Children and Loss

Hello and welcome to my children and loss presentation, I hope you are sitting comfortably, and you've got a drink to hand and a notebook and pen and let us begin. I'm going to presume that you have already taken part in the bereavement presentation and if you haven't, I'd recommend you do that first. It should be quite easy to see in the library. It's a presentation that I did. Do that first because that's foundational for understanding this presentation today.

Let's look at our aims. So, the aim of today is to gain a deeper understanding of how bereavement and loss can affect children and young people. Discover new ways of working within this niche area. Our objectives are to understand the factors affecting bereaved children and young people. Look at key facts and figures relating to bereaved children and young people. Learn how to talk to children and young people about death. Discover their age-related understanding of grief. Look at a child's possible grief reactions. Explore various elements of working with the grieving family. Pick up ideas of how to work with the grieving children and young people. Now, that kind of looks like a full day's training, and this will be up to forty-five minutes to an hours' presentation. We're just going to do little snippets of all of those objectives, but you might want to go and do some more reading or some different training to learn more about that. This presentation is really useful if you have children or you have influence over children in the community in which you live. Sometimes I will speak to you as if you were a parent or carer, because I think we need to practice what we preach. This presentation is also essential if you work with children who are bereaved and also very useful if part of your role is to advise and assist parents of children who are bereaved. So, if you are a family support worker in school as well, I know a lot of counsellors do a multiple job. If the child is bereaved, then so is the family, which is often why support is needed, because the parents can't see the wood for the trees, so to speak. When I say parents, I am referring to any caregiver and as normal, any case studies I give have been anonymized.

A little bit about me first, who is giving this presentation to you today. I'm Nicole Hughes. My first placement was with a bereavement charity. I have worked with bereavement children and their families since 2010. I deliver extensive training to professionals within the community, schools and universities. I have been a group supervisor for bereavement charity and I'm now in private practice as a creative counsellor, clinical supervisor and trainer. I work with individuals, young people and couples face-to-face, online and outdoors. That is me.

Just a little brief overview. First of all, we're going to start with you. As I do in all my training and presentations, it's really important to start with us. You'll learn some key information and look at some key facts and figures, the facts and figures. We will look at how to help a bereaved family as a whole and then finally look at the actual work you might do. To start with, we're going to look at some of your thoughts and opinions around death and children. I'm going to show you some statements and invite you to think about whether you agree or disagree with them. Try not to think about it too much, give your initial response and work with that. It might be worth pausing the video and writing down your initial thoughts. I encourage you to find a peer to explore your answers with or use the Facebook group to discuss this further. So, if you're ready, this is the first statement coming up.

Do you agree or disagree or somewhere in between? "Children should be introduced to death as early as possible". Perhaps if you've got a pen or a paper, you might note down your score. One, if you really agree and five if you disagree or maybe somewhere in between. This might be a good part to pause the video and have a little bit of a think about your answer.

Ok, welcome back. I'm glad you've done that, so we'll just move straight on to the next one.

Do you agree or disagree or somewhere in between? "Children grieve differently to adults". If you agree with that statement, you might be putting in one. If you disagree, strongly disagree, you might put five or somewhere in between. Feel free to pause the video.

Welcome back and on to the third and final one.

Do you agree or disagree or somewhere in between? "Funerals are not for children".

I think by this point, you know what you're doing. You can pause the video now if you like.

Welcome back. Ok, so there are three different statements there for you to think about your opinions. I'm really sorry at this point that this isn't a live video and you're not really there with me as I love hearing people's responses to these. There is no right or wrong. It's just your honest thoughts and opinions. I love the discussion that often goes with this so when I do it live and people are with me in the same room, which has not happened for a while, I get people to stand along a line and people move about. So strongly disagree over one side and strongly agree on the other and as we're discussing, people change their minds. They move about as they hear different people's opinions. Usually their initial response is to do with their own experience, something that they've been through. They will make their decision based on that. We need to be really aware of our personal thoughts and feelings and our own experiences when we are working with bereaved families. For example, the funeral one that's on the screen at the moment. If I wish to answer that, 'funerals are not for children', I would probably be along the disagree scale of it. That's because when I was a child and my granddad died, no one talked to me about the funeral. I wasn't allowed to go. I wasn't told that I wasn't allowed to go, I just didn't go. I think I would have really been interested in the process and what it looked like. As a child you don't really understand, and you may ask "what's a funeral?" I've been into church and I knew what a church was. I didn't really understand what a graveyard was. I don't think I'd ever been to visit one. There was a lot of information missing from that experience so as an adult, I thought actually it's important for children to be given an opportunity to go to the funeral. Then I hear stories where actually it's really not appropriate for children to go to funerals, so you just have to bear that in mind. I would support a family taking a child to a funeral, but there are definitely occasions where that's not okay.

