International Society for Traumatic Stress Studies

Parental Grief Facilitation: How Parents Can Help Their Bereaved Children During the Holidays

Posted 4 December 2014 in StressPoints by Julie Kaplow, PhD, ABPP, Christopher Layne, PhD and Robert Pynoos, MD, MPH

For most children and families, the holiday season is a happy time that they look forward to all year. It is traditionally a time for revisiting fond memories of prior celebrations and creating new, meaningful holiday traditions.

However, holiday gatherings and other special occasions often serve as potent loss reminders (i.e., reminders of the continuing physical absence of the deceased; Pynoos, 1992) for bereaved families that make this an especially difficult time of year—one that calls for considerable sensitivity on the part of mental health professionals.

A growing literature is beginning to highlight the critical role that caregivers play in helping their bereaved children cope with loss reminders, make sense of their personal reactions to reminders, and find comforting and healthy ways to feel connected to their deceased loved one (Kaplow, Layne, Pynoos, Cohen, & Lieberman, 2012).

Bereaved parents must typically deal with their own mourning and personal grief reactions, which can make it more difficult to recognize their children’s grief reactions and intuitively understand how to help each child grieve in adaptive ways (Furman, 1981). Family members often grieve differently, depending on such factors as their previous life experiences, development, relationship to the deceased, family roles and experiences surrounding the death.

These differences can create dyssynchronies between how family members grieve and mourn that make it more difficult for them to be sensitive to one another’s needs. Our research program is providing us with insights into parental grief facilitation—that is, into how parents can help their children to grieve in comforting and adaptive ways. Below, we offer six guidelines that parents can draw upon to promote their children’s adaptive grief and ease their distress during the holidays.

Guideline 1: Body language matters
Our work has shown that certain positive parenting behaviors (as measured during conversations between surviving caregivers and their children) are linked to lower levels of distress in bereaved youth. These parenting behaviors include: (1) parental warmth; (2) hugging or other expressions of physical affection; (3) smiling; (4) making appropriate jokes; (5) engagement and enthusiasm about what the child is sharing; (6) enjoying being with the child; and (7) maintaining good eye contact (Shapiro, Howell, & Kaplow, 2014).

Of particular interest, these forms of body language are more strongly associated with reductions in the child’s distress than the verbal content of the parents’ conversations about the deceased person. This finding suggests that it may be more helpful for parents to focus on being present and engaged than to focus on finding the “exact right words.” Bereaved children are often very “tuned in” to the expressions and emotions of their surviving parent, and thus may worry that discussions about the deceased person will upset their parent, particularly during the holidays.

Consequently, children may avoid mentioning the deceased out of a caring desire to protect their parent from further distress. Instead, the parent’s ability to demonstrate (including through nonverbal cues) a capacity to listen and a genuine interest in the child’s thoughts or feelings about the deceased person (including difficult questions and emotions), may help to alleviate children’s concerns. This can open the door to honest and supportive parent-child communication in ways that reduce the child’s distress and foster a sense of positive connection to the deceased.

Guideline 2: Be sensitive to the child’s reactions and needs in the moment
Given that children grieve in personal and often private ways (e.g., a child may enjoy warm reminiscing and joking, have lots of questions about the deceased’s life or death, or instead need moments of quiet sadness), the positive engagement behaviors listed earlier should be viewed as part of a repertoire of potential ways to communicate with a grieving child.

Caregivers can look for opportunities to “sync” how they talk about the deceased with how the child is grieving and mourning in ways that feel sensitive and supportive. It is important to appreciate individual differences in how bereaved children grieve, including among siblings. Some children may want to talk frequently about the deceased person and his/her death, whereas others may not want to discuss the topic at all during the holidays.

Further, some youth may become extremely emotional (e.g., sad, tearful, angry, or bittersweet joyful) during these discussions, and others may show little emotion. It is important for parents to remember that children grieve in many different ways, and that there is no “right” or “wrong” way to grieve. The most important thing that parents can do is to meet their children where they are at in terms of their own readiness to discuss the death or engage in memorializing activities.

Guideline 3: Be prepared to answer questions honestly
When confronted with loss reminders such as holiday gatherings, children may experience not only separation distress (intense longing for the person who died), but also circumstance-related distress (preoccupation over how the person died or the cause of death) (Kaplow et al., 2012; see also Layne, Warren, Saltzman et al., 2006, for definitions and conceptual distinctions between loss reminders and trauma reminders).

