Periodically, Journeys Art Therapist Laura V. Loumeau-May, M.P.S., A.T.R.-B.C., L.P.C., will present information on children and bereavement. If you have a question you would like answered, please e-mail it to Laura at firstname.lastname@example.org.
To learn more about the Journeys Program, click here.
Is it worse for a child to lose someone suddenly than from a long term illness?
You cannot adequately compare the two because you cannot measure grief. Qualitatively, the two are quite different, both in terms of the issues involved and in terms of the psychological and emotional responses that typically occur. On top of that you have the similarities and the differences in the ways children experience the death of a loved one.
The main differences between the two categories of loss would be time to prepare psychologically versus the witnessing of pain and suffering. However, that is an oversimplification. It is true that the ‘shock’ factor of a sudden, unexpected death, combined with the ways that death may occur suddenly (accident, heart attack, etc.) can contribute to the death being experienced as traumatic, and thus more complicated than an ‘expected’ death. However, even with a prolonged illness, a child may not be cognitively or emotionally prepared for the reality of death. Thus, it may be experienced as sudden. This can be true for adults as well.
With adults who have a loved one dying from a prolonged illness such as cancer, one may assume that those closest to the patient have had time to prepare themselves for the death. This process is called anticipatory grief. However, many remain ‘in denial’, always hoping that their loved one may yet recover, or may at least have more time. In many cases a cancer patient will ‘go into remission’ for a while, but later may have a reoccurrence of symptoms or have the cancer reappear in another part of the body. This cycle may repeat many times, contributing to confusion, apparent denial, and resistance to ‘giving up hope’. Some adults may acknowledge the severity of the illness and the probability of death, and do what they can to be prepared for the inevitable, and yet still feel, once the death has occurred, that they were not ready for it, or did not realize fully how difficult it would be.
Usually, what is communicated to the children and/or what the children see of the illness and of the patient during a long illness, is affected by the way the adult caretakers are handing it themselves. Therefore a child may have limited knowledge of the situation both because of their developmental level and capacity for understanding, and because of whether or not they are being included in the family dialogue. However, there is a lot they do witness and they do pick up on emotional atmosphere and tensions. If they are not told what is going on, they will logically and/or imaginatively come up with their own answers, because, what is happening in their family is of utmost importance to them. This is one of the reasons the Journeys Program offers support to children during the illness of a loved one. Even when the ‘prognosis’ is good, and the cancer patient survives, there is a lot of anxiety experienced by children in relation to the illness and to the disruption to family life that occurs when the family is dealing with the life threatening illness of one of its members.
Another factor mentioned above in comparing sudden to prolonged death is the pain and suffering of the deceased. With a long term illness, it is more likely that children will have witnessed physical and behavioral changes including evidence of pain over a long period of time. This affects them, because they are capable of empathy, and because it can be frightening. However, even in a sudden death, pain and suffering can and often does occur. Children have been witness to this. However, even when they have not, they wonder if there was pain and sometimes imagine what their loved one experienced.
There are additional factors to be considered when comparing the two categories of loss. All factors affect the children of a family both directly and indirectly. How the family handles the death as well as the supports that are in place for the children both within the family and within the community, are the best determinants of how well a child or teen will be able to cope with their loss and the changes in their lives that result from it.
How much should I let my child know about their parent’s cancer? I don’t want to frighten them.
Children and teens have excellent powers of observation and deduction, especially when it comes to the most important things in their lives - their families. They will pay attention. They will notice. When they don’t understand and haven’t been given an explanation for the changes and behaviors they have noticed in their parents, they will figure out the answers they are seeking with their imaginations. Chances are if one of their parents has cancer, the more secretive their parents are about it; the more alarmed they may be – consciously or unconsciously. It is quite likely that they are more frightened without an explanation than with one. Many of the children who have attended the Journeys Program revealed that they already had guessed that their parent had cancer by the time they were officially ‘told’. Prior to the explanation, they were worrying and wondering, more anxious because of the secrecy.
One of the reasons many parents hesitate to tell their children is because they want to protect them from premature and/or excessive anxiety. Unfortunately, this is a life situation where parents cannot protect their children from pain or anxiety. But what parents can do, is perhaps more valuable. Parents can include their children, and help prepare them to cope with the illness and its ramifications. What open discussion of the illness will accomplish will be to enable all members of the family be more direct and honest about their concerns and give members of the family the opportunity to support each other on all levels.
