helping bereaved children and adolescents: … of mental health counseling volume 32/number 3/july...

Journal of Mental Health CounselingVolume 32/Number 3/July 2010/Pages 206-217

PRACTICE

Helping Bereaved Children and Adolescents:Strategies and Implications for Counselors

James P. MorganJesse E. Roberts

This article provides an overview of how loss affects young people of different ages and describes meth-ods for helping bereaved children and adolescents. Case examples demonstrate the use of drawings toelucidate the inner experiences of young people who are grieving and to facilitate the counselingprocess. A format for a bereavement support group is detailed, and guidelines are provided for the useof bibliotherapy. Cultural, ethical, and counselor competency issues are also considered. The impor-tance of counselors'awareness of the impact of their own toss experiences is also discussed.

One of the greatest challenges we may ever face as adults is to provide sup-port to a grieving child. This process is particularly difficult because we natu-rally try to protect children from emotional pain, we may have our own anxi-eties about death, and we may feel at a loss as to how we can be helpful to achild who is grieving (Webb, 2005). The words of the poet WilliamWordsworth, written over 200 years ago in "Now We Are Seven," ring as truetoday as then: "A simple child/ that lightly draws its breath/ and feels its life inevery limb/ what should it know of death?" (cited in Webb, p. 3).

Children at different developmental levels perceive death differently. Anunderstanding of these differences is essential if we are to effectively help chil-dren understand and cope with their grief. As Webb (2005) notes, by the age of

James P. Morgan and Jesse E. Roberts are affiliated with Gardner-Webb University.Correspondence concerning this article should be addressed to James P. Morgan, School ofPsychology and Counseling, Gardner-Webb University, PO Box 7344, Boiling Springs, NC 28017.E-mail: [email protected] Note: We would tike to express our appreciation to hospice workers everywhere who tirelesslycare for those who are dying and for those who mourn. We also gratefully acknowledge June Hobbs,Gardner-Webb University, who supported this project with an undergraduate research grant, and DavidCarscaddon, Gardner-Webb University, for his helpful review of our paper.

206

Morgan and Roberts I HELPING BEREAVED CHILDREN AND ADOLESCENTS 207

7 or 8 most children achieve the knowledge about death that we as adults havecome to know: death is "irreversible, inevitable, and universal" (p. 4).However, from the preschool years through adolescence, there are significantdevelopmental differences in how children experience grief Because of thesedifferences, counselors who work with bereaved children and adolescents needto use a variety of approaches in their efforts to meet their needs. To that end,this article reviews developmental factors associated with bereavement in chil-dren and adolescents and describes an approach to working with bereavedyoung people that integrates drawings, bereavement support groups, and bib-liotherapy. We also discuss cultural concerns related to grief in young people,and the implications of ethical issues and their own grief experiences for men-tal health counselors who work with bereaved children and adolescents.

DEVELOPMENTAL FACTORS

Preschool ChildrenWhile their conception of grief is different from that of older children, young

children are capable of experiencing sadness and therefore grieve in their ownway when a loved one dies. Young children typically do not comprehend thepermanence of death and may ask repeatedly when the deceased loved one iscoming home (Fitzgerald, 1992). Young children are also prone to magical andegocentric thinking, as Piaget and Inhelder (1969) suggest, and may think thatthey somehow caused the death because of their inability to differentiatebetween thoughts and deeds (Webb, 2005). For example, a young girl whosebrother has died may think that her past anger toward him caused his death.

Often young children also think that a deceased person's biological ftinctionscontinue even after burial (Bering & Bjorklund, 2004; Slaughter & Lyons,2003): A young child may ask how a deceased person can breathe or go to thebathroom after being buried. In the movie My Girl (Grazer, Friendly, Gold,Carraciolo, & Zieff, 1998), which deals sensitively with different types of lossthroughout the life span, a little girl puts her best friend's eyeglasses on him inthe casket so that he will be able to see after he is buried (Webb).

