Abstract
In this qualitative case study researchers interviewed 16 parentally bereaved children and their 11 surviving parents in order to conceptualize the emotional impact of losing a parent to death and to understand the possible influence of one bereavement program’s attempt to address these issues. An inductive constant comparative method was used to identify themes which were enriched through deductive computer assisted analysis. Themes presented by children and parents are discussed in terms of the emotional impact of the death and the influence of the program on each issue. Themes revealed were Sadness, Anger, Being Set Apart, Worries, Trauma, and Contemplation of Suicide.
RahDee’s mother died by suicide. RahDee, age 16, walked into their apartment happily talking on the cellphone to her teenage boyfriend. Her life changed as she screamed and cried, shaking the body of her lifeless mother. In the following months, she had to move to another state, lost her boyfriend, her friends, and her school, and considered ending her own life.
Adam, age 14, was awakened by the shouts of his mother as she called him to help her. His father was lying on the bedroom floor and his mother was crying into the phone as the 911 operator tried to calm her. Adam had learned CPR, and he worked diligently, and unsuccessfully, to revive his beloved father until the ambulance arrived and he watched the body of his father taken out of the house.
Billy, age 8, knew that there was more going on than just an automobile accident, as his grandmother cried and struggled to compose herself to talk to him and his brother. His mom was coming to pick them up, and she had had car accidents before. Billy still does not know the whole story of the flames that instantly engulfed his mother’s car, leaving no body of his mother for the family to mourn and bury.
In this qualitative case study the researchers interviewed 16 children and their 11 surviving parents or guardians (henceforth both called parents) in order to explore the emotional impact of the death of a parent and the influence of a therapeutic, theory-based grief camp on the children’s coping. All children had lost a parent within the past two years and had attended a camp for grieving children and their families within the previous eight months.
The death of a parent can change the whole world in a child’s experience (Kaffman and Elizur, 1979, 1996; Worden and Silverman, 1996). Since one in every 20 children lose one or both parents before the age of 15 (Steen, 1998) and grief in children may lead to future marital difficulties, depression, and other psychiatric issues (Florian and Mikulincer, 1997), it is imperative that mental health professionals learn as much as possible about the experiences of bereaved children. Interventions then can be applied to alleviate the negative consequences of childhood bereavement and promote the healing process. Much of the research on childhood grief is based on reports from adults in the children’s lives. There are few narratives from children themselves, where they describe their experience of losing a parent, to support the perceptions of the adults. In addition, no study could be found where children told in their own voices how they felt a bereavement program influenced their grief related issues after the death of a parent. This study is an attempt to fill this gap in the literature.
Literature review
Background
The loss of a parent, regardless of whether the death is sudden, expected, violent, or peaceful, is a traumatic experience for a child (Kaffman and Elizur, 1996). Freud and Burlingham (1943) first brought children’s grief to professional literature with their work with children in England during World War II. In early work on attachment and separation, Bowlby (1973) explored childhood loss and the resulting sadness, anxiety, and anger. Classic understanding of childhood grief has been explored by Fox (1988), Wolfelt (1996) and Worden (1991, 1996). Bereaved children may experience shock, denial, guilt, and anger (Silverman et al., 1992; Worden, 1996). They also report feelings of fear, low self-esteem, and social disconnection (Silverman et. al., 1992). Loss of a loved one may invoke feelings of sadness and helplessness in children (Christ, 2000; Goldman, 2004). Children bereaved by suicide may experience anxiety, depression, aggression, withdrawal (Ratnarajah and Schofield, 2007), and post-traumatic stress disorder symptoms (Cerel et al., 1999).
Previous studies
Childhood grief.
Many researchers who report on childhood grief rely on quantitative measures, which are usually surveys distributed to adults in the children’s lives. Qualitative reports involving adults who have lost a loved one to death (e.g. Pietila, 2002) or adults who lost a parent as a child are available (e.g. Schultz, 2007). However, the voices of children and adolescents who have recently experienced a parental loss are more difficult to locate.
