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Helping Parents with Grieving Children
Grieving Children continuing education social worker CEUs

Section 20
The Nature of Adolescent Grief & Its Meaning for
Mental Health Counseling

CEU Question 20 | CEU Answer Booklet | Table of Contents | Grief
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

There are two major features of adolescent grief that may be distinguished as different from the grief of adults and should be recognized as normative by mental health counselors. First, it has been noted that Adolescent Grief Helping Parents with Grieving Children counselor CEUadolescents' grief experience is profoundly personal in nature. They grieve more intensely than adults (Christ et al., 2002; Oltjenbruns, 1996), but the grief may be expressed in short outbursts, or there may be a concerted effort to control emotions. Adolescents generally believe that their experiences are completely unique unto themselves and that everyone is paying attention to them (Elkind, 1967). This sense of being alone and special leads adolescents to feel as though their grief is obvious to all but no one could possibly understand how they feel. Such beliefs may lead them either to retreat into themselves by listening to music, reading, writing, or exercising, or to enact angry or antisocial behavior (Worden, 1996). Second, their grief may follow a life-long developmental trajectory. That is, the loss may be continued to be felt throughout the teenager's lifespan, as he or she graduates high school or college, finds a job, gets married and has children, and grows older than the parent, sibling, or friend who has died (Silverman, 2000). Thus, the relationship that ended with the death will continue on in the thoughts of the adolescent and will be reconstructed throughout the life span. Working towards closure, or putting the death behind, might not be a helpful therapeutic goal. Grieving adolescents and adults commonly fear that they will forget the person who is lost. Current technology could go a long way in maintaining relationships changed through death.

Understanding these unique features of the adolescent grief experience is necessary in order to provide the social support that has been found to be very valuable in coping with loss (Oltjenbruns, 1996). Certainly adolescents are more sophisticated than children in their understanding and response to death. However, their mourning is not adult-like either. Of course, it is essential to take into consideration who died, how that person died, the significance of the relationship of that person to the adolescent, the family's dynamics of open or closed communication patterns, and characteristics of the adolescent.

With regard to the personal characteristics of the adolescent, self-esteem was found to be important in adolescents' responses to loss. Balk (1990) and Hogan and Greenfield (1991) found that adolescents with lowered self-concept scores showed more problems with their grief. Gender has also been found to be an important factor to consider in the adolescent grief experience (Raphael, 1982). The ways in which male and female adolescents respond to the death of a person close to them reflects a history of gender socialization that began early in their lives. More adolescent males than females die suddenly and violently, via accidents, homicides, and suicides (Corr et al., 2003). However, no one knows if, as a consequence, teenage males more than females are grieving over the loss of their same-sex best friend. Parallels between the socialization of males into hiding emotions, being independent, and displaying aggressive behavior when upset are reflected in adolescent males' grief reactions (Adams, 2001). Bereaved adolescent girls may express more adjustment difficulties (Servaty & Hayslip, 2001), but this may be consistent with the latitude afforded women to talk about their feelings. Oltjenbruns (1996) and Rask, Kaunonen, and Paunonen-Ilmonen (2002) found that social support was one of the most important factors in helping bereaved adolescents cope with their loss. Reaching out to others seems to be easier for females than males (Noppe et al., 2003). However, recent research on masculine models of grief suggests that grieving men seek comfort in directed activity and problem solving (Martin & Doka, 2000). It would not be surprising to observe a bereaved adolescent male avoid a support group but spend hours in competitive sports or rebuilding a car with his father. Mental health counselors, therefore, need to be conscious of the different ways adolescent males and females respond to loss and to intervention efforts.

Age is another factor that is critical for understanding adolescent bereavement and grief. A useful way to organize adolescent adjustment to loss (Fleming & Adolph, 1986; Fleming & Balmer, 1996) is to break down the long span of the adolescent years into early, middle, and late periods, with an examination of the developmental tasks of each period. According to the model of developmental tasks proposed by Fleming and his colleagues, young adolescents (i.e., ages 11 to 14 years) must learn how to emotionally separate from their parents; middle adolescents (i.e., ages 14 to 17) need to develop a sense of mastery, competence, and control; and during the late adolescent years (i.e., ages 17 to 21), the major developmental task involves forming intimacy and commitment with friends and romantic partners. Linked to these tasks are five core issues that must be addressed: emotionally separating from parents, developing a sense of mastery and control, establishing a sense of belonging, developing a positive self-image, and creating a sense of fairness and justice. Although hints of involvement with such concerns are seen prior to adolescence and vestiges of these issues are certainly evident well into the adult years, it is during the adolescent years that they are prominent and often all-consuming, thereby highlighting what is unique about this period of the life span. It is no surprise that adolescent bereavement is also distinct from childhood or adult bereavement, primarily because of the core issues that are embedded in the grief process.

