Grief in Adolescence
Family is the basic structure of society. Times have evolved and with evolution comes change; family’s structure may be quite different; nevertheless, it remains the main element of society. Families may go through transitions and struggles, and one of them is the loss of a loved one; this paper will examine how children and adolescents may react to the loss of a loved one, as well as effective interventions that may be implemented to assist this population to better understand this difficult transition.
One of the most difficult struggles a family may deal is mourning the death of a family member. Death is a common experience and the only event that all human beings will have to face at one point or another throughout their lives. Grief that comes with the death of a loved one is a unique experience for every individual (Cooper, 1999). Adults going through this process may be able to logically process their feelings. In addition, they may have a more accurate understanding of grief and loss when they experience the death of a loved one (Archer, 2008). This may be quite different regarding children and adolescents who may be still developing; therefore, they are not able to cognitively or emotionally process such feelings (Cooper, 1999). Copper (1999) discusses that grieving children and adolescents may not have the necessary coping skills to face a loss and they may not even be able to verbalize their feelings.
Grief and loss is not a new topic; in an article by Archer (2008), he discusses that although Darwin did not create or wrote anything regarding a theory of grief, he left a trace of such through his observations in the facial expressions of animals who had recently lost a close one. Archer indicates that the first formal work regarding grief and loss goes back to Freud. Freud (1917) describes mourning as the individual’s normal reaction to a loss. Freud does not exclusively describes loss as death; He said that individual may also experience grief by losing a privilege or a right, such as freedom or changes in life.
Furthermore, Kubler-Ross (1969) proposed a five-stage model that identifies the grieving process. Those grief stages are denial, anger, bargaining, depression, and acceptance. Vazquez (2008) discussed in depth Kubbler-Ross’ stages of grief. She argued in her work that it seems as if younger children’s feelings are not acknowledged by their caregivers or surrounding adults. Vazquez indicated that the lack of acknowledgment may not necessarily be due to the lack of adults’ sensitivity to the child’s feelings, but rather because addressing grief and loss with adolescents is rather difficult. Vazquez also emphasized the importance of keeping in mind children and adolescents have a very different ideas regarding death. She discusses that for a child between the age of three and five death is rather temporary; between the ages of five to ten death may be seen as something scary. Vazquez (2008) states that it is between the ages of nine and ten that a child can see death as something permanent. She added that individuals who are ten or older are capable to cognitively understand that death is a biological and natural process in one’s life. On the other hand, being an adolescent is already a difficult stage due to all the physical and cognitive changes the individual is experiencing (Enez, 2017). Although adolescents may be able to understand the concept of death, they may not be able to express their grief and loss. Vazquez (2008) indicates that it is common for adolescents to express themselves through rage, guilt, and sadness; it is important to provide support during this grief period. She added that there is a lack of competent counselors to help adolescents during their grief process. Hence, it is important to have knowledge about effective tools to assess and help this population.
In a study conducted by Unterhitzenberger and Rosner (2016), they analyzed the Extended Grief Inventory (EGI), which is a grief questionnaire for adolescents. They indicated that this inventory the most common tool to assess prolonged grief disorder in children and adolescents. The EGI encompasses three subscales, which consist of positive connection, traumatic grief, and existential grief reactions. Results from the study indicated that the EGI had high reliability, especially in the scores regarding trauma and grief. However, a limitation of this study is the sample size, which consisted of 69 participants whose ages ranged from 14 to 18 years old who had lost a parent (many of them during a genocide) in rural Rwanda.
Furthermore, it is important for counselors to have knowledge of effective interventions when helping adolescents who have experienced a loss. When adolescents experience a traumatic loss, it is possible that they develop traumatic symptoms that can disrupt the normal grieving process (Cohen and Mannarino, 2004). Research has found that Cognitive Behavioral Therapy (CBT) techniques are effective interventions in helping adolescents in the grief process (Edgar-Bailey, and Kress, 2010). CBT grief-focused interventions help clients to talk, mourn, explore feelings, and redefine maladaptive or negative thinking patterns about the loss (Cohen and Mannarino, 2004). However, counselors need to be creative if they want to engage and make a positive impact in adolescents. Creative interventions can help clients have a sense of control over how their grief treatment is being managed (Edgar-Bailey, and Kress, 2010). Additionally, creative interventions can help clients identify and manage conflicting feelings related to their loss (Crenshaw, 2007). For example, I love my mother, and I miss her, but at the same time, I feel angry with her because she left me. It is worth noting that before utilizing any interventions, it is important that counselors focus their attention in helping their clients to develop coping and emotion regulation skills (Edgar-Bailey, and Kress, 2010). After improvement has been observed in the client with the mentioned regulatory factors, the counselor can apply cognitive behavioral interventions. An effective technique to help adolescents with their grief is trauma narrative. This technique involves the client addressing the loss and then the counselor identifies any inaccurate or unhelpful thoughts the client may have. In addition, the therapist should help the client understand how those negative thoughts may be negatively influencing the way the client is feeling and behaving (Cohen and Mannarino, 2004). Furthermore, understanding the interconnectedness of behaviors, feelings, and thoughts allows clients to understand the consequences of negative thinking patterns related to their loss (Edgar-Bailey, and Kress, 2010). Another important technique that helps adolescents in the grief process is journaling. This technique allows clients to reflect outside and in the counseling session about the cognitive, physical, and emotional effects related to their loss (Cohen and Mannarino, 2004). Moreover, journaling can provide the client an opportunity to express a range of emotions that they may not feel comfortable sharing with the therapist (Edgar-Bailey, and Kress, 2010). The topic in grief in adolescence has several implications for counselors. First, it is important to note that grief can be described as a multidimensional concern that could promote different emotions such as anxiety, sadness, fatigue, guilt, and loneliness (Enez, 2017). Grief can also promote depersonalization, social withdrawal, avoidant behaviors, and sleep and appetite changes (McLellan, 2015). In addition, a loss during adolescence can be a traumatic experience (Edgar-Bailey, and Kress, 2010). A traumatic loss can result in posttraumatic stress disorder if symptoms are not identified and interventions are not implemented on time (McLellan, 2015). Bereavement is a factor associated with the development of mental health disorders, impartment in physical functioning, and increased mortality (Wilson, 2006). In addition, the reactions and manifestations of children and adolescents are not comparable to those of adults (McLellan, 2015). It is important for counselors to understand that research suggest that CBT techniques are effective interventions that can help adolescent clients alleviate the emotions, feelings, and behaviors associated to their loss (Cohen and Mannarino, 2004). Additionally, having a clear understanding of such interventions allows counselors to make an effective implementation of such techniques. Nevertheless, before the implementation of any therapeutic interventions, the counselor should become competent in delivering those techniques. The ACA indicates that counselors should practice within their level of competence and expertise based on their education, training, and experience (ACA, 2014). Lastly, future research should focus in examining the cultural differences in the grief process with diverse populations.
Grief in Adolescence