Qualitative studies include Andrews and Marotta’s (2005) interviews with six young children ages 4 to 9, four of whom had lost a parent, two a grandparent. The authors explored spirituality as a coping mechanism and found that the children’s grieving process was non-linear, attachments to others served as a comfort and containment of emotions, objects of the deceased served as a way of keeping in touch with the deceased, and conversations about God or a higher power were prominent. However, the children had not made meaning of their losses. Eppler (2008) explored the themes expressed by 12 children ages 9 to 12 years who had lost a parent. Children were engaged in hour-long guided interviews and helped to create a written narrative that described each child’s situation. Themes of the children’s stories were ‘sad, mad, scared, and happy’ (p. 192). Eppler stressed the need for a strength-based perspective in approaching grieving children.
Outcome studies.
To come through grief children have to complete certain tasks (Fox, 1988; Wolfelt, 1996; Worden, 1991). Interventions to improve children’s coping with grief based on these tasks of traditional grief theory have been discussed, and some of these interventions have proven effective (Graham, 1999; Samide and Stockton, 2002; Sandler et al., 2003) but others have not (Adams, 1996; Huss and Ritchie, 1999). Indeed, whether most treatments are helpful or not has not been conclusively determined (Curtis and Newman, 2001). Use of interventions based on emerging grief theory that takes into account trauma treatment has increased positive outcomes (Cohen et al., 2004; Cohen et al., 2006; Layne et al., 2001; Saltzman et al., 2001).
Brief weekend camps for bereaved children have been available since the early 1990s (Sorensen and King, 1999) and their prevalence and quality has continued to expand. Farber and Sabatino (2007) used Likert scales to rate children’s involvement and their psychosocial functioning when examining their camp sessions, but findings were inconclusive. No direct verbal input was provided from the children in the study. Using satisfaction surveys, Creed et al. (2001) received positive feedback about grief camp from 19 children age 6 to 15 who had lost a sibling to cancer. Both parents and children felt camp helped them talk about their loss. Other camp researchers used both quantitative and qualitative input. Nabors et al. (2004) evaluated the satisfaction with and impact of a weekend camp as expressed by children ages 6 through 12 using a Likert scale. The authors focused on sadness and anxiety while exploring the children’s involvement and enthusiasm for camp activities. They found no changes in the measured variables but heard positive feedback from the campers in semi-structured interviews. McClatchey and her colleagues studied 100 children attending a weekend healing camp using a non-equivalent comparison approach. Children attending camp showed statistically significant lower childhood traumatic grief symptoms after camp compared to the waitlisted children (McClatchey et al., 2009).
No study could be found where, instead of measuring outcomes of predetermined variables, the children stated what their experience was in relation to the death of a parent and if they felt a program addressed those issues. The two research questions posed by the current study are: 1) What is the emotional impact of the death of a parent as described by bereaved children? 2) How did a bereavement program influence children’s coping with identified issues?
The camp intervention
The interviewed children had attended a 48-hour residential weekend camp for 50 children ages 7 to 18 with a parallel camp for parents. The camp was founded by and is directed by a licensed clinical social worker.
The camp is based on trauma focused grief interventions (Cohen and Mannarino, 2004; Cohen et al., 2002) and on grief-focused psychotherapy (Layne et al., 1999; Pynoos et al., 1995). The interventions include exposure, stress inoculation techniques, and cognitive restructuring and have shown positive results reducing post-traumatic stress disorder and childhood traumatic grief symptoms among bereaved children (Cohen et al., 2004; McClatchey et al., 2009). At camp children are assigned to counseling groups based on age. They also participate in memory art work, a memorial service, a balloon release, and traditional camp activities. Staff members include one licensed social worker for each counseling group of five to eight children with two co-counseling volunteers per group, usually social work or psychology students, who are trained to support the professionals.