So, you can see there as I had a little bit of a discussion by myself on that last statement. Please go ahead and talk about some of these to peers or your supervisor or in a group. You'll have a really interesting discussion.

We're now going on to talk about euphemisms. If you have done my first presentation, we talk about this in a lot of detail and we look at it from a personal development point of view. However, today I want to look at it from an instructional perspective. So, yes, not often do I do this as I'm going to tell you what to do or what I think. Let's read some of these euphemisms. Popped his clogs, pushing up daisies, kick the bucket, brown bread, slipped away. You can read the rest of those. There might be some there that you think 'I've never heard of those' or you might see some there that you use yourself. I live in Yorkshire and the people say 'passed', my grandad passed a lot that was new to me. I've not heard that as I'm from Cheshire, the other side of the country. We don't really say that so much.

I want you to think about the effect that these words might have on children. As we know, young children take words literally, they are confusing, or they can be confusing terms and it collides with their fantasy thinking. I want to encourage you to instead be explicit, honest and keep it simple. So, for example, if you tell a child that their grandma has gone to sleep, they may think that she will wake up. They also might get confused about them going to sleep. Remember this point as I'm going to come back to this when we look at reactions to grief in terms of sleeping. If you tell your child you've lost their grandad and presumably something that's lost can be found. So, euphemisms are very confusing for children, and I would recommend that you never use them. Be aware of what children over here as well. Remember this when you're doing your assessments. What words are parents using and then gently challenge this. We'll talk a little talk a little bit about this when it comes to assessments. I've discovered what the families' issue or problem is based on the fact that the child has overhead something that's not been true.

Key information, so facts and figures. I think facts and figures are quite interesting. Some of these ones are a little bit sad. Let me read these to you. A parent of children under 18 dies every 22 minutes in the U.K. That's around twenty-three thousand a year. This equates to around a hundred and eleven children being bereaved of a parent every day. One in twenty-nine five to 16-year old's have been bereaved of a parent or sibling. So, if you think about it, that's probably a child in every average class. That's a lot of bereaved children in a class and this is just about the death of parents and siblings, not grandparents or friends or extended community. So, the number of bereaved children in schools is probably much bigger so really, we do need to be talking to children about death as they're experiencing the effects of it, whether we like it or not. Now, if you are a parent, you might be interested to find out what your child's school is learning about death. It's probably in their PSHC curriculum and you can ask to see that and see what information they're being told so you can continue that conversation at home. It's done very matter of factly in school. They usually use life cycles and things to talk about death. They don't generally talk about the emotional side of it. You might want to do that.

This one here, the slide gets me quite angry, actually. Children who've experienced the death of a parent, sibling or friend are more likely to have continued issues than the non-bereaved peers. So, I'll let you read those for yourself. You can go through that in your own time. Basically, there is nothing really positive on there. They are more likely to have serious illnesses, mental disorders, be excluded from school just for having somebody in their life died, it just seems very unfair. I wonder what your thoughts are on this and maybe pause a little bit, stop the video and have a think about what your thoughts are about the effects of death having on a child.

