A Parents Guide to Traumatic Bereavement
Adjusting to the death of someone close can be difficult and painful for children and young people; For some children and young people, the way the person died, or the traumatic nature of the death can seem to make grieving more difficult.
Different people react in different ways, but the following are common:
- Nightmares and other sleep problems
- Frightening images or memories of the death unexpectedly popping into their mind
- Playing or drawing about the death repeatedly
- Not wanting to talk or think about the death
- Avoiding anything that might remind them about it
- Getting angry or upset more easily
- Not being able to concentrate
- Being more jumpy
- Being more clingy
- Physical complaints such as stomach aches or headaches
- Regressive behaviour (e.g. bedwetting)
- Problems at school
Even if the child or young person did not actually see the death, they may imagine what it might have been like. Memories, images or thoughts of the death can be very vivid and frightening; they may keep coming to mind unexpectedly. The fact that the memories, images or thoughts seem to be out of control, may make them feel even more scared or may make them feel as if there is something wrong with them. To avoid these very distressing memories or images of the death, they may try really hard not to think about the person who died. This then makes it very difficult for them to think about more pleasant memories of the person’s life; as a result it then becomes difficult for the child or young person to feel sad about their loss, because they feel scared about the way the person died.
Sometimes the death can have a huge and lasting effect on the way that the child or young person sees things and this can cause problems. For example, as a result of the death, they may be so afraid that other people will die in the same way that they become very clingy. Or they may think that there is no point in living their own lives.
Some of these reactions may be very normal in the short term, but can cause major problems if they continue for too long.
What you can do to help:
Because the event may seem so extraordinary it might seem that the child or young person needs something that is equally extraordinary. In fact they will benefit a great deal from a lot of ordinary. Even if “normality” is impossible, regular routines help them to feel that the world is predictable and that they are safe. Familiar things and familiar people also help them to feel secure; good social support from family, friends and school can help make things less difficult. One of the best “antidotes” to a traumatic event, is a strong relationship with someone on whom they can rely (such as a parent or carer). This means that adults who are important to the child or young person may need to continue to be “available” and pro-actively invest in spending time with them, just at a time when they are dealing with so many other things. Main carers are really important at this time, but other familiar adults (e.g. family, neighbours, teachers) can help a great deal too.
Give information and help them to develop their own “story” of the event
Calling it a “story” does not mean that it is untrue, it is just a description of what happened together with a commentary which explains the event and what it means to them now. Even young children need such a story that explains what has happened in a truthful and helpful way. Without such a story they might “fill in the gaps” from their imagination, and that may be more scarey than the reality. If the event is not “talkable-about”, then children and young people may develop unhelpful misunderstandings.
Children and young people need to be able to ask questions so that they can clarify what happened and they need to know that their questions will be answered honestly and appropriately given their age and understanding. As they say in the booklet “Beyond the Rough Rock” (see resources section), if the child or young person asks the question they are probably ready to hear the answer.
What happened may be so extraordinary that children and young people may need to go over it more than once. As children get older, they may ask more questions and need more information. So explaining to them what has happened is likely to be something that happens over time, rather than over the course of a single chat.
Access Extra Support if necessary
Some children and young people will need a bit of extra help coping with a traumatic death. If they continue to have bad dreams, or they seem to be very disturbed in other ways and things do not seem to be getting better, then it might be worth considering getting some professional help.
What we can do to help:
As the parent or carer of the child or young person, you might feel that you would like someone to talk to, perhaps to discuss how you can best help the child or young person. Or it might be that the child or young person would benefit from having someone to talk to about their worries and how they are coping. Sometimes the ideal people to offer support are those that the child or young person already knows, such as friends or family. But sometimes it helps to have a professional to talk with – someone who is not directly affected by the event and to whom the child or young person can speak freely.
Trauma Focussed Cognitive Behavioural Therapy (TF-CBT)
Sometimes, the difficult memories or the meaning that the person has made of the event cause significant problems (see Reactions section above). In order to stop the memories, images or thoughts being so vivid and uncontrollable, the child or young person might need some help to “process” the event.
“Processing” involves bringing the event to mind, thinking it through and developing a helpful description and explanation of what happened. This can help the memory to change; so that rather than being stored as vivid sensory information (sights, smells, tastes, touches) which is triggered very easily, the memory becomes more like other memories of normal events – stored as words and a story, the child or young person can then have more control over the memory, choosing to think about it when they want to, rather than having it come to mind automatically. This “processing” can also help them to acknowledge the reality of what has happened whilst still having a helpful view of the world. For example, following a murder a child or young person might think that all people are dangerous and should be avoided. But over time as they process the event, they come to realise that some people are dangerous some of the time.
