16 PA, Children: making sense of separation and loss - test 3

Question 1

True or false:

The word “dead” is never any harder to say than when an adult is speaking it to a child.

Answer 1

True

Question 2

1- Tell the child as soon as possible about the death
2- Be truthful
3- Share only the details the child is ready to hear
4- Encourage the child to express feelings
5- Take the child to the funeral
6- Take the child to the cemetery, even if the person is already buried.
7- Let the child tell others about the death
8- Encourage the child to talk about the loss.
9- Be available to answer the child’s questions
10 - Never say “you shouldn’t feel like that.”

Answer 2

10 things to tell a child about the death of a loved one

Question 3

• Start with what the child knows.
• When appropriate, it is important to touch the child. This gives the child a sense of security.
• When telling the child about the death, one should be gentle and trustful, and should choose a place that is comfortable, safe, and familiar.

Answer 3

1- Tell the child as soon as possible about the death

Question 4

• A child can sense dishonesty, do not make up stories that will have to be changed later. This only confuses the child and promotes emotional instability.
• Withholding information can be a threat to the child. Emphasis needs to be placed on the facts.
• Avoid euphemisms because they are less than honest.

Answer 4

2- Be truthful

Question 5

• Children will actualize a crisis much like an adult, make it real in their mind, they need a logical explanation of why the person died.
• They may not be ready emotionally or cognitively to accept all of the facts surrounding the death.
• Children mentally reprocess the information about the death of a loved one at each developmental level.
• Truthfulness is very important, but it should be balanced with the child’s readiness for the details.

Answer 5

3- Share only the details the child is ready to hear

Question 6

• A child will experience stages of grief very similar to those of adults.
• The child relies upon the adult for permission to feel the loss during each stage.
• The best way for a child to learn how to identify, own, and express feelings is to hear and watch an adult do so.
• For the first few years, children get their understanding of grief through their senses, not through their intellects, so it is important for adults to feel their grief in the presence of a child.

Answer 6

4- Encourage the child to express feelings

Question 7

Thoughts about taking a child to a funeral:

• The child does not have to be present during all of the visitation hours.
• If the casket is on a bier, the child may have to be lifted up to see the body.
• The child should have the security of having an adult present at all times.
• The child should be allowed to touch the body but should not be forced to do so.
• The child should not be allowed to “roam” the funeral home.
• The child should be allowed to participate in the rituals for the purpose of expressing grief and recalling the event later in life.
• The child should be able to observe those who are mourning.

Answer 7

5- Take the child to the funeral

Question 8

• The child will take some degree of comfort in knowing where the body is buried and how to get there.
• Like adults, children need to direct their grief feelings toward the appropriate object. (this lessens the child’s emotional disorganization)
• The grave site could be where the child makes contact with the loved one.
• Periodically taking the child to the cemetery lessens the chances of the child denying or avoiding the death.

Answer 8

6- Take the child to the cemetery, even if the person is already buried.

Question 9

• The adult taking over a child when the child is asked how someone died can create anxiety in the child.
• The child feels more in control and has greater understanding of the loss when he or she can explain it to another person.
• The adult should be quiet and let the child speak.

Answer 9

7- Let the child tell others about the death

Question 10

• When a child talks about the death, not only are the feelings generally expressed, but if the child has incorrect ideas about any aspect o the loss, it can be brought to the attention of the adult and corrected.

Answer 10

8- Encourage the child to talk about the loss

Question 11

• The questions may focus on life, death, spiritual values, relationship, etc.
• May simply want to know why the loved one had to die.
• Adults need to answer each question as accurately as possible, and with the understanding that some questions cannot be answered.
• The adult needs to spend time with the child.
• What is important is not so much the ability to answer each and every question, but being available to discuss each concern as it arises.

Answer 11

9- Be available to answer the child’s questions

Question 12

• The child should be encouraged to express anger, sorrow, loneliness, fear - any feeling the child has should be accepted.
• Not allowing the child to feel may create a type of repression that potentially creates interpersonal conflict in later life due to the child’s inability to communicate emotions.

