Abstract
This article is written to help counselors as they work with grieving mothers in their efforts to guide their children through the grief process while grieving themselves. It begins with a self-evaluation for counselors followed by an overview of the variances in grief between children, adolescents, and adults. Particular attention is paid to a newer aspect of grief study, which is thanatechnology. Following this overview, the article narrows in on the experiences of grieving mothers, leading to a discussion on specific counseling interventions as well as examples. Finally, a brief case study is provided for application purposes.
The authors of this article, all highly credentialed counselors and educators, arrived at this topic after facing the loss of loved ones and the aftermath that came along. A sister, a brother, two fathers, and a close friend's child are among some of the deaths they experienced and then had to walk through their own grief while simultaneously helping their children, ranging in age from preschool to high school. Along the way, it was realized that while there are a plethora of resources available for those who are grieving, there is a dearth of literature on how this dual process of a grieving mother and a grieving child can successfully take place in the same home. This article is an attempt to add to the literature by providing an overview of the different ways that adults and children grieve, as well as the unique ways that adolescents process and cope with loss. From there, an overview of the ways that grieving mothers can help their children in their grief will be provided, followed by counseling specific interventions and resources. The goal is to help counselors help their clients with practical tools that they can utilize as they walk down the grief road hand in hand with their children. First, it is important that counselors evaluate their own losses to help ensure they are prepared to join their clients in the deeply painful, and hopefully healing, grief journey. It should be noted that while there are many losses other than death that can lead to grieving, the focus of this particular article is on grief after death.
Self-Evaluation
In an article written to counselors about professional counselors processing personal loss, Professor Eric Cowan (2013) quotes the famed poet Robert Hass. In his 1979 poem “Meditation at Lagunitas,” Hass begins with these profound words: All the new thinking is about loss. In this it resembles all the old thinking. Whether it is fear of loss or grieving a loss that has taken place, humans spend a great deal of time thinking about loss. Cowan goes on to write that “We need to learn to live alongside loss because it is the rule and not the exception” (2013, para. 7). Counselors are also not an exception. As they help clients accept what they cannot change, are counselors doing this work themselves after experiencing a personal loss? Certainly, counselors cannot be expected to have it all together or not experience pain; they are, often, wounded healers. Henri Nouwen (1972) noted that, “A wounded healer is someone who can listen to a person in pain without having to speak about his or her own wounds.” If a counselor cannot remain present with a client or draws off his or her own loss—even if it is an attempt to help the client—then it may be that the counselor is not in a place to be able to assist clients with their grief. In these instances, counselors must take seriously the requirement in the ACA Code of Ethics (2014) that “counselors engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual wellbeing to best meet their professional responsibilities,” which is found in the introduction to section C, Professional Responsibilities (p. 8). There are many helpful self-care practices, and a plethora of resources for counselors to peruse to learn more about this important topic. In addition to self-care, grieving counselors should consider supervision, their own counseling, or taking a break from providing counseling services until they are in a more emotionally stable place.
Grief
Grief is not linear; rather, it is complicated, and often a never-ending process. Age and comprehension level impacts how one processes and grieves a loss. This includes how the loss is understood, the ability to remember both the person and loss, the length of grief, and how the loss and grief are communicated about (Hospice of North Coast, 2020). Some aspects of understanding include permanency including what happens after death (with varying faith perspectives being an important aspect of this for many people). These will be looked at more in-depth as they pertain to adults and children.
Adults
Adults have a continued awareness of loss with a fully developed memory of the deceased and a more mature understanding of what the death means, though they are less likely to share their feelings openly than children (Hospice of North Coast, 2020). Adults with grief have been found to be less accepting of the death of a loved one if the death was not natural (Gegieckaite & Kazlauskas, 2020). The researchers also determined that neutral acceptance of death was also associated with higher age and “the ability to find meaning in the death of a close one” (para. 1). On the other hand, older adults sometimes have a more difficult time with grief, with up to 7% experiencing a complicated grief reaction which may in part be due to cumulative loss, lack of social support, diminished capacity to cope, and dissatisfaction with counseling (in part due to counselors not being comfortable with grief) (Ghesquiere, 2013).
