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Section 26
Strategies for Working with Bereaved Adolescents

Question 26 | Test | Table of Contents

In reality, school counselors often lack the time and specialized training to offer extended services in bereavement counseling to individual adolescents. However, students who lose a parent during this critical stage of development are in need of intervention. In fact, providing services as soon after the loss as possible is a critical factor in the recovery process. Unfortunately, an in-depth literature review revealed only a limited number of references that offered models or practical recommendations for adolescent bereavement services designed for school settings. These few bereavement models provided general information on services for adolescents with no systematic evaluations in objectives measures. In addition, only one study (Moore & Herlihy, 1993) offered a model that specifically focused on adolescent loss in response to the death of a parent; no references were found that provided strategies specially related to the death of a mother. Following is a composite of the few models and strategies that are available for both individual and group counseling.

Individual Strategies
The bereaved adolescents frequently use denial as their primary coping strategy in response to the death of a parent. Given this heavy reliance on denial, the bereaved adolescent may not be willing to even discuss the loss. Counselors need to be prepared for resistance that results from denial. The school counselor can support the bereaved adolescent by simply acknowledging the magnitude of the loss and the pain that such a loss can inflict. This acknowledgment may then lay the groundwork for future mourning, when the adolescent matures and feels more capable of confronting his or her grief issues (Rosen, 1991).

Kandt (1994) and Wolfert (1997) offered the following individual counseling strategies for short-term bereavement work in a school setting.

  1. Acknowledge the pain and grief: Assure him or her that it is normal and give permission to grieve. Provide a supportive and empathetic environment for the adolescent to feel comfortable in experiencing emotions and to understand that reminiscing is essential to healing.
  2. Biotherapy and journaling strategies. Books and stories pertaining to death and grief issues can be employed to help the adolescent deal with denial issues in response to losses and get in touch with feelings. In addition, through journal writing, adolescents can be invited to explore themes related to the grief process. A memory book and family tree was recommended by Kandt (1994). The family tree, as a means of helping the youth to evaluate the different roles that family members played in his or her life. The memory book can include photos, poems, letters, and other memorabilia related to the deceased. This provides concrete objects to connect the adolescent to the deceased and encourage sharing.
  3. Relaxation techniques. Used with discretion, progressive muscle relaxation, deep breathing, and guided imagery can be taught to promote feelings of peace and well-being and serve to alleviate stress.
  4. Take a loss history. This is beneficial in determining experiences that adolescents have had with grief and possible unresolved issues.

In school settings, additional long-term individual support can be gained through referrals to outside agencies. Depending on adolescent needs, more extensive counseling may be offered, or for more complicated bereavement cases, intense therapy may be required. Grief counseling is an accepted initial approach for adolescents who are experiencing an uncomplicated grief (Worden, 1991). Grief counseling allows these adolescents to resolve unfinished matters with their deceased mothers and to say goodbye.

The school counselor must assess whether counseling or therapy is more appropriate in assisting an adolescent to adjust to a loss. It is important to become familiar with the adolescent's social and emotional history. Determination of how many earlier deaths or losses the adolescent has experienced and how those losses were mourned are important factors. If these earlier losses were not mourned or resolved, there is a greater risk for a more complicated grief reaction with the current loss (Keitel et al., 1998; Valentine, 1996). It is also important to assess the adolescent's mental health history. Adolescents with a history of depression should be considered at risk for a more complicated bereavement (Valentine, 1996). Finally, it is necessary to assess the amount of support available to the individual, both within and outside the family. If the family system is unable to provide support to the adolescent, he or she is at risk for a more difficult grief reaction (Worden, 1991).

Whether counseling or therapy is undertaken, the goal is to facilitate the mourning process. Worden (1991) enumerated four tasks of mourning, (1) to accept the death of the loved one, (2) to uncover and endure the pain inherent in the grieving process, (3) to adapt to an environment in which the loved one is absent, and (4) to reconnect with the deceased in a way that the mourner is able to continue with life. These goals should guide any therapeutic interventions undertaken.

Support Groups
One of the central tasks in resolving grief is to maintain a supportive social network in the grieving process (Johansen, 1988; Meager, 1989; Rosenblatt, 1988; Van Der Wal, 1989). Adolescents who experience the loss of a parent may be reluctant to express their grief because it makes them different from their peers (Garber, 1995). A grief group can serve to normalize adolescents' experiences because it would allow them to feel less isolated from their peers. In addition, it would provide them with a collaborative opportunity to continue the developmental tasks of mourning (Corr & Balk, 1996). The school is an ideal setting for such a group because school personnel can recruit students who have recently experienced the death of a parent. In forming the group, only children who have suffered the loss of a parent may be included, or the attendance could be expanded to include students who have endured different types of losses such as sibling loss.

A peer support group model used as a resource for facilitating the mourning process among bereaved adolescents has been suggested by a number of authors (Cornell & Pack, 1993; Kandt, 1994; Keitel et al., 1998; Quarmby, 1993; Wolfert, 1997). However, few models exist for conducting such groups in a school setting. Obviously, grief is a complex process that takes time and energy as everyone moves through their own pace regarding strategies and issues. However, two short-term models in school settings are summarized below.

