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Models and theories for grief and loss with children and young people
Models and theories for grief and loss with children and young people
There are a number of psychological theories and models that support an understanding of grief and loss. They attempt to explain the experience but we should remember that each child and young person has their own unique response. The models describe grief as a non-linear process that is complex, unpredictable and may reappear in different forms.
Dual Process Model of Bereavement (Stroebe & Schut, 1999)
Dual Process Model of Bereavement (Stroebe & Schut, 1999)
This model shows the two different ways of behaving: loss-oriented and restoration-oriented.
When grieving you move between the two.
It suggests that people need both time to confront the feelings of loss and to have times where they do not.
Loss-oriented: This includes things that make you think about the bereaved person and their death. These thoughts, feelings, actions and events that make you focus on your pain and grief are called loss-oriented stressors.
- Looking at old photos/hearing a song
- Noticing that someone is not there waiting for you.
Restoration-oriented: These are the things that let you get on with your life and distract you from your grief for a while. Even for short periods of time these can allow small breaks from focusing on the pain. The behaviour is designed to restore order and normality.
- Going to school and working.
- Spending time with friends.
Movement between loss- and restoration-oriented behaviour can support people to manage feelings of intense grief as they can tackle it bit by bit. It can be a helpful way of considering children’s behaviour when they jump in an out of feelings of loss; for example, a child may be enjoying time with friends but in a short space of time may be feeling anxious and sad. It can also provide a simple explanation for children around their emotions – feeling an intense emotion and then a little later feeling better. It also gives them permission to be doing the things they need to do e.g. going to school and seeing friends.
Growing Around Grief - (Tonkin, 2009)
Growing Around Grief - (Tonkin, 2009)
This model can provide a helpful visual to use with children to explain that the aim of grieving is not to get rid of the feelings of loss but to reduce the intensity and to enable them to reach the point where they can function well most of the time. The feelings can re-emerge during significant events or when they are reminded of the person. It does not remain at the forefront of their mind stopping them from engaging fully in life.
Child Bereavement UK video: Puddle Jumping
This animation from CBUK aims to help adults understand how grieving children can seem to move in and out of their grief, a bit like they’re jumping in and out of a puddle.
Children often have many different thoughts, feelings and behaviours when processing death and loss.
It is important to keep in mind;
Their current age and developmental stage may differ.
The age they were when the bereavement occurred.
Children’s understanding of death changes as they develop.
Children do not move abruptly from one stage to the next and characteristics from each stage may overlap.
East Lothian's guidance document has more information on children's understanding of bereavement by their developmental age.
Bereavement 1 - developmental age and understanding.pdfThe ages and stages detailed below are a guideline and it is essential you take into account an individual’s specific needs when using them as a guide.
Children and young people's concept of death
Children and young people's concept of death
It is important to remember that children's understanding of death will change as they develop and get older.
Below are examples of how children and young people might think about death depending on their age.
0-2 years old
0-2 years old
Have no understanding of death
May think of the death as separation from someone they were attached to who is no longer there
No awareness that the absence is permanent
Aware of changes to routine as a result of a death
2-4 years old
2-4 years old
May see themselves as cause of death
Think that death is reversible
May worry about who will take care of them in the future
May be affected by the sadness of others close to them
4-6 years old
4-6 years old
Death may be seen as temporary - somewhere people can go to and come back from
May think of the separation as a punishment
May start to realise that death is irreversible
6-10 years old
6-10 years old
Around 6-8 years, still ‘magical thinkers’
By around 10 years may recognise that death is universal and irreversible
10-12 years old
10-12 years old
Death is irreversible and happens to everyone
Adolescence
Adolescence
Understand death as a concept, but just beginning to deal with it emotionally
Do not yet have the experiences, coping skills or behaviours of an adult
Behaviours you might notice
Behaviours you might notice
Children may show different reactions to death dependent on their age and what stage they are in their development.
However it is important to remember that not all children behave the same as a result of loss. Often other factors influence their reactions and behaviours; personality, previous experience with death, gender differences, religious and cultural beliefs and family support, all play a part in processing loss.
Below are some examples of behaviours which may be presented following bereavement and loss during particular ages. More in depth examples are provided on the previous page; Common responses to bereavement and loss.