As I said, I believe it's really important to talk about death to children, and I'm just going to go through and give you some top tips. Bare something in my mind at this point, this might not be completely relevant to your role as a counsellor, but with so many of us who are connected to schools and communities and with our own families, I think it would be remiss of me not to talk about it. For me, it is part of a package, I'm a whole person, not just a counsellor, not just a parent, not just a person in the community. To give you a little bit of context, I was on holiday recently and I met a lady who has an elderly family member who had recently died. She was really embarrassed to tell the story that she didn't know how to tell her daughters that she died so she didn't tell them. It happened during when we were in lockdown, so the family hadn't seen this elderly person for quite a while anyway and her daughters were saying, we've not seen this person. Just the easy thing to do was continue to say that we're not allowed to see that person than to tell them they died. It stayed with me for a little while. Why had she not told them? What was stopping her? Did she not have the words? The more I thought about it, I believe it boils down to the fact that she doesn't want her children to be sad. They were sad that they couldn't see them, and she didn't want them to be more sad that they were dead. As parents, as adults, we don't want our children to be hurt, and we often try really hard to protect them from difficult things. This information would have been saddened and the kids would have been sad, but actually we shouldn't try and protect our children from experiencing difficult feelings because it's a skill for life. They're going to be feeling difficult feelings throughout their life. We should be supporting them through it and not avoiding it. These are my top tips for talking to children about popping your clogs, just joking death. So, tell the truth. Don't lie. The truth comes out so just tell the truth. Maybe not all the truth but tell the truth and answer questions simply. They do not need the detailed answers that you think we need and as we talk about age related understanding, they'll come back to things they don't understand when they go into that next age bracket, I guess, and something doesn't make sense. They'll ask for some more information so keep it really simple. I mentioned this a minute ago but teach life cycles. I've got some great old-fashioned books that talk about life cycles. It's factual, not emotions. They know that we are born, animals are born, and they live and there's various reasons why we might die. Maybe in an accident. If you're an animal, you might get stood on or eaten. You might just become old and die. Books could help illustrate that, there are movies out there with themes that talk about that. Somewhere within this presentation, there'll be an opportunity to download some handouts. All the handouts are in one pack, I have made it quite easy and I've given some book recommendations and movie recommendations. Now, obviously, have a look at it yourself, read the blurb about it and see if it's appropriate for you. I've done a general overall list really on bereavement and death, but that not everything will be age appropriate, so you have to look at what works for you. Movies are a great way to talk about death if your child is old enough to understand that. Use and look for opportunities within daily life, when you see or walk past the graveyard, you can say this is where people are buried when they die. When you walk past dead animals on the side of the road, you can point it out and say, 'oh, look at that hedgehog or whatever it is at the side of the road'. Kids are fascinated in these things. Talk about how sad it might be when someone dies. We have a dog and she's getting quite old now and we talk about how sad it will be when she dies and they know that within the next five years or so, that's likely to happen. We talk about how sad it will be and how we will cry a lot and it's okay. We will cry together. So, they're very aware of death, we talk about it.

I'm going to tell you a little story, I think I might have said a little bit about this in the Bereavement presentation. This is like stage two of the conversation. I'm not sure how we got onto the topic of cremation and burial with my children, but we had this conversation and then we met their grandma for lunch and she's eighty-three and she's traditional, old. My oldest pipes up, he's seven and said, "Grandma, are you being buried or burned when you die?" She, as you could imagine, was a little aghast, but I explained to her that when she died, they would be very sad but already knowing about burial and cremation and graveyards would make it less overwhelming. There's less new information to take in so she shared her wishes with us, and it made sense to them. She really talked about why she'd made the decision that she had made and what she wanted, and we went to see granddad's grave afterwards and it just all fit together and made sense. I think that's a lovely opportunity that we have to talk about that with our children so I encourage you to have those conversations, as shocking as they may seem to those of you that might not have thought about doing this before. That's my top tips on how to talk to children about death. I'm sure there's a lot of other things out there as well, but it's a good starting point.

