In my therapy work with grieving children and adolescents, it is important for me to keep in mind that the child’s age and stage of development at the time of the loved one’s death will strongly influence the ways in which the child reacts and adapts to the loss. An understanding of the child’s emotional and cognitive development will enable me to determine how best to communicate about death with the particular child, to understand and empathize with the child’s experience and guide the child through the grieving and healing process with appropriate interventions.
For example, I successfully worked with a grieving twelve-year old girl, who I will call “Abby.” I worked with Abby both individually and in a small group with other grieving pre-teens at a hospice-based children’s grief support group. Abby’s maternal grandfather died suddenly and violently two years ago while cleaning his gun. There is some uncertainty as to whether the death was accidental or a suicide. Abby is an only child, who lives with her mother. Although Abby did not speak with me about it, her mother has reported that Abby’s father physically abused Abby when she was four or five years old and he has been court ordered to not have contact with her. Abby has not seen her father (who is divorced from her mother) since she was six years old. She had a very close relationship with her grandfather, and spent every Saturday with him, doing special things together. Abby reports that since her grandfather’s death, she spends her Saturdays alone, mostly sleeping.
The Interdependence of Grief and Development
Childhood grief and development are interdependent: The early death of a parent or other loved one affects a child’s development, and the child’s development affects how he or she will grieve and reconstruct his or her relationship with the deceased. Furthermore, children re-experience their grief as they reach each milestone in their development. .
Capacity to Grieve and Understand Death’s Finality
A child’s ability to understand the meaning and finality of death corresponds to his or her cognitive development. For example, a three to five year old believes that the deceased person has gone away and will return at some point. Thus, it is common for a child of this age to constantly ask questions such as “Where’s Daddy?” and “When is Mommy coming home?” A child of five to approximately nine years of age believes that death can be avoided. Furthermore, a child in this egocentric phase also believes that his or her parent died because either the parent was bad or the child was bad, and that if the child is good, the parent can return. This is thus seen as one of the most vulnerable and difficult developmental stages for adjusting to a parent’s death
In working with Abby’s grief over her grandfather’s death, I always kept in mind that she was dealing with her loss both from her current cognitive developmental stage, and from the earlier stages she was in when her father abused and then left her. Thus, she was likely relating to her grandfather’s death emotionally from that earlier stage, and may believe that she is somehow be responsible for his death. The child at this stage needs someone who can clarify what the child is thinking and feeling, and can reassure and build self-esteem by praising the child’s accomplishments. This is something that I tried to do each time I met with Abby.
Although Abby is able to grasp and verbalize abstract concepts about death, her grief process was still informed by early developmental issues of safety and trust, as well as the magical thinking of the child in latency. Abby’s grandfather’s sudden and violent death, coupled with her father’s abuse and abandonment, seems to have made it unsafe for Abby to trust and truly connect with her peers at a life stage when peers and feeling accepted are so important to social and emotional development.
Developmentally, even in more “normal” circumstances, 12-year olds yearn to belong, but may feel different and isolated, as the brain and body go through a dramatic growth spurt instigated by a surge of hormones. Physically, a 12 year old girl is starting to become a woman, and may experience self-consciousness and awkwardness that may lead to withdrawal. Emotionally, she may experience a strange and seemingly uncontrollable roller coaster of highs and lows exacerbated by pubertal hormonal changes, as well as grief over the impending loss of her childhood. Cognitively, in moving from concrete to abstract thought, an introspective and intelligent 12-year old like Abby is increasingly aware that others may not share her feelings, thoughts and values. A grieving pre-teen, like Abby, may also feel different because so few of her peers have experienced the loss of a loved one. This recognition can lead to the first taste of existential alienation, causing further withdrawal. Those who are more firmly in the formal operational stage of abstract reasoning can have a more panoramic view about these differences, and develop true compassion and empathy for others. The child not quite out of concrete operational thought, especially one dealing with profound grief like Abby, may have a difficult time getting to that stage, and may regress to more egocentric behaviors, like those I have witnessed in Abby’s case.
Tasks of Children’s Mourning
Worden (1996) has identified four tasks of mourning: (1) accepting the reality of the loss, (2) experiencing the pain and emotional aspects of the loss, (3) adjusting to an environment without the deceased, and (4) relocating the dead person in one’s life. The satisfactory completion of these tasks depends on both the child’s stage of development at the time of the death and his or her adaptability and ability to attend to any unfinished tasks at later stages of development.
Accepting the Reality of the Loss
A child can accept the reality of losing a loved one when he or she understands, through the achievement of formal operational thinking, “the nature of abstractions such as finality and irreversibility” (Worden, 1996, p 13, citing Piaget, 1954). Some grasp of such abstractions is possible during the concrete operational stage of cognitive development, and is only fully understood at the formal operational stage. Thus, if a loved one dies before formal operational cognition has been achieved, the child will experience a deeper level of grief when he or she attains that cognitive stage and fully and deeply comprehends the finality and irreversibility of the loss.
This was clearly the case for Abby. Abby has an understanding of the abstraction of death’s finality. She has been grappling in our sessions with giving spiritual meaning to the finality of death. My job was to empower Abby’s cognitive work by normalizing and validating her process and the private thoughts she has chosen to share with me, while at the same time providing a safe space for her emotional process. Furthermore, as Abby was then a pre-teen on the cusp of profound developmental challenges, I needed to stay aware that as she comes to terms with the meaning of her grandfather’s death, her new cognitive abilities also opens her to a new level of understanding – and pain – about the loss of her father.
Experiencing the Pain and Emotional Aspects of the Loss
The pain and emotions of grief can be frightening for a child to experience. Awareness of the child’s capacity based on his or her stage of emotional development to cope with strong emotions is important. It is also important to assess the child’s coping and defense mechanisms, and their effect on how the child experiences the pain of the loss.
In Abby’s case, the abuse and abandonment by her father early in her life has left deep developmental holes and she has split off from her emotions, which has complicated her grieving process over the death of her grandfather. Journaling in a group setting proved to be an effective means for Abby and the other group members to deal with their feelings, as well as allowing them to connect with the others and feel less isolated, empowered by the realization that they have all experienced a loss, and they are not so different, after all.
Adjusting to an Environment without the Deceased
This task is an ongoing process through progressive stages of development as well as important transitions throughout one’s lifetime. The child– as well as the adult he or she will become – re-experiences his or her grief at each stage of development as a result of his or her growing cognitive abilities, and also as he or she comprehends the vacuum left by the dead loved one, who is not there to nurture and support the child’s growth and achievements. An intervention I used with Abby was the creation of a memory box for her grandfather, in which she has placed pictorial depictions of their relationship. We also did an art therapy project together when Abby returned from summer vacation. This was primarily a non-verbal exercise in which Abby was able to “tell” her grandfather through the medium of collage about her summer activities and experience her emotions of loss and sadness on a somatic level. My job in this process was to simply sit beside her and be an empathetic witness. In joining with Abby in this way, we established a good degree of contact and trust.
Relocating the Deceased in One’s Life
As the child grows and changes, his or her relationship with the deceased parent or other loved one also changes (Christ, 2000). Thus, according to Worden (1996), another ongoing task is to find new ways to memorialize the deceased loved one with the attainment of each developmental milestone: Children need to “find a new and appropriate place for the dead in their emotional lives – one that enables them to go on living effectively in the world.” The above-described art therapy projects have been helpful with Abby in this regard. The narrative therapy intervention of letter writing was also helpful at this stage, having Abby write a letter to her grandfather. This process helped Abby clarify her feelings and create a safe container for them, allowing her to relocate her grandfather and live an effective life.