Methods
Using the children’s own words, the 27 interviews in this qualitative study contribute to professional literature by presenting the emotional impact of the death of a parent and how an intervention may have influenced the children’s coping with issues expressed. A case study design (Cresswell, 2007) was used to provide focus while allowing for multiple voices. The case design was bounded by time and place through a sample from two camp sessions. In addition, the desire of the researchers for extensive use of triangulation led to the case study design. Together the researchers designed the questions based on literature review and observed camp experiences. The questions posed to the children were: 1) What was it like when you found out that your parent had died? 2) What was different after your parent died? 3) What, if anything, about camp changed things for you? 4) How are things now after camp? Related questions were asked of the parents. The interviews are analyzed with a focus on themes expressed by the children and their parents and the change, if any, that camp had on the issues affecting the children.
The research team was made up of the camp director, experienced in therapeutic camp research, and an outside experienced qualitative researcher engaged specifically for this project. One semi-structured interview was held with each participant 6 to 18 months after their loss: 11 boys and 5 girls who were age 8 to 18 and 11 parents. The purposive sample was obtained in response to a letter from the camp director asking all families (N = 49) from two camp weekends held within the previous six months to volunteer to participate in the study. The camp director made follow-up telephone calls to all families who responded to arrange interviews. The sample included White (n = 6), Black (n = 7), and Latino (n = 3) children and their 11 surviving parents, with nine US citizen families and two legal immigrant families. There is no charge for camp, and the resulting variation in family incomes and living conditions was reflected in the sample.
Interviews were held during a two-month period. Families were visited in their homes by the two researchers simultaneously. The camp director interviewed the children and the outside researcher interviewed the parents separately. Interviews lasted approximately one hour. Each interview was audio recorded and transcribed by an outside source, and field notes were made by the interviewers after each interview and were added to the data. To analyze the data the constant comparison method (Glaser and Strauss, 1967) underlay the data collection and analysis. The researchers discussed the themes apparent in either or both interviews with each other as they completed interviews and on occasion they probed more completely on topics that had surfaced when interviewing later participants.
Using models of qualitative analysis the researchers worked together with inductive analysis to discover themes of emotional impact of parental death and related camp influence. Ezzy (2002) points out that in developing themes ‘the researcher attempts to build a systematic account of what has been observed and recorded’ (p. 86). At the completion of all interviews and field notes, the researchers copied the interview transcriptions and notes and worked together highlighting themes. Themes were ‘coded’ (p. 86) and a computer-assisted qualitative analysis system (Hyper-RESEARCH 2.8.3) was used to review data and provide depth and richness to the findings (Ezzy, 2002). Triangulation of sources – using multiple child and adult participants, internal and external researchers, and both inductive and deductive analysis – added trustworthiness to the study (Creswell, 2007; Patton, 2002).
Ethical research considerations included Institutional Review Board approvals and informed consent. Adults’ consents and children’s voluntary assents were received in each case. Recordings and transcriptions were securely stored and pseudonyms were used in transcription, analysis, and writing.
Findings
All themes presented by the children are discussed in terms of the emotional impact of the death and the influence, if any, of camp on each of the children's issues. Themes discovered include Sadness, Anger, Being Set Apart, Worries, Trauma, and Contemplation of Suicide.
Sadness
As could be expected, the overwhelming emotion experienced by the children was sadness. Mike was age 9 at the time of the death from cancer of his elderly guardian grandfather. He said that time was ‘Very sad. Very badly sad.’ He valiantly tried to keep from crying in front of his grandmother, but he said he could not hold his sadness in at the funeral. ‘I wasn’t crying until they started playing music, which is what me and him always used to do at church. He would play the piano and I would sing along or play the drums.’ The sadness that overwhelmed him in the small church the family had been part of was so difficult that he and his grandmother now attend a larger church of the same denomination. Mike said, ‘I tried to not think about him that much, and we stopped going to the church that we went to where me and him would sing all the time. We started going to a new church and that kind of helped me.’ Thinking of camp, he said, ‘You learn how to cope with your feelings better. Now if I get sad, I know what to do.’