We're going to talk about age related understanding of death. Now, this might not be exact for every age, but it's a really good table to get an idea of it. As we start talking to children about death, you may realize that that understanding isn't concrete. Their understanding grows, which means it isn't one conversation, which I said earlier. It's a conversation that gets repeated and added to as they get older and they start making sense of things. Let's look at naught to two years. While no concept of death, the child will be very aware of the loss of a carer and child can also sense grief from others. Bereaved toddlers can be observed actively seeking the deceased person. For instance, if Grandad spends a lot of time prior to death in the sheds, the toddler might persistently return to investigate the sheds in hopes of finding him there, because that's their connection. They can't verbalize it. Then age two to five years, aware of difference between alive and dead. Children may think that people continue to do everyday things or that death is temporary. There's been a dead hedgehog on our walk to school, which was incredibly interesting for five- and seven-year old's. My five-year-old would say things like, 'when it wakes up' or 'shall we get it some food?' I would say things like 'death is forever' or it's still dead, it can't eat'. She's five and still not quite grasped that death is forever but, you know, she'll get there. Bear that in mind and yeah, I've had to repeat myself quite a lot of times saying, 'the hedgehog is still dead.' Five to nine years. The child may develop the concept that death is permanent and irreversible, and they may personify death, for example, it might be a monster or a person. Death is a weird concept so it might become a person to them. I guess it is in a lot of movies as well. So, they'll start to know that everyone dies. They may be very curious about the physical process of death and what happens after a person dies. They may fear their own death because of uncertainty of what happens to them after they die. Fear of the unknown, loss of control and separation from family and friends can be the school age child's main source of anxiety and fears relates to death, my seven year old is definitely in that stage of 'I'm going, I'm really going to miss you and what happens if'. Yeah, they're hard conversations to have. So, nine to 11 years, a child is developing a more realistic understanding of the concept of death. They may show an interest in the biological aspects and also the spiritual aspects. A sense of their own mortality may develop. They might start wondering about heaven and hell and what happens and maybe as a family wants to take advantage of that and talk about what you as a family believe happen to you. I wonder whether children that are part of families that follow a faith or religion may be better informed about death generally, as all faiths have a belief about the afterlife. That's taught as part of the faith or religion. Perhaps there is less fear and more certainty. I definitely want to think about that actually, with the children that you're working with and maybe your children if you have them. It's always important to understand what people believe. Adolescents, they have a full understanding of death, but also of spiritual and abstract elements and are more aware of long-term consequences of death. Increased influence of peer group and also tension between dependence and independence. Generally, I guess, especially if you're a parent to an adolescent, that might resonate with you. Yeah, so have a look through that, maybe think of some children or young people or if you are a parent, which one does your child fit into. If you're working with a bereaved child at the moment, does this knowledge make any difference to your work? Does it maybe make more sense why this five-year-old keeps asking me this question? Bear in mind that they're not exact. As you know, my five/six-year-old is still in that two to five years bracket. Okay, let's move on.

Let's look at developmental issues regarding bereavement. There are some factors that we need to bear in mind when working with children. They have an immature thinking capacity. They have an egocentric view and 'magical thinking'. I worked with the family once who would tell that five-year-old a very grandiose and elaborate story about where her loved one was. It was very difficult to help her initially as nothing was concrete and, in the end, I had to encourage the family to tell her the truth about where this person was or maybe wasn't. Yeah, that was really hard piece of work. Difficulties comprehending the concept of death, as we've just discussed. Possibly a lack of control over their options. Lack of information or knowledge, like I shared, regarding being a child and not being able to attend a funeral. There's a lot of things that I didn't really understand, and I didn't know what to ask. Less able to handle stress and lack of language to communicate to others how they are feeling and coping.

Ok, so grief is a natural process, it does not necessarily require professional intervention. We looked at that on the bereavement presentation, but here we are again, looking at how we can intervene professionally and how we can be useful. I've helped many grieving children, so it obviously does need help at times. Parents often bring children to therapy as they are struggling to cope with the child's reactions to grief so we're going to look at those now. Child's reactions to grief.

I'm not going to read all of those. You can look through them. Children often can't say what is going on for them, they will act out or they'll behave so there's a list of behavioural there. Maybe they've gone naughty or acting out. They may get ill or have similar symptoms to the deceased or reoccurring bladder infections or tummy problems, for example. It's probably the stress in their bodies trying to find a way out. When I assess bereaved families, I consider these possible reactions. I ask about eating and sleeping behaviour, not that I aim to fix it or make it better. Quite often in the work, I don't draw attention to it, but I hold that information in my mind and usually by the end of the work, those symptoms have either really reduced or they're not there anymore. A parent might tell me that their daughter is really struggling to sleep when before the death they would go to sleep without a problem. Do you remember when we looked at euphemisms and I said about telling her grandma has gone to sleep rather than grandma died? This girl may not be sleeping because she heard that grandma went to sleep and isn't going to wake up and she doesn't want to go to sleep because she's afraid she won't wake up. This is not stuff I'm making up. This stuff really happens, that children just get the wrong end of the stick. They hear things and then it really affects them, and this is why families often do need some intervention, because they're dealing with everything and they can't see those seemingly small things. They need the professionals to come and get this big perspective of everything and ask all the questions. That's behavioural and physical.