Circumstance-related distress may manifest as a need to revisit and make sense of the events leading up to the death, including asking the parent questions about how the person died, even if the death was due to “natural” causes (Kaplow, Howell, & Layne, 2014).

Our experience suggests that children are almost always aware on some level of parents’ attempts to hide important information about a death. Although caregivers may have the best of intentions by withholding certain facts about the circumstances of the death, this can create problems by making children feel invalidated, confused, or distrusting towards their caregivers.

Our recent work suggests that children “know what they are not supposed to know” (Bowlby, 1979) about the death itself and display symptoms consistent with the “true” cause of death, even if this information was not shared by their caregivers (Kaplow, Howell, & Layne, 2014). We also find that the more parents are able to provide honest answers to their children’s questions about how the person died, the more adaptive grief reactions the children exhibit (Kaplow, Wardecker, Wamser-Nanney, Layne, & Pynoos, 2014).

Consequently, providing age-appropriate information about the circumstances surrounding the death of a loved one (by “titrating” facts based on children’s developmental capacity to comprehend and accept the information) appears to be an important part of facilitating adaptive grief in bereaved children. These discussions can be especially challenging or anxiety-provoking for parents when the circumstances of the death were particularly tragic or violent, such as in cases of suicide or homicide (Furman, 1981). In these situations, it can be helpful to have an additional trusted and caring adult or bereavement therapist available to help facilitate the discussion and serve as a support to both the parent and the children.

Guideline 4: Do not assume that parents’ grief is similar to their children’s grief
Using our multidimensional approach to assessing children’s grief reactions (Kaplow, Layne, & Pynoos, 2014a; Kaplow, Layne, Saltzman, Cozza, & Pynoos, 2013; Layne, Kaplow, & Pynoos, 2014), we have found that parents’ own self-reportedgrief reactions are not correlated with their children’s self-reported grief reactions (Kaplow, Wardecker, et al., 2014).

Despite empirical evidence that parent’s own self-reported grief reactions are quite different (and indeed independent) from their children's own self-reported private grief reactions, parents (and perhaps also researchers) may presume that bereaved children experience the same grief reactions as their parents do and thus have the same grief-related needs and wishes. In fact, as with other forms of internalizing symptoms such as anxiety and depression (e.g., De Los Reyes & Kazdin, 2005), parents tend to be poor reporters of their children’s internal grief experiences (Kaplow, Wardecker, et al., 2014). It is imperative to understand that grieving and mourning are often intensely private experiences and thus very difficult for even close attachment figures to accurately identify and assess in children (Pynoos, 1992).

Parents’ misperceptions regarding children’s private grief experiences can lead to inaccurate conclusions, misunderstandings, and potential conflict. For example, based on his/her own desire to avoid holiday-specific loss reminders, a surviving parent may choose to discontinue former holiday traditions (e.g., playing the deceased person’s favorite Christmas songs), whereas the child may instead wish to hold on to these longstanding traditions that he/she perceives as comforting and helpful in fostering a sense of positive connection to the deceased.

This potential for dyssynchronies and misunderstandings may require that parents plan ahead by sensitively asking their children what they think would be most helpful to them during the holidays and laying out different options for how to handle the challenges of celebrating the holidays without the deceased person there.

Guideline 5: Provide opportunities to help children feel connected to the deceased
The holidays are often a time when children feel greater separation distress and may feel more disconnected from the deceased, especially if the death occurred some time ago. Thus, it can be helpful for parents to providetheir children with opportunities to feel more connected to the deceased when and if they are ready. This can include sharing stories about the deceased person, looking at pictures, handling his or her favorite things, reading his or her letters, or even reading condolence cards or sharing things heard at the memorial service that help to honor the deceased.

Similarly, we have found that parents’ sharing of honestly held, comforting spiritual beliefs (e.g., Dad is your guardian angel and will protect you, or we will all be together again someday) can be particularly helpful in promoting children’s adaptive grief reactions and reducing separation distress (Kaplow, Wardecker, et al., 2014; Howell, Shapiro, Layne, & Kaplow, in press). We have also found that it can be helpful when adult caregivers disclose their own grief reactions (to a reasonable degree), rather than asking children to self-disclose by posing direct questions.