His grandmother said ‘[Camp] helped with feelings of loss … The hurt’s still there, but it helped.’ A poignant moment came when the family cat, especially loved by Mike’s grandfather, died suddenly. The sadness of the loss rekindled Mike’s sorrow. His grandmother explained that they came home from errands and described the incident: Mike went in there screaming ‘Mamaw, Boots is dead! Boots is dead!’ … Oh he cried and he cried, and I said ‘Boots was Papa’s cat.’ He was until Papa died. That cat stayed right with him and I said ‘now Boots has gone to be with Papa.’ Well that kind of made him feel better and he said ‘I believe I need to go back to that camp.’
Shavonna, age 13, one of three close siblings, watched her father die a lingering death from leukemia. Their African immigrant family lived in poverty as the father became unable to work. Shavonna’s sadness consumed her in the months after the death, and she wrote notes to her father every day. Her mother tearfully recalled one of the notes: ‘Hi Dad, I love you very much. I’m so sad that you left us … I know that we will meet one day in heaven.’ She added, ‘When we would talk about her dad she used to keep quiet and didn’t want to talk about him. She would cry at night and cry herself to sleep.’ Her camp experience helped her come to terms with her sadness. When asked if camp changed her, Shavonna stated, ‘It helped… I used to cry every day and now I don’t anymore.’ She felt camp activities allowed her to tell her father ‘I love you … I miss you’ but also gave her the insight that you have to ‘move on with your life.’ Her mother added, ‘She is grieving, but she is different. Now she can talk about memories of dad. She can write about her dad and now she is doing good.’
Anger
Almost all of the interviewed children stated that they had experienced anger after the death of their parent. For some children the anger was directed at the lost parent. Rosie, who attended camp at age 17, was at church camp when the call came that her father had died by suicide. Her immediate response was concern for her younger sister, and her mother described her as a responsible girl who puts others first. However, Rosie stated repeatedly in various ways that she felt anger at her father: I felt overwhelmed and rejected … I was very mad … I graduated high school, my dad wasn’t there. I’m not about to get married, but when I get married, he’s not going to be there. And when I have children, so you know – I’m constantly seeing a pattern and my dad’s not going to be there and it really, kind of, it hurts, it really sucks, really a lot, ’cause I’m just like, this isn’t fair. It’s not fair because I didn’t get to choose, he chose for me, and I just don’t think that’s fair … It’s a selfish act and it’s not fair to the ones you leave behind.
However, Rosie stated about camp, ‘I felt like I got closure there … I got to process a lot of stuff that I hadn’t really been thinking about … It helped me a lot.’ Rosie hoped to return to camp as a volunteer in future years.
For Adam, age 14, the anger became a global mode of functioning after his father’s death. A bright only child, who desperately tried to revive his father after a sudden heart attack, Adam had begun failing at school and fighting constantly with his mother. His internal turmoil was evident as he talked, ‘I just feel like the world is just dicking with me … I had all these flashes of memory, some trying to keep me in the moment, some anger, confusion, how could the world do this to me?’ His conflicts with his mother seemed irresolvable but his desire for a more peaceful new family pattern was also evident. Speaking of his mother he said, ‘I have all this built up anger at the world right now, and I just can’t put it anywhere … I’m just desperately trying to avert this anger away from her and it’s exhausting.’ Although Adam’s anger was still evident after camp, and he and his mother were in on-going counseling, he felt that camp was helpful; it was ‘A place for people that are struggling with the loss of someone close to them that makes it extremely easy to feel.’
Being set apart
Many children felt set apart from their friends after the death of a parent. Billy, age 8, touchingly said, ‘The thing that hurt me the most is Mother’s Day. The Friday before Mother’s Day I saw everybody writing notes. That made me feel sad. Then I got home and I saw all these people with their momma, and that made me feel sad.’ Asked how camp impacted him in this regard, his grandmother stated, ‘Seeing other kids that went through the same thing – that helped him a lot. You know, because he knew he wasn’t alone.’