Onto thoughts and feelings now. Again, just read those in your own time, pause the video if you want to. These are just some thoughts and feelings that a bereaved child might be experiencing. When parents are grieving too, do they make time and space to listen to the thoughts and feelings of their children, or are they just trying their level best to get through the day? You'll know in your own lives when something bad and something really hard has happened, it's just enough to cook the food and get up and get the kids out then to sort of make time to say, and how are things for you? That can be a real challenge and that's why parents often need our support.

Working with bereaved families. Notice I say families and not children, because when you're working with a bereaved child, you have to see them as part of a community or a system. We will look at the child's needs first and then we'll go on to look at the parents and what they might need. The first thing we're going to look at is the 12 needs of a bereaved child.

So, you can search for this and sometimes it comes up as a bereavement charter, sort of same information and it can be a really lovely list of 12 things. Now, for the sake of this, I've kind of changed it around a bit and split it up into three categories. So, these 12 needs, I think, come on to three titles. Information, feelings and grief. We're going to look at information first. If you follow these points within your work with children and young people and the advice that you give, then I believe you can't go too wrong. Everything's in here. As a counsellor we aren't necessarily going to be involved in all these points directly, but we can help caregivers and give reassurance when they're feeling out of the depth and lost on how to support their child. Part of my role when I worked for a bereavement project was as a consultation role. Quite often we would get social workers, health visitors, teachers, head teachers phoning for advice so quite often I would focus my attention on going through these 12 needs of a bereaved child because whatever they were struggling with, the answer was in this list. That's why I think this is really important. Information; a child needs clear, comprehensive information about the death. A child needs reassurance that they are not responsible for the death. So, for example, the argument that they had with their dad the night before he died wasn't the cause of the death. A child needs reassurance that they will be cared for. Someone may no longer be able to take them to school, so who does that? Time needs to be taken to cover these bases. It might be something really seemingly small for us, who takes him to football practice now or who brushes their hair? These little things are big things for children. A child needs safe companions who respond to their questions. I wonder what sort of questions a child might ask, probably the kind that makes parent feel uncomfortable. They might ask all about the death. Who, what, when, where, why? They're trying to make sense of it, and it isn't necessarily an emotional factor for them at this point, they just want the questions answering. Neuro diverse children tend to want to know even more information than that. What happens when you die, what happens to your body, your skin, details about the composition? It can be really hard for a parent or caregiver to talk about this because it is emotional for them. The questions are likely to feel a bit hit and miss. Questions asked at an unexpected and possibly inappropriate time, although I would argue that questions answered in an appropriate time. It's just that they make us feel uncomfortable. So really, think about that. The information thinks about any cases you're working with where perhaps more information needs to be given so that they can understand. If you think children have very little control over their lives, maybe pause the video at this point if something's resonating with you right now and see that thought through. What does that child need to know to help them feel a bit better?

Now, feelings. This is probably where you will feel, if you're a counsellor, you might feel that this is your area of expertise and that's what we do well. A child needs to be allowed to express feelings and then have their fears and anxieties soothed. A child needs to have someone who will listen attentively so their feelings will be acknowledged and respected. A child needs their thoughts and feelings validating. This is a normal reaction. A child needs help gaining perspective on their emotions. So, the whirlpool of grief can be useful here and I have used that a lot with children. That's in your handouts in the last presentation. It's not always possible for a caregiver to do this when they're struggling to manage their own feelings as well, and this is often what I have seen, that the parent just can't provide this space and support for the child. There's two ways here, you can support the parent to give the support the child or you can support the child as well. It might be that you might need to do some work with the school as well to help them understand. If their knowledge on bereavement is limited, maybe there's some opportunity for you to go and deliver some training in school and talk about these things, use the 12 needs as a plan and there you go, you've got some training that you can deliver. Okay, let's move on to the next slide, which is grief.

