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Therapy for Children's Grief
Childhood traumatic grief (CTG) is conceptualized as a grief response distinct from what would be expected or normative following a death. The response follows the death of a loved one in a way that is subjectively or objectively perceived as traumatic. A child with CTG has symptoms of reexperiencing, avoidance, and arousal that are characteristic of posttraumatic stress disorder (PTSD) and that interfere with bereavement. In CTG, positive memories or reminders associated with the trauma, the loss (e.g., a photo of the deceased), and change (e.g., no longer playing ball with the deceased) segue into upsetting thoughts and memories, triggering the use of avoidant or numbing strategies. These PTSD-like reactions impinge on the child’s ability to complete the tasks of uncomplicated bereavement.
Children and adolescents with CTG may also show signs of depression and anxiety, which are the most often cited diagnoses following a death. In addition, CTG may be expressed differently in children of different ages, with adolescents more vulnerable to internalizing and externalizing behavior problems. Reactions to the loss of a parent from death and from divorce are often thought to be similar due to the issue of separation. Servaty and Hayslip found, however, that parentally bereaved adolescents suffered more "interpersonal sensitivity" problems than teens from divorced families. Parentally bereaved adolescents feel dissimilar from, and may feel stigmatized by, peers from both intact and divorced families.
Adolescence seems to be a time of particular vulnerability for the long-term negative impact of death involving trauma. Goenjian and colleagues found that six months after the 1998 hurricane that killed 4,000 people in Nicaragua, severe PTSD and depressive reactions in adolescents were related to their proximity to the most affected region and also to the rate of injury and death among family members. Desivilya and colleagues found that teens who had survived being held hostage while on a high school trip when other students were killed, exhibited psychiatric symptoms and still suffered effects of the ordeal seventeen years later. Bachar and colleagues found that the suddenness and meaninglessness of events resulting in traumatic deaths, such as a vehicular accidents, were factors in adolescents’ reactions to such events.
Bereavement and Adolescent Development
Adolescent-parent conflict is another hallmark of adolescent development that may be exacerbated by parental bereavement. As the parent and adolescent grieve, symptoms in each may well affect their relationship, roles, and naturally occurring separation process. The surviving parent may become overly dependent on the adolescent, who, in turn, suppresses emotion to protect the parent. This breach in the necessary parent-child relationship, coupled with a bereaved adolescent’s feelings of stigmatization, can interrupt identity formation. In addition, bereaved adolescents may express their grief by cultivating interests similar to those of the deceased parent or by adopting an increased sense of responsibility to the family—again to the potential detriment of development.
Traditional Treatment for Bereavement, Trauma, and CTG
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