8 Strategies for Working with Grieving Children

On the last track we discussed depression. We discussed ways to differentiate between normal depression and clinical depression. 

On this track we will discuss fear as it relates to the grief process. Three concepts regarding fear are manifestations of fear, why children become afraid, and identifying specific fears. If a grieving child you are treating is old enough, or if the parent could benefit from learning how and why death can shatter a child’s perception of security, you might consider playing this track for him or her.

Three Concepts Regarding Fear

Concept #1 - Manifestations of Fear
First, let’s discuss manifestations of fear.  Robert, age 33, was grieving the death of his wife, Jennifer.  Robert shared his grief with his 8 year old son, Billy. Jennifer’s death was the result of pelvic inflammatory disease. The pain and deformities that Jennifer suffered traumatized Robert and left him with painful memories. 

Robert stated, "I know why I’m so messed up. I was there for the horrible pain and suffering Jennifer went through. But I’m worried about Billy now. He seems so afraid. Billy whimpers and whines sometimes. He refuses to sleep alone, and always has bad dreams. Things Billy used to do confidently have become problems. Like going to the bathroom alone, sleeping with the lights off, or even going to the playground. The kid acts like he’s shell shocked!" 

In addition to the manifestations of fear that Robert described, you have probably also experienced grieving children who regress, Robert is doing, due to this fear. Manifestations of fear regarding regression may include thumb sucking, urinary accidents, baby talk, or choosing to crawl instead of walk. Think of your Billy. Perhaps the "Coping with Fear" exercise explained at the end of the track may be of benefit.

Concept #2 - Why Children Become Afraid
To help Robert understand Billy’s fear, I stated, "When Billy lost his mother, he also lost the idea that the world was safe and secure. Billy sensed the upheaval in his family. Billy has seen you crying and at first you were emotionally unavailable to him. Also, Billy has experienced much that he doesn’t understand. Discipline and daily routines have been altered and Billy has heard family members say confusing things that might have scared him. With his security disrupted, it is almost expected that Billy would become fearful."

As you can see, when important aspects of Billy’s sense of security were disrupted, he experienced fear. Think of your grieving client. Is his or her fear the result of an interrupted sense of security? Later on this track, we will discuss a technique which benefited Billy.

Concept #3 - Identifying Specific Fears
In addition to manifestations of fear and why children become afraid, the third concept to be discussed regarding fear is identifying specific fears.

Step #1: Working with parents to first identify specific fears and then address those fears I find is an effective technique for providing a child with the reassurance he or she needs.

Once Robert and I identified Billy’s fears, we dealt with each one.  In talking to Billy about his fears, the following questions came up and one question Billy had
-- 1. "Is daddy going to die?"  and
-- 2. "What will happen to me if daddy dies?" is a second question Billy had.

Other fears Billy had that were expressed as questions were,  
-- 1. "What if our house catches fire?"  or,
-- 2. "You always said I was a lot like mommy.  Does that mean I’m going to die, too?" 
Have you experienced treating grieving clients who have identified specific fears? 

Step #2: The next step I suggested to Robert, was to talk to Billy to provide him with reassurance regarding his fears.  For example, one of Billy’s biggest fears was what was going to happen if Robert, his father, died. First, Robert reassured Billy that he was very healthy, and would not die soon.

However, Robert asked Billy, "Just in case I would die, who would you like to live with?" Billy selected his uncle, and Robert agreed. Billy then expressed worry that his uncle lived in another state. Robert went further and worked out a plan that Billy could follow if anything ever happened. Do you have a client like Billy who could benefit from identifying specific fears and discussing specific custody preferences and plans? 

Technique:  Coping with Fear
Three other techniques I used were also beneficial in providing Billy with reassurance regarding his fears. These three techniques for coping with fear were dreams, balloons, and routines. 

1. The first technique I used was dreams.  Billy’s fears often emerged in bad dreams, and he anticipated those bad dreams prior to bedtime. I encouraged Robert to comfort Billy when he awoke and talk with him about his bad dreams. At one of our sessions, I suggested Billy draw one of his bad dreams. Billy drew Robert driving into a tunnel of fire. I stated to Billy, "That seems like a story with a sad ending.  Can you think of a happy ending?" Billy then drew his dad driving him to Disney World. 

2. The second technique I suggested was the use of balloons. 

--- First, I encouraged Robert to explain to Billy what the word symbolic meant, that it was an object that stood for or represented an idea or feeling. 
--- Next, Robert got some helium filled balloons on which he and Billy could write their fears. 
--- Finally, Robert explained that by releasing the balloons, their fears would be carried away. 

3. In addition to dreams and balloons, the third technique I like to use is that of routines. As we discussed earlier, part of Billy’s fears resulted form the disruption of his routines. I encouraged Robert to reestablish Billy’s routines that took place prior to his mother’s death.  These routines included discipline, chores, school, and bed time. Also, pizza night on Fridays was something Billy had stated he missed.

Think of your Billy.  Does the surviving adult need to reevaluate the disruption in their child’s routine.  What routines is it possible to reestablish? 

On this track we have discussed fear.  Three concepts regarding fear are manifestations of fear, why children become afraid, and identifying specific fears. 

On the next track we will discuss involving children in change.  Two types of involvement are negative and positive involvement. 

- Fordyce, L. (Aug 2009). Overcoming Loss: Activities and Stories to Help Transform Children’s Grief and Loss. Community Care, 1782.

Peer-Reviewed Journal Article References:
Ebesutani, C., Smith, A., Bernstein, A., Chorpita, B. F., Higa-McMillan, C., & Nakamura, B. (2011). A bifactor model of negative affectivity: Fear and distress components among younger and older youth. Psychological Assessment, 23(3), 679–691. 

Marshall, A. D., Roettger, M. E., Mattern, A. C., Feinberg, M. E., & Jones, D. E. (2018). Trauma exposure and aggression toward partners and children: Contextual influences of fear and anger. Journal of Family Psychology, 32(6), 710–721. 

Stutey, D. M., Helm, H. M., LoSasso, H., & Kreider, H. D. (2016). Play therapy and photo-elicitation: A narrative examination of children’s grief. International Journal of Play Therapy, 25(3), 154–165.

QUESTION 6
What are three concepts regarding fear resulting from the grief process? To select and enter your answer go to Test.