A Portfolio of Academic, Therapeutic Practice and Research Work: Including an Investigation into Supervision and Risk : A Grounded Theory Approach.

taken from the movie 'My Girl' (1991) The above quotation is taken from a movie about an 11-year-old girl called Vada. She writes the above abstract after the sudden death of her closest friend Thomas J, a neighbourhood boy with whom she spends long hours of summer vacations. His death leaves Vada shocked, horrified, angry and inconsolable and it takes her a long time to cope with the realization that he had left. Her words appear to be significant for the topic of this essay since they retain a childlike quality that allows for an easier conceptualization of the topic. This essay focuses on a slightly different subject: that of children who are aware of the imminent death of a significant other. Their experience is often mistakenly believed to be equivalent to that of adults. However, different factors come into play when children are involved. Their well being in such circumstances is marked by the interplay between their understanding of the situation and their environmental circumstances. The role of the counselling psychologist is necessary when children need support and when the people surrounding these children need some help in understanding and communicating with them. This essay includes a discussion of some salient issues for children in their understanding of death and the process of bereavement according to their developmental stage and in relation to the expected loss Academic Dossier p. 13 of a significant other. It also takes into account the ways in which counselling psychologists might be involved in such situations. The meaning of anticipatory grief in children's lives The process of grief that takes place before the death of another is referred to as 'anticipatory grief' (Rosenheim & Reicher, 1986; Worden, 1991). Abrams (1999) associates the process of anticipatory grief with a 'rehearsal' of what is expected to happen when the person actually dies. It is a period pregnant with feelings of insecurity and apprehension. During anticipatory grief children usually have to adjust to a lot of changes (Solvi & Ulfsset, 2003). However, in many cases they are not provided with explanations of what is going on possibly because they are believed to be oblivious to what is happening around them. In fact, literature has also indicated that children are often inadequately informed about illness possibly because many adults are under the inaccurate impression that children are unable to understand or that they are too vulnerable to cope with pain (Nelson, Sloper, Charlton, & While, 1994). Indeed they have often been described as the 'forgotten mourners' (Smith & Pennels, 1994). A number of studies have focused on this area and they have shed some light on the psychological processes that children may experience in these circumstances. Psychological distress is very common among children who expect the death of a loved one (Beswick & Bean, 1996; Kroll, Barnes, Jones, & Stein, 1998; Solvi & Ulfsset, 2003). The distress emerges from different factors related to the illness including the prospect of death, the physical distancing from the dying person and the interference that the illness brings in the roles and lifestyles of all who are involved (Compas, Ey, Worsham & Howell, 1996). The preannounced death of a significant other is also believed to bring a lot of insecurity, fear and a sensation of lack of control for children (Compas et al. 1996). This also leads to further anxiety about their own mortality and that of other significant people (Hurd, 2004). In their study Compas et al. (1996) discovered that children's emotional state is often correlated with that of the dying person. These authors investigated the cognitive appraisals and coping of 134 children whose parent had been diagnosed with cancer. The results indicated that children depended on their terminally Academic Dossier p. 14 ill parents' stable periods in their illness to feel tranquil themselves. This highlights children's capacity to empathise and absorb the feelings of others and possibly their need to mirror the behaviour of trusted adults in unfamiliar situations. In fact, in another study conducted by Solvi and Ulfsset (2003) children admitted being frequently anxious and worried whilst being completely unaware of the actual source of their distress because they had been left unaware of the actual source of the significant person's distress. Further studies have confirmed that there are a number of reactions that children experience in cases of bereavement, including: outbursts of anger, somaticisation and guilt. Other authors (e.g., Black, 1978) also suggest that there is a potential for long-term psychological difficulties associated with deaths in the family. An understanding of children's feelings and reactions is important for the role of counselling psychologists who may be asked to intervene either directly with the child or indirectly with older adults responsible for the child. However, they would also need to take into account the children's developmental stage and cognitive abilities. Understanding children's needs in light of their development Children's learning and reasoning hinges upon their social interactions and their communication with others. Echoing a 'constructionist' perspective, contemporary literature in child development sustains that children are active in the construction of their knowledge about the world (Thompson & Payne, 2000). The depth of children's understanding of the circumstances surrounding the death of a loved one depends on many factors including their support system and any previous experience of death (such as that of a pet). However, one needs to remember that other underlying factors such as their developmental stage and cognitive abilities also play a role in their understanding of the implications of illness and death. In the preschool years children are not yet able to distinguish between logic and fantasy (Rauch, Muriel, & Cassem, 2002). They are also unable to understand the lasting nature of death. At the same time they believe that they are the main cause of events. Thus, children at this stage of development could interpret a terminal illness as being caused by Academic Dossier p. 15 them or by something they have done. It is imperative for adults to constantly remind children that this is not true. At this age children are also very curious and they repetitively ask 'why' questions (Rathbone, 1996). Children need to receive meaningful and coherent answers to these questions from trusted adults. Occasionally, the latter, who are experiencing anticipatory grief themselves, may overlook this. Counselling psychologists may be involved at this stage. They need to help adults understand the importance of such clarification for the child or else provide the coherent story themselves if working directly with the child. Between the ages of seven to twelve children are believed to be in what Piaget called the 'concrete operational stage' (Bee & Boyd, 2004). At this age, children start grasping the concept of death: its inevitability, permanence, and finality (McEntire, 2003; Worden, 1996). Hence children may be overwhelmed by the newly acquired knowledge about the fate of the significant other. However, they may be unable to explain themselves. This has been acknowledged by a study carried out by Wetton and McWhirter (1997) where they discovered that although by the ages of seven and eight children can identify with different emotions, they may not have yet grasped the vocabulary needed to express themselves. Consequently, adults may fail to estimate the extent to which children are being affected by the imminent loss of the significant other (McWhirter, Wetton & Hantler, 1998). If someone is not available to discuss these issues with them and enable them to describe their feelings, children may feel more confused and isolated. Consequently, in absence of a verbal medium for expressing their pain and confusion, they may start to act out their feelings behaviourally. In these cases, counselling psychologists may be able to offer a non-judgemental space for understanding these behaviours. Additionally, they can help them by offering other creative means of communicating (e.g., through play or drawing) or by providing them with vocabulary in order to express their feelings. Adolescents often get caught between the urge for independence and their family's expectation for them to be closer. Indeed, they are frequently given more responsibilities such as taking care of their younger siblings especially when parents are ill or hospitalized (Rosenheim-Borus, Weiss, Alber & Lester, 2005; Wells, 1988). When the Academic Dossier p. 16 illness of the significant other or relative is contagious (such as AIDS), adolescents are likely to experience stigmatization and thus may end up isolated at a stage of their life when the support of peers is so important (Rotheram-Borus et al. 2001; Rotheram-Borus et al. 2005). Indeed, 'being teased at school and feeling 'different' seem to be particularly common' for them (Thompson & Payne, 2000; p. 94). Such situations and the emotional distress that accompanies the approaching death of a significant other may again lead to a lot of challenging behaviour on their part where they can become disruptive and abusive. Kiibler-Ross (1984) maintains that at this stage adolescents "need the extraordinary understanding of a non-judgemental person who can see their actions as defence against the fear of impending loss" (pp. 77). Whilst fulfilling this role, counselling psychologists could also help adolescents vent their feelings anger and mistrust towards others and cope with them. By being honest and available for them, counselling psychologists could operate as a safe base for support and containment. Coping with the prospective death of a significant other The process of bereavement has been a special area of interest for various authors (e.g., Kiibler-Ross, 1973 & Worden,