Similar to feelings, but more specifically grief. A child needs to see other people grief and learn how people grief in the group they belong to, being aware of diversity in different cultures in your area might be useful here. What is normal for this family? So quite often I would see families who would come in and say 'oh, no, we've not cried in front of the child. We're just trying to keep a brave face'. I can understand that. I can understand you don't want your child to see you crying or being very sad, but then from the child's point of view, they're not seeing what it's like to grief. They don't know how to grief. They don't know that it's okay to cry and they're not seeing grieving as a normal thing to do when somebody dies. Bear that in mind. A child needs to be involved and included in open grieving, and this can make families feel very uncomfortable as they don't want to grief in front of the children or don't want them to go to the funeral, which is totally understandable. Parents might need some support and just talking this through and what it'll be like and how to manage it. A child needs permission to continue with interests and activities. This is the oscillation of grief we talked about in the last presentation. It's okay to live and it's okay to cry and children are great at doing this oscillation. A child needs opportunity to say goodbye to the person who has died and have opportunities to remember the deceased throughout their lives. It might not be appropriate for them to attend the funeral, but they still need to say goodbye. So, perhaps think about how you can support or facilitate this. The child I worked with hadn't attended the funeral or visited the grave. There was a really weird family connection which made Mom kind of on the outskirts of it, but with Mom's permission, I found the grave and my young client wrote a beautiful card and we delivered it to the grave together. We had a really lovely time looking at the grave, saying goodbye. I've got a really beautiful memory of that piece of work. Interestingly, the work did end quite soon after that. I thought she would need longer to process, and grief and I've been putting off taking her to the grave because I'm a counsellor and it's not my job to take a child to the grave site and I don't know if that's allowed. Actually, that is what she needed, she just needed somebody to support her to say goodbye to this person that she loved and wasn't really allowed to love anymore. Yeah, it was really a lovely thing that we did together. It taught me a lot. Ok, so that is the 12 needs of a bereaved child. In the handout there is a full list of 12, so print it out and keep it by your side when you are assessing families or talking to professionals about grieving children. There will be something on this list that's missing that the child needs help with. I would put money on it.

Let's now talk about the parent. So, the function of the surviving parent is the most powerful predictor of a child's adjustment to the death of a parent. Now, that is to do with another parent dying and this presentation isn't just about parent dying. However, I like this quote because I agree with it and it makes it clear that a child's recovery or ability to process their grief is reliant on their parent or caregiver. It's also very unfair because if you are a parent of a grieving child, you're grieving as well and you may have lost your partner, somebody close to you, and that's going to be really hard to be that strong person for your child as well. Often the adults would suck it up and not grief. They show a brave face, but what they are doing is not modelling how to grief, as I've already said, or express emotions or give permission to talk about it. I've lost count of the times I have said to a parent, 'you're asking a six-year-old to engage with a new and unknown adult and talk about really difficult things, yet you won't do this for yourself'. Obviously, I don't say that as the starting points, but quite often that is the last thing I have to say, because they're just not getting it, that they need the help as well. It can be a little bit of a wakeup call to parents if I use that phrase carefully.

Okay, so let's look at the 'good enough' grieving parent. How do we help this grieving parent? Psychoeducation might be some part of it but let me just go back a little bit. I don't know the way in which you work. You might have your own model and that's absolutely fine. Stay with the model and the way that you work and fit some of this around it. The model I used to use and still would use in private practice is that I meet the parents first and I would do a couple of assessment sessions. We were allowed to leak out the assessment session and make it a little bit longer so we could do some of these work with the parents before we met with the child, because I believe that once you meet the child, then you can't go back to work with a parent because that would be crossing boundaries. So, bear some of this in mind, but I'm not suggesting you have to change the model of the way that you work, but this is how I would work. I would do some psycho education. I would share information, share books and movies, the list that I've given you, I would encourage them to go to counselling if applicable, and I might even teach them some theory. The whirlpool of grief, some oscillation to help them make sense of what was happening in their family's lives. I might tell them some home truths, as I've said, I would perhaps do a longer assessment period. I couldn't do the therapeutic work with the parent. That was another service, but we could leak out that assessment so we could support the parent as much as we could. Maybe some of your work is just holding that parent while they have some difficult conversations themselves with their child. I worked with a family who referred their seven-year-old daughter. Her three-week old sister had died when she was three, so it was a long time ago. She was referred due to her difficult behaviour. Our sessions contained a lot of hospital role play, sick dolls and nurses, etcetera. Meanwhile, I had given mom the very hard message about needing her own therapy and fed back what I thought was going on in the work. Eventually, mom was ready to listen and engaged in her own therapy and was emotionally available for her child, my clients again and when I look back, I realized I've been holding them both while they worked it out. At the end the mom wrote me a letter explaining that she had lost one daughter and was about to lose another, but I helped her find her way back to her. It just goes to show that I really didn't think I was meant to be doing the work with the child. I knew it was mom that needed the support and knew the key lay within her, but she just wasn't ready. What I could do was meet with this child, keep the family within our service, keep saying the same things and reminding and feeding back and working as part of a team until that family were ready. She was ready to get some counselling and face up to her part in this. So, holding is a really important role that we might have as well.

