Please send comments to:jrw@largocanyon.org
Patricia Barlow-Irick, Albuquerque, NM. 1997.
The archetypal experience of adolescence is the death of ones childhood and birth of ones adult self. Actual bereavement during this time of transition can intensify this important inflection point. This paper surveys the literature concerning the adolescent experience of parental death to provide a broad perspective of the relevant issues and research. To gain breadth of perspective, I have ranged well outside of mainstream social science literature. I begin this paper with a discussion of the grieving process in general, followed by a review of relevant ideas from psychological theory, and finally offer practical considerations for counseling.
The definition of death is culture specific. Clearly, one's concept of death is based on one's concept of life (Valente, Saunders, & Street, 1988). In mainstream American culture, our predilection towards secularism results in what social-scientists call the "Mature Conception" of death. This so-called "mature" conception holds that death is universal, irreversible and simply involves the cessation of bodily function The secular viewpoint is that death is the end of identity. Other less secular and concrete beliefs about death are also pervasive through American culture: heaven, afterlife, and reincarnation are all common beliefs (Noppe & Noppe, 1997). An adolescent's beliefs about death will certainly reflect the uncertainty, ambiguity, and inconsistency of the cultural beliefs. Adaptive behaviors maybe associated with a non-secular viewpoint that places meaning and spiritual continuance on life. For example, Noppe and Noppe (1997) found that perception of death as a pathway to another life was associated with less risk-taking by adolescents. An objective counseling perspective of the experience of bereavement should allow for all underlying belief structures, also recognizing that grief, itself, is likely to bring about a reconceptulization of reality (Gilbert, 1996).
Adolescent grief has characteristics in common with both adult and childhood grief. Grief for adults usually consists of conflicted emotions of guilt, anger, powerlessness, withdrawal, and isolation. The clinical symptoms of complicated grief in adults include somatic distress, preoccupation with the image of the deceased, guilt, hostile reactions, and loss of conduct previously influenced by the deceased (Vargas, Loya & Hodde-Vargas, 1989). The biggest difference between adult grief and childhood grief is the degree to which the individual has any power or autonomy. The child typically has no experience surviving without the parent; children have limited access to information except through adults; and children may have limited resources to seek sympathy, comfort, and understanding (Bowlby, 1980, p. 290). The adolescent will fall somewhere between childhood dependence and adult autonomy. Lattanzi-Litcht (1996, p. 225) suggests that adolescents, sensitive to issues of autonomy and competence, are more likely to feel and resent being over-protected than are children. This adolescent drive to autonomy is critical to understanding adolescent bereavement and differentiates it from grief at other ages.
Table 1. NORMAL BEREAVEMENT EFFECTS & CITATIONS OF RELEVANT RESEARCH
THE CONSEQUENCES OF COMPLICATED GRIEF.
Grief is not pathology in itself, but becomes pathological in its persistence, frequency and intensity (Vargas et al, 1989). Symptoms of complicated grief across all ages include profound dejection, loss of the capacity to adopt a new love object, loss of interest in the outside world, and preoccupation with thoughts of the dead person (Valente et al, 1988).
Valente, Saunders, and Street (1988) concluded from a survey of the literature that the inability to resolve bereavement issues puts adolescents at risk for diverse behavior problems, morbidity and suicide. Although unique adolescent responses to bereavement have not been identified, bereavement complicates value formation and achievement of intimacy, tasks which are necessary for emotional entry into adulthood (Valente et al., 1988). Citing Van Eerdweg, Bieri, Parrilla & Clayton (1986), Valente et al. wrote, "Adolescents may be more prone to negative consequences of bereavement because, unlike children, they are no longer protected psychologically by immature cognitive skills and concrete thinking that could buffer them from the full impact of bereavement."
Whether childhood bereavement is associated with subsequent adult depression more than other forms of separation, (such as abandonment and divorce) is not clear. Tennant (1988) holds that childhood separation involving parental psychopathology, continued conflict, and non-normative transitions later put an adult at risk for depression more than death of a parent. Breire, Kesloe, Kirwin, Beller, Wolkowtiz & Pickar (1988) found that depressed adults who had experienced parental loss as children had increased plasma levels of cortisol and -endorphin immunoreactivity, over similarly bereaved but non-depressed adults. Early trauma, dependent on the quality of home-life after bereavement, seems to directly or indirectly alter neuroendocrine functions in hypothalamic-pituitary-adrenal axis function. Bereavement counseling should focus on both minimizing the long-term psychological and physiological consequences of complicated grief.
