Transcript HAVERING

Supporting Children When Someone
in the Family Dies
Julia Samuel
Founder Patron & Trustee
Factors affecting the grieving process
Situational Stress Factors
• Witnessing or hearing the death
• Manner of death
• Circumstances surrounding the death
• Conflict between relatives
• The police investigation
• Powerlessness
• Cultural and spiritual factors
Circumstances
of death/dying
Relationship with
person who died
Factors affecting
the grieving process
Ourselves,
personality,
background
‘Recovery’
environment
Children and Young People
Physical & Mental Health
• Bereaved children visited their GP more frequently
(1998 Lloyd Williams, M. & Wilkinson, C.)
• Bereaved children were found to be more likely to
develop symptoms such as headaches, stomach
aches (1996 Worden, W.)
• Between 50-66% bereaved children show distress
and depressive symptoms which may persist over
time (2006Ribbons McLardy, J.)
Traumatic Bereavement
Definition of Trauma
The person’s response involved intense fear,
helplessness or horror
(In children this may be expressed instead by
disorganised or agitated behaviour)
Criterion A2 of DSM-IV-TR PTSD
There is evidence to suggest that
traumatic memory is encoded in
the brain in a different way than
non-traumatic memory
Sight
Smell
Sound
Fear Network
Feeling
Touch
Physiological
Thought
© David Trickey
Taste
Maintenance Cycle of Avoidance
Memory not processed
Memory or thought
suppressed or avoided
Intrusions e.g. memories,
images, dreams, thoughts
Original fear,
horror, helplessness
© David Trickey
Common reactions after a frightening event
• Nightmares
• Memories or pictures of the event unexpectedly
popping into the mind
• Feeling as if it is actually happening again
• Not wanting to think or talk about the event
• Avoiding anything that might remind them of the
event
What Bereaved Families Need
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Knowledge
Your time
Comfort & reassurance
Space and time to grieve
Someone to share their journey
Ways to express their grief
Help to build their resilience
To be allowed to have a break from the pain
How children make sense of what has
happened will depend on a number of factors,
including their stage of development
Up to 6 months
Concepts:
• Withdrawal of care and nourishment from a familiar
person
• Emotional withdrawal of carer
Likely feelings and behaviours:
• abandonment
• insecurity
• anger
• cries in protest
• disrupted sleep and feeding routine
6 months – 2 years
Concepts:
• Developing ‘object constancy awareness’
• Begins to have mental image of person when absent
and can ‘miss’ them
Likely feelings and behaviour:
• Protest and distress
• Withdrawal
• Separation anxiety
• No interest in food or toys
• Searching behaviour
2 – 5 years
Concepts:
• Establishing that he/she is
a separate person
• Interested in the idea of
death in birds, animals etc
• Understands that death is
a part of natural order but
lacks ability to appreciate
its finality and irreversibility
• ‘Heaven’ is a physical
place: concrete thinking
Likely feelings and behaviour:
• Expectations of return sadness and disappointment
• Constant questions
• Anxiety about physical
needs
• Fear of the dark when going
to sleep
• Toilet regression
• Clinging/marked increase in
separation anxiety, even
when left for short periods
5 – 8 years
Concepts:
• Age of magical thinking
• Believe they can influence events
with thought and behaviour
• Developing ‘conscience’ so can
feel guilt about what their
supposed power brings about
• May think independent events at
time of death ‘caused’ it
• Fuller understanding of concept of
death
Likely feelings and behaviour:
• Can fear death of others
• Especially ‘good’ to compensate for
sense of badness, which they
believe contributed to the death
• Behave badly and therefore draw
the punishment they ‘deserve’
• Compulsively caring towards
surviving adults or siblings
(especially girls)
• Cover up sadness by behaving as
if nothing happened
• ‘Is big now’ and fears behaving in
an infantile way
8 – 12 years
Concepts:
• Begins to have an adult concept of death as
permanent separation
• Develops fear /understanding of own mortality,
especially in case of sibling death
• Can imagine how the death will alter his/her future
Likely feelings and behaviour:
• Will display many symptoms of adult grief, but
expressed in childish ways
• May develop anxiety about their own health for fear
they may die too
• Preoccupied at school and social withdrawal
12 + years
Concepts:
• Puberty – time of great change
• Feelings of ambivalence – separation/dependency
• Moving from familial ties to increased involvement with peers
• Becoming aware of issues of life, death and meaning of life
Likely feelings and behaviour:
• Similar to those of adults but have strong inhibitions about
expressing them, partly to be ‘grown up’ and partly to avoid
being different in their peer group
• May lead to apathy, withdrawal, depression
• May express anger in anti-social ways e.g. stealing
• May take grief outside family
Supporting bereaved children
How do I talk to a child about death?
