want to protect their children from unnecessary pain and suffering. However, lying to them about the whereabouts of a deceased loved one or offering false hope for a cure to a terminal disease is not protective. Instead, a culture of deceit builds mistrust between child and caregiver, leading the youngster to wonder, “What else are they not telling me?” I often remind parents, “My experience indicates he will find out; the question is from whom you want him to learn about his dad’s suicide—from you or from another student on the playground?”
Affirm the role of healthy families. Strong evidence indicates that a warm and nurturing parent (or other caregiver) paired with firm boundaries points to the best outcome for bereaved youngsters (Kwok,, 2005; Worden, 1996). While all grieving children, teens and families need support, relatively few require psychotherapy. One important intervention for newly-widowed parents, for example, is to provide printed materials, workshops, groups or one-to-one mentoring on effective single parenting skills. A growing number of bereavement services for children have adapted their programs with just this concern in view, often offering groups for parents simultaneously with their groups for children and teens.
Acknowledge increased financial stress in bereaved families. In addition to the emotional upheaval following a parent’s death, these families face potentially high levels of financial stress. Families with children receiving Social Security Survivor Benefits have median family income 24% less than all families with children (Tamborini, Cupito & Shoffner, 2011, pp. 7, 10), pointing to the continued need for free or low-cost bereavement support programs. Because these families face an array of challenges to their social and financial well-being, we must always look for ways to provide holistic support, perhaps in part through the use of volunteers who can provide financial and legal counsel or job skills training.
View grief and trauma as separate experiences. When a death was unexpected, caregivers see trauma responses in addition to loss responses. Typical markers of trauma—persistent re-experiencing of the traumatic event, hyper-arousal and avoidance of reminders of the experience—indicate the youngster is dealing with traumatic responses rather than grief, and significant research and practice indicates the traumatic material should be dealt with first. When a grieving person describes her experience in terms of the relationship that has been changed, she is likely experiencing grief; when she persistently dwells the event of the death itself (details about how it happened, where it happened, and how she was told), we are likely witnessing her reactions to the trauma..
Acknowledge the diversity of grieving styles. While research and experience now rejects the simplistic gender stereotypes in grief popular a decade or two ago (males grieve one way, females grieve another), there are clearly preferred styles in the ways we grieve. In their provocative work, Ken Doka and Terry Martin (2010) say we all live somewhere along a continuum of “styles,” and refer to the end-points as “instrumental” and “intuitive” grief. You can learn more about this perspective in this short video. Clearly, children and teens express grief differently according to style preferences and it can be highly frustrating to youngster and caregiver both to normalize and affirm only an “intuitive” style. Dr. Doka will be presenting a 90-minute continuing education-approved web seminar on December 14; you can learn more here
Involve youngsters in memorial rituals.A compelling study (Fristad,, 2000) indicated that children and teens do better in their bereavement experience when they participate in complete mourning rituals, including a visitation with the body present (p. 337). Worden (1996) reached similar conclusions about the importance of children’s involvement in the rituals; O’Rourke, Sptizberg & Hannawa (2011) attest to the value of involvement in the ceremonies for increasing satisfaction for college students when they reflect on past funeral rituals they have attended. While research into the effectiveness of various kinds of mourning rituals is still in its infancy, strong evidence points to the importance of children’s participation. Preparing young children for funeral participation can offer a “sensory” explanation: this is what you will hear, this is what you will see, etc. I like inviting young children to smell the flowers and quietly point out the fragrances and colors they think Grandma would have most liked.
Provide good resources to parents. Books, videos, websites and other resources related to grieving children have proliferated in recent years. While not all are of high quality, some resources are notable. The National Alliance for Grieving Children, for example maintains a list of bereavement centers with children’s programs. Portland, Oregon’s Dougy Center, one of North America’s premier programs for grieving children publishes a wide array of helpful materials. And professionals, volunteers and family members can access the free New York Life Foundation publication, After a Loved One Dies—How Children Grieve here and click on “Bereavement Resources.” In addition to this free downloadable PDF file, the site contains instructions for ordering multiple copies of this 32-page booklet in both English and Spanish.
Our best estimates indicate that more than 60% of GriefPerspectives readers are at least occasionally called upon to support grieving children, teens or their parents. Care for these youngsters and their families will be most effective when our strategies and programs are based on up-to-date ideas.
Doka, K.J. & Martin, T.L. (2010). Grieving beyond gender: Understanding the ways men and women grieve . New York: Routledge.
Fristad, M. A., Cerel, J., Goldman, M., Weller, E. B., & Weller, R. A. (2000/2001). The role of ritual in children’s bereavement. Omega: Journal of Death, Dying, & Bereavement, 42 (4), 321-339.
Kwok, O., Haine, R.A., Sandler, I.N., Ayers, T.S., Wolchik, S.A., & Tein, J.Y. (2005). Positive parenting as a mediator of the relations between parental psychological distress and mental health problems of parentally bereaved children. Journal of Clinical Child and Adolescent Psychology, 34 (2), 260-271.
O’Rourke, T., Spitzberg, B.H., & Hannawa, A.F. (2011). The good funeral: Toward an understanding of funeral participation and satisfaction.  Death Studies, 35, 729-750.
Tamborini, C.R., Cupito, E. & Shoffner, D. (2011).  A profile of Social Security child beneficiaries and their families: Sociodemographic and economic characteristics. Social Security Bulletin, 71 (1). Washington, DC: U.S. Social Security Administration.
Worden, J.W. (1996). Children and grief: When parents die. New  York: Guilford.
The Author: William G. Hoy is a counselor, author and educator with more than 25 years of experience in walking with the bereaved and equipping the professionals and volunteers who care for them. Dr. Hoy directs the counseling program for Pathways Volunteer Hospice and teaches in the graduate program in bereavement at Marian University. He blogs at  