Moore and Herlihy (1993) recommended a group model for adolescents who had lost a parent. Their design included a 6-week group of six to eight members for weekly 60-minute to 90-minute sessions. The sessions focused on a discussion of various individual experiences in the grieving process. They found that adolescents preferred interaction with peers in the familiar context of the school environment to individual counseling. Since adolescents have a more difficult time grieving than adults, they found that using some structure and themes was beneficial for this age group. The group sessions were very structured and included the following content: (a) sharing the event, (b) mini-sessions on stages of grieving such as Kubler-Ross's (1969) stages of grieving, (c) events after death, (d) special concern of the changing family, (e) family rituals and holidays, and (f) termination. Although these groups were short term, Moore and Herlihy (1993) found them to be beneficial to students and very manageable in a school setting.

Similarly, Kandt (1994) presented a short-term support group for grieving adolescents. Although it was not specifically designed for adolescents grieving the death of a parent, it does at least provide another school-based support model. An eight-session bereavement support group focused on issues surrounding the loss and provided opportunities for further exploration. Again, this group model was highly structured and included the following content sessions: (a) establish norms and procedures and have participants share the loss experience, (b) share keepsakes identified with the deceased, (c) provide adolescents with opportunities to tell their stories while receiving education about death and dying issues, (d) deal with concerns which often include final rites, special occasions, and unfinished business with the deceased; (e) summary evaluation and a closure celebration; and (f) a final meeting one month after termination to serve as an opportunity to share how they were getting along and decide on any referrals for more long-term counseling.

Family Counseling
Although long-term family counseling is not usually possible in a school setting, benefits can be gained even from a few family sessions. An understanding of the family context is essential to appreciate the adolescent's unique grieving process (Corr & Balk, 1996). Children cope better after the death of a parent if the surviving parent helps the children grieve and intermittently reminisce about the deceased parent (Clark et al. 1994). School counselors can assist a surviving father in the grieving process and can help him to connect with his child's needs and the concern of other siblings in the family. A counselor could also act as a source of support for the father by offering referrals to community agencies that could assist him in managing his own grief as well as the new stresses of single fatherhood.

If the surviving father proves to be emotionally unavailable and unsupportive of the adolescent's grief, the counselor could step in and act as a temporary parental substitute (Rosen, 1991). The counselor may act as a parental figure who provides the support, nurturance, and guidance that the "parentless" adolescent requires for healthy developmental progression. A female counselor may be particularly effective in this respect since she might act as a temporary replacement for the mother-figure. The bereaved daughter, in particular, might be able to use the female counselor, via the transference relationship, to resolve issues of guilt or ambivalence towards her deceased mother.

Conclusion
There is limited research, few models, and many unanswered questions about adolescent bereavement and appropriate interventions in a school setting. This population has been neglected in the past and incorrectly classified with children or adult groups. Therefore, counselors face many challenges as they attempt to provide services for grieving adolescents at a critical time when unresolved grief can easily result in risk for other deviant behaviors. Counselors can be an important force at this critical developmental stage. Most adolescents experience conflict with their mothers as they struggle to assert their independence and become adults. Fortunately, most adolescents do not lose their mothers during this time of turmoil. For a loss of such magnitude to occur at this crucial juncture is unfortunate. Counselors, through their awareness and supportive presence, can assist by providing services so that a tragedy is less likely to escalate into a crisis in which the wrong choices and decisions are made that could result in long-term negative effects in the lives of adolescents. Both daughters and sons can be helped to overcome unresolved grief by school professionals who provide adolescents with the opportunity and support to cope with their feelings of grief and guilt. Both short-term work in the school setting, and referrals are important. Counselors can provide a critical opportunity to help adolescents explore their grief and build a bridge, a scaffolding to a healthier future. Adolescents should not have to suffer in silence as the forgotten ones (Kubler-Ross, 1969).
- Lenhardt, Ann Marie & Bernadette McCourt; Adolescent unresolved grief in response to the death of a mother; Professional School Counseling; Feb 2000; Vol. 3; Issue 3.

Grief and Loss Coping Strategies for Foster Parents

- Washington State Department of Social & Health Services. Grief and Loss Coping Strategies for Foster Parents.

Personal Reflection Exercise #12
The preceding section contained information about strategies for working with bereaved adolescents.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Resilient Phenotypes among Bereaved
Youth: A Comparison of Trajectory,
Relative, and Cross-Domain Approaches

- Espinosa Dice, A. L., Ye, X., Kim, S. G., McLaughlin, K. A., Amstadter, A. B., Tiemeier, H., & Denckla, C. A. (2023). Resilient phenotypes among bereaved youth: a comparison of trajectory, relative, and cross-domain approaches. Child and adolescent psychiatry and mental health, 17(1), 23.

Peer-Reviewed Journal Article References:
Howard Sharp, K. M., Russell, C., Keim, M., Barrera, M., Gilmer, M. J., Foster Akard, T., Compas, B. E., Fairclough, D. L., Davies, B., Hogan, N., Young-Saleme, T., Vannatta, K., & Gerhardt, C. A. (2018). Grief and growth in bereaved siblings: Interactions between different sources of social support. School Psychology Quarterly, 33(3), 363–371.

Oosterhoff, B., Kaplow, J. B., & Layne, C. M. (2018). Links between bereavement due to sudden death and academic functioning: Results from a nationally representative sample of adolescents. School Psychology Quarterly, 33(3), 372–380.

Salinas, C. L. (2021). Playing to heal: The impact of bereavement camp for children with grief. International Journal of Play Therapy, 30(1), 40–49.

QUESTION 26
What are Worden's four tasks of mourning? To select and enter your answer go to Test.

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