One way in which we might help with this process, is to offer “Trauma-Focussed Cognitive Behavioural Therapy”. It is the only therapy recommended by the National Institute for Health and Clinical Excellence (NICE) for helping traumatised children and young people. After the event has been processed, then the child or young person may be able to start to adjust to their loss.
Receiving this sort of help can sometimes be hard work; it involves thinking through the very thing that the child or young person is trying hard not to think about. But we will spend time developing a good therapeutic relationship and helping them to feel able to think the event through. In addition to talking, we will often use creative methods such as play or art.
What happens if you come to the trauma service?
Children and young people who live in Luton and Bedfordshire can quickly and easily be referred to CHUMS, but the system is a little different depending on where the child lives. For more information contact the office. A decision will then be made together with the family, about the best way that CHUMS can help the family and whether the trauma service can help.
Children and young people who live outside ofLutonand Bedfordshire can still be referred to the Trauma Service, as long as funding has been agreed. This is usually done by the person’s NHS Primary Care Trust, their Local Education Authority, or an insurance company.
The first meeting will involve gathering lots of information. It will be useful for us to understand as much as possible about how the event has affected the child or young person. This involves finding out lots about how they were doing before the event, details of what actually happened and how they are doing now. We will also be interested to find out how you will know if we have been helpful. It’s usually useful to talk to the child or young person together with their parent or carer, as well as talking to them on their own. But we can discuss this with you and them.
What we talk about in any session is confidential. This means that we will not usually tell anyone else what we talk about in the session (you and the child or young person can tell whomever you like). If someone else (like a teacher or a doctor) asked us to see the child or young person then it would be good for us to write to them at some point to let them know how we are getting on, as well as letting them know how things have gone when you have finished working with us. But we will discuss this letter with you and the child or young person before we send it. Everyone who works at the trauma service has supervision. This means that we talk with another professional about our work and what we are doing. We think this is really important, because it helps us to help you and the child and young person as much as possible. But it does mean that sometimes, we might talk about you to our supervisors. Our supervision sessions are also confidential. It might be helpful for us to talk to other professionals who are involved, but we will talk with you and the child or young person before we do so.
The only other time that we would talk to someone else about the child or young person, is if we are told something that makes us think that someone is in danger – if this happens then we would tell whomever would be able to ensure that everyone is safe. If we are going to do this, if we are able to, we will tell you before we do so.
Letter & formulation
After a few sessions, we should have some idea of what the problem is and how we can help. This is called the “formulation”. We will usually write to you or the child or young person at that point, describing what we think is going on and how we can help. This is important because it will give you and the child or young person a chance to let us know if we have got anything wrong and it will give you a good idea of how we think we can help.
The support offered
Sometimes it is better to work with the child or young person on their own, sometimes it is better to include other family members. This will be discussed with you and the child or young person.
Other sources of help and support:
Organisations that you might find helpful:
DIPEx Charity www.healthtalkonline.org
The information on Healthtalkonline is based on qualitative research into people’s experiences, led by experts at theUniversityofOxford. The intention is that these personal stories will enable people to benefit from the experiences of others. There are sections on bereavement, including traumatic bereavement and bereavement by suicide.
Support After Murder and Manslaughter – Abroad (SAMM-abroad) www.sammabroad.org
AUKcharity which exists especially for people in theUKwhose loved ones are the victims of murder or manslaughter abroad. It is a support group for families, partners and friends of the victims of murder and manslaughter abroad. It is also an action group, working for change in the support received in theUKafter a murder abroad
Support After Murder and Manslaughter (SAMM) www.samm.org.uk
A UK charity which offers understanding and support to families and friends who have been bereaved as a result of murder or manslaughter, through mutual support of others who have suffered a similar tragedy.
The National Child Traumatic Stress Network www.nctsnet.org
An American based network that provides excellent resources for parents, schools, the media and professionals.
Survivors of Bereavement by Suicide (SOBBS) www.uk-sobs.org.uk
A self-help organisation which aims to meet the needs and break the isolation of those bereaved by the suicide of a close relative or friend.
Books and leaflets that you might find helpful:
Grief in Children: A Handbook for Adults. 2nd Edition. Written by Atle Dyregrov (2008), published by Jessica Kingsley. Available from booksellers.
Grief in Young Children: A Handbook for Adults. Written by Atle Dyregrov (2008), published by Jessica Kingsley. Available from booksellers.
Hope Beyond the Headlines: Supporting a child bereaved through murder or manslaughter. Winstons Wish (2008). Available to order from www.winstonswish.org.uk
Beyond the rough rock: Supporting a child who has been bereaved through suicide. Winstons Wish (2008). Available to order from www.winstonwish.org.uk
Post-traumatic stress disorder (PTSD): the treatment of PTSD in adults and children. Understanding NICE guidance – information for people with PTSD, their advocates and carers, and the public NICE guidelines. NICE (2005). Available to download from www.nice.org.uk/CG026publicinfo