Theoretical models of bereavement may be especially difficult to study empirically because of inherent research obstacles. One of the research obstacles to studying childhood bereavement is the psychological state of the surviving caretakers. For example, the children of widows always appear to be more affected than the children of widowers in research studies, but this difference is likely to be an effect of the way women maximize discussions of emotions, while men minimize them (Eerdewegh et al, 1985). Another obstacle is that surviving parents are likely to project their own feelings of grief onto the children and not be able to objectively report on their children's behavior. The randomness and unpredictability of death make control of the research variables difficult. For example, inadequate parenting, irrespective of bereavement, is associated with development of depressive illness in adulthood. Research shows that bereavement increases the probability of inadequate parenting (Breier et al., 1988), but we have no way to determine how adequate the parenting was before the death. Finally, it is difficult to separate effects of adult confusion, the child's reaction to the event, and the child's reaction to the adult's confusion (Bowlby, 1980, p. 269). These are all barriers to our understanding and empirical study of adolescent bereavement.
Psychoanalytic antecedents
The conception of childhood grief has changed extensively over the past 50 years. According to pre-1960's psychoanalytic theory, young children were not capable of grieving. Bereaved children were encouraged to just get on with their lives (Adler, Wingert, Springer, Stone, King, Kalb & Foote, 1997). In direct contradiction, psychoanalytic theorists of that era also believed that the mere temporary loss of ability to perceive the gestalt of the mother was enough to cause profound emotional disturbance (Mahler, 1961)). Modern theorists have resolved the inconsistencies of the psychoanalytic framework by recognizing that children are capable of grief and that childhood grief is resolved through mourning.
Object relations theory
According to Object Relations Theory, the individuals self-concept is based on the internalized representations of others (objects). A death of parent is a crisis involving complete and irreversible object loss. Because of undeveloped self-object differentiation, the child cannot differentiate between the part of the ego that is self from the part that is parent (Murphy, 1986). Mourning, a process of reality testing which leads to differentiation between self and others, becomes possible when the child has reached the age of object constancy (Murphy, 1986). Grieving becomes complicated when it is perceived as a narcissistic insult rather than an object loss (Van der Kolk, 1985).
Hill and Foster (1996) outlined the theory of "self" psychology, whose fundamental assumption is that through the process of relating to others and experiences, humans develop a central identity, or "core-self". The core-self is sustained by internal representations of significant others (self-objects). The evolution of the core-self involves a gradual transition from infantile fantasy to a realistic sense of self.
Bereavement in self psychology is the loss of a self-object, which disrupt the narcissistic fantasies which organize a person's sense of self. Three phases of grief in self psychology are: first shock and disbelief; followed by preoccupation with the memory of the deceased; and finally resolution. Resolution comes as some degree of emotional detachment associated with a more realistic sense of self.
Internal Working Model
The late Dr. John Bowlby was a leading researcher in the field of personality development. His work on loss and bereavement uses the concept that one's attachment history (experiences in significant relationships) will produce an "internal working model", which is a cognitive set of expectations. Bowlby's work tends to have a medical orientation and a predilection towards looking at the biological basis of behavior; he referred to his concepts as "environmental" (Bowlby, 1980, p. 317). His conception of attachment was as biologically instinctual and not the developmentally complex constructs of the Neo-Freudians, who held that emotional problems of grief were due to arrested development.
In Bowlby's scheme, death of a parent leads to reorganizing existing elements of the Internal Working Model (composed of mental representations of self, other, and of the relationship that direct attention and organize memory in a way that guides interpersonal behavior and interpretation of social experience) (Tyson-Rawson, 1996).
TABLE 2. BOWLBY'S (1980) CONDITIONS FOR HEALTHY MOURNING
Bowlby's model included four phases of grieving process: numbing, yearning / searching, disorganization / depression, and reorganization (Hill & Foster, 1996). These phases are not necessarily sequential or linear. Bowlby also identified three tasks of grieving: intellectual recognition, emotional acceptance, and identity transformation (Hill & Foster, 1996).
Information processing theory
Individuals create mental structures (schemata) comprising a set of expectations and associations that guide and organize the data of experience. Noppe and Noppe (1997) looked at how death schemata evolve into more complex constructs including the incorporation of life beyond physical death. Schemata usually develop towards complexity. College students are less likely than children to clearly dichotomize between life and death. Concomitant with a decreased attachment to family and peers, their contact with death is increased. Cognitive changes associated with losing an illusion of immortality include assigning a meaning to death typically involving reincarnation or afterlife.