Preschoolers often consider death to be temporary and reversible (Nagy,1948; Speece & Brent, 1984). This belief was poignantly demonstrated by a5-year-old girl whom I (JM) saw for counseling. Her parents were goingthrough a divorce, and she had recently returned from the ftineral of her aunt.When I asked her about her aunt's death, she told me in a matter-of-fact waythat her aunt was now "in a clock." Perplexed, I tumed to her mother for clari-fication. The child's mother explained that the aunt had been cremated andplaced in a clock-urn on the mantle! In our first session, I used the FreelyDrawn Picture technique developed by Gardner (1992), asking the child todraw a picture from her imagination and to tell a story about it. Her picture was

208 JOURNAL OF MENTAL HEALTH COUNSELING

of a female figure in a long gown, holding a bouquet of fiowers in one hand andthe hand of a male figure in her other hand. Roses bordered the picture. Thechild's story nicely demonstrates her conception of the reversibility of death:

A woman and a man. They had a fire. The woman was still sleeping. The man got out. She gotkilled. Then the hospital came. The fireman got the lady out. The hospital fixed her up. She wasin the hospital 40 days. And then a few days after 40 days, she got married.

School-Aged ChildrenSchool-aged children 7 to 11 begin to appreciate the permanence of death but

generally see it as removed from them, something that primarily happens to theold and weak and can be beaten if only one is fast or strong enough (Webb,2005). Children this age may feel guilty when someone close to them diesbecause they believe that they should have done something to prevent it. Forthis reason, whenever children lose someone it is important to reassure themthat it was not their fault, even if they do not verbalize guilt. Interestingly,among children in this age range, death often assumes extemal forms, such asskeletons, ghosts, or bogeymen, which are sometimes manifested in dreams. Inthe video What About Me? Kids & Grief (Film Ideas, Inc., 1992), a boydescribes a dream after his younger sister died in which bogeymen shoot herwith guns.

Prepubertal children between 9 and 12 begin to think of death in moreabstract terms because of changes in their cognitive development. Their art-work reflects this change. Lonetto (1980) found that children around this ageused black crayon, which they described as "darkness," in their artistic repre-sentations of death. However, while prepubertal children begin to think of deathin more mature ways and experience increasing awareness of their own mortal-ity, they still tend to view death as far removed from themselves.

AdolescentsFor teenagers, death can become an area of fascination; for some it is even a

romantic concept. Much to the chagrin of adults, teenagers may flirt with deathby engaging in dangerous activities, such as fast driving, experimenting withdrugs, or taking other unnecessary risks. Teenagers may even wonder whowould come to their funerals and what those people would feel. Yet at the sametime, they may not be fully aware of the finality of death (Webb, 2005).Adolescence can be a turbulent time marked by paradoxes (Corey and Corey,2006). We encourage adolescents to be responsible and accept reality at a timein their lives when they are confronted with a variety of temptations and avenuesof escape. Teenagers are also expected to act as mature adults before they areready for full autonomy. And they are encouraged to think of the future even asthey have a strong desire to live for the moment. This paradoxical context in


which they live can easily give rise to conftision, isolation, and loneliness.Superimpose on this scenario a significant loss, and teenagers become vul-

nerable to a personal crisis that may not be readily apparent to the adults in theirlives. They are not prepared for the conundrum of emotions that accompany apersonal loss. Moreover, teenagers coping with death often struggle with thesame philosophical issues that adults do, though they may lack the conceptualframework for doing so (Noppe & Noppe, 1987). Questions about fairness, thenature of life and death, and the meaning of life become personal issues to begrappled with after a significant loss.

This struggle was brought home to me (JM) in a very personal way during ameeting with a 14-year-old girl who had recently lost her best friend in adrowning accident. After an unsuccessful attempt to help the girl talk with meabout her feelings about the loss, I asked her if she would mind drawing a pic-ture about them. She immediately put pencil to paper, drawing a picture of anoutstretched hand reaching for a heart. The wrist was encircled by a chain thatextended downward. She explained:

That's love and complete happiness [pointing to heart]. I go to reach for it. I always get pulledback. Sometimes, when I feel happy, I don't get to enjoy it for long because something bad hap-pens. When my friend died, something bad happened, and it started tugging me down.

We were then able to have a meaningftil therapeutic discussion about theimpact of her tragic loss, which gave her the opportunity to better understandand express her grief.

Since adolescents often give the outward appearance that everything is okayand hold adults at arm's length emotionally, the adults may assume wronglythat adolescents who have experienced a personal loss need less emotional sup-port than younger children. We may be concemed that we will invade their pri-vacy and not respect their independence if we try to engage a grieving adoles-cent. However, just as younger children need help with understanding andexpressing their grief, so do adolescents.

