STAND BY ME

:
Working with Children Who Are Grieving

Lisa Kynvi, MA, MT-BC, LMHC Merrimack Valley Hospice Lawrence, Mass.
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OUTLINE
1. Central Concepts a. Loss b. Bereavement c. Grief d. Mourning 2. Types of Loss 3. Important Factors 4. Prominent Issues 5. Bereavement Needs 6. Four Tasks of Mourning 7. Continuing Bonds 8. Development & Bereavement 9. Case Example: Pre-Bereavement 10.Case Example: Stand By Me project

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FOUR CENTRAL CONCEPTS
Loss Bereavement Grief and Grieving Mourning

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LOSS
Primary Loss Separation from lost person, object, status, relationship Secondary Loss Follows from primary loss Meaning Depends on what is involved & child’s interpretation

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BEREAVEMENT
Situation of having experienced loss. The child: has a relationship with a person who is valued experiences the loss—ending, termination, separation—of that relationship is deprived of the valued person by the loss

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GRIEF
Reactions to the loss Internal & external Experienced, but may or may not be expressed outwardly Many types of reactions...

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GRIEF: TYPES OF REACTIONS TO LOSS
Feelings (i.e. sadness, anger, guilt, self-blame) Physical sensations (i.e. lump in throat, hollowness in stomach, dry mouth, exhaustion) Cognitive responses (i.e. disbelief, confusion, preoccupation, difficulty concentrating, dreams of deceased)

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GRIEF: TYPES OF REACTIONS TO LOSS
Behaviors (i.e. sleep or appetite disturbances, regression, bedwetting, loss of interest in activities, crying) Social difficulties (i.e. fighting, problems at school) Spiritual dimensions (i.e. searching for a sense of meaning, hostility toward God)

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GRIEF
Most grief in children & adolescents is healthy, normal, appropriate reaction to loss Some grief reactions can become excessive, complicated, unhealthy Although unusual for a child, does NOT mean abnormal or alien, like disease is to health

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GRIEF
Generally avoid use of symptoms in bereavement Symptoms are indicators of disease Think signs, manifestations of grief Honest reactions to loss are real, cannot be turned on & off at will Developmental situation & individual personality will influence grief

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GRIEF
Usually grief reactions come from: Realization someone loved & valued is gone Recognition that child has been left behind Simply realistic human reactions Grief is reactions to loss, grieving is process of experiencing those reactions...

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MOURNING

Mourning is child’s responses to, and processes of, coping with loss & grief Child’s efforts to manage his/her experiences in bereavement, and To incorporate them into ongoing living

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MOURNING
Mourning two complementary aspects: Internal, private (intrapersonal) process— child’s inward struggle to cope with both loss & grief reactions to loss Outward, public (interpersonal) process—child’s overt, visible, shared expressions of grief, together with efforts to obtain social support

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MOURNING

Mourning is child’s capacity to move toward, work with her/his loss & grief Hopeful child can eventually find solace or comfort, perhaps even grow through managing experiences in bereavement

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MOURNING

“Mourning is one of the most profound human experiences that it is possible to have. . . . The deep capacity to weep for the loss of a loved one and to continue to treasure the memory of that loss is one of our noblest human traits.”
Shneidman, E. S. (1995). Voices of death. New York: Harper & Row

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MOURNING

“The way we deal with loss shapes our capacity to be present to life more than anything else. The way we protect ourselves from loss may be the way in which we distance ourselves from life.”
Rachel Naomi Remen (2010) on the American Public Media radio program Speaking of Faith

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TYPES OF LOSS
Typical types of death children & adolescents encounter Grandparents Parents Significant adults: extended family, teachers, neighbors, parents of friends Peers, friends, classmates Cherished pets Adolescents can experience death of own offspring

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IMPORTANT FACTORS
What was the nature of the relationship between the child and the person who died? Were there complications to consider? Were there mixed feelings?

