What About Us? Supporting Children After a Traumatic Death Liz Koole
Grief and Trauma • GRIEF • Expected loss – child prepared • Expected loss – child unprepared • Unexpected loss – sudden death, illness • – child not present • Unexpected loss – accidents, disasters, wars • – child not present • Unexpected loss – murder, suicide • – child not present • Unexpected loss – murder, suicide • – child witness • Unexpected loss – accident, disasters, war • – child witness, survivor • TRAUMA Dyregrov, A The interplay of trauma and grief, Trauma and crisis management 1993. Association of Child psychology and psychiatry
Traumatic Bereavement The circumstance of the death leave the bereaved deeply shocked, horrified, in disbelief, angry Following a death that occurred under traumatic circumstances, particularly homicide or suicide, there are: • images, or feelings related to traumatic nature of the death eg. Degree of suffering, gruesome injury, blame of self or other for the death • persistent, frequently distressing thoughts
Outcomes After bereavement in natural circumstances up to 20% of people experience complicated grief After bereavement due to violent cause: • 60-70% experience complicated grief • Up to 40% experience PTSD • 75% experience adjustment difficulty/depression • Some experience all three
Media Headlines
Grief with the Volume Turned Up • Managing the press – portrayal of the person who died, incorrect details, feeling under the microscope • Police investigation – not knowing/being allowed to know details • Not being allowed to view/touch the body • Not being able to have a funeral when they would like to.
Grief with the Volume Turned Up All the feelings usually associated with grief but can be more emphasis on:- • Fear • Feeling that the world is unsafe • Vengeance • Blame • Guilt – ��hat if?� • Confusion
The Impact of Suicide on Children and Young People Research shows: Children are affected more profoundly & more in the long term by suicide than by other types of death (Dyregrov et al) 25% of all children struggle with depression and anxiety after a suicide & many struggle with despondency for a long time (Brent, Perper, Mortiz, Liotus et al) “o�e �o��y a�out �hethe� taki�g o�e�s life �a� �e �ge�eti�� Many children experience suicidal thoughts
The Impact of Suicide on Children and Young People Complicating Issues • Taboo – family secrets • Stigma • Media – public bereavement • Why? • Potentially shocking language associated with death • Difficulty telling story – confusion, detachment • Co��e�� as to �hethe� sui�ide ��u�s i� fa�ilies� • Shattered world view • Feeling abandoned • Family conflict • Heightened arousal & anxiety
The Impact of Suicide on Children and Young People Common individual reactions • Shame • Blame • Guilt • Anger at others • Anger at person who died • Reduced self-esteem • Identity crisis • Relief • Intrusive memories & images • Difficulty talking to friends
What helps children after a traumatic death? Really listen to & acknowledge what children are saying to you Believe that what they say is how it is for them Take them seriously, then they will take you seriously Stand in their shoes & look at the world with their eyes Be atte�ti�e to the thi�gs that a�e��t said, o� a�e��t �uite said, said as a joke or as a throwaway while playing. Search for creative ways to have these conversations Active conversations, not just questions
What helps children after a traumatic death? Be open & honest A�k�o�ledge it�s diffi�ult to talk a�out thi�gs Na�e thi�gs that a�e��t �ei�g spoke� - elephant in the room Generalize to make conversations less intense & not just focused on child Think about different developmental stages and understanding If children ask questions they are probably ready for the answer Be prepared to venture where they lead
What helps children after a traumatic death? Whe� it �o�es to the ��u��h do��t shi�k it, ho�e�e� u��o�fo�ta�le it makes you feel. Unpack adult words to make sure they have understood them Accept that children are still going to be silly, mess around, annoy each other, embarrass their parents Have conversations with the whole family Everyone has experienced this death. Everyone will respond in their own way Including children shows that adults are interested in how it is for them
What helps children after a suicide? �“peak so that the �hild�e� liste� a�d liste� so that the �hild�e� speak�. �E�e�ythi�g o�e says should �e t�ue, �ut o�e �eed �ot say e�e�ythi�g that is t�ue�. K. Dyregrov, E. Plyhn & G. Dieserud
Working with children of different ages Trying to understand suicide at different ages and developmental stages A demonstration from casework Talk about the person who died
14 year old girl whose sister died
Working with children of different ages Help them make sense of what happened – their story Listen to their questions 4 yr old girl who was one when her father died 6 & 7yr old siblings whose father died when they were 5 & 6 yrs
Working with children of different ages When children have a good understanding of their story help them think about who they want to tell what to – taking charge of their story 4 year old girl who was 1 when her father died
Working with children of different ages Help children acknowledge difficult feelings • find names for them • ways to express them • strategies for dealing with them • ways of being in charge of them 7 year old girl who was 6 when father died
11 year old boy who was 10 when his father died Things Z. says he still finds difficult Does��t feel he �a� �e happy Did��t like �ot �ei�g told st�aighta�ay ho� dad died Did��t like that his f�ie�ds k�e� �efo�e hi� Was��t a�le to �o�t�i�ute a�ythi�g to dad�s fu�e�al Did��t �a�t to go �e�ause of fa�ily situatio� �ut feels ��ade to� Says he gets very angry. Punched a door when told his dad had died & hit a boy who was taunting him “till left �ith �Why?� Blames himself. Asked mum to pick him up from football as dad was shouting & embarrassing him in front of friends Feels bullied at school “aid the�e a�e �thi�gs i� �y head I �a��t talk a�out a�d a �assi�e hole i� �y sto�a�h� Stressed at small things
13 year old girl whose 16 year old brother died 13 yr old C. came home from school & found her brother hanging in his bedroom • Had to phone her mum to tell her • Had to go to neighbours for help • Had to leave her brother • Had to phone for an ambulance Very traumatic finding him & having to take responsibility • Traumatic images and Flashbacks • Difficulty going upstairs & past his room • Difficulty sleeping in own bed • He had ��ee� a sou��e of st�e�gth & se�u�ity fo� �e� • Lacking in confidence & day to day life inhibited by her fears & anxieties
13 year old girl whose 16 year old brother died At this age C reflected in more detail than the younger children on: • memories of her brother • how he died • thoughts & feelings associated But also more subtle things • What were the hardest things about her brothers death • The deaths of others in the family (grandfather) • Family relationships • Risk taking behaviour in friends • Things she would like to change in her life • Awareness raising • �What if?�
13 year old girl whose 16 year old brother died C. Identified the most important things for her: • Want to be able to tell mum more things • Trying to let go of looking after dad • Fi�d a �ay to stop thi�ki�g the ��hat ifs� • Stop thinking about every detail of what happened • Meet other young people bereaved by suicide • Sleep better • Try to stop bullying
13 year old girl whose 16 year old brother died And the things she has found helpful • School creating a quiet area and family donating a bench • Doing a sponsored walk & raising money • Working to stop bullying • Wanting to achieve at school • Doing charity work • Wanting to make a record for her brother • W�iti�g do�� all he� ��hat ifs�
16 year old boy whose mother died P�ote�ted f�o� k�o�ledge of �u��s �e�tal health p�o�le�s Very angry as no idea mum unwell Dad suicidal for a while In meetings circumstances of her illness & death reflected on more fully Complicated by other deaths – illness & suicide Working for As exams Dad depended a lot emotionally on his son Both concerned about him going to university
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