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Upcoming Seminars 

American Airlines will be seeing quite a lot of Bill this fall, beginning October 3-4 in San Diego and Carlsbad, California with an all-day seminar (repeated in both places) that will also be webcast live. This seminar, Grief: New, Contemporary Counseling Strategies for Typical and Complicated Grief will also be presented in the next few months in Minneapolis/St. Paul, Oklahoma City, Albuquerque, Indianapolis, South Bend, Chicago, and Springfield, Illinois. You can also find Bill in the next few months in Owensboro (Kentucky) Orange County (California), Atlanta (Texas) and Los Cabos (Baja California), an extremely tough assignment for January! To learn more about any of these, check out our home page.

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Professional Bookshelf
Silverman, P.R. & Kelly, M. (2009). A parent’s guide to raising grieving children: Rebuilding your family after the death of a loved one. New York: Oxford University Press.  Paperback, $ 16.95
When a single book is recommended by Donna Schurrman (Portland’s Dougy Center for Grieving Children), Dr. Phil (McGraw), bereavement researcher Hannelore Wass, Rabbi Earl Grollman and P.J. O’Roarke, you have to wonder, “What’s up?” How many books could garner praise from that diverse group?
Yet, Silverman and Kelly have done just that and more in this extraordinarily readable handbook for parents of bereaved children. In addition to parents, though, school counselors, therapists, clergy, educators and hospice staff, will all find practical and common-sense advice here, peppered with stories of real people who have lived out the experience of a loved one’s death while caring for kids.
Readers will find sage insights from clinicians and parents on dealing with children facing a loved one’s dying, making decisions about funerals, communicating with teachers and school staff, seeking help from the mental health community, accepting the kind offers of friends, facing the variable moods of a grieving teenager, and much more.
That all-in-one approach should not surprise the reader, however, considering this book’s authors.  Phyllis Silverman was co-principal investigator (with J. William Worden) of the Harvard Child Bereavement Study and is an internationally-renown expert on the science of bereavement. Widowed with two children, Madelyn Kelly writes out of her own heartfelt experience following the 2003 death of her husband, Michael, the first journalist killed in the Iraq War.
Learn more or buy the book on 

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Research that Matters
Biank, N.M. & Werner-Lin, A. (2011). Growing up with grief: Revisiting the death of a parent over the life course. Omega: Journal of Death & Dying, 63 (3), 271-290.

Some research studies examine the experiences or reports of hundreds of study participants. Like the current study, others closely examine a single case in light of current research, theory and practical intervention strategies. What sets “Growing Up with Grief” apart, however, is that this case report follows a single youngster and his family over a 14-year period—from when he was four and his mother was first diagnosed with cancer, through her death when he was eight and periodically throughout the developing young man’s life. The case concludes with one last visit with the clinician who looked after him throughout those years, just as the bereaved student is packing for college.
As the authors point out, theories about children’s bereavement are often based on cross-sectional designs with all of the data gathered at one moment in time, much like the sample collected in a tissue biopsy. A better research protocol looks at children’s grief longitudinally, checking back in on the same kids multiple times over a period of perhaps a year or two; the Fristad, study referenced in the lead article is this type. Almost unheard of, however, is a case study in which a single clinician works with a child and family over such a long period—and takes the time to write it up so the rest of us can learn.
So what did they discover? Mostly, they confirmed what other research has shown or at least what we have long-suspected. Bereaved children thrive with warm parental support and they struggle when that support is absent. In this case, Matthew’s dad was very supportive in the early months but ignored the boy’s emotionally-laden bereavement experiences later, chiding his son to “get over it.” Periodic visits to the therapist who first worked with him helped provide stability and even perhaps a surrogate parent in the absence of warm, supportive encouragement at home. A child’s grief changes over the years as their own identity matures and develops and these children grieve different parts of the relationship as they continue to transition through the phases of their own physical and psycho-social-spiritual development.
One important application for hospices, funeral homes, faith communities, bereavement centers and other support services is assuring ongoing support, especially if the agency’s child program is a time-limited group of say six or eight weeks. Helping parents and youngsters know they have a place to which they can turn will be vital. Parents, children and teens all need to hear that grief issues “morph” over time, and that the agency stands ready to help throughout those transitions. Since we must jettison the notion that grief is “finished” in a matter of months, we can even deploy volunteers to make follow-up phone calls to former participants a year, two, or three down the road.
Like all articles in Omega: Journal of Death & Dying, members of the Association for Death Education & Counseling  have free access to this article as a member benefit. After logging in to the association website, click on the Members Only section and then click Journals

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