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IMPORTANT FACTORS
The way the death occurred Natural & expected? Sudden & unexpected? Human element in causation? Trauma? Violence or multiple deaths? How it is shared with the child?

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PROMINENT ISSUES

Issues likely prominent in experience of bereaved children:
1. Did I cause it (death or other form of loss)? 2. Is it going to happen to me? 3. Who is going to take care of me?

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HARVARD CHILD BEREAVEMENT STUDY
Longitudinal, prospective study of children ages of 6 -17 who lost a parent to death.

Bereavement needs include:
Adequate information—clear, comprehensible information about impending death (whenever possible), certainly after death occurred Fears & anxieties addressed—to know they will be cared for, to experience consistent care

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BEREAVEMENT NEEDS
Reassurance they are not to blame Careful listening—someone who will hear them out & not minimize their concerns Validation of feelings—respect for & safe ways to express individual reactions in their own ways Help with overwhelming feelings—especially intense sadness, anger, anxiety, guilt

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BEREAVEMENT NEEDS
Involvement & inclusion—before & after death, with preparation, without being forced to join in Continued routine activities—age-appropriate activities, play & school Modeled grief behaviors—adults who can share their own grief & mourning, show how to experience & express in constructive ways Opportunities to remember—both after death & throughout life

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4 TASKS OF MOURNING
Worden (1996)
1. To accept the reality of the loss

The death may seem unreal to many bereaved children & adolescents Involve children in making losses real, acknowledging & accepting reality of the death

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4 TASKS OF MOURNING

2. To experience the pain or emotional aspects of the loss

Find ways of experiencing the pain encountered during bereavement in a manner that is not overwhelming

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4 TASKS OF MOURNING
3. Adjust to an environment in which the deceased is missing

Requires child to determine significance of now-severed relationship, to identify each of the various roles that the deceased played in the relationship, and to adjust to the fact that the deceased is no longer available to fill such roles

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4 TASKS OF MOURNING

4. Relocate the dead person within one’s life & find ways to

memorialize the person Change or restructure a cherished relationship in light of the new realities brought about by death, Even as memorialization activities honor and treasure the legacy of the deceased person’s life

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CONTINUING BONDS
Developed from research on childhood bereavement (Silverman, Nickman, & Worden, 1992)

For bereaved children, important to maintain form of symbolic connection to loved one who has died Rather than disengaging, breaking bonds, putting the past behind them, getting over it, or forgetting the deceased, Bereaved children often work to alter their relationship to deceased & develop a set of memories, feelings, actions that keep them connected to that individual

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DEVELOPMENT & BEREAVEMENT
All stage-based theory is flawed: Resist treating in overly rigid way Resist drawing sharp lines between stages Resist applying in fixed, mechanical ways All aspects of development in childhood are complex & highly individualized Particular children are organic, living beings with multiple dimensions Children don’t move in mechanical ways through preordained levels

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DEVELOPMENT & BEREAVEMENT
Further caution: An inability to grasp finality or universality of death does not leave a child in blissful ignorance Children can think of death as living somewhere else, and also find separation from loved one & other changes incredibly painful & sad Child does not have to grasp the finality of death, or the complete cessation of bodily activities, in order to react to separation from loved one

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DEVELOPMENT & BEREAVEMENT
Hungarian psychologist Maria Nagy Children Under 5 Recognize death, but not as irreversible, final or definitive Consciousness attributed to the dead Death may be understood as departure, kind of continued life elsewhere sleep, diminished form of life

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DEVELOPMENT & BEREAVEMENT
Children Ages 5 to 9 Accept existence & definitiveness of death, but think of death as a reality that is remote from them Death conceived of as final, but avoidable, not inevitable & not universal Not satisfied with fact of loved one’s disappearance; want to know where & how deceased continue to live

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DEVELOPMENT & BEREAVEMENT

Children Over Age 9 Recognize death is a process operating within us View death as final & universal, inevitable & not avoidable

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SUB-CONCEPTS
Sub-concept Subordinate Component Typical Questions from a Child
“Is it true that all living things must eventually die?”

