Treatment For Grief & Loss

What is Loss?

Unfortunately, loss is an unavoidable part of life and grief is a very natural part of the healing process. Sudden, shocking losses can be the result of accidents, crimes, or suicide that lead to intense feelings of trauma and do not allow the person to prepare for the loss. Sudden losses are those that cannot be easily prepared for and lead to challenges in feelings of security and confidence in the predictableness of life. These sudden losses can lead to sleep problems and nightmares, intrusive, disturbing thoughts, depression, intense feelings of anxiety, and social withdrawal.

Predictable losses, such as those that result from terminal illnesses or impending life changes often allow people some time to prepare for the losses. While this can help in some ways, predictable losses create two layers of grief:

1)      Anticipatory grief related to the anticipation of the loss

2)     Grief related to the loss itself

Common situations that invoke feelings of grief and loss include:

  • Loss and breakup of a close friendship
  • Romantic relationship breakup
  • Death of a close friend
  • Death of a parent or sibling
  • Death of a classmate
  • Death of a loved one or partner
  • Loss of safety following a trauma
  • Childhood abuse and trauma

There are also less subtle forms of loss that can cause strong grief, even though others around may not understand the intensity of the feelings. More subtle, but equally painful types of losses may include:

  • Leaving home
  • Selling the family home
  • Diagnosis of chronic illness in the child or his or her parent
  • Graduating school
  • Death of a pet
  • Changing schools
  • Moving to a new home
  • Graduation from school
  • Decreased physical ability
  • Loss of financial security

What is Grief?

Grief is our natural response to loss – the emotional pain and suffering felt by children and teens when something or someone loved is taken away. The more significant the loss, the more intense the grieving will be. It’s important to note that children and teens at different ages and developmental stages grieve in very different manners. The length of the grieving process as well as the symptoms themselves are all going to vary immensely from person to person. Additionally, there is no way of rushing the grieving process and it is normal for the feelings of grief to abate for some time only to resurface during dates and events that remind a person of the loss.

While grief is often associated with the loss of a person, any types of loss can cause someone to grieve. Common types of losses that cause grief in children and teens can include:

  • Divorce of parents
  • Loss of health
  • Failing a class at school
  • Death of a pet
  • Serious illness of a loved one
  • Lost friendship
  • Loss of sense of safety
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Factors Affecting a Child or Teen’s Adaptation to Loss

There are a number of factors that are involved in the ways in which a child or teen can adjust to a significant loss in his or her life. These factors include:

Type of loss: Any loss can be a painful life-changing experience. However, when a loss involves a death from a long-term illness, a family has time to prepare, plan for closure, and be involved in the dying process. When a loss is more sudden, such as a suicide, it can be harder for a child or teen to understand and acknowledge the loss, leading to different emotions. This is especially true when the type of death – such as a drug overdose or suicide – carries some amount of shame and embarrassment.

Value of the relationship: When an individual experiences the loss of someone, the type of relationship between the two will impact the ways in which the child or teen recovers from the loss. Teens may feel guilt for saying harsh words during anger to a parent who died, while siblings may feel regret and blame for fighting in a normal manner when one child dies.

Coping skills of parents or caregivers: Children and teens are particularly reactive to the response of his or her parents. If the parent is overwhelmed by grief and loss, the child or teen may be frightened by the intensity of the emotions. Similarly, a parent who is in denial can confuse and limit a child or teen’s ability to express sadness. Additionally, children will be affected by a parent’s emotional and physical availability and support.

Characteristics of the child and family: Children’s ability to understand what death or major loss means is sorely limited by their age and cognitive abilities. Families may be limited in their ability to access help for the child’s short and long-term needs.

Family structure: Each family has a unique way of working and relating to one another. Families who have an open communication and strong structure can provide comfort and reassurance to the child or teen during the grieving process. More dysfunctional families may find that fighting, strained relations, and resentments impede the ability to come together and grieve the loss.

Personality and temperament of the child or teen: Each child and teen has his or her own individual styles of coping and functioning during a time of crisis. During the grief and crisis, some characteristics may be exaggerated. An anxious, cautious child may be more fearful, while a practical child will quickly attempt to reestablish a routine and sense of normalcy.