The constructs of normal grief versus complicated grief in adults has been widely debated and researched. One measure for normal grief is the Texas Revised Inventory of Grief-Present Scale, which explores reactions such as missing the deceased, experiencing pain when recalling memories, feeling the need to cry sometimes, being reminded of the deceased, and difficulty avoiding thinking about the deceased (Dillen et al., 2008, p. 391). The Inventory of Complicated Grief-Revised assesses separation distress, traumatic distress, length of distress, and impairment (Pigerson et al., 1995).
Children
Despite fearing their loved ones will die, children often believe death only happens to older people. They “do not fully conceptualize the fact they are mortal” (Chachar et al., 2021, para. 2). Their understanding of the loss is limited, sometimes the grief comes intermittently or appears all together absent, and—in fact—they may communicate more openly than adults (Hospice of North Coast, 2020). It should be noted that grief is more complicated for children that have a disability (Fitzgerald et al., 2021, p. 20).
Children experience grief in a variety of ways. Normal grief reactions include anger, fear, guilt, denial, sadness, acting out, difficulty concentrating, and withdrawal (Hospice of North Coast, 2020). Children can be further broken down into younger children (infants and preschoolers) versus school age children, with some differences between the two highlighted in the next two sections. Adolescents will be addressed separately.
Infants and Preschoolers
Children do not understand object permanence until they are over 2 years old (Fisher, 2018a). Unfortunately, as a result, this age group can be overlooked after experiencing a loss. Yet, what they exhibit demonstrates that they are impacted. Fisher (2018a) notes that these young children can be clingy, have poor impulse control, lack of emotional regulation, and might even have toilet training issues such as regression. Because of brain development that takes place during this developmental stage, “losses at this age have a higher chance of impacting children in significant ways” (Fisher, 2018a, para. 3).
Despite the research on bereavement in young children being scarce, it is vital to both understand how they grieve as well as how they can best be supported to give them the best chance at reducing the negative consequences they can experience after loss (Lytje & Dryegrov, 2023). These researchers conducted a qualitative study with 13 young children who had lost a parent; in addition to the children, the surviving parents were interviewed. The most common grief reaction was difficulty with sleep, which “many parents associated…with the quiet that existed” (Lytje & Dryegrov, 2023, p. 11). The parents also noted both regression and aggression as well as learning and concentration difficulties among their children.
School Age Children
Children who are older and with higher cognitive functioning can experience death as feelings of abandonment, may be preoccupied with death, may experience hyperactivity, might report somatic complaints (specifically experiencing physical symptoms similar to the way the loved one died), participate in emotional eating, and/or have difficulty concentrating (Fisher, 2018a). Experiencing the death of a loved one as a child or adolescent has been determined to be “a risk factor for distress and dysfunction” (Spuij et al., 2013, p. 187). These researchers note, as others have, that up to 10% of children who have experienced the death of a loved one develop psychiatric disorders including major depression and post-traumatic stress disorder. One study found that “children and adolescents with prolonged grief reactions had higher rates of previous personal history of depression” (Melhem et al., 2011, p. 911). The unique ways that adolescents experience and process death will be addressed next.
Adolescents
Adolescent grief looks different from that of younger children in multiple ways. Their reactions are significantly influenced by their level of development. Adolescence is a time of physical, emotional, social, and spiritual transition where teens begin to move out of black and white thinking and into more complex and abstract thinking (Fisher, 2018b; Wong et al., 2015). They question the world around them and want to know how and why things are as they are. This is also a time when teens long for independence and become less comfortable in seeking out support when issues or concerns arise. The period of adolescence is such a vulnerable time in terms of the development and establishment of significant relationships so a loss can be detrimental and severely impact their mental health and attachment if not addressed appropriately (Ross et al., 2021). During this period in life, adolescents are aware of the permanence of death but struggle to conceptualize what it means for them, their own mortality and the impact and implications on their life, so they often turn to the means in which they are most comfortable. They turn to technology for answers, support and feelings of connectedness (West et al., 2021).