Universality

All-inclusiveness “Does everyone die?” Inevitability Unpredictability Irreversibility
Non-functionality “Does everyone have to die?” “Is the timing of death certain and predictable?” “Once you are dead, can you come back to life again?”
“What do you do when you are dead?”

Causality Non-corporeal continuation

“Why do living things die? What makes them die?”
“What happens after death? Where does your soul or spirit go when you die?”

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ALLEN & ANDREA
Pre-Bereavement work

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Allen’s Story

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Andrea’s Story

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You go to Westford, Mass

To find the best mommy in the world Her name is JoAnn She knows everything About all you need to know Her smile lights up the whole town She’ll turn your frown Upside down You go to Westford, Mass To find the best mommy in the world

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C H I L D R E N ’ S B E R E AV E M E N T G R O U P
Merrimack Valley Hospice

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STAND BY ME
1. Individual recordings 2. Hearing what we said 3. Individual songwriting in group 4. Putting it all together

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INDIVIDUAL RECORDINGS
1:1 time, small private room Question: “If I were a friend at school who came to you at recess & I was having a hard time because someone I loved had died, how might you try to help me?” Almost regardless of what question we ask, what arises is what the child needs to talk about. Great therapy, processing opportunity
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HEARING WHAT WE SAID
I listened to individual recordings many times I typed & printed key quotations from recordings, no names attached Handed out quotations to the group (no one knew whose was whose) During group, took turns reading them aloud Kids had quotes as they wrote song verses, for inspiration; no one quoted directly
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HEARING WHAT WE SAID
Do you miss them? What happened? Are you okay? If it’s in school, tell the teacher, “Can I go to the bathroom or can I go somewhere else?” Think about what you’ve done with her. I ask my family to come to me and tell me, “Calm down. Calm down.” They wait for me to stop crying. Basketball, soccer, football. We pray all night and we know that they’re in our corazón, that means heart.
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SONG WRITING
Learned Stand By Me as a group Lyric analysis Individual songwriting Template Adults available Individual work scanning lyrics

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SONGWRITING TEMPLATE
Stand by Me Original Song by Ben E. King
When the night has come, and the way is dark And the moon is the only light we'll see No, I won't be afraid, No, I - I - I won't be afraid Just as long as you stand, stand by me. Chorus: So darlin' darlin' stand by me, Ooo stand by me
Oh stand, Stand stand by me, C'mon stand by me

If the sky we look upon should tumble and fall And the mountain should crumble to the sea I won't cry, I won't cry, No, I won't shed a tear Just as long as you stand, stand by me. Chorus ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ When _____________________________________ And _______________________________________ Then ______________________________________ Just _______________________________________ Chorus

If__________________________________________ And _______________________________________ Then ______________________________________ Just_______________________________________ Chorus ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________

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Shifting plans for the recording: A. Record kids singing their own lyrics.
(none of them agree to sing)

B. Ok, record kids playing an instrument, multi-track, over me singing their lyrics.
(missed session due to snow)

C. Fine, I’ll sing their lyrics, but will also mix in their spoken words (recorded in individual sessions).

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PUTTING IT ALL TOGETHER

Like I know more stuff for my age than a lot of people do.

(original verse) When the night has come, and the way is dark, And that moon is the only light you see. No I won't be afraid, no I-I-I won't be afraid Just as long as you stand, stand by me Chorus: So darlin' darlin' stand by me, Ooo stand by me Oh stand, Stand stand by me, C'mon stand by me

That itʼs going to be okay, and that heʼs probably in a better place now... or she. And I would hug you.

(original verse) If the sky we look upon should tumble and fall And the mountain should crumble to the sea I won't cry, I won't cry, no, I won't shed a tear Just as long as you stand, stand by me. Chorus
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I miss my mom, and I love her, and I wish she could hold me. ✦ Itʼs okay.