DRAWINGS

Often when young clients have difficulty finding words to express theirthoughts and feelings, they are able to do so through drawings. Goodman(2005) described a 14-year-old boy who had lost his father to suicide. Goodmanexplained how the boy's drawings resulted in the "externalizing of significantmemories" which became "a bridge for discussing unarticulated thoughts andfeelings about death" (p. 301). Goodman suggested that the use of drawings canbe easily adapted to the approach of a particular counselor: When taking anondirective approach, counselors can follow their client's lead and allow for


"a more open-ended unfolding of issues" (p. 301). A directive approach can betaken when drawings are structured around "particular themes" (p. 301).

Webb (2005) presented the case of a 9-year-old girl who lost her friend to atraumatic death. With this client, Webb used another drawing approach, theSquiggle Technique (pp. 182-184) developed by Winnicott (1971). The coun-selor first makes a squiggle mark on a page; the client is then invited to makeanother mark. Counselor and client take turns with this process until the draw-ing is completed. This method can strengthen rapport between counselor andclient while at the same time facilitating the exploration of important themes.Use of the Squiggle Technique helped Webb's client to explore her fear of deathand gain some closure regarding the traumatic loss of her friend. Sagara-Rosenmeyer and Davies (2007) reported on a study in which they used inter-views and drawings to explore Japanese children's views of death and afterlife.In their study, children aged 6-12 "perceived life as an evolving process thatleads to death, and regarded death as a transitional point to an afterlife" (p.223). Worden (1996) described how drawings can be used in groups as well asindividual counseling. In a group setting, he suggested, children might initiallyshare their drawing with another child or a couple of children before sharing itwith the entire group.

BEREAVEMENT SUPPORT GROUPS

One way of assisting bereaved children and adolescents is to give them theopportunity to come together with other grieving young people and help themto learn about and share their grief (Haasl & Mamocha, 2000). This can beaccomplished using a support group format. In collaboration with a hospiceprogram, I (JM) developed a support group format for use with children andadolescents. The group met for two hours weekly for six weeks. The first weekwas for the parents only; during the remaining five weeks parents met in theirown support group at the same time their children were meeting. The childrenwere divided into three groups based on age: 5 to 8, 9 to 13, and 14 to 18. Ageranges for each group were meant to be guidelines only; a younger or olderchild might be appropriate for a particular group depending on the child'sdevelopmental level, the makeup of the group, and the number and ages of theother children. Optimum group size was 6 to 8 members. Each group had twoco-leaders. Most participants had lost a parent, sibling, or grandparent.

The basic philosophy was that the support group was designed to providebereaved young people with a safe place where they could better understand,express, and cope with their grief. Group activities were designed to normalizethe grieving process, encourage sharing with other children, and instill hope.The support group was not therapy; it was not designed to help children workon personal problems or make behavioral changes. Rather, it was intended to

Morgan and Roberts / HELPING BEREAVED CHILDREN AND ADOLESCENTS 211

give bereaved young people and their parents support and encouragement.During the first meeting, parents were given information on child and ado-

lescent bereavement and an overview of the program. We then discussed theloss that had occurred in each family and learned about each parent's concernsand expectations. Thereafter, the parents met to share feelings and concerns andlearn from each other. Parents then joined their children for the second half ofthe final session, during which they discussed what they had gained from par-ticipation in the bereavement support group. The activities and discussion foreach of the five meetings for children and adolescents revolved around a differ-ent theme: 1—Introduction and Discussion of Death/Grief; 2—Feelings; 3 —Memories; 4—The Funeral Process; 5—Coping Skills/Saying Goodbye. Ideasfor the content and structure of each group meeting were gathered from a vari-ety of sources, including publications on children's bereavement groups byBeckman (1990), Davis (1995), Haasl and Mamocha, (2000), Johnson, (1995),Sandier et al. (2003), Wolfe (1995), and Wolfe and Senta (1995).

Each session followed the same format. We began with a warm-up exercisethat encouraged group interaction. For example, in the first session for parentsas well as children , the group broke up into pairs who were asked to get toknow their partners and then introduce them to the group. In another warm up-exercise, we passed out index cards with different feelings written on them andasked participants to talk about a time when they experienced that feeling. Wefound that such warm-up exercises provided an excellent means of helpinggroup members to feel comfortable and encouraged open sharing.