Death often involves traumatic events. Traumatic memories seem to involve a complex relationship between memory and emotion, according to Koss, Tromp and Tharan (1995). Emotional arousal changes the way information is processed, leading to a narrowing and reduction of attention, and to increased selectivity in respect to central aspects of the situation. Traumatic memories can be blocked from conscious memory, but they remain, now "forgotten" to the conscious mind but continuing to affect experience, thought, and action. Koss et al. suggest that one of the goals in therapy should be to change the meaning of traumatic events though narrative repair. The meanings of memories can be changed through narrative emplotment. The client can develop an awareness of their cognitive processes, an ability to monitor and interrupt maladaptive cognitive-affective-behavioral chains, substituting an adaptive alternative.
Developmental Model
The developmental model focuses on how bereavement affects the developmental tasks of the child, in adolescence these tasks largely concern belonging and ego development.
TABLE 3. Developmental tasks (Balk and Corr, 1996):
Early Abandonment vs. safety: emotional Adolescence separation from parents Middle Independence vs. dependence: competency, Adolescence mastery, control Late Closeness vs. distance: intimacy and Adolescence commitment
Young adolescents have such a strong need to identify with their peers that they may sublimate their feelings to maintain identity; these buried feelings are then likely to manifest as physical illness (Fleming & Balmer, 1996; Balk, 1996). Older adolescents will be more willing to discuss bereavement (though their peers might not be), and will respond on a less physiological level (Balk, 1996). When bereavement affects the late adolescents ability to form commitments, it seems to typically move them toward immediately making a committed relationship or to avoid them altogether (Tyson-Rawson, 1996).
Grief in Five-Element Theory of Chinese Medicine
Chinese psychotherapy offers a frame of reference which does not divide the body from the mind for looking at the effects of grief. According to the systems-model of Dr. Shen (Hammer, 1990), sudden profound grief will affect the weakest part of the body (usually the lungs), generally creating conditions of stagnation, depressing the circulation of Qi (the life force). Dr. Shen characterizes grief by wailing and crying. In his model, if grief does not terminate, it becomes a non-functional psychosis, a form of melancholia, which will deplete Yin-Water. If grief continues in a more subdued and controlled fashion it is called anguish, which is audibly distinguishable by "little groans without tears". Anguish stagnates the Kidney System, blocking the flow of Water, which creates a dryness. Eventually the dryness will turn into Fire.
Dr. Shen differentiates repressed grief from anguish in that the cause is forgotten in repressed grief, but remembered in anguish. Stagnation in the lungs is the result of repressed grief. The earlier and more severe the loss, the greater the effect on Lung function. Grieving for a parent can lead the child into to a profound state of defeat. Those who have the fantasy of the lost person as still being available to them or who maintain such connection through some mystical level are not as likely to show lung problems. The physical effect of this stagnation may be asthma, chronic bronchitis, upper respiratory tract infections, allergies, pneumonia, and even tuberculosis. There may be problems with bonding and separation at any time. The feeling of emptiness and worthlessness may be compensated for by compulsive perfectionism. There may be a problem with ethics or a "hole" in the personality where repression inhibited the growth and development of feelings of attachment. The result is a profound sense of grief for one's lost self, which perpetuates until one finds it in conscious experience, and there, find themselves.
In Dr. Shen's model , the loss of parent can also be experienced as disappointment that results from a slow erosion of faith and trust, not only an emotional shock. The long range symptoms of childhood disappointment are decrease in general energy circulation. This pattern can be exacerbated by re-exposure to current disappointing conditions. Because the original disappointing event will be mostly forgotten, drawing a parallel between the current and the original event can help expand self-knowledge and self-awareness.
Traditional Chinese methods of treatment of psychological problems include acupuncture and herbs to stimulate Qi production and circulation. Although this type of psychotherapy is out of the ordinary, there is little empirical research available from which to evaluate its effectiveness. Traditional practices are often based on long histories of effective use and should not be discounted solely because they are not explained under the currently accepted paradigm. It would be interesting and informative to see research on treatment of complicated grief using these traditional methods.
Coping model
Balk (1996) described a coping/defense mechanism model in which the tragedy of bereavement overwhelms typical coping strategies of the individual. Balk divides coping strategies to deal with bereavement into three main categories: appraisal-focus coping by assigning meaning to them; problem-focus coping by actively responding; and emotion-focus coping in which feelings are camouflaged or postponed. There seems to be large discrepancies as to how these terms are used. Another useful way of categorizing coping skills is whether they are assimilative (in which the individual aims to alter the environment to his needs) and accommodative (in which the individual aims to alter himself to accommodate the environment). Accommodative coping is also known as secondary control.