Pre-existing risk factors: Children and teens who already experience mental illness, learning problems, or social challenges may have a harder time with the loss. These children may have trouble understanding or managing the associated changes. Children who have poor social skills may have strained relationships with their peer group causing them to lose the benefit of supportive friendships and relationships with peers.

Simultaneous life stressors: Existing stresses such as money problems, difficult living situations, illnesses among family members, or divorce can make adjustment to a major loss more complex. This can lead to the child or teen becoming overwhelmed and unable to properly grieve, adding a sense or feeling of a lack of security.

Support: The availability of support services, interventions, and networks following the loss can have a huge impact on how well a child or teen is able to grieve a loss. It can be helpful to have familiar faces around to provide love, support, and assurance that things will, once again, be okay.

Responses to Death from Children and Teens

Expressions of grief vary based upon developmental stage and a number of other factors. Grief may be expressed through:

  • Emotions
  • Behaviors
  • Physical reactions
  • Thoughts

There are certain ways in which children react to major losses in their lives. Feelings of fear, anger, sadness, and guilt are associated with the following:

  • Ability to fully understand the situation
  • Concern for the emotional and physical wellbeing of others
  • Desire to protect loved ones from physical harm
  • Reactions to changes in home life
  • Changes in roles and expectations
  • Feelings of isolation, being alone, and being different than others
  • Loss of the sense of security of the world
  • Fear of being taken care of and fears about the future

Typical Responses to Grief and Loss Based Upon Age and Developmental Stage

Grieving a major loss can be hard, especially for children, and these losses can lead to a profound effect upon the rest of his or her life. A child who experiences grief may move in and out of intense feelings rather than having sustained levels of extreme emotions for a longer period of time. Additionally, when a grieving child is seen laughing or playing it doesn’t necessarily mean that they have completely recovered from the loss.

Early School-Aged Children: Ages 6 to 9

Children during this stage have the ability and vocabulary to comprehend simple concepts related to loss – such as disease. Children in this age group have a fascination with the concrete details surrounding the death or loss such as being able to organize the information in such a way that makes sense to them. These children have a sense of logic about, and contributing factors regarding personal safety and health. However, the emotions these children experience can be incongruent. Their less mature beliefs may include the idea that their own thoughts can lead to bad things. Death may be personified as a “monster” that comes to take people away. The emotions and behaviors displayed during ages 6 to 9 may include:

  • Denial
  • Anger
  • Irritability
  • Self-blame
  • Mood swings
  • Withdrawal
  • School problems including school avoidance, academic difficulty, and challenges with concentration

Middle School Children: Ages 9-12

By age 10, most children have developed a mature understanding of loss and death; they understand that:

1)      After death, the body cannot function any longer

2)     Death is a permanent state

3)     Death happens to everyone at some point

4)     They, too, will die

This mature, adult-like understanding of death is usually accompanied by more adult reactions. Responses in this age group may include a sense responsibility, feelings of being different, behaving protectively of others who have affected by the loss, thoughts that certain feelings are childish, or that they should put on a brave face to the world.

Common reactions for children between the ages of 9 and 12 include:

  • Aggression
  • Academic problems
  • Decline in academic performance
  • Sobbing and crying
  • Longing
  • Isolation and withdrawal
  • Resentment
  • Sleep problems
  • Suppression of their emotions
  • Sudden concern about their physical health

Early Teens and Adolescents

Early teens and adolescents do understand the significance of loss and death and their reactions are openly associated with developmental tasks. As teens struggle toward becoming independent, they may feel unsure of themselves and bitter while feeling pressure to fill more adult roles. Teens understand the future, understand and think about the ways their life is now forever changed, imagine the ways in which normal events will be now be different, may question their own mortality, and ask themselves “what if”? Early teens and adolescents may be afraid to expose their strong emotions and feelings and, in turn, may be ignored during the grieving process.