The awkwardness of being different was especially felt by teenagers. Typical of these teens was Shavonna’s 16-year old brother Kenny. Kenny was aware of his need for support from his peers, but he said with frustration, ‘They seem like they want to help but they can’t. Like, they don’t know what to do.’ Sharing how the camp helped him, Kenny’s mother said, ‘He talked about how many people are like us. He felt encouraged because there are so many people like us. Yeah, he said that helped.’ His fellow camper Adam stated, ‘There are some friends that have decided to kind of just, not in like a rude or blatant way, but to kind of just drift away from me … They were just like “this isn’t part of my world and this doesn’t happen to people around me.”’ Describing his camp experience Adam said, ‘I feel a lot less alone … more understood … there are people out there who understand me, and more importantly, who have made it to the other side.’
Worry
Most of the children expressed worry about losing their surviving caregiver. Having faced the death of one parent, the children were fearful that they might lose their now only surviving parent or guardian. This theme was found in children of all ages and in those whose parent’s death was anticipated and not anticipated.
When Ishaan was 7 to 9 years old he watched his father die from Amyotrophic Lateral Sclerosis (ALS). The family was financially comfortable, but moved and made other adjustments to accommodate Ishaan’s father’s progressive decline from an active life to immobility brought on by the disease. His mother stated, ‘After his father first passed he was very emotional. It was difficult at school for him to focus and he had outbursts. He just could not communicate his feelings very well.’ The underlying concern left from his experience with his father transformed into his worry about his mother’s health and his dependence on her. These emotions were clear when he said, I worry about my mom. I mean, now that I only got one parent, I worry about if anything will happen to her, but I understand my mom knows how to take care of herself. If she didn’t, she wouldn’t know how to take care of me … My mother is like a father and mother all tied up in one … What if she got sick or something? I don’t know how we would do anything.
His mother was sensitive to his fear: ‘It seemed as if when we first heard about it [camp], he was reluctant to go. I think the fear of something happening to me, he just didn’t want to be apart from me.’ Ishaan said at camp he ‘tried new things’, gained self-confidence, and found it ‘really relaxing … I just had fun with other people.’ He had difficulty putting his feelings about the camp experience into words but said, even 18 months after his father’s death, ‘I was pretty much the same when I went to camp, and I was just … different when I came out.’ Camp aided the maturing process that has brought him to a more comfortable place with his worries, and his mother has noticed changes as he moves into middle school and his focus shifts from his mother to his peers.
Some of the campers expressed worry over real or imagined financial problems after the death of their parent. Jimmy and Ricky, high energy little boys of 9 and 8 years who lost their young father to a sudden heart attack, share a tiny apartment with their mother, step-father, and half-sister. Ricky commented, ‘We’ve, like, gotten poorer and we hardly even have stuff no more.’ Their 26-year-old mother, who had continued her close friendship with their father after their divorce, and was dealing with her own depression as she tried to help her sons, stated, I feel like since James died my life has been a total pit because it seems like I’m losing everything … Before it was easy. I mean it wasn’t Easy Street, but we had money and the bills were paid all the time on time. And now, it’s just like I can’t do it no more.
According to their parents, some teenagers took their worries a few steps further and felt they had to replace the dead parent to financially help support the family. Kenny’s mother expressed her concerns over her son’s distress, ‘My older one, he felt like because his daddy was gone that he had to maybe find a job … everybody was telling him that he was man of the house now, and you know, he took it literally.’
In this area of worry, little in the camp experience had direct impact, even though camp helped explain to both campers and parents the risks of parentification. Also, as Kenny said, ‘You feel much better when you see that the other people have the same problems as you.’
Trauma
Trauma symptoms included hypervigilance, avoidance, and intrusion. The fear of seeing or sensing a dead parent’s presence was a common phenomenon among the children. The presence of the deceased parent was sometimes brought on by flashbacks. Jimmy and Ricky’s mother described the fear her sons had experienced, We went and got their daddy’s stuff. After that they started saying they see their daddy in here. Ricky started saying that he sees his dad in here, and they’ve been getting scared because they think that their dad’s going to hurt them or something. The first night at camp, the counselor told me that Ricky woke up screaming. I asked him why, and he said, ‘Because he saw his dad sitting on some boy’s bed.’
Their mother thought that these fears had subsided since camp and in interviews the children mentioned these experiences as something that happened before camp.