Secondary control has four faces according to Rothbaum, Weisz and Snyder (1982). In predictive secondary control the individual predicts events (often justifying self-defeating behavior) as a way to control disappointment. Illusory secondary control aligns the individual with the force of fate or chance giving up a perception of competence for a perception of luckiness. In vicarious secondary control the individual associates with a more powerful entity, such as "the Almighty". An individual is using interpretative secondary control when they increase attributional activity, deriving meaning from problems in order to accept them. Each of these may be brought into play in bereavement issues.
Balk suggests increasing the repertoire of coping skills as an approach to bereavement counseling. He outlines five adaptive tasks for the bereaved. The first task is to establish meaning and personal significance, integrating the loss into one's world view. The second task is to confront reality and respond to it, figuring out how to respond to ones relatives and learning how the death will change the environment. The third task is to maintain interpersonal relationships, keeping communication and support flowing. The fourth task is to maintain an emotional balance, finding a way to express feelings and hold on to some element of hope. The final task is to preserve a satisfactory self-image and some feeling of self-efficacy. This model is congruent with a cognitive approach to therapy.
Seligman (1997) used the cognitive therapy model of Albert Ellis as the basis of a model for "depression-proofing" children. In his model, adverse events in combination with the underlying beliefs or conception of reality result in consequent feelings and actions. If the underlying beliefs are that reality is permanent (rather than dynamic), pervasive (rather than local), and external (denying an internal reality), then an adverse event will tend to be a first-order catastrophe. As a coping skill, Seligman suggests gathering specific information though discussion and exploration, then developing a plan of action.
Taylor (1983) proposed a way to think about coping as cognitive adaptation. In this model adjustment and recovery revolve around three processes: searching for meaning, gaining a sense of mastery, and restoring self-esteem. Marveling at the resilience of the human mind, she concluded that "when individuals experience personal tragedies or setbacks, they respond with cognitively adaptive efforts that may enable them to return to or exceed their previous level of psychological functioning" (Taylor, 1983, p. 1170).
Socio-cultural model
Balk (1996) also presented a model to consider bereavement as an obstruction in the quest for fulfillment of our psychological needs, which he called the 10 essential human sentiments. Bereavement may impede one in this quest, or may totally derail the quest altogether, having a "profound, pervasive influence on the functioning of the personality system as a whole." Balk suggested that if we could find a way to measure this impediment, we would have a way of measuring unresolved grief.
Family Systems approach.
Gilbert (1996) compared grief among families. The family, in a systems approach, is an interactive meaning-making system. The grieving process for a family is focused on regaining stability and meaning, with the individual members grieving in the arena of the family system. Differential grieving styles or processes among different family members is frequently a source of additional problems, when allowances are not made for individual differences. Gilbert lists three tasks for the family unit: recognizing the loss, reorganizing after the loss, and reinvesting in the family.
Partridge and Kotler (1987) compared two family models. They found that the model in which bereavement issues stem from the absence of a parent to under-represent the degree of complexity in family systems. Their findings better fit a family environment model in which the quality of relationships, the cohesiveness, and adaptability of family life is the best predictor of adjustment to parent loss, especially in a day and age when mothers work outside the home. They found that adolescents might experience compensatory benefits by assuming increased responsibility and greater decision making roles in the family structure. Yet other researchers reaffirm that it is important for the family not to put the adolescent in the role of the deceased (Lattanzi-Licht, 1996, p. 225).
Archetypal orphans: a quest for meaning
The experience of bereavement might also be looked at in terms of the symbolic consequences of death. Adolescent individuation involves letting the child "self" go, in the active process of "self" creation (Noppe & Noppe, 1996). The astrological symbol of Scorpio precisely represents this process of transformation and provides a keyword to look at the process symbolically. In the concrete world, as the sun is in Scorpio, late fall descends on the northern hemisphere and our world dies back to its winter condition. In myth, Scorpio encompasses the transformation cycle from death and the sojourn to the underworld to the promise of resurrection and rebirth. All processes of separation and regeneration fall under the domain of Scorpio. The snake, who sheds its skin, is intimately associated with the Scorpionic mysteries of life, death and sex. Sometimes this journey to the underworld can be experienced as a journey into the subconscious, but the lives of Scorpio dominated people are also said to have sensate themes of literal death, or near-death and birth. The destruction of old life patterns and forms involved in a transformational crisis releases the very energy (usually in the form of pain and deep agony) which can nourish one and enable one to push toward new growth (Arroyo, 1992.) Some of the myths associated with Scorpio include The Rape of Persephone, the Phoenix, Hercules Battles the Hydra, Orpheus, the Resurrection, the Conception of Horus, and numerous fertility myths from all cultures.