Thanatechnology
Teens today are entrenched in technology and are using multiple digital platforms to engage in key developmental tasks and as their primary means of socialization and communication (Ehrenreich et al., 2021). Research indicates that by 2018, 89% of teens between the ages of 13 and 17 reported having their own smartphone (Rideout & Robb, 2018). In addition, 45% report being online almost constantly and 97% have access to at least one form of social media (Anderson & Jiang, 2018; Hutchison, 2018). While social media is used for a myriad of things, a recent article in the New York Times (Seligson, 2014) addresses how young adults are now redefining mourning via the Internet. This proliferation in adolescent use of digital technology has changed how teens are coping with grief and loss, both positively and negatively.
Adolescents are using digital media to deal with grief and loss through what is known as thanatechnology (Fisher, 2018b; Moore et al., 2019; Sofka et al., 2012). They are seeking comfort and creating connections through grief blogs, mourning sites, music playlists, social media apps, etc. (Sofka et al., 2012). There are benefits behind social media mourning and the use of digital platforms when dealing with grief. These include resources that can be accessed to gain information about grief, it provides a platform to speak from which allows connections with others that may be experiencing the same struggles, provides opportunities for self-expression, and support systems may be established. Social media also provides a creative outlet for honoring the deceased (Wagner, 2018). While there are benefits to the use of technology to deal with grief, it is critical that counselors also recognize the dangers. As teens navigate the world, they are vulnerable to the sensationalistic nature of things they see on the internet which can also lead to the glamorization of loss (Fisher 2018b). All of which can lead to unhealthy coping mechanisms as they navigate their grief. If social media is going to be used as a way to mourn, counselors must guide this population to develop not only the skills but also the perspective to navigate this in a healthy way (Sofka, 2018).
Helping Mothers Help Their Children—An Overview
One of the hardest experiences of being a mother is to experience one's child struggling and not know how to respond. A child struggling with grief resulting from the loss of a loved one can be one of the most difficult of these parental experiences. Some parents may want to shield their children from such grief, but it is not realistic to think such a goal is possible or even desirable. It is not a question of whether such grief will come, but when it will come. If parents want to raise children who become well-adjusted adults and can handle the trials of life, then they should allow experiences that build resilience toward that end (Fitzgerald et al., 2021). Since mothers typically spend more time with their children than anyone else, they know them more intimately and can usually provide emotional support in a unique way. However, if mothers are also grieving it may be more difficult for them to support their children as needed. In cases where the parent cannot provide emotional support during a period of such grief, another adult, including a counselor, should be considered (Lytje & Dryegrov, 2023). There are many important strategies to employ as the counselor comes alongside mothers in helping their children through the grief process.
Successfully navigating the grief process is important to a child's emotional development. One way to promote this emotional development is to allow children to experience the grief with their parents. Mothers should not shy away from grieving in front of their children. For example, mothers who allow their children to see them cry can communicate that grief is permissible and not something that should be hidden or shameful (Mae, 2019). However, this is not a time for the parent to lean on a child or look for them to lead in the grief process. Rather, it is important for a parent to have an appropriate peer to consult about their struggles with grief. Nevertheless, there may be times that a child chooses to comfort a parent or walk alongside them in a moment of grief (Mae, 2019). This “tender intimacy and shared vulnerability” can be healing (Mae, 2019, p. 1). While allowing a child to see a parent walk through grief can result in healthy emotional development, this can lead to some confusion (Mae, 2019; Thompson, 2016).
While including children in the grief process is important, it can cause them to have questions along the way. Oftentimes, these questions may be difficult to answer, but it is essential for mothers to respond to them honestly and age appropriately (Stevenson & Cox, 2017). Adults tend to shy away from the difficult questions of the grief process resulting in avoidance. Some examples of difficult questions from children may include: “Where is his/her body now?”, “Can they hear me in heaven if I talk to them?”, or “Will this happen to me soon?” The goal for the parent is to answer as much as possible and realize that it is permissible to say, “I don’t know.” Avoiding the difficult questions can come across as a lack of respect for the child's feelings and stifle further open communication between parent and child (McEntire, 2003; Stevenson & Cox, 2017).