Aim:
to give enough accurate information in an
understandable manner, so that the child can answer
‘how’ and ‘why’ in a way that makes sense
How do I talk to a child about death?
• Be honest
• As soon as possible: or may undermine confidence in
adults
• Begin talking to the child about what he/she
experienced or noticed - beginning with the child’s
experience makes it harder for the child to deny his
own fears and feelings and gives permission for him
to trust his own observations
• Use the adult reality, facts and words as simply as
possible: use the word ‘dead’, not ‘asleep’ or ‘lost’
How do I talk to a child about death?
• Give child permission to figure out what has happened
by letting him/her ask questions as often as wants
• Answer questions accurately – say “I don’t know” if you
don’t and encourage the child to share his feelings by
asking what he/she thinks
• Watch out for the child’s tendency to blame him/herself
• Give clear message it was not his/her fault
• Encourage child to remember and talk about the person
who has died, to strengthen positive memories
My wife was treated as having lost
someone she loved. I was treated as having
lost someone I was responsible for
A Bereaved Father
Culture
• We all come from a family culture
• In times of stress, people revert to their culturally
acquired coping mechanisms
• We must never assume a person’s cultural
background will dictate their needs and the practices
to be followed in bereavement
• We need to ask people what is important to them
A Dual Process Model of Coping with Bereavement
Stroebe & Schut (1999)
Everyday Life
Experience
Loss-oriented
Grief work
Restorationoriented
Attending to life
changes
Intrusion of grief
Doing new things
Breaking
bonds/ties
Distraction from grief
Denial/avoidance
of restoration
changes
Denial/avoidance of
grief
New roles/identity/
relationship
Tasks of Mourning
• To accept the reality of the loss
• To experience the pain of grief
• To adjust to an environment in which the person who
has died is missing
• To emotionally relocate the person and move on with life
J William Worden
We offer ourselves
There are no answers and no explanations
adequate to justify the injustice of a baby
or child dying ……
…but involvement, the sharing of one’s
humanity, will make a difference
In working with grieving families we all
bring our own:
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hurts and losses
feelings about loss by death
desire to care for others
ability to reach out and involve ourselves
inability, when overpowered by the tragedy of a
child grieving and our own sadness
What makes it especially difficult for us:
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Concerns children
Normalises what is abnormal
Situation has parallels in your own life
Situation occurs when you are exhausted, in
personal crisis
Work climate not supportive
AUTONOMIC NERVOUS SYSTEM
IS OUR EMOTIONAL SYSTEM WHICH RESPONDS TO
EXTERNAL DEMANDS. SEEKS TO KEEP US IN A STATE
OF HOMEOSTASIS THROUGH AFFECT REGULATION
AROUSAL RESPONSE: SYMPATHETIC
WIND DOWN RESPONSE: PARASYMPATHITIC
Care providers are helped by:
• the mutual support of colleagues
• education and training
• debriefing soon after events
• supervision and mentoring which acknowledge
emotions
Standards for Bereavement Care
Paediatric Intensive Care Society
Care providers are helped by:
• an open and caring attitude from senior staff
• an atmosphere where staff feel able to express their
feelings
• the opportunity to access psychological help if
required
Standards for Bereavement Care
Paediatric Intensive Care Society
We must take the initiative to care for
ourselves so that we can feel good about
ourselves and our work
Supporting Yourself
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Be aware of your own limitations
Access support and supervision to meet your needs
Look after yourself physically, emotionally and spiritually
Notice any changes in sleep, eating and mood patterns
and take action
• Cherish yourself – you are special
• Energise yourself by taking regular exercise
Dent & Stewart (2004)
Survival Factors
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Understanding our own emotions
Somewhere safe to express feelings
Access to regular support and supervision
Clarity about boundaries of our role
Ways to relax mind and body
Being part of a supportive team
Life outside work!
Look After Yourself
• Accept your need for support, both practical and
emotional
• Be aware of what support is available to you
• Establish who is going to provide this
• Take responsibility for asking for what you need
Website
www.childbereavement.org.uk
Families Discussion Forum
Professionals Discussion Forum
Support and Information Line
01494 568900
Email:
[email protected]
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