Therapeutic Interventions

Express personal feelings related to the loss and identify appropriate methods for coping with these feelings and sharing them with the children. (1, 2)

List and implement behavioral techniques for coping with strong grief feelings. (3, 4)

1. Assign the family members to write a letter to the lost loved one expressing personal feelings, questions, fears and perceptions about the loss.

2. Instruct the parents to encourage the child to draw pictures, write songs or poems, play music, or use sculpting or sand play to describe reactions to the loss and to share these artistic expressions with the parents and the counselor.

3. Assist the parents in devising a plan for managing strong grief reactions during the week (e.g., talk with a friend or family

Verbally acknowledge the children's feelings of grief and loss and encourage an ongoing interchange of feelings. (5, 6)

Verbalize an understanding that grieving and adjusting to a loss takes time and effort for both adults and children. (7, 8)

member, draw a picture, write in a journal, take 10 deep breaths.

4. Assist the parents in developing a personalized working definition of grief and to recognize that typical waves of grief that can overwhelm temporarily, but also diminish over time.

5. Assign the parents to assist their children to monitor their reactions to the loss through drawings or journal entries (or assign the "Monitoring our Reactions to Change and Loss" activity from the Parenting Skills Homework Planner by Knapp).

6. Assign parents to read How to Talk so Kids Will Listen and Listen so Kids Will Talk (Faber and Mazlish) to develop additional active and empathetic communication skills with their children.

8. Outline for the parents the stages of working through grief (e.g., shock and denial, anger, accepting the loss, experiencing the pain, adjusting to the change, investing in an altered life pattern) and assign them to work with the child to determine which stage is currently being experienced and plan for stages yet to come.

8. Assign the parents to watch The Secret Garden (Playhouse Video) or the Lion King (Walt Disney Home Entertainment) with their children and discuss the stages of grief experienced

5. Gather information about grieving and/or join a grief support group. (9, 10)

6. Identify sources of comfort within the extended family, school, work environment, and community. (11, 12)

7. Meet with clergy to discuss the spiritual perspective of death and/or loss. (13, 14)

by the characters after the loss or death of loved ones.

9. Refer the parents to a grief support group offered by local hospitals, hospice, religious groups, or community agencies.

10. Assign the parents to gather information about family and personal grieving by reading literature (e.g., Parenting with Wit and Wisdom in Times of Chaos and Loss by Coloroso) or by accessing information from the Internet (e.g., Children's Grief and Loss Issues: www.childrensgrief.net).

11. Assign the parents to acknowledge their personal support system by identifying several supportive and caring gestures from family, fellow workers, the child's school, and friends (or assign the "Grief and Loss Circle of Support" activity from the Parenting Skills Homework Planner by Knapp).

12. Instruct the parents to meet with the child's teacher or school counselor to discuss the effects of the loss on the family and the ramifications on the child.

13. Instruct the parents to arrange a meeting for the child and/or the entire family with a rabbi, priest, or youth minister to discuss the loss from a spiritual perspective and to receive guidance and support.

14. Assign the parents to encourage the child to join a grief and loss

8. Verbalize an understanding of the child's grieving and reactions to the loss from a developmental perspective. (15, 16)

9. Children and the parents describe their emotional and behavioral grief symptoms. (17, 18)

10. Plan and implement coping strategies for anniversaries, holidays, or other periods of heightened grief. (19, 20)

support group sponsored by the family's place of worship.

15. Assign the parents to read Explaining Death to Children (Grollman) and The Way Children Grieve (Bissler) to gain insight on the effects of grief on children.

16. Assign the parents to read the Developmental Considerations Concerning Children's Grief (Metzgar) and discuss the child's reactions to grief and loss from a developmental perspective.

17. Describe to the parents the common reactions to grief and loss (e.g., shock, anger, guilt, shame, lack of focus, behavioral changes, mood swings, regression, and preoccupation); ask the parents to add any symptoms personally experienced or observed in their children.

18. Assign the parents to play "The Talking, Feeling and Doing Game" (Gardner, Western Psychological Services) or "The Ungame" (Taicor Inc.) with their children to help each family member identify and express feelings related to the death or loss.

19. Brainstorm with the parents ideas for facing holidays, birthdays, and the anniversary of the loss (e.g., plan an activity with the family, share fond memories with one another, visit the cemetery, and talk to the lost loved one).

11. Impl ement strategi e s focused on offering comfort and support to the grieving child. (21, 22)

12. Facilitate the child's entry into individual counseling if the grief reaction is severe or prolonged. (23, 24)

13. Maintain consistent and supportive discipline strategies. (25, 26)

20. Assign the parents to involve the child in planning a memorial devoted to special memories, stories, and experiences involving the lost loved one on the anniversary of the loss, birthday, or holiday.

21. Instruct the parents to implement strategies to assist the child in dealing with grief (e.g., be open and tell the truth, don't hesitate to express own grief, reassure that the death or loss was not the child's fault).

22. Encourage parents to read books or watch video's with the child about grief and loss (e.g., The Fall of Freddie the Leaf by Buscaglia, Don't Despair on Thursdays by Moser) and to discuss the thoughts and emotions triggered by the stories.

23. Assign the parents to keep a daily journal of the child's grief reactions; discuss them during subsequent counseling sessions, being alert for signs of a severe or prolonged grief process.

24. Instruct the parents to watch for prolonged or severe grief reactions from the child (e.g., sustained disinterest in daily activities, loss of appetite, difficulty sleeping, extended regression, withdrawal from relationships) and refer the child for individual therapy if appropriate.

25. Instruct the parents to continue to have reasonable expectations for their child's behavior and to

Reassure the child about personal security; express an awareness and empathy for existing fears; and commit to maintaining a close, loving relationship. (27, 28)

Verbalize an understanding that losses are an unavoidable part of life. (29, 30)

discipline in a loving, compassionate, consistent manner that holds the child accountable.

26. Advise the parents to remain intimately involved in the lives and activities of all of their children; explain that careful monitoring of the children's behavior, although not always appreciated, is an essential responsibility of both the parents especially during times of family trauma.

27. Assist the parents in planning a time and method of reassuring the child about personal security and expressing awareness and empathy for the child's fears and feelings of grief.

28. Assist the parents in identifying age-appropriate, positive interventions to help the child deal with grief (e.g., active listening, frequent affirmations, answer questions, read books about grief and loss together, and continually express support and encouragement).

29. Assign the parents to collaborate with their children to create a time line of significant events including births, deaths, marriages, and graduations to gain a visual perspective of the celebrations and losses encompassed within their family history.

30. Instruct the parents to encourage elder family members to share their wisdom and experiences in dealing with grief and loss with them and the child.

Describe ways to turn despair into positive, productive effort. (31, 32)

List personal and family goals and express optimism for family and personal relationships in the future. (33, 34)

31. Encourage the parents to assist the child in writing an article about the family's grief experience and share it with members of their grief support group or submit it to a grief newsletter or Web site.

32. Assign the parents to brainstorm with their child methods of turning reactions to a traumatic event into a positive effort (e.g., volunteer to help others who are grieving, work for a significant charity, start a project for change, promote the seatbelt law) and choose one project for family participation.

33. Assign the parents to construct with their children a collage picture representing their family five years in the future focusing on achievements, activities, career paths, personal and family relationships.

34. Assign the parents to read Lessons from Geese (Clayton) with their child and follow with a discussion of how people, like geese, can help one another cope in times of grief and loss.

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