In addition, healthy communication is vital in helping children through the grief process. Counselors should encourage mothers to avoid downplaying death when responding to their grief. Instead, parents should strive for honesty and clarity when communicating and not withhold appropriate information. If children sense adults are not being honest with them it can fracture important relationships (Treasure, n.d.,). These relationships are vital to a child's growth and development so having good communication through a healthy relationship following loss strengthens resilience in bereaved children. This has been shown to reduce the likelihood of aloneness and risky behavior (Lytje & Dryegrov, 2023).
Another important aspect of helping children through the grief process is remembering the lost through conversations. It is natural to want to suppress feelings of grief by not bringing up the person who has died or talking about them. However, reminiscing about the deceased can help the grief process. Taking time to look at pictures, videos or sharing favorite thoughts or memories about the deceased is healing and should be encouraged. This approach creates healthy connection and can reduce distress (Wardecker et al., 2017).
Counselors should also guide mothers to pay attention to their child's verbal and nonverbal messages for cues in the grief process. “Children often speak to us most clearly through their play, illnesses, and other behaviors” as much as their words (Treasure, n.d., p.1). A child having an outburst or reporting an unexplained pain after a significant loss is not abnormal (McEntire, 2003). There are even times when a child communicates how they feel by using drawings, songs, or other creative means that they are unable to otherwise express (Edgar-Bailey & Kress, 2010; Thanasiu & Pizza, 2019). Thus, mothers should pay attention to any changes in behavior as to not miss these potential signs of grief.
Since most children spend so much of their day at school, these behaviors may likely manifest in that setting. It is important for parents to communicate with teachers, administrators, or school counselors about the loss. Specifically, the school counselor or other school personnel may be able to provide support to the student (Eftoda, 2021). Support from schools or daycares can reduce additional strain and provide some relief for parents who may not be able to provide their child with all the support needed while they, too, are grieving (Lytje & Dryegrov, 2023).
Mothers should also keep in mind how the developmental needs of a child impact their grief (Fitzgerald et al., 2021. Some concepts of death, such as permeance, can be different for younger children than older children (Chachar et al., 2021). As such, the parent may need to revisit issues with their child as they grow and develop keeping in mind that death is not a one-time conversation, but rather an ongoing process over time. Allowing the conversation to remain open is very important for children as grief is a process (Dealing, n.d.). This allows them time to grieve because the process of grief for children can be unpredictable and delayed. Like adults, grieving children have good days and bad days. Often children's expressions of grief may seem abrupt. There may be moments of tears followed immediately by pretend play or coloring. Counselors should help mothers to know that such behavior is normal and healthy. Children know what they can handle emotionally, and when they are ready to express or discuss this grief again, they will (Webb, 2010).
Finally, memorializing events can also help children in the grief process. Including the children in these memorial acts or conversations is important. Some parents are hesitant to allow their children to attend a funeral or view the deceased body. However, most research shows that allowing children to view the body can have positive impacts on the grief process (Lytje & Dryegrov, 2023; Søfting et al., 2016). Another way memorialize is to remember the lost loved one during birthdays, anniversaries, holidays, and other special times. For children, creativity is life (Arnold, 2017). Mothers should encourage them to draw pictures, make cards, write songs, or engage in other creative outlets. This activity can help process grief and should be promoted. Mothers should also not be afraid to let the child lead in this process. They may have plans for the special day or a specific way they want to memorialize the lost loved one. Mothers should try to be patient and listen to their children's ideas and redirect when necessary.
Grieving while a child grieves can be a challenging experience. However, the reality of grief and loss cannot be avoided and often affects both the mother and the child. As a mother intentionally walks with her child through grief, there is great benefit for their emotional, social, and mental well-being. Therefore, it is essential that mothers are equipped with the necessary tools to help their children navigate the journey of grief and loss.