Answer 12

10- Never say “you shouldn’t feel like that”

Question 13

• Shock
• Alarm
• Disbelief
• Yearning
• Searching
• Disorganization
• Resolution

Answer 13

The stages of grief for children

Question 14

Grief responses that could be considered “norms”.

Answer 14

stages

Question 15

• Generally a lack of sensation
• Numbness can lead to withdraw
• little physical activity
• loneliness
• sadness
• “flat” facial expession
• Lasts a few hours to a few days
• as the loss begins to register, child may alternate between crying/sadness and anger/irritability
• “protest” the loss
• The child’s ability to move through the process will determine the outcome

Answer 15

Shock

Question 16

• Children look to adults for safety and security, their world becomes less safe.
• Intensified at the death of a parent
• feelings of vulnerability
• Separation anxiety
• Depression
• Immobilization
• Bodily tension, sweating, dryness of the mouth, shortness of breath, bowel and bladder relaxation, physical exhaustion when discussing the death
• Insomnia (when the trust in the world is shaken, it if difficult to let your defenses down and sleep).
• Acute night terrors, a desire to sleep with a parent or sibling at night, fear of the dark.

Answer 16

Alarm

Question 17

A conscious or unconscious defense the child uses to avoid, prevent, or reduce anxiety.

• Akin to denial
• Uses this to reject the reality of the loss
• Tries to “forget”, which enables the exclusion of feelings that rightfully go with the loss
• Magical thinking
• Occasionally will use this at some time during the grief process to allow for a reprieve from the pain and work of mourning.

Answer 17

Disbelief

Question 18

The intense longing a child has for the dead loved one to return.

• Normal for all children to yearn, wish, and hope that the loss will “go away” and that the one who has “left” will come back.
• Conflict between letting go and the wish to hold on to it can have a positive effect on the child.
  
  • working through the ambivalence enables the child to identify conflicting impulses, practically learn to live without the one who has died, and eventually understand the reality of the separation.
• May cause regression - a child will temporarily give up a skill that was mastered earlier in the developmental process.

Answer 18

Yearning

Question 19

Return to the behavior of an earlier age. Temporarily giving up a skill that was mastered earlier in the developmental process.

• younger child: wet the bed, suck a thumb, or cry for a bottle.
• Older child: sit on mother’s lap, cling to daddy

Answer 19

Regression (not a stage)

Question 20

Has 3 basic elements:

1- Preoccupied and intense thought about the lost person, involving a compulsion to speak of him, to review a lifetime of memories about him, ad to ignore anything not relevant to his presence.

2- A sense of waiting for something to happen and a distraction of attention to places where the person is likely to be found.

3- Restless, sometimes aimless moving around with an inability to sit still, and constant searching for something to do, a scanning of the environment.

• This stage will end when the child realizes that all attempts to restore the lost relationship with the one who has died are unsuccessful.

Answer 20

Searching

Question 21

Understanding emotions like sadness, guilt, shame and anger is extremely demanding to a child. Sometimes the child cannot keep up with the energy required for grief. Hence, the child’s life becomes disorganized in:

• social activities
• domestic responsibilities
• schoolwork

Observes may see:

• walking around aimlessly
• withdrawn
• daydreaming
• unable to complete simple tasks or follow directions
• ignoring school assignments
• fighting with friends
• The child is focused on the enormous pain of separation and loss, with very little energy left for anything else.

Answer 21

Disorganization

Question 22

This is the quality of being determined or the ability to preserve.

• Child is no longer preoccupied with the loss
• Decreased anger and irritability
• Return to stable eating and sleeping patterns
• An ability to focus on schoolwork and other responsibilities
• Child has a greater understanding of death and its finality
• He or she is able to freely love again

Answer 22

Resolution

Question 23

These are given to better assist the death car professional in understanding the grief process a child goes through.
- Should be used by adults who allow and encourage children to move toward their grief, not away from it, keeping in mind, that our best gift to children is ourselves, with the assurance that life will go on.