An typical Scorpionic myth of transformation is that of the Phoenix. Through the fire of existence (tragedy, loss, bereavement, trauma), this mythical Egyptian bird immolates itself on a funereal pyre only to rise reborn from it's own ashes. This transformation is alchemical in nature as the dross is burned away and the baser nature is transformed into alchemical gold. As the result of trauma, one finds the path to conversion. When we speak of it in terms of mythology, it does not seem so morbid to see death as a learning opportunity or potential for growth. Many of the death researchers have pointed out this facet of the bereavement experience (Balk & Corr, 1996; Fleming & Balmer, 1996; Eisenstadt, 1978).
It seems useful to consider the potential for what I call the Bereavement-Hero cycle. Eisenstadt (1978) drew attention to the link between historical eminence and parental loss in a study of the 573 famous individuals in Encyclopedia Britanica for whom parental mortality was known. By the age of fifteen, thirty-four percent of these famous individuals had been bereaved. The statistical significance of this cannot be assessed due to sampling problems, but the evidence is suggestive. Eisenstadt suggested four reasons for this effect: 1) the child developing an ego ideal that lead to accomplishment; 2) bereavement might trigger a crisis requiring mastery on the part of the child; 3) compensatory energy might be invested to overcome insecurity, guilt and emptiness; or 4) there may be a compensatory need for power and achievement. This phenomena is not without mythological precedence as many of the classical heroes were orphaned in myth.
A final important Scorpionic myth for bereavement (or any crisis of consciousness) is that of Hercules battling the Hydra. The Hydra was a gigantic many-headed sea-serpent whose blood was particularly toxic. This monster had been nurtured by Hera in her relentless quest to defeat Hercules, who fought it as one of his labors to atone for killing his children during a spell of insanity. The beast was 9-headed and he fought it with a sword, lopping heads off, but as fast and furiously as he cut them off, they would grow back. In some versions of the myth as he tires, he finally lifts the Hydra into the light, causing it to die. In other versions, a helper sears the stumps at their severed roots, finally enabling Hercules to sever all but one head, at which point the monster is defeated. In either case, this myth is frequently cited as an analogy to the effects of denial and repression. As long as the severity of problem is denied or minimized and the aspect is not held up to the light of day or dealt with at the roots, it will continue to manifest itself in multiple expressions of its toxicity. This veracity of this myth has also been born out by research, which shows that confronting the reality of bereavement facilitates resolution of grief (Bowlby, 1980; Valente et al, 1988; Tyson-Rawson, 1996; Lattanzi-Licht, 1996).
Problems and miscellaneous issues.
The good news is that adolescent bereavement does not seem to cause personality disorder. The bad news is that bereavement and psychic trauma reinforces predisposition towards psychopathology (Balk, 1996). The majority of pathological outcomes are the product of the interactions of adverse conditions following bereavement and premorbid vulnerability towards mental health disorder (Bowlby, 1980). Some of the adult personality disorders which seem to be exacerbated by childhood bereavement are depression, anxious attachment, suicidal ideation, hopelessness, alcoholism (ibid., p. 301), compulsive caregiving, euphoria and de-personalization (Bowlby, 1980, p. 351)
Psychic trauma is an emotional condition following a sudden and unexpected event which exceeds the capacity of the coping skills and psychological defenses, temporarily rendering the individual helpless (Terr, 1985). Terr suggests that there are four main effects of childhood psychic trauma:
The effects of parental suicide are complicated (see Sheperd & Barraclough, 1976). From a naive perspective, one might assume that suicide would be a cause for feelings of deep rejection, guilt, depression, shame, and anger towards the surviving parent, but the reality of the pre-suicide family dynamics can also make suicide feel like a relief. Sheperd and Barraclough (1976) found five factors that might precipitate psychopathology in children of suicidal parents: living with a mentally ill parent; bereavement during a formative period; the circumstances of the death; social and economic difficulties of the surviving parent, and genetic inheritance from a sick parent. Valente et al. (1988) wrote that the general conclusions that adolescents were likely to draw from parental suicide were one of irresponsibility of self and powerlessness of self, both creating a pessimistic belief system with a destructive impact on identity.