David, age 14, was sleeping in the middle of the night when his mother awakened him with screams to come and help her roll his prostrate father into position for CPR as directed by the 911 operator. His mother repeatedly sent him from the room ‘to look for the ambulance’ as she was frantically trying to revive his father. Weeks later she noticed his refusal to go into the bedroom. She commented, ‘When I had asked him to get something out of my closet he kind of stopped by the door. And then I asked him, I said, “Are you OK?” And he just shook his head and said, “I can’t go in there.”’ David had not shown emotion about his father’s death and seemed more concerned with caring for his mother. It was not until David went to camp that he began to share his feelings, and his mother learned from the counselors that he was having flashbacks of the night his father died and constant nightmares. She said, He had never told me about that, so when I found out about that I contacted a Christian counseling center. He went to counseling for a while with them and was able to talk about his feelings … I think that camp is like a safe haven for kids to come out with their feelings and not just get support from the counselors but from each other, too.
Contemplation of suicide
The most distressing emotional reaction voiced by several children was their desire to end their own lives. Camp was credited by both the children and the parents with having an extraordinary impact on these children. The youngest child for whom this was a concern was Maria, age 8, who as the baby in a large Latino family had a close relationship with her father. His early shift work allowed him to be home each day as she returned from school, and they shared warmth and open communication. Since Maria’s mother did not speak English, Maria’s oldest sister carried the responsibility for the search for her father’s body after he drowned on a fishing trip. As the family mourned, she became concerned about Maria’s increasing depression and lack of cooperative interaction in the family. Maria’s sister tearfully said, ‘Everything we asked her to do she didn’t want to do it. She just cried or she went so negative. Everything was so negative … Her behavior became worse like she wanted everything her way.’ Eventually Maria told her, ‘I don’t want to be here. If my dad’s going to go away, I want to go with him.’ Her sister continued to explain, ‘And now [since camp] she hasn’t said anything like that. I mean, so it’s okay for her now.’ Maria’s grades and behavior markedly improved after camp and she is taking an interest in family life again.
Thoughts of her mother’s suicide and of killing herself were put most clearly by RahDee. Now age 17, RahDee is a tall, slender, attractive teen who exudes energy and personality. Describing feelings after her mother’s death she said, ‘It’s a lot of days that I’ve cried … just like, okay, maybe I should join my mom. You know, it’s in my blood. I might as well do it.’ When asked what was different for her after camp she replied with happy laughter, The difference is I don’t want to end my life anymore. I don’t want to stop. I feel there’s, in me, I feel like there’s more options than I had before. I felt like there was a wall before camp, and after, the wall is gone! And I feel like I can go anywhere and do anything.
After receiving rave reviews in the camp talent show, RahDee is in the process of applying for scholarships to attend college majoring in performing arts.
Discussion
In this case study the children shared in their own voices the emotional impact of parental death and how bereavement camp influenced these issues. The themes were found in the saturation of qualitative data across this sample of children and parents. These themes were Sadness, Anger, Being Set Apart, Worries, Trauma, and Contemplation of Suicide. The themes of sadness, worries, and anger correspond with themes found in other qualitative studies with bereaved children (Eppler, 2008). Contemplation of suicide and post-traumatic stress disorder symptoms were not found in other qualitative studies, although these variables have been explored with quantitative measures in previous studies (Cerel et al., 1999; Cohen et al., 2004; McClatchey et al., 2009). However, the prevalence of suicide risk in both young and teenage campers was surprising to the researchers but was addressed by the social workers at camp.
In most families both children and parents indicated some resolution of presenting concerns. The findings were consistent among parents and their children as well as among age groups. Although sadness over the death of a loved one cannot be erased, campers were provided an outlet for identifying and expressing their feelings of sadness in counseling groups and were given tools to use after camp to deal with their loss. Rituals were provided as a means to process feelings of sorrow.
Anger was not a surprising theme. Anger is a natural part of the grieving process (Wolfelt, 1996; Worden, 1996) and has been expressed by other parentally bereaved children (Eppler, 2008). At camp the mental health professionals reviewed with the campers safe ways to express their anger and provided opportunities to practice these new coping skills.