Answer 23

Children’s grief stages

Question 24

1. Be a good observer
2. Respond in an empathetic manner
3. Allow the child to express feelings and thoughts
4. Respond to the child in langue that he/she can understand
5. Respond to the impact of events on the child (internal frame of reference) rather than to external facts only.
6. Respond in a voice, tone, and intensity that reflect the affect expressed by the child
7. Develop your skill in recognizing and responding to minimal cues of the child.
8. Express your own feelings that are natural to the situation
9. Accept the child’s questions
10. Be patient and available
11. Provide reassurance through action as well as words
12. Learn to tolerate and feel at ease during reasonable periods of productive silence
13. Maintain a continuing dialogue with children about death as the opportunity arrises
14. Create a healthy relationship between you and the child.
15. Select and adjust your procedures according to the child.

Answer 24

Alan Wolfelt’s general suggestions concerning children and grief.

Question 25

Receptively attend to a child’s behavior by maintaining eye contact and a responsive posture.
- explore questions, no quick answers

Answer 25

1. Be a good observer

Question 26

Make your baseline helping response to reciprocal empathetic understanding, acknowledging the explicitly expressed feelings of the child and the reasons of experience behind them.

Answer 26

2. Respond in an empathetic manner

Question 27

Do not attempt to “over understand” the child, particularly in fields related to psychological data. It is better to allow the child to communicate depth of understanding to you, rather than attempting to “diagnose” what the child is thinking and feeling.

Answer 27

3. Allow the child to express feelings and thoughts.

Question 28

Be simple and direct. Begin at the child’s level and remember that attitude is more important than words. What is said is not as important as the emotional meaning communicated to the child.

Answer 28

4. Respond to the child in language that he/she can understand.

Question 29

Remember- reality is for the child the world as he/she perceives it.

Answer 29

5. Respond to the impact of events on the child (internal frame of reference) rather than to external facts only.

Question 30

Impact of events on the child.

Answer 30

Internal frame of reference

Question 31

6. Respond in a voice, tone, and intensity that reflect ________________.

Answer 31

The affect expressed by the child.

Question 32

Check out the accuracy of your understanding with the child, but in such a way that the child can modify or change your perceptions in the reaction. If you are aware that a child is experiencing feelings, even though your awareness is from the child’s nonverbal behavior, feed this back to the child in supportive, non-threatening permissive manner.

Answer 32

7. Develop your skill in recognizing and responding to minimal cues of the child.

Question 33

This will provide the child with a basis for expressing feelings.

Answer 33

8. Express your own feeling that are natural to the situation.

Question 34

Do not try to attach adult meanings to the child’s questions. Usually the child’s questions are quite simple and factual.

Answer 34

9. Accept the child’s questions.

Question 35

Do not expect a child’s reaction to the experience of death to be obvious and immediate.

Answer 35

10. Be patient and available

Question 36

Remember- the child is part of the family. Reassurance comes from the presence of loving people. Children feel secure in the care of gentle arms and loving tenderness.

Answer 36

11. Provide reassurance through action as well as words.

Question 37

Generally speaking, acceptance, reflection, and silence often result in increased understanding. Oftentimes the child needs permission to talk at his/her own pace, not to be talked to.

Answer 37

12. Learn to tolerate and feel at ease during reasonable periods of productive silence.

Question 38

Do not wait or plan for “one big tell-all.”

i.e., Death of a pet, news event.

Answer 38

13. Maintain a continuing dialogue with children about death as the opportunity arises.

Question 39

Recognize your helping-healing ambition and attempt to create a relationship with the child which is basically a healthy one.

Answer 39

14. Create a healthy relationship between you and the child.

Question 40

Remember- no one procedure or formula will fit all children, either at the time of a death experience or during the period that follows.

Answer 40

15. Select and adjust your procedures according to the child.