While suicide can cripple the home environment, one parent killing the other shatters the family totally (see Black & Kaplan, 1988). The child is plunged simultaneously into roles of the bereaved, the child of a murderer, and separated from the surviving parent. The child is likely to have been a witness and the chance of developing post-traumatic stress disorder is high. These children are often denied the opportunity to talk about the event in a supportive setting simply because the tragic story is painful to listen to, and this suppression can lead into deeper complications of grieving (Black & Kaplan, 1988). Bowlby (1980, p. 287) holds that the new parental figure must be sensitive to the child's persisting loyalties and to respect his past relationships; when children bereaved by inter-parental homicide are placed with relatives, this may not be possible (Black & Kaplan, 1988). In the case of the child being an adolescent, these issues of prior loyalties are even more volatile.
There is also a dilemma in the resolution of Survivor's Guilt. Consider the question of is it better to feel helpless as a victim or to blame yourself for a tragedy? The boundary between culprit and victim is unclear when in the course of rescuing the child-survivor, the rescuer-parent is killed. Is it better to strip the child of any sense of empowerment by removing any culpability? The people in the social environment of the child are going to make their own judgments of the situation and child will have his own predisposition to evaluate his or her responsibility. The therapist may have limited ability to change a perception of guilt or victimization, given the underlying dynamics of the situation. It may be, in the long run, psychologically less destructive to live with guilt than helplessness (Terr, 1985). Bowlby (1980, p. 289) advises that if the child is implicated in the death by infectious disease or complicated rescue, then only open discussion can give the child a proper perspective to put his life back in order.
To begin with, the counselor should try to work with the entire family system. It may be that the best help for adolescent bereavement is to support the surviving parent maintain open communication with the adolescent. Bowlby (1980, p. 273) suggested that the counselor provide a supportive relationship for the parent, facilitating the expression of the feelings necessary for mourning to take a healthy course. Then the counselor is advised to help the parent include his/her children to also express their sorrow and distress. The surviving parent and the change in the family structure are fertile fields for the counselor's work.
TABLE 4. Mourning behavior checklist
(from Murphy, 1986).The counselor should encourage the family, including the adolescent, to participate in mourning rituals. Murphy (1986), working from a large survey of young adults who were bereaved as children, suggests that many of the associated problems are due to a lack of participation in the mourning process, with attendant pressure on them to deny or stifle their feelings. She found that the reality testing of mourning behaviors was important in resolving grief.
The importance of honest confrontation of the situation and being able to talk it through cannot be understated. There is a general agreement that children and adolescents manage grief better when they have a supportive person to talk about the bereavement experience (Valente et al., 1988, Tyson-Rawson, 1996). Many times an adolescent will change peer groups to find others with the maturity and ability to discuss death (Tyson-Rawson, 1996.) Only when the adolescent is given the truth can they face the situation with realism (Bowlby, 1980, p. 273) It is important that truth and accurate information be provided for individual to act from. Misguided efforts to provide disinformation in order to protect the youth seem to only complicate matters. Freedom to discuss death is a coping mechanism, but if the parent is afraid to express their feelings, the adolescent is not likely to feel that this is an option open to them either. Bereaved teenagers reported that the most helpful activity after bereavement is simply "talking about it" (Gray, 1989). The counselor should facilitate this process. Group-counseling or internet bereavement discussion groups such as kids-to-kids@grief.net are also avenues to find someone to talk with about this experience.
Counselors should be aware of the additional concerns in the case of parental suicide. Suicide is particularly vulnerable to distortion of truth; researchers found that only about half of the children survivors were told that the death was suicide (Sheperd & Barraclough, 1976). Many of the children witness the death or find the body, but if the surviving adults distort the facts to avoid calling it suicide, this can place a great strain on the children's connection with reality. On the other hand, since the adolescent, in particular, may identify with the deceased and develop suicide ideation, it would seem reasonable to provide disinformation about the circumstances of death. however the effect of dishonesty may be seriously damaging to the relationship between the adolescent and the caregiver and it is difficult to coordinate all the possible sources of information to any degree of consistency. Avoidance, denial, or overprotection sends the message, "You / We can't handle it." (Lattanzi-Licht, 1996). The act of suicide has serious repercussions though out the family system which have no easy approach in therapy.