Counseling Specifics
Interventions
Grief is personal and no two people grieve the same. Iglewicz et al. (2020) stated, “Each close relationship is unique and so too is each person's grief. Loss of a loved one is a complex and profound experience that brings many associated changes in physical, psychological, and social spheres” (p. 94). Grief does not have an end date and requires care and attention throughout an individual's life. Grief counseling helps individuals learn healthy coping skills, understand emotions, and ultimately find a way to adapt to life without their loved one.
Adults and children react differently to grief. It is critical that counselors do not impose adult models for coping with grief on children and adolescents but that there is a recognition of the varied symptoms of grief as it may be masked in a variety of behaviors resulting in misdiagnosis and treatment. Children often behave differently after a significant loss; older children often feel helpless and frightened, desiring to revert to childhood where they had a sense of protection from death or loss while also feeling the need to act more like an adult, leading to suppressed emotions (Halder & Samajdar, 2020). Caregivers and counselors have a responsibility to help children learn to process their feelings surrounding the death of their loved one while being intentional to remember and celebrate who they were in their life and setting new goals for opportunities ahead (Ferow, 2019). Counselors and parents can use various grief focused interventions to help children and their parents process their grief. A definition of the intervention and how the interventions can be used to help individuals dealing with grief will be provided.
Mindfulness
Dr. Jon Kabat-Zinn (1994) coined the term mindfulness. He defines as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994). Mindfulness helps individuals manage stress, unpleasant thoughts, reactions, and symptoms while feeling more in control (NCTSN, 2005).
A few examples of helpful Mindfulness activities are:
Deep breathing—Individuals are taught to use diaphragmatic breathing, inhaling through their nose and exhaling through their mouth. Children can be taught to breathe like they’re blowing out a birthday candle. Grounding Technique—This can be done alone or lead it with your children. Especially when you feel highly emotional or notice your children highly emotional. To start, take a deep breath then using your 5 senses ask, what do you see, feel, hear, smell and taste. It's okay if you can't come up with them but try. Then end with one mantra you say to yourself, ex: “I am trying.” “I am doing the best I can” whatever is helpful. Explore a fruit—Using your five senses, observe and describe a fruit while you peel and eat it. Categories—Ask yourself to recall five things in a specific category. For example: Name five of your favorite restaurants, name five of your favorite colors, etc. Guided imagery—Visualize a positive experience that was experienced with the deceased in the past. OR Visualize a calming place (such as walking in a field of flowers and picking them to give to your loved one).
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a form of therapy that helps individuals learn to identify and change negative emotions, behaviors, and thoughts. CBT for grief looks specifically at techniques to encourage the acceptance of loss, modifying negative thoughts, and avoidance behaviors toward grief. Therapists may ask individuals to discuss their thoughts or feelings about their loss. This may help individuals identify any negative thoughts to understand how they’re impacting their current behaviors as they grieve.
A few examples of helpful CBT grief activities are:
Have clients write down or discuss their questions and feelings about death. Clients could also act out their feelings toward death. Have clients write or discuss what they miss most about their loved one who passed. Clients may also want to discuss what they will miss most in the future and what they can do to cope/honor the person. Encourage the client to create a memory box or photo album. Discuss special dates or events that will be coming up. Develop a coping plan. Replace negative thoughts with positive/calming thoughts. Example: “My grandma is dead, life sucks!” Vs. “Sometimes life is fun and others it's hard. Right now my life is hard and it's okay to be sad.”
Narrative Therapy
Narrative therapy is based on the idea that people interpret meaning out of their lives through the stories they live (Ricks et al., 2014). The more individuals share their stories, the easier it is for them to accept and change their story. Children often avoid reminders of death because it overwhelms and upsets them (NCTSN, 2005). When children are able to control their feelings in a controlled environment, using coping skills, they’re better able to tolerate the thoughts and feelings about death (NCTSN, 2005). Individuals can retell their story about their experience and grief to take ownership of their experience. This helps clients with self-exploration and empowers the client. Some examples of narrative therapy that can be used in grief counseling are:
Have client tell you their story. Encourage clients to tell others. Have children tell you what life was like before their love one passed. Roleplay—“Imagine you are ______, what would they say to you right now?” Creating a timeline—“How do you position yourself within this situation/ story?” Images—“Could you describe what you saw, felt, heard?”