Campers’ worries about the possible loss of their current caregivers were not unexpected given that parents are the most important support for most children. The perceived need to take care of adult responsibilities, such as earning money, was another worry. These worries were addressed in counseling sessions and may have subsided at camp with discussions about adult versus child responsibilities. Many parents had picked up on their children’s concern about parental well-being and were given skills by camp counselors on how to address this fear by validating it and discussing contingency plans openly.
Camp seems to have had the greatest influence on the campers’ coping with feelings of being set apart, trauma symptoms, and contemplations of suicide. Being set apart from friends by losing a parent may create a social isolation in bereaved children (Worden, 1996) that may only be helped by sharing with others who have had similar experiences. The opportunity for sharing their stories was provided to the campers chiefly in counseling sessions, but also in other poignant ways such as a balloon release and a memorial service.
In most cases, campers appeared to have experienced healing in respect to trauma symptoms and in one case newly recognized trauma symptoms were cause for referral for further counseling. Camp counselors used several trauma interventions, including exposure, stress inoculation techniques, and cognitive restructuring (Cohen et al., 2001).
Interventions also influenced the campers’ contemplations of suicide. Although children who have experienced the suicide of a parent may feel this is also their destiny (Pfeffer, 1981), or as RahDee, age 17, expressed it, ‘it’s in my blood,’ campers bereaved by other means were also contemplating suicide before camp. Supportive counseling with other bereaved children, regardless of the means of the loss they had experienced, may have normalized these feelings of depression and suicidal ideation. In addition, the counselors used techniques such as cognitive restructuring to help the campers move forward.
Limitations
The families who participated in this study had received a weekend experience at no charge. The camp director approached families for participation in the study and conducted the children’s interviews. Thus, the findings of this study might not be free from bias both from the researchers’ desire to find camp useful and the families’ desire to express their appreciation for the experience. Use of thorough qualitative methods reflected the researchers’ awareness of and efforts to minimize such bias.
The struggles of bereaved children underpin the referrals received by camp. In view of this fact the sample in this study cannot be generalized to other bereaved children or adolescents.
Implications for practice
Social workers come into contact with bereaved children in schools, hospitals, hospices, and through various bereavement programs. They need to understand the concerns of parentally bereaved children as they seek the best interventions to address children’s grief issues. The findings of this study suggest that professionals working with bereaved children need to be well versed in assessing and treating trauma symptoms. Findings also imply that social workers seeing bereaved children need to assess for suicidal ideation. Those who refer bereaved children to resources must make it a priority to know that the resources they utilize are operating based on evidence-based practice. Many bereavement camp models are based on traditional grief theory alone, but these findings support continuation and replication of this camp’s programming that includes trauma treatment.
Conclusion
This research was conducted to clarify and conceptualize the emotional impact of the death of a parent as described by children and to explore the influence of the camp experience on these issues. This connection had not previously been explored from the child’s point of view. Bereaved children bring to camp deep wounds based in the vulnerability of childhood development (Erikson, 1982; Wolfelt, 1996; Worden, 1996). Society lacks rituals, assigned roles, and social conventions to respond to the grief of a child whose parent has died (DeSpelder and Strickland, 2008), yet rituals acknowledge death and give room for expression of feelings (Giblin and Hug, 2006). At camp, the children and adolescents get a chance to acknowledge through rituals, counseling sessions, and other activities that loss has occurred. Interventions open avenues for campers to express feelings surrounding the loss as well as provide the campers with tools to deal with their feelings and join with other children who have had similar experiences. This study was not an evaluation of camp and does not claim that specific camp interventions changed the children’s grief reactions. Other variables, such as family support and passage of time, may also have influenced these changes. However, the study does provide interesting information on children’s emotions before and after camp.
More studies, including studies on camper re-traumatization, post-traumatic growth, and secondary traumatization of camp staff, are needed to help better understand how to help this at-risk population. This study highlighted the importance of understanding the emotional needs and issues of bereaved children and of assisting this vulnerable population in their journey towards healing.
Footnotes
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.