We're going to talk about assessments now. Again, I'm not saying you should change the way you work, but just bear in mind these are some of the things that I might do in my assessment. It might be useful for you to go back to the bereavement presentation and look at the assessment slide there. All the factors in there you might consider will still be relevant, but you can see what I've added into this assessment now of the child's reactions. You can ask about euphemisms as well if you want or you can listen out for, probably don't need to ask because you'll hear it within the conversation and remember that you are assessing the child and their family. If you just ask about the child, you might miss some vital information about the family. I worked with the family whose grandparents had died. The child's mom had entered a very deep and dark depression as a result of this news or event. She wouldn't or couldn't get out of bed. She would stop for hours. The child didn't need help with his grandparents dying, but the fact that he was losing his mom and mom just was not really available. Her reactions totally freaked him out. Now, I could have easily missed that because it wasn't something the mom was generally wanting to talk about. I think she was quite ashamed and embarrassed by the time she'd come to me. She was sharing information about the general grief, the child's and their reactions and it wasn't until I'd said, and how's it been for you? How are you managing this? Then it came out that actually she wasn't managing it so then I knew the work that I had to do was helping the child to overcome this quite traumatic experience for him seeing his mom cry so much. It was really shocking for him. So, you have to do a family assessment. Ok, that's assessment. On the bottom there, I put in why now as well? It's always a really good question to ask. Why now? Why not last week? Why not last month? Why not in six months’ time? What is it about now that you need the work?

So, the work. This is probably the bit you've been waiting for. What is grief counselling with children and young people? It could be one of these things. It could be whatever of the 12 needs isn't being met. It could be the work is a place to remember. I've done a lot of memory activities with children. I think I'll come on to that later when we talk about some ideas. Maybe it's a space to feel uncomfortable feelings, because at school or home they don't feel safe enough to talk about uncomfortable feelings because parent might cry, or the sister might cry, and school is too busy. Your job might be to help them say goodbye, to write a letter and to take it to the grave, to burn it, to help create memories and memory points at home. It might be some psychoeducation for parents, and the work probably will involve some sort of creative work because children generally want to be doing things as well. So, those are some of the things I think bereavement work with children. This is some of the things you could be doing.

This is something quite cool that I came up with that I think you'll quite like. It's called a contracting box. I used to find it quite difficult contracting with children because I just wasn't sure how much they understood about what contracting was. I put a link on the bottom there to my Facebook page, the creative supervision world and there's a video there that explains the contracting box really well. I demonstrate it. I think I put the link on the handout as well, but I'm going to talk you through it. I have a box and I have all these items that go into the box and this is me explaining to them what contracting is. This is not just to do bereavement; you can do this with any child, but I just thought you might really like this and find it quite useful. The box symbolize the room and we talk through the different items that they are going to put in the box. So, there were some figures and I had two figures, but you can have a whole load of them and get them to choose one for themselves and you can then choose one for you or you can get them to choose one for you and see how they view you. That can be interesting. So, we say that we're both going to be in this box. There's a clock which says we're going to have the same time and the same day every week and that your parent or caregiver knows that, and they'll bring you and that you're coming for six sessions if that's what you're offering. Then I'd have a key and I would say that this key represents the work and the notes that you might do or that I might keep and these are going to be kept in a safe place and no one would see them until the end of the work. Then at the end, we would decide what we do with them. I had a little purple purse, it was lovely, and it had a zip, and that's just to explain confidentiality. This is what I said 'everything that happened in the session would be kept in the purse and zipped closed at the end. If you want to tell the people you know about the session, then you could unzip it and say whatever you liked but I wouldn't. I wouldn't tell parents and I wouldn't tell teachers. However, if you told me you were being hurt, then I would unzip the purse and tell my manager the parts to do with the hurt and she would tell us what we would need to do so that hurt wouldn't happen anymore'. That's the way that I used to explain confidentiality and they used to really understand that because it was something they could see. It was visual, but also the zipping. This choice that they could open it if they wanted and I could not. I would Just open it a little bit and take out the bits that are related to the hurt and not anything else. There are probably other things that you could add in as well and if you do find other things to add in, send me an email and let me know what you're going to put in. I just wanted to keep it really simple. That box would be in the room each week so they would understand. If a child particularly liked it, we might do it at the beginning of every session if it helps as a kind of starting point, but you work in the way that you work with that.