We then provided structured group experiences involving art, writing, andsharing to help participants better understand and express their grief. For thesession dealing with memories, we asked participants to bring in pictures andother objects that reminded them of their deceased loved one to share with thegroup. We took a field trip to a funeral home for the session dealing with thefuneral process. There participants had the opportunity to learn what happensfrom the time of death until burial, to ask questions of the funeral director, andto share feelings and memories of their own experiences at funerals. In our finalsession, eaeh group created a mural of ways of coping with grief. Also, in thatsession, as a way of saying goodbye to each other, participants each designed agreeting eard from eonstruction paper that all other group members signed. Atthe final session, participants received a certificate of completion.

While we did not collect outcome data on the children's bereavement supportgroups, the feedback from parents and young people who completed the groupwas uniformly positive. Parents often reported that they had acquired a betterunderstanding of their children and were therefore able to be more supportive,and young people often commented on how the group helped them to betterunderstand and express their grief and not to feel so alone. Few studies haveexamined the efficacy of bereavement support groups (Tremblay & Israel,


1998). Sandler et al. (1992), in an empirical investigation of the effectivenessof a support group with bereaved young people and their parents, reportedimproved family communication about grief, increased family support, anddecreased conduct problems and depression for adolescents, but not foryounger children. Subsequently Sandier et al. (2003) completed an experimen-tal study of a bereavement support group that led to improvements in both par-ents and children: enhanced parenting, better coping in both children and par-ents, increased caregiver well-being, and reduced stress.

We have examined two approaches to helping bereaved young people andtheir families deal more effectively with their grief: drawings and bereavementsupport groups. These approaches are valuable tools counselors can use tofacilitate the counseling process and promote healthy grieving. Bibliotherapyalso holds promise for counselors in their work with bereaved young people.

BIBLIOTHERAPY

Bibliotherapy is the practice of using books and stories as part of the coun-seling process (Jones, 2001). Although many people are not familiar with thepractice, the term was coined as far back as 1916 by Samuel Carothers (Cohen,1987). Literature can sometimes help children better understand concepts thatmay not otherwise be clear to them. "Therapeutic reading," as it is sometimescalled, is an effective way to stimulate conversation about topics that childrenmay not be comfortable discussing openly, such as death, sex, or abuse. Whena child experiences a loss, bibliotherapy can be used to both help the child tobetter understand death and clear a path for open conversation about it. Asnoted by Malchiodi (2008), bibliotherapy also reassures children that they arenot alone and often answers questions they may have. As a result, children whoare traumatized experience decreased isolation when they realize that othersshare their situation (Webb, 2005).

When considering bibliotherapy, there are many factors to take into account,such as CANS: cognitive ability, age, needs, and situation. Counselors need tochoose the literature careftiUy, keeping in mind the client's specific situation,age and cognitive ability, and needs related to the situation experienced.Bibliotherapy that does not match the developmental age and needs of the childwill probably have no significant impact.

The counselor also needs to read all books before recommending them. It isnecessary to consider the relevance of the book or story to the child's currentsituation and individual development (Malchiodi, 2008). Also, the vocabularymust be appropriate for the child. When choosing literature, it is also importantto know the relationship of the child to the person who died, how the individ-ual died, the age of the child at the time of the loss, and how the child learnedabout the death (Malchiodi). Counselors will also find it beneficial to inquire


about the child's cultural or religious background so that they can choose liter-ature that is culturally relevant for the child (Malchiodi).

Books chosen should provide comfort and reassurance, along with explana-tion and insight, and be realistic. Rather than being frightening, the book shouldbe a source of comfort. The books chosen should help children gain a betterunderstanding of the feelings they are experiencing and be realistic in the sensethat the child can relate to what is happening. Once you have chosen a book,explain why it is relevant and why you think the child should read it, to help thechild relate the story to personal experience (Malchiodi, 2008).