Trauma surrounding bereavement is another consideration for the counselor. Terr (1985) pointed out that after a traumatic event, there are no generally successful methods of restoring a child's optimism, rebuilding their trust, and recreating their innocent autonomy. Antidepressants may be used to manage depression. Desensitization may help alleviate specific fears associated with the traumatic event. Group therapy may be especially effective with adolescents under skillful leadership managing the group to prevent it from becoming a vehicle for contagious infection of others by rage associated with PTSD. Family therapy, likewise vulnerable to acting as a contagion unit, is a valuable approach when the entire family was involved in the traumatic event. Play therapy and storytelling, like individual psychotherapy, offer a means to reorder thoughts, feelings, and perceptions. This reordering of perceptions can help address issues of survivors guilt, hopefully showing the child that he couldn't really do anything other than what he did. The counselor should have some understanding of the symptoms and treatment of PTSD, or should refer the traumatized child out to a qualified therapist.
The most important factor for the therapist to keep in mind with adolescent bereavement is the developmental issues of the client. The relationship between an adolescent and his/her family is in a state of transition as the adolescent becomes increasingly autonomous from his/her family. In the transition between childhood and adulthood, the peer group assumes a important role which can be utilized for therapeutic purposes. The adolescent peer group normally provides a sense of belonging, uncritical acceptance of separation from family, submergence into a group, and identification with the power of the group (Van der Kolk, 1985). For this reason, group-therapy can be especially valuable for this age group. "Being one of the crowd", Gray (1989) suggested, "seemed healthy and necessary to reassure the bereaved adolescent that life could go on," but he cautions that friends that always try to distract instead of discussing the loss were not very helpful in the long run. The skillful therapist must keep the group focused on discussion of loss and prevent it from becoming a contagion unit for rage. Clearly, this requires the extraordinary skill in group therapy guidance.
There are reasons to be optimistic about the long-range outcome of bereavement. Many modern social researchers look at the situation optimistically. Balk and Corr (1996) suggest that bereavement offers the opportunity for adolescents to develop a concrete personal appreciation of the implications of death for life and living. "This task asks adolescents not to abandon, but to enrich, the intensity of their lived experience."(ibid., p. 24). Some of the positive conclusions that children might (and do) draw from the experience of bereavement are that there are ways to cope with adversity, that irrevocably bad things happen in life, and that people should be valued while they are alive (from Valente et al., 1988 citing Balk, 1983). The counselor may do well to avoid premature closure of this chapter, and help the adolescent realize the value (and hence meaning) of the experience.
TABLE 5. FIVE ADAPTIVE TASKS
The coping model offers the counselor what seem to be the most promising avenues of therapy. Balk's (1996) five adaptive tasks set clear guidelines for therapeutic goals for bereavement. If the therapist can help the adolescent find meaning in his/her loss, gain a sense of mastery, and restore his/her self-esteem, perhaps death will offer the adolescent the truly Scorpionic experience of rising from the ashes.
References:
Adler, J., Wingert, P., Springen, K., Stone, B., King, P., Kalb, C. & Foote, D. (1997). How kids mourn. Newsweek, September 22, 1997, 58-61.
Balk, D. (1983). How teenagers cope with sibling death: Implications. The School Counselor, 31, 150-158.
Black, D., & Kaplan, T. (1988). Father kills mother: Issues and problems encountered by a child psychiatric team. British Journal of Psychiatry, 153, 624-630.
Bowlby, J. (1980). Attachment and Loss. Vol. III: Loss: sadness and depression. Harper Collins: Basic Books.
Schroeder, C. S. & Gordon, B. N. (1996). Practitioners Corner: Helping Children Understand and Cope with Death. Clinical Child Psychology Newsletter, Fall, 1996, 4-6
Conley, B. (1984). Interdisciplinary care in adolescent bereavement. Family Therapy Collections, 8, 61-72.
Balk, D. E. & Corr, C.A. (1996). Adolescents, developmental tasks, and encounters with death and bereavement. . In Corr, C. A. & Balk, D. E. (Eds.) Handbook of Adolescent Death and Bereavement, (pp. 2-24). New York: Springer Publishing Co., Inc.
Breier, A. Kelsoe, J. R., Kirwin, P., Beller, S. A., Wolkowitz, O. M., & Pickar, D. (1988). Early parental loss and development of adult psychopathology. Archives of General Psychiatry, 45, 987-993
Eisenstadt, J. M. (1978). Parental loss and genius. American psychologist, 33(3), 211-223.
Fleming, S. & Balmer, L. (1996). Bereavement in adolescence. In Corr, C. A. & Balk, D. E. (Eds.) Handbook of Adolescent Death and Bereavement, (Chapter 7). New York: Springer Publishing Co., Inc.