This will validate the psychological and emotional experience of your child as well. It will also acknowledge your child’s role in the family. Even the youngest child has a capacity for empathy, and also a desire to do something. To be able to do something is empowering. In a situation where powerlessness can be overwhelming, making a difference, even in a small way, can mean a lot.
What and how you talk with your children about the cancer depends on many things including the age of your child, their previous experience with illness and loss, their maturity level, coping skills, etc. Simplicity and honesty are the most important factors in an explanation. While you don’t want to hide the truth from your children, it is also not necessary or good to overwhelm them with more details than they need to know. They will have questions which should be answered, but may need to think about the information you have shared before they approach you with more questions.
They may not voice their deepest fears right away; perhaps because they may be afraid of the answer, but knowing that you are willing to talk with them about it will reinforce their trust of you and will reassure them that you are willing to answer their questions when they are ready to ask them. As you talk with them, remember to review what you have told them to see how they understand it. This way you will better understand their concerns and can correct any misinterpretation of what you have said. It is also useful sometimes to find out what their concerns are when they ask a particular question before you answer it directly. However, once they have told you their concerns, it is important to respond to those as openly as you are able.
It is alright not to know the answers to some of the questions and important to state that honestly along with what your hopes and fears are. You are not only a source of information for your children, but also a role model. If you are comfortable acknowledging your own anxiety, it will be easier for them to come to you when they need support for their own. If you let them know you have feelings of sadness, anger or worry, and are coping with those feelings, then they will not feel a need to hide similar feelings from you. It is not unusual for even the youngest of children to conceal feelings when they think their parent is overwhelmed with a situation at hand.
No one can avoid anxiety about living with cancer; bringing it into the open helps the entire family deal with it better. It is important to remember two more facts about talking with your children or teens about it. Even when the prognosis for a full recovery is positive, there is still stress and disruption to family routine.
Everyone in the family, especially the children, can benefit from help in coping with this. If the prognosis is uncertain, the sooner your children are told, the better their overall adjustment and development of coping skills will be. If you are uncertain about the particulars of talking with your children, use the Journeys Program as a resource. We are always available to talk with you about this.
Will enrolling my child in a bereavement support program make them focus more on the death or illness and upset them?
Many parents are anxious that this will happen. The answer to this question is both ‘Yes’ and ‘No’. The benefits of the program, discussed below, outweigh initial concerns about discomfort.
It is important to understand that bereavement is a process that all people who have suffered a loss, no matter how young they are, experience. Some believe they can avoid topics that will trigger memories and pain, and can ‘refocus’ on the future without dealing with that process. They want their children to be able to do this also, possibly fearing that facing the pain will be the cause of a set back for their children from which they may not recover. However, the pain of loss is closely connected with the significance of the relationship.
The quality of future intimate relationships and the capacity to form and maintain them is connected with the healthy resolution of grief. Avoidance of grief work usually leads to more difficulties in character and in life adjustment later on, including the capacity for mature adult relationships. Therefore, a healthy adjustment to the death of an important family member includes some focus on what happened and the experience of uncomfortable feelings. The thoughts and feelings about this significant life event are quite present for your children - even if they are not expressing them openly. If children and teens have the opportunity to process the experience of death in a supportive environment with a professional counselor, they are more likely to make a healthy adjustment to life.
The purpose of the Journeys Program is to help them focus on the death, express and validate feelings, explore questions, develop coping skills, and find ways to adjust to life without the loved one. However, each child and teen is approached as an individual, and each is encouraged to ‘set his or her own pace’ when exploring the loss. This includes allowing a period of time for the teen or child to avoid and circumvent the more painful issues until they feel more comfortable exploring them directly. The use of art therapy in our program is beneficial on many levels, and is effective with the youngest and the most mature as well.
Ability to benefit from this approach does not depend on talent, proficiency or experience in art. Creative tasks are geared toward self soothing and comforting, release and management of feelings, memory work, problem solving, narrative, ‘reframing’, and communication. Although participants in the Journeys Program have come because of unhappy circumstances, they enjoy being here because they have an opportunity to express themselves freely, tell their stories, try new things, look at things in a different way, have fun, and be themselves.
Intense and difficult emotions do come up during the course of their work in the program, but when these do there is an opportunity for children and teens to channel them into a creative image, obtaining release and control in a non-destructive way. Therapists help them accept and manage these emotions as part of a process in adjusting to and responding to the death. Within the ‘frame’ of the art therapy milieu participants see their images, feelings, and themselves changing as they develop new coping skills and attitudes. This leads to greater confidence; out of pain has come growth.
For more information on any of the topics discussed here, or other concerns that you may have, please contact Laura Loumeau-May at email@example.com.