As the child reads the book, the counselor can stimulate discussion by askingspecific questions to tie the story to the child's situation. Malchiodi (2008, p.182) suggests the following questions to help children explore a story and itscharacters and how they relate to the reader:

• Are you like any of the story's characters?• Do any of the characters remind you of someone?• Who would you like to be in the story?• Is there anything you would like to change about the story?• How would you change the characters, what happened, or how the story

ended?• What is your favorite part of the story?• Did anything in the story ever happen to you?• What do you think will happen to the characters in this story tomorrow, in

a few weeks, or a year from now?

Bibliotherapy is a wonderful tool when it is used correctly. It can benefit chil-dren by helping them to understand their emotions, realize that they are notalone, and answer their questions. However, it is important for counselors tokeep in mind that every child is unique and that bibliotherapy may not beappropriate for every person or situation. Berns (2003) and Goldman (2000)provided helpftil lists of bibliotherapy resources for use with bereaved youngpeople, but we have not found any studies that systematically examined theeffectiveness of bibliotherapy as an intervention with bereaved children andadolescents. This is an area in need of further research.

CULTURAL INFLUENCES

Any discussion of bereavement in childhood and adolescence needs to takeinto account cultural influences on the bereavement process. Counselors work-ing with this population need to be mindful of how their own cultural experi-ences have shaped their views of death and the grieving process and how eachclient is similarly affected (Brinson, 1996; Florian & Kravitz, 1985; Sagara-


Rosenmeyer & Davis, 2007). Families vary greatly in their views and customsrelated to death, and counselors need to respect these diverse perspectives inworking with bereaved young people and their families (Webb, 2005). Oneexample of the influence of cultural factors is the question of whether a youngchild should attend the funeral. While many counselors who work withbereaved children and their families would probably agree on the advantages ofincluding the child in the family's mourning rituals (e.g., Shapiro, 1994), somefamilies may have strong feelings against this practice rooted in their culturaltraditions. Counselors need to be sensitive to this, attempt to understand howcultural factors may exert an infiuence, and work respectfully with familieswithin the context of their religious and cultural beliefs.

PROFESSIONAL IMPLICATIONS

Counselors working with bereaved young people and their families need tobe mindful of the ethical issues that arise in providing services to them. Theyalso need to be aware of how their own grief experiences affect their work. Theethical guidelines of the American Counseling Association (ACA, 2005) andthe American Mental Health Counselors Association (AMHCA, 2010) areexplicit in emphasizing the importance of gaining competence in the areas ofcounseling they offer. They also emphasize the importance of cultural sensitiv-ity. While work with bereaved children and adolescents and their familiesrequires general skills that any competent mental health counselor would beexpected to possess, there are additional areas of knowledge and skill that arenecessary for effective work with this population, among them (a) child andadolescent development as it relates to the process of bereavement; (b) culturalvariations in beliefs about death and mourning practices; and (c) specific inter-ventions to help bereaved young people and their families. Hopefully, articleslike this will be of help to counselors interested in working with this popula-tion. In addition, the Association of Death Education and Counseling(http://www.adec.org/) provides continuing education opportunities and certifi-cation of professionals as experts in death and bereavement.

To work effectively with bereaved clients, counselors need to be aware ofhow they have been affected by their own loss experiences (Morgan, 1994).Many adults, including counselors, have lost someone at a tender age but didnot have anyone to talk with about their loss. James (2008) emphasized theimportance of counselors' self-care concerning their own grief experiencesbefore they attempt to help bereaved clients. Rando (1984) cautioned that coun-selors who have not worked through their own grief run the risk of reliving theirlosses in ways that could undermine the counseling process. He suggested thatcounselors need to deal effectively with their own losses so that they can usethose experiences to enhance their effectiveness with bereaved clients.


The experience of losing someone in childhood but not having the opportu-nity to grieve was poignantly described in Albom's 1997 book, Tuesdays withMorrie, in which Albom shared his weekly conversations with his former col-lege professor, Morrie Schwartz, who was dying. His description could applyto any adult who has lost a loved one at a tender age. Morrie's story can helpus as counselors to become more aware of how we and our clients can beaffected by early loss experiences. Albom described an interview that Morriehad with Ted Koppel on the television program Nightline, in which Morrierelated his experience of losing his mother at a young age. After receiving a let-ter from a schoolteacher in Pennsylvania who taught a class of nine children inwhich every child had experienced the death of a parent, Morrie wrote back totell the teacher about his loss.