When you went away, I cried And I felt all alone Then the memories, they made it okay Just remember: I will see you again some day

Chorus There is no worry ʻcause mostly your mother can be in your head, your heart and even in your soul, either way if it isnʼt or if it is. Yes.

When Iʼm sad, I donʼt need to worry I donʼt need to worry every time I cry Because I- I- I am beinʼ protected I just be calm and play with my friends

Chorus

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I play with my friend. Like playing basketball. ✦ Read a book or watch TV. ✦ Basketball. Soccer. Football. Batten ball.

A color might make me feel better And remembering all the animals that we colored Then looking out the window, seeing birds & trees Just stand, stand by me

Chorus

My meme she used to like always color with me when I slept over there. ✦ Well, sometimes she tells me stories about her. ✦ Tell like your mom that if she has any, like, videos of her and you together or something.

When I hear stories about her And I, I feel sad Then I cry, then I cry, oh then I cry I just feel her hold me

Chorus
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Sunday, April 3, 2011

Hug her. Pray to God that I love you. ✦ Maybe like say, “I want you to stay with me tonight.” ✦ When I was never born, my dad died in an accident. ✦ I lost my grandfather, my dad, then my uncle. 2009 and 2010. ✦ Well, Iʼd talk about how great he was, or what he might have that he couldnʼt have down here.

When I am trying to go to sleep And laying there in bed all alone Then I think of my dad, oh I think of my dad Just laying, laying there with me

Chorus

Sheʼll always be there with you in your heart. ✦ Do you miss your dad? What happened? You okay? ✦ Pray to them every night, and you should always love them, and theyʼre always- theyʼre always with you.

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If I am having a bad day And I am fighting with my sister Then I go outside and play basketball Just having fun, that is all I need
• • • •

Chorus Itʼs gonna be okay, and maybe you will be fine in like the last couple, couple of few days.

When I am mad, and when I need help And when I am having trouble Then I need a hug, oh then I need a hug Just give me a hug and Iʼll be fine

Chorus Sometimes- I know with me, you start thinkinʼ about her one day, and then you just like break down. I yell. Sometimes I cry, sometimes I just take a little walk or jog around my block and just talk to myself. Itʼs kind of lettinʼ your emotions out and then you donʼt feel as bad later on.
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Sunday, April 3, 2011

I ask my family, come to me and tell me to “calm down, calm down” and for me to stop crying. And I told my grandma that my dad is- and my, and my uncle- is in your heart. And I saw her stop crying, and she started believing me. Because we pray all night and we know that theyʼre in our corazón, that means “heart.”

When Iʼm having a bad day And sittinʼ- sittinʼ there crying Then I hope youʼll be there, then I hope youʼll be there Just waitinʼ, waitinʼ just for me

Chorus They didnʼt want me to feel like sad. So they like- they would just- they would just like not say nothinʼ. And that kind of like made me feel like do they not even care? But my friends told me that they just didnʼt want to make me sad, so they didnʼt say nothing.

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When I am mad- I cry And I donʼt want to talk Then everything goes ʻround, everything goes ʻround Just like, just like the world

Chorus

Weʼll always be there for you. ✦ Talk to somebody in your family, or do something like what your brother did.

If- if I, if I tell why and I - I will cry Then I take a deep breath Oh I take a deep breath And just, just calm down

Chorus Maybe you should think about what youʼve done with her, or look at pictures of her and you, or share stories about what, what were great days you had with her.
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The things youʼve loved or the things that are sad or happy or silly. ✦ To think of happy things instead of bad things. And that everything would be okay. So that they would feel okay.

(original verse) When the night has come, and the way is dark And the moon, is the only light you see I won't be afraid, no I won't be afraid Not as long as you stand by me.

You know that the person that died to you is going to always be there. And that itʼs- theyʼre always going to be watching you. And that itʼs going to be okay if you believe that theyʼre there with you.

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C H I L D R E N ’ S B E R E AV E M E N T G R O U P
Merrimack Valley Hospice

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