0-2 years old
0-2 years old
Crying/screaming to express their loss
Eating/sleeping problems
Decreased responsiveness
Regression
Looking or asking for a missing parent or carer
Becoming clingy and afraid of strangers
2-4 years old
2-4 years old
Conflicting statements showing inability to understand the finality of death
May ask a lot of questions repetitively
May regress in their development,
4-6 years old
4-6 years old
Egocentric orientation – everything is from their perspective
‘Magical thinking’ – make up fantasies to fill any gaps in knowledge
Can hold a reasonably secure picture of their loved ones in their mind
May not have the language to express their emotions, but may repeat a memorised script
Pretend play may feature death/dying - this is normal and helps the child integrate the reality of the death
Feelings of guilt, rejection, anger or resentment
6-10 years old
6-10 years old
May want to know more about death
May worry that you or others may die too
May make them feel less safe and become more dependant
May experience a range of emotions
May find it difficult to express these feelings
May show compassion for someone who is bereaved
May worry about effect on others if they are sad, and therefore try to hide their feelings
10-12 years old
10-12 years old
May have lots of thoughts around the meaning of life and death
May be living life to the full, to avoid thinking about the loss or bereavement
Can feel like they are the only one to experience grief
Adolescence
Adolescence
May protest loss by acting out or withdrawing
May feel life is unfair and act angrily
May test own mortality by taking risks
May express a wish to be with the person that has died.
May act in a way that is ‘expected’ and therefore hide what they are really feeling
Feeling of responsibility, possibly stepping into a new role within the family
A wish to be normal
Changes to eating patterns
Things that can help
Things that can help
Children may need different responses to their grief depending on their age.
It is important to remember that no reaction to loss is wrong, and every child is unique in their response to death.
0-2 years old
0-2 years old
Minimise disruptions to their care
Minimise the number of caregivers
Provide extra comfort,
Wondering aloud
Talk to them about what has happened in a simple and meaningful way
Take care of the caregiver and make sure they are supported
2-4 years old
2-4 years old
Acknowledge their feelings and show empathy
Be patient and give factual information
Short and honest interactions
Comfort and reassurance, while being nurturing
Consistent routine
4-6 years old
4-6 years old
Consistent caregiving and daily routines
Let them know it is not their fault
Acknowledge feelings and show empathy
Avoid euphemisms
Help them understand what dead is
Allow the child to express grief through play and art
Encourage memories
Support children to name their feelings
Adults can join pretend play and offer guidance
6-10 years old
6-10 years old
Let them know it is not their fault
Acknowledge feelings and show empathy
Let them know there is no ‘wrong’ feeling
Check what they know and what they want to know
Be truthful and open
Provide simple concrete information
Where required, help them understand what dead is
Maintain access to peers
Allow the child to express emotions through creative activities
Encourage memories
Give physical outlets
10-12 years old
10-12 years old
Check what they know and what they want to know
Check understanding of language
Allow and encourage expressions of emotion
Be clear, honest and open
Provide privacy
Maintain access to peer/social support
Consider support groups
Consider impact of emerging independence/identity
Adolescence
Adolescence
Experiences of varying emotions and increase in mood swings will require patience and consistency from adults close to them
Young people will require regular reassurance that their feelings are okay
Permission to ask questions and receive honest responses
Follow their lead. Allow the right not to talk- it is important to recognise that although talking is the main way in which adults communicate when experiencing difficulties, this may not be what the young person wants.
Calm space / time out - provide opportunities to take ‘time out’ in a quiet or calm space for a specified amount of time during the day
Not being singled out
Peers can be a huge support to adolescents as young people become more independent
Remembering the person who died
Honesty in situations such as a terminal illness
In time, most adolescents are able to return to daily routines with predictable ups and downs. There are others who may require more significant support in the longer term.
References
References
Stroebe, M.S., & Schut, H. (1999). The Dual Process Model of coping with bereavement: Rationale and description. Death Studies, 23, 197-224.
Tonkin, L. TTC, Cert Counselling (NZ) (2009) Growing around grief – another way of looking at grief recovery, Bereavement Care, 15:1, 10.
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