Art Therapy
Art therapy focuses on creativity to help individuals process their grief. The goal is for clients to use their art to share their memories and/or honor their loved one who has passed. Art therapy has been shown to help individuals express complex emotions while gaining a sense of control and reshaping how they see themselves (Arellano et al., 2018).
Have client paint or draw a picture of their favorite memory Draw/paint emotions Past/present/future—Have clients draw out what their past with their loved one held, how their loved one has shaped their present and what their future may look like without the departed.
Play Therapy
Play therapy helps individuals express their feelings, emotions and problems through play. Children often have a hard time expressing their feelings in words, especially their feelings surrounding death (Webb, 2011). Play therapists use a variety of play materials to have children express their anxieties and fears related to death and their loved one.
Have child draw out their feelings of their loved one's death. Draw a picture of their favorite or significant memory. Using playdough, have children create a sculpture of their loved one. Ask them to describe them once they’ve finished.
Music Therapy
Music can be used in counseling to help individuals put words to their feelings and emotions. The American Music Therapy Association (2005) states music therapy interventions help promote wellness, manage stress, alleviate pain, express feelings, enhance memory, improve communication, and promote physical rehabilitation. Music can help individuals express painful life stories they have been unable to express previously (Ricks et al., 2014). Some examples of music therapy for grief counseling are:
Having clients share a song and explain how/why they identify with the song. Have clients write a song to express their thoughts/emotions. Share a song/lyric and ask clients if they speak to them.
Children who are grieving may have a hard time learning to cope with their loss. Identifying various grief focused interventions can help children and their parents cope with social and emotional changes while also finding new ways to integrate their loss into their life.
Fictional Case Study
A 40-year-old female, the mother of 3 children ages 3, 7, and 14, is seeking professional counseling because she is struggling with the loss of her father while also navigating the grief experience of her 3 children. Not only are the children dealing with the loss of their grandfather, but also the impact their mother's grief is having on them. The mother feels overwhelmed with emotion and a sense of dread and has indicated that “nothing will ever be the same.” She does not know how to cope with her loss, let alone help her children, all at different developmental stages, through the grief journey. Her youngest child is experiencing occasional tantrums while her middle child is having difficulty sleeping, sharing that she is afraid if she goes to sleep, she will not wake up just like grandpa. The mother is most concerned about her oldest child as he seems to be withdrawing and spending extra time on his computer while showing little to no emotion and no desire to discuss the loss with anyone. By using a CBT approach with this mother, she will be able to express her feelings about her father's death, identify any negative thoughts and learn to replace those with positive and calming thoughts. She will have the opportunity to grieve his loss in a healthy and safe environment while also learning strategies that will help her children grieve. The counselor suggests play techniques, being the most appropriate for the youngest, art for the middle child, and thanatechnology for the oldest where he creates a blog that can be used to share his pain, his memories and songs that bring comfort.
Conclusion
There is no easy or quick fix to grief. In fact, there is no fix at all. Rather, grief truly is a process with many ups and downs. This process can be made more challenging and complicated for mothers who are simultaneously carrying their own grief while trying to walk their children through grief. This article attempted to assist counselors who are working with female clientele in this position, through a broad overview of the differences between childhood, adolescent, and adult grief experiences while also providing clinical applications and examples of how each proposed intervention can be utilized in counseling. Many factors must be considered with working with the grieving, including their own cultural background and how that informs their inward and outward experiences and expressions after loss. Additionally, developmental stages of the child as well as the context of and specifics surrounding the death must be taken into consideration as a treatment plan is developed. The authors of this article are in the process of further developing and contributing to the limited body of literature surrounding this important topic of helping grieving mothers guide their children through the grief process.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
