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Anticipatory Grief and Bereavement

December 5, 2011

TLC Guest Blogger: Lori Gill, M.A.

“Anyone old enough to love is old enough to grieve.” Alan Wolfelt

Imagine being a child of 7 or 8 years whose parent has been terminally ill since you were born. You grow up with the understanding that your parent is going to die, being told, “this is it,” witnessing several close calls, hearing ambulances, being rushed to the hospital, and witnessing overall family anguish. Fear, lack of control, confusion and a considerable degree of unpredictability often characterize this experience.

What it is

The situation described above is often referred to as anticipatory grief, bereavement or mourning. The anticipated death creates a sense of loss before death has occurred and often generates feelings of fear and confusion. Loss and bereavement are a natural part of the life cycle. When illness is prolonged with impending death looming, it can be particularly traumatic. However, according to Perry (n.d.), educating and preparing a child for the anticipated loss can help ease the experience and facilitate healthy change.

How to help

Many children lack an understanding of what is happening, often because parents do not know what or how much to share. Providing a child with developmentally appropriate information helps them process and prepare for the anticipated loss. Victoria Hospice Society provides guidelines for helping children and teens with anticipatory grief and bereavement when someone is terminally ill. This is a valuable resource for explaining the developmental aspects of various age groups in the information, language, and overall comprehension around death and dying.

What parents, professionals and educators need to know

Those involved need to be educated about the symptoms of trauma and the impact it can have on school performance, behaviors in various settings and overall functioning. The experience of anticipatory bereavement and grief can profoundly impact a developing child and his or her ability to function and learn. Similar to other trauma experiences, these symptoms may be misinterpreted as behaviors such as opposition, inattention, defiance etc. However, this is often not the case. Imagine being the above child living in a home where the illness is not discussed. You have no awareness of what is happening or why mom or dad look different, you don’t understand why they can’t get out of bed and you are unsure whether or not they will be alive tomorrow. Is it any surprise that learning shifts to the low end of the priority list? Knowledge empowers us and provides a sense of increased control and a degree of predictability, not just for the family and child but also for school staff. Many Hospice organizations offer anticipatory bereavement services.

“What is sharable is bearable.” Daniel Siegel

Therapeutic Activities

There are many activities that can be completed individually or as a family to help process and prepare for the loss or following their loss. Malchiodi (2008) suggests that various creative therapies, including music and art, can be helpful to children during this transition. Some of my favorites include:

  • Creating a family tree painting using the handprints of family members as the leaves with wishes for each other.
  • Constructing a worry creature using visualization and sensory integration and asking questions such as: if worry was a creature what would it look like, sounds like, smell like, feel like, taste like etc. (Adapted from Erinne Andrews, Art Therapist).
  • Creating a grief or memory collage to music.
  • Developing messages in art (if you could create a message for your special person using art as a form of expression, what would you want to communicate?).
  • Creating a CD cover of songs that represent their emotions pre- and/or post- bereavement (Malchiodi, 2008).
  • I have consistently used TLC’s Trauma Intervention Program for Children and Adolescents very successfully to address anticipatory bereavement. This was particularly effective for providing insight into the impact on the child and their needs for the parents  (Steele et al, 2008).

Worry Creature (Creative Counseling, 2011)

References

Malchiodi, C., A. (2008). Creative Interventions with Traumatized Children. New York: Guilford Press.

Perry, B., D. (n.d.). Children & loss: Teachers serve as a crucial emotional bridge for a child at times of loss. What do we need to know to help students cope? Retrieved November 15, 2011 from: http://www.scholastic.com/browse/article.jsp?id=4040

Steele, W. (1997). Trauma intervention program for children and adolescents: Short-term intervention model. The National Institute for Trauma and Loss in Children (TLC). Gross Pointe Woods: MI.

Supplementary Resources

TLC’s Parent Trauma Resource Center

Child and Teen Grief: Information for Parents and Caregivers http://www.victoriahospice.org/sites/default/files/imce/VicHospChildrenTeenGrief.pdf

A developmental guide to anticipatory grief and bereavement.

Give the Gift of Goodbye

http://www.youtube.com/watch?v=4T0a8GUpQgQ

A video clip speaking about anticipatory grief, the associated benefits, and relevant activities.

Strength for Caring

http://www.strengthforcaring.com/manual/grief-death-and-dying-end-of-life-care/what-is-anticipatory-grief/

A manual with resources in relation to death and dying.

WinterSpring Centre

http://www.winterspring.org/resources/old_enough_to_grieve.shtml

An organization providing information about anticipatory grief and bereavement.


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