Gilbert, K. (1996). "We've had the same loss, why don't we have the same grief?": Loss and differentiated grief among families. Death Studies, 20, 269-283.
Gray, R. E. (1989). Adolescents; perceptions of social support after the death of a parent. Journal of Psychosocial Oncology, 7(3), 127-144.
Hamlin, J. E. (1997). Confronting Trauma - Confronting Life. Retrieved October 15, 1997 from the World Wide Web: http://www.ozemail.aust.com/~jsjp/cisd2.htm
Hammer, L. (1990). Dragon rises - red bird flies: psychology and Chinese medicine. Barrytown, NY: Stanton Hill Press, Inc.
Koss, M., Tromp, S., & Tharan, M. (1995). Traumatic memories: Empirical foundations, forensic and clinical implications. Clinical Psychology Science and Practice, 2(2), 111-132
Lattanzi-Licht, M. (1996). Helping families with adolescents cope with loss. In Corr, C. A. and Balk, D. E. (Eds.) Handbook of Adolescent Death and Bereavement (Chapter 11). New York: Springer Publishing Co., Inc.
Mahler, M. S. (1961). On sadness and grief in infancy and childhood. Psychoanalytic Study Child, 16, 332-351.
Morillo, E., & Gardner, L. (1979). Bereavement as an antecedent factor in thyrotoxicosis of childhood: Four case studies with survey of possible metabolic pathways. Psychosomatic Medicine, 41(7), 545-555.
Noppe, L .D. & Noppe, I. C. (1996). Ambiguity in adolescent understanding of death. In Corr, C. A. and Balk, D. E. (Eds.) Handbook of Adolescent Death and Bereavement, (Chapter 2). New York: Springer Publishing Co., Inc.
Noppe, I. C. & Noppe, L. D. (1997). Evolving meanings of death during early, middle and later adolescence. Death Studies, 21, 253-275.
Partridge, S. & Kotler, T. (1987). Self-esteem and adjustment in adolescents from bereaved, divorced, and intact families: Family type versus family environment. Australian Journal of Psychology, 39(2), 223-234.
Rothbaum. F., Weisz, J. R., & Snyder, S. (1982). Changing the world and changing self: a two-process model of perceived control. Journal of Personality and Social Psychology, 42, 5-37.
Seligman, M. (1996). The optimistic Child: A revolutionary program that safeguards children against depression and builds life long resiliency. Review by Nancy Sharp-Light in Resiliency in Action. Winter 1996. Retrieved October 15, 1997 from World Wide Web: http://www.resiliency.com/book.html
Sheperd, D. M., & Barraclough, B. M. (1976). The aftermath of parental suicide for children. British Journal of Psychiatry, 129, 267-276.
Smith, P., Range, L., & Ulmer, A. (1991). Belief in afterlife as a buffer in suicidal and other bereavement. Omega Journal of Death and Dying, 24(3), 217-225
Taylor, S. E. (1983). Adjustment to threatening events: a theory of cognitive adaptation. American Psychologist, Nov. 1983, 1161-1173.
Tennant, C. (1988). Parental loss in childhood. Archives of General Psychiatry, 45, 1045-1050.
Terr, L. (1985). Psychic trauma in children and adolescents. Psychiatric Clinics of North America, 8(4), 815-835.
Valente, S., Saunders J., & Street, R. (1988). Adolescent bereavement following suicide: An examination of the relevant literature. Journal of Counseling and Development, 67(3), 174-177.
Van der Kolk, B. (1985). Adolescent vulnerability to post-traumatic stress disorder. Psychiatry, 48(4), 365-370.
Van-Eerdeweg, M., Clayton, P. & Van-Eerdeweg, P. (1985). The bereaved child: Variables influencing early psychopathology. British Journal of Psychiatry, 147, 188-194.
Van-Eerdeweg, M., Bieri, M., Parrilla, R. & Clayton, P. (1982). The Bereaved Child. British Journal of Psychiatry, 140, 23-29.
Vargas, L. A., Loya F., and Hodde-Vargas, J. (1989). Exploring the multidimensional aspects of grief reactions. American Journal of Psychiatry, 146(11), 1484-1488.
CITATION FOR THIS PAPER
Barlow-Irick, Patricia. (1997). Adolescent Bereavement. World Wide Web http://www.largocanyon.org/largo/heroes/grief.htm
For more information on Bereavement see heroes.htm