For example, instead of directly asking his children, “How are you feeling about celebrating Christmas without Mom this year?” a bereaved father might say, “This is our first Christmas without Mom. Even though I'm feeling happy and grateful to have all of you here, I’m sad that she can’t be with us to celebrate” and then sensitively respond to the children’s reactions.

Guideline 6: Be aware of “red flag” grief-related behaviors
Notably, most bereaved children do not exhibit “clinically significant” psychiatric symptoms (Kaplow, Saunders, Angold, & Costello, 2010), and the majority of bereaved youth go on to lead productive and healthy lives (Keyes et al., 2014; Kaplow & Layne, 2014). Although some symptoms of grief-related distress are perfectly understandable and expectable, it is important for parents to be aware of signs that signal a possible need for referral, assessment, and intervention.

For example, it is common for children to have reunification fantasies about seeing the deceased person again (Kaplow et al., 2012), especially during the holidays. However, if children express overt wishes or urges to hurt themselves or have elaborate fantasies that involve ending their lives in order to be reunited with the deceased in an afterlife, a more in-depth, grief-informed assessment by a mental health professional may be warranted (Layne, Kaplow, & Pynoos, 2014).

The fact that parents tend to be inaccurate reporters of children’s internal grief experiences (thoughts and feelings about the death or the deceased person) underscores the need for “best practice” bereavement assessment tools and procedures. These procedures should include the use of children’s self-reports of their own personal grief reactions (e.g., Layne, Kaplow, & Pynoos, 2014) supplemented by parental assessment of their children’s observable, behaviorally-anchored risk indicators that caregivers can accurately identify (e.g., Kaplow, Layne, & Pynoos, 2014b).

For example, observable high risk behaviors that may require grief-informed intervention (e.g., Saltzman, Layne, Pynoos et al., 2014) include: (1) an inability to keep up with daily tasks, such as going to school, completing homework assignments, personal hygiene, and so on; (2) significant signs of sadness, tearfulness, lethargy, or social withdrawal that persist for at least six months following the death; (3) risky behaviors (drug use, driving under the influence, stealing, reckless driving, etc.); or (4) inability to acknowledge the death, or appearing numb, emotionless, or disconnected from the reality or consequences of the death (Kaplow, Layne, & Pynoos, 2014b; Layne, Kaplow, & Pynoos, 2014).

Although the holidays can be a very difficult time for bereaved families, parentally facilitated grieving can help children to remember and honor their deceased loved ones while creating new, meaningful holiday memories. Thoughtful balancing of comforting holiday traditions with open, honest discussions and new celebratory activities can serve to buffer feelings of distress, promote a sense of connection to the deceased, and encourage a positive outlook on the future as children enter the New Year.

About the Authors

Julie Kaplow, PhD, ABPP,  is a licensed clinical psychologist, Associate Professor, and Director of the Trauma and Grief Center for Youth in the Department of Psychiatry and Behavioral Sciences at the University of Texas Health Science Center at Houston. Dr. Kaplow’s professional interests have focused on adaptive and maladaptive grief reactions in bereaved youth as well as the interplay between childhood trauma and grief. Findings from these research studies are now being used to inform theory-building, test development, assessment, and intervention efforts targeting bereaved youth and families, including those in underserved communities.

Christopher Layne, PhD, is a Research Psychologist in the UCLA Department of Psychiatry and Biobehavioral Sciences and Director of Education in Evidence Based Practice at the UCLA/Duke University National Center for Child Traumatic Stress. His professional interests include evidence-based assessment and practice; professional education; and the conceptualization, measurement, and treatment of traumatized and bereaved youth. Dr. Layne has over 15 years of experience in constructing and empirically evaluating tests designed to assess grief reactions.

Robert Pynoos, MD, MPH, is Professor of Psychiatry and Biobehavioral Sciences, Director of Outpatient Trauma Psychiatry, and Co-Director of the UCLA/Duke University National Center for Child Traumatic Stress at UCLA. Dr. Pynoos was a member of the DSM-5 sub-work group that formulated the criteria for PCBD. He is an internationally known expert in childhood traumatic stress and grief and has written extensively on the developmental consequences of childhood trauma and loss, including efforts to elevate the standards of mental health care for child victims and witnesses.
 

References

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