"I lost my mother when I was a child . . . and it was quite a blow to me . . .I wish I'd had a group like yours where I would have been able to talk aboutmy sorrows. I would have joined your group because . ." His voice cracked."Because I was so lonely. . ." "Morrie," Koppel said, "that was 70 years agoyour mother died. The pain still goes on?" "You bet," Morrie whispered (pp.71-72). Hopefully, self-aware counselors who have encountered significantlosses can experience growth and use those experiences to develop deeperempathy for their clients.

CONCLUSION

We have described developmental variations in how young people of differ-ent ages experience loss and approaches that can be useful to counselors whowork with bereaved young people and their families. We have emphasized theimportance of considering the developmental level of the child, the family con-text, and cultural factors that may affect the bereavement process. Moreover,we have encouraged the use of an integrative counseling approach that includesthe use of drawings, support groups, and bibliotherapy, which can be combinedwith other counseling techniques and tailored to the needs of a particular client.We have also raised ethical issues that need to be considered in working withbereaved children and adolescents and their families, and we have highlightedthe relevance of the counselor's own personal experience with grief

As counselors become more knowledgeable about bereavement resourcesand counseling approaches, they will be in a better position to assist grievingyoung people and their families. Articles like this one can provide mental healthcounselors with information and encouragement to develop their own bereave-ment services for individuals in need. However, more outcome studies areneeded to determine the best approaches to take with young people who havesuffered loss.


REFERENCES

Albom, M. (1997). Tuesdays with Morrie. New York: DoubledayAmerican Counseling Association (ACA). (2005). ACA code of ethics. Alexandria, VA: Author.American Mental Health Counselors Association (AMHCA). (2010). AMHCA Code of ethics.

Retrieved from http://www.amhca.org/assets/content/AMHCA Code_of_Ethics_l l_30_09bl.pdf

Beckman, R. (1990). Children who grieve: A manual for conducting support groups. HolmesBeach, FL: Learning Publications, Inc.

Bering, J. M., & Bjorklund, D .F. (2004). The natural emergence of reasoning about the afterlife asa developmental regularity. Developmental Psychology, 40, 217-233. doi: 10.1037/0012-1649.40.2.217.

Berns, C. (2003). Bibliotherapy: Using books to help bereaved children [Abstract]. Omega:Journal of Death and Dying, 48, 321-336. doi:10.2190/361D-JHD8-RNJT-RYJV.

Bowlby, J. (1980). Attachment and loss: Vol. 3: Loss sadness and depression. New York: BasicBooks.

Brinson, J. (1996). Cultural sensitivity for counselors: Our challenge for the twenty-first century.Journal of Humanistic Education & Development, 34, 195-206. Retrieved from AcademicSearch Premier database.

Cohen, L. J. (1987). Bibliotherapy: Using literature to help children deal with difficult problems.Journal of Psychosocial Nursing, 25, 20-24. Retrieved from PsycINFO database.

Corey, M. S., & Corey, G. (2006). Groups: Process and practice (7th ed.). Monterey, CA:Thompson/Brookscole.

Davis, C. B. (1995). The use of art therapy and group process with grieving children. In S. C. Smith& S. M. Pennells (Eds.), Interventions with bereaved children (pp. 321-331). Bristol, PA:Jessica Kingsley.

Film Ideas, Inc. (Producer). (1992). What about me? Kids and grief [DVD]. Available fromwww.filmideas.com/whataboutine.htm

Fitzgerald, H. (1992). The grieving child. New York: Simon & Schuster.Florian, V., & Kravetz, S. (1985). Children's concepts of death: Across-cultural comparison among

Muslims, Druze, Christians, and Jews in Israel. Journal of Cross-Cuttural Psychology, 16,174-189. doi: 10.1177/0022002185016002003.

Gardner, R. (1992). The psychotherapeutic techniques of Richard A. Gardner Cresskill, NJ:Creative Therapeutics.

Goldman, L. (2000). Life & loss: A guide to help grieving children (2nd ed.). Philadelphia/ London:Accelerated Development.

Goodman, R.F. (2005). Art as a component of grief work with children. In N.B. Webb (Ed.),Helping bereaved children: A handbook for practitioners (2nd ed.) (pp. 297—322). New York:Guilford.

Grazer, B., Friendly, D. T., Gold, H., & Caracciolo, J. M. (Producers) & Zieff, H. (Director). (1998).My Girl [Motion Picture]. USA: Columbia Pictures.