We're going to go through some ideas. I tend to work quite creatively, so a lot of these ideas will be creative and I'm not going to go into too much detail because I think that would probably be another presentation. I generally don't have a repertoire of things I do with children and young people. I do work quite intuitively and organically, so I don't have ready-made tools to apply as such. I don't say that I do this at the beginning and this at the end, but I definitely have some things that I caught in more than others. So, here are just some of my ideas really. I tend to introduce the clients to the space we're using. If I'm in my own therapy room and it's full of different items, I would just go through looking in all the drawers, looking in all the boxes and I would show them. They don't know they can do painting or drawing or playdough, so I show them all the items. When I've worked par apathetically, I take a suitcase into school or a centre and I'd keep everything in the suitcase, and I open it up and have a little space for everything. So, we go and stand by the suitcase and I show them everything in there. They could do these things, these workbooks or whatever, go through everything with them because I like to work non-direct so at the next session I can say, 'well, you've seen everything there is to do. What would you like to do today? What would you like to play with? Or if you're not sure, what you're in the mood for? Here are some of the ideas, for getting to know clients you might play Jenga. It's quite a common tool. Let's put some questions on. I might number them one to three. You pick one and one might say, 'tell me how you feel, how you felt today' or number two might be your favourite thing or your favourite colour and three would be something else. That's a just a way to get going, I guess but you can be quite clever with some of your questions. I always answer too. I think if you play a game like that, it is important to share, and I think that children and young people need slightly more disclosure than an adult need so I would answer the questions that they ask me. You might have some assessment worksheets that you might create about feelings. I had one with a body outlines and they'd say how much of them felt a certain thing. So, there is plenty of resources and tools out there. Have a look but an assessment worksheet could be a good starting point too. The whirlpool of grief, if you think they're old enough to understand that. That could lead on to an activity of them deciding the road or drawing or painting their own. Helping them to remember, if that is the work that you're going to do. You can decorate a candle that they can light a photo frame, you can do some pebbles or a pillowcase. A pillowcase is a really lovely idea that I with a child who couldn't sleep, so we got some fabric pens and paints and they painted this pillowcase and then they went to bed at night, and it was just a lovely place to remember and a really soothing and nurturing activity. You can make a memory box. I've not ever made memory boxes actually, but I'd encourage families to do that together. Get a special box and put things in. We've talked about that. If you go online and search it, you'll find instructions for that as well as a memory jar using salt and chalks. That's a lovely activity to do. Again, search for that, I think it's on Winston's wish. I've got a worksheet on the memory jars. Children really enjoy doing that and then helping to say goodbye. You might encourage them to do some writing, some poetry. Write a letter, a diary entry for teenagers maybe or the tween age, might want to buy them a journal that they can decorate and write some of their feelings in. Then some of your work will obviously be about helping them to express feelings, so drawing and painting, you can have a box or an envelope with feelings inside, feelings outside. You can use clay, sand, play dough. You can make a puppet or do a collage. Just a lot of ideas of things that you can do, and again, you can use these ideas with any work, not just bereavement work.

So, I've said before that children have often been excluded from the decisions the adults have made regarding the bereavement. You can ask them about your work together and find out what they want to do and how they want to spend the time with you, empower them and give them choice. I might suggest 'I think you want help saying goodbye' or 'I think you need some information' and then they'll either agree with me or not. If you have a child that's not really very forthcoming, you might write some little cards and feelings, memories, goodbye or whatever and choose which one would you like to do today just to try and empower them, trying to get them to have a choice.

We're here already. The final breath. As a result of this learning today, what are you going to do now? What next? More specific training maybe? Watch a grief movie? Buy some children's books, the ones I've recommended on the handout maybe? Maybe make some changes to your parenting? Maybe you'll start to talk about death more. Maybe you make some changes to your work as well. I've really enjoyed putting this presentation together for you. I'm in the Facebook group, if you have any questions. Please see my biography on counselling tutor for more information about me and what I can offer you.

On our last slide now. Don't forget to download your CPD certificate. For further information, links and resources, please refer to the lecture delivery page below this video. Thank you for your time. Thank you for being here. Don't forget to claim your CPD certificate for this presentation.

Thank you.