The most common reactions for early teens and adolescents may include:

  • Anger
  • Fear of death
  • Changes in sleep and eating
  • Emotional numbing
  • Mounting anxiety
  • Emotional distance
  • Avoiding feelings
  • Guilt
  • Feelings of intense responsibility
  • Risk-taking behaviors
  • “Acting out”
  • Increased physical problems and complaints
  • Increased self-involvement
  • Apathy about school and academic decline
If you feel that you are in crisis, or are having thoughts about hurting yourself or others, please call 9-1-1 or go to the nearest emergency room immediately.

Ways to Help a Child or Teen Struggling with Grief and Loss

There are some ways parents and caregivers can help a child or teen cope with a tremendous loss or death. The statements below should be tailored to the child’s developmental level and age as well as toward the situation. It can be helpful to use the following tips of coping for children and teens grieving a loss. These may include:

Be simple, yet direct: Use the right words and language to discuss death with children and teens. Avoid euphemisms like “she passed on,” or “she’s sleeping,” which can be confusing to children. Instead, be direct, “she has died.”

Be truthful: Hiding information can make children and teens confused as well as cause them to be distrusting of adults. Tell the truth, but don’t share unnecessary information.

Model appropriate responses: Don’t hide your emotions to “protect” your children. Explain your feelings so that a child can understand what he or she is experiencing. Be sure to avoid expressions of particularly strong, dramatic outbursts and feelings in front of the children.

Reassure the child that he or she is not to blame. Make certain that you do this often. Children often operate under the misconception that their own behaviors and actions somehow caused the death or loss.

Encourage dialog: Ask questions, find out what the child or teen really thinks about the loss and be sure to correct any misunderstandings or misinformation the child may have.

Explore feelings about loss: Understand that your child may have unique feelings about loss and provide time to explore these feelings with the child.

Acknowledge and affirm: When your child is expressing the ways he or she feels, it’s important to accept these feelings and reassure the child that their feelings are completely normal.

Enlist others: Talk to the child’s school and caregivers about the loss so they can be similarly supportive to the child.

Understand the child’s pace: Each child chooses to express his or her feelings at his or her own pace, so offer comfort and opportunities to be available when the child or teen is ready to talk.

Continue talking: As a child or teen works through their grief, his or her understanding, interest, and questions about hard things change. Be available and look for moments that allow for a dialog with the child.

Involve the child: Find the way for the child or teen to be involved in the family if you can. Involvement in hospital routines, funeral rituals (as appropriate), or other aspects of the loss that can help the child demystify the loss and provide closure.

Provide extra help: As daily life may become challenging for a grieving child, offer extra assistance with school assignments, social obligations, and chores at home.

Signs a Child or Teen Should Seek Professional Help

In the first year following a major loss, children are at highest risk for developing adjustment problems; 10% to 15% of children and teens are at risk for developing problems such as depression. While most children and teens will become emotionally adapted and resume normal daily activities, some develop more serious concerns that require the help of a mental health professional. Additionally, it is not uncommon for problems to not emerge for two or more years as new the child or teen faces new developmental processes as they age. Some of the things to look for in your child that may indicate they need the help of a mental health professional may include:

  • Appetite disturbances or change in weight
  • Long-term denial of the topic
  • Avoidance of the topic
  • Lack of notable response to the loss
  • Extended periods of sadness
  • Loss of interest in once-enjoyed activities
  • Loss of ability to feel moments of happiness
  • Feeling helpless or hopeless
  • Intense feelings of emptiness
  • Regression into an earlier age
  • Vague, general feelings of guilt and depression about the loss
  • Lack of ability to responds to comfort and rejecting of support
  • Loss of sociability and deliberately withdrawing from friendships
  • Outbursts that are destructive
  • Inappropriate feelings of euphoria
  • Becoming “accident prone”
  • Engaging in inappropriate, illegal behaviors
  • Decline in academic performance
  • Refusal to attend school
  • Ongoing anxiety about the child’s own death or preoccupation about illness
  • Extreme grief – difficulty weeping or controlling crying
  • Recurrent statements regarding the desire to join the deceased that suggest an intent to cause self-harm or suicide (not said as a longing to be reunited)

If you are concerned about your child or teen’s grieving or subsequent behaviors – especially if they appear to be related to substance abuse, self-harm, and suicidal intent, do not hesitate to seek help immediately.

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