Haasl, B. & Mamocha, J. (2000). Bereavement support program for children (2nd ed.).Philadelphia/London: Accelerated Development.

James, R. (2008). Crisis intervention strategies (6th ed.). Belmont, CA: Brooks/Cole.Johnson, C. (1995). Adolescent grief support groups. In D. W. Adams & E. J. Deveau (Eds.),

Beyond the innocence of childhood: Vol. 3: Helping children and adolescents cope with deathand bereavement (pp. 229-240). Amityville, NY: Baywood.

Jones, E. H. (2001). Bibliotherapy for bereaved children: Healing reading. London: JessicaKingsley.

Lonetto, R. (1980). Children's conceptions of death. New York: Springer.


Malchiodi, C. A. (Ed.). (2008). Creative interventions with traumatized children. New York: TheGuilford Press.

Morgan, J. P. (1994). Bereavement in older adults. Journal of Mental Health Counseling, ¡6,318-326. Retrieved from Academic Search Premiere database.

Nagy, M. (1948). The child's theories concerning death. Journal of Genetic Psychology, 73, 3-27.Retrieved from PsychlNFO database.

Noppe, 1. C , & Noppe, L. D. (1997). Evolving meanings of death during early, middle, and lateradolescence. Death Studies, 21, 253-275. doi: 10.1080/074811897201967.

Piaget, J., & Inhelder, B. (1969). The psychology of the child. New York: Basic Books.Rando, T. A. (1984). Grief, death, and dying: Clinical interventions for caregivers. Champaign, IL:

Research Press.Sagara-Rosemeyer, M., & Davies, B. (2007). The integration of religious traditions in Japanese

children's view of death and afterlife. Death Studies, 3¡, 223-247. doi:10.I080/07481180601100525.

Sandier, I. W., Ayers, T. S., Wolchik, S. A., Tein, J., Kwok, O., Haine, R. A., et al. (2003). The fam-ily bereavement program: Efficacy evaluation of a theory-based prevention program forparentally bereaved children and adolescents. Journal of Consulting and Clinical Psychology,71, 587-600. doi: 10.1037/0022-0068X.71.3.587.

Sandier, I., West, S., Baca, L., & Pillow, D. (1992). Linking empirically based theory and evalua-tion: The Family Bereavement Program [Abstract]. American Journal of CommunityPsychology, 20, 491-521. doi:10.1007/BF00937756.

Shapiro, E .R. (1994). Grief as a family process. New York: Guilford.Slaughter, V, & Lyons, M. (2003). Learning about life and death in early childhood. Cognitive

Psychology, 46, 1-30. doi: 10.1016/S0010-0285(02)00504-2.Speece, M. W., & Brent, S. B. (1984). Children's understanding of death: A review of three com-

ponents of a death concept. Child Development, 55, 1671-1686. doi: 10.2307/1129915.Tremblay, G., & Israel, A. (1998). Children's adjustment to parental death [Abstract]. Clinical

Psychology: Science and Practice, 5, 424-438. Retrieved from PsycINFO database.

Webb, N. B. (Ed.). (2005). Helping bereaved children: A handbook for practitioners (2nd ed.). NewYork: Guilford.

Winnicott, D.W. (1971). Playing and reality. New York: Basic Books.Wolfe, B. S. (1995). Group interventions with bereaved children five to seventeen years of age. In

S. C. Smith & S. M. Pennells (Eds.), Interventions with bereaved children (pp. 296-320).Bristol, PA: Jessica Kingsley.

Wolfe, B. S., & Senta, L. M. (1995). Interventions with bereaved children nine to thirteen years ofage: From a medical center-based young person's grief support program. In D. W. Adams & E.J. Deveau (Eds.), Beyond the innocence of childhood: Vol. 3: Helping children and adolescentscope with death and bereavement (pp. 203-227). Amityville, NY: Baywood.

Worden, J.W. (1996). Children and grief When a parent dies. New York: Guilford.

Copyright of Journal of Mental Health Counseling is the property of American Mental Health Counselors

Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the

copyright holder's express written permission. However, users may print, download, or email articles for

individual use.

helping bereaved children and adolescents: … of mental health counseling volume 32/number 3/july...

Documents