With regard to the core issue of parental separation, it is important for mental health counselors to keep in mind Silverman's (2000) point that adolescents do not feel completely independent outside of their relationships. A death occurring just when they are trying to reallocate their emotional investment from their parents to their peers can cause the adolescent to feel incomplete. Although they may wish to pull away from their parents, they feel abandoned if they do (Rowling, 2002). Thus, the mental health counselor has the difficult task of helping the adolescent and his or her parents find the right balance between independence and control during an emotionally vulnerable time for both. Parents who are grieving are consumed by their own emotions and may be understandably unresponsive to their children. Mental health counselors who are working with adolescents may have opportunities to consult with parents and to serve to educate the family about bereavement and grief in the process of offering social support to the bereaved family. Supporting parents and family members by gently coaching them toward recognizing the need to remain available to their adolescent child and being a parent educator about adolescent grief, may be important roles for the mental health counselor.

The adolescent's developmental tasks of feeling in control, attaining a sense of mastery, and being able to predict events are also seriously compromised by death. In a landmark longitudinal study on the effects of parental death, the "Child Bereavement Study" (Silverman, Nickman, & Worden, 1992; Silverman & Worden, 1992; Worden, 1996), children and adolescents were closely surveyed and observed for 2 years after their loss. Compared to adolescents who had not experienced the death of a parent, bereaved adolescents expressed more anxiety and fear over time and believed that their schoolwork and behavior were inferior to their peers. Perhaps the adolescent engages in risky behavior to test the limits of his or her own mortality as a way to regain a sense of mastery and control (Hogan & DeSantis, 1996). Conversely, feeling out of control may exacerbate the attitude of "Live it up today for tomorrow you may die." Such attitudes may have serious negative consequences. Mental health counselors need to be alert to changes in behavior that signal an adolescent's need for control. Restoring order to a life turned upside down may be accomplished by maintaining routines as much as possible, involving adolescents in decision-making processes, and redirecting the adolescent towards more positive activities. A grieving adolescent may be resistant to the latter, unless they are tied directly to the loss itself. For example, a teenager who has lost a parent due to cancer may be interested in participating in events that raise funds for cancer research. In addition, teenagers frequently find a sense of mastery through self-expression in music, writing, or art.

The normative task of creating an identity and mature self-concept can be undermined by death. This task is intimately tied to the need to be accepted and part of a peer group. Because bereaved adolescents feel different than peers who are not grieving, they may show lower levels of self-esteem, less of a sense of belonging, and become more socially withdrawn (Worden, 1996). They feel out of touch because they feel more mature than their peers. Their lack of experience may also lead them to be self-conscious and worry about how to act when they are grieving (Glass, 1991). Many bereaved adolescents have reported that their peer relationships have changed (Servaty & Hayslip, 2001). Thus, participating in a support group may help to remove the sense of isolation experienced by the adolescent and help to create a sense of belonging and identity. This is what may foster higher levels of self-esteem, which is crucial in helping the adolescent negotiate through grief (Balk & Corr, 2001). Although we are not advocating the use of chat rooms, carefully monitored Internet groups may be particularly appealing to this generation of adolescents, who have grown up with instant messaging and e-mail and have learned to rely on computers to maintain connection with others. Ironically, although bereaved adolescents may stand to benefit the most from peer support groups, not much information is available about such groups in the literature. Mental health counselors can consult Tedeschi (1996) for excellent advice as to how to form, facilitate, and structure support groups for bereaved adolescents.

Working with grieving adolescents is challenging. The mental health counselor must be prepared to continually keep in focus how the path of normative development may be deflected by death. Respecting the heightened cognitive powers of the adolescent is also necessary. Adolescents are notorious for constructing hypothetical, ideal worlds as they develop the capability to think in abstract ways. This increased cognitive sophistication leads adolescents to more fully anticipate the aging and death of their parents and themselves, view social isolation as a form of death, contemplate the demise of the world through war and violence, and question the continued existence of the spiritual essence of humans and the universe. These reflections on life and death can move to the forefront of an adolescent's concerns when he or she becomes personally involved with death.

The capacity to think in abstractions helps adolescents to move out of simple polarized thinking, but their sense of fairness and justice does not yet take into consideration the compromises demanded by the social context. Death, then, can seriously affect the adolescent's sense of fairness and justice, especially in the case of traumatic deaths. Thus, working with bereaved adolescents involves helping them to construct a sense of order and justice even in the face of senseless acts. An important component of the grieving process is problem solving. The mental health counselor can capitalize on the increased mental capabilities of adolescents by teaching them to use cognitive strategies to problem solve. For example, the mental health counselor can ask "what if" questions; have adolescents consider the perspective of others who are bereaved, including that of the deceased; and ask adolescents to generate a number of solutions to the same problem. Such strategies may provide lifelong coping skills. Teaching problem solving, providing a sense of stability, offering the notion that crises can be overcome, maintaining a positive outlook, and ensuring that the teenager remains connected to someone can go a long way towards promoting a positive outcome.
- Noppe, Illene & Lloyd Noppe; Adolescent experiences with death; letting go of immortality; Journal of Mental Health Counseling; Apr 2004; Vol. 26; Issue 2.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #6
The preceding section contained information about the nature of adolescent grief and its meaning for mental health counseling. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 20
What five core issues must be addressed for a mental health professional to organize an adolescent’s adjustment to loss? Record the letter of the correct answer in the CEU Answer Booklet.

 
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