BLOG: Traumatic Bereavement
Barnardo's Education Community Project Worker, Marie Thomas, blogs about attending the Child Bereavement UK course on ‘Understanding Traumatic Bereavement in Children and Young People’
Prior to attending a course with Child Bereavement UK on the above subject I had assumed that the term related to deaths that happened violently/in difficult circumstances or were very sudden/unexpected such as my own experience of my mother-in-law’s death, which happened very suddenly after we had taken her home following a lovely Christmas together.
I learnt however, that the trauma involved does also relate to the way the bereavement is managed, and how people respond to it. Our individual circumstances mean that we can be triggered by different things. We might have prepared for a death but what we see, hear, had to do can impact hugely on our responses. The language we use with children, for example, is crucial, as is the way they learn about a bereavement.
The following definition of trauma by the recently formed UK Trauma Council is helpful:
‘Trauma refers to the way that some distressing events are so extreme or intense that they overwhelm a person’s ability to cope, resulting in lasting negative impact.’
Models of grieving
The Clinical Psychologist leading the course explained that Child Bereavement UK use 3 main models, one of which is Warden’s tasks of mourning:
- To accept the reality of the loss.
- To process the pain of grief.
- To adjust to a world without the deceased.
- To find an enduring connection with the deceased whilst embarking on a new life.
I was introduced to another model: ‘The Dual Process Model of Coping with Bereavement’ created by Strobe and, which divides the process into 2 areas:
- Loss oriented work
- Restoration oriented work
Key points for me from this explanation:
- Children seem to cope best with moving between grieving and restoration-oriented work.
- Adults can struggle with seeing children grieving but it is crucial to allow them the time and space to do so.
- There is some evidence that boys and girls have a different tendency in terms of loss-oriented work and the restoration-oriented work, with boys more likely to focus on the latter.
- Strobe believes that trauma can impact on the way people move between the 2. It can stop people from doing the grief work, and from sitting with those emotions.
I find this model very helpful in developing my understanding of grief and the connection to trauma.
Support – what is wanted and required
Evidence suggests that 85% children and young people want support, especially when dealing with a traumatic bereavement, from people they know and trust. Most of them will get their support needs met in that way.
Many of the reactions to grief are normal in the first 4-6 weeks.
The World Health Organisation (WHO) have put together best principles of support for natural recovery - these fall into 5 key areas. The table below provides some examples of ways you can support in each:
Look out for the following:
*If reactions continue /persist
*How frequently they occur
*The severity of the responses
*Impact upon the young person’s functioning
There is a small group who will require the input of more specialist bereavement services and about 16% will experience PTSD. The