Decreasing the Risk of Complicated Bereavement and Future Psychiatric Disorders in Children

Journal of Child and Adolescent Psychiatric Nursing, Apr-Jun 2005 by Kirwin, Kathleen M, Hamrin, Vanya

The clinical implication of the initial stage is that children need extra support from their families. During this stage, psychoeducation is important for the adults in the families. The psychoeducational work with the parental figures should help develop an understanding of children's developmentally-based needs and abilities (Baker et al, 1992).

In the middle phase, the clinical focus is on the emotional pain of grief. For therapists, the middle phase is the time to closely monitor the issues that stem from the child's ambivalent feelings towards the individual before the death, and the issues that arise after the death of a loved one. The therapist needs to be aware of the child's feelings. The child may feel angry with the dead parent for abandoning him or her, or might have feelings of guilt because the child thinks he or she may have driven the person away. The therapist needs to be aware that the child could have difficulty verbalizing these feelings. (Baker et al., 1992).

In Baker et al.'s (1992) late phase of grieving, the focus is on the child's reorganization of identity and significant relationships in his or her life. In psychotherapy, the child can explore his or her new personal identity and work through any conflicts that may arise with the child developing new relationships. In family therapy, the parent can be helped to understand the meaning of any reoccurrence of grief-related emotions after what seems to be a long period of time. The parent can work on any unresolved grief as well, in an attempt to help promote the child and the parent through the tasks of grieving (Baker et al., 1992).

Worden (1996) disagrees with Baker et al. (1992) on the number of tasks of mourning. He identifies four tasks of mourning that he modified to match the age and developmental level of the child. The comparison of Baker et al.'s (1992) and Worden's (1996) tasks of grieving can be seen in Table 5. As with other theories of the tasks of grieving, these tasks of grieving occur on a continuum. The individual moves in and out of these tasks of grieving on their own time frame. The psychosocial factors that can influence an individual's grief reaction can be seen in Table 6.

Alan Wolfelt is a noted grief counselor who has written numerous books on the grieving and mourning process of children and adults. He stresses that grief work is a journey because the death of a loved one changes our lives forever. He also states that children heal over time as they proceed through their grief journey with the guidance of companions, which can be a counselor, a parent or an adult caregiver.

Psychiatrie Disturbance in Parentally-Bereaved Children and Their Surviving Parents

According to Black (1998) and Geis et al. (1998), there are a number of factors inherent to the child, the family's, circumstances of the death and how the child is told about the death that will affect the child's reactions to the death of a parent (Table 6).

In Geis et al. (1998), preschool children have a higher incidence of separation anxiety and other fears after the death of the father. Children of depressed surviving parents do not receive the extra support they need from their parents. According to Geis et al. (1998), Kranzler and colleagues found that in their work with the bereaved, depressed surviving parents were the most powerful predictor of disturbance in preschool children who lost a parent. Fristad and colleagues (as cited in Geis et al., 1998) found that older children, particularly boys, demonstrated more school difficulties and the death of a father lowered their self-esteem. Older children appear more vulnerable to feelings of guilt than younger children. Depression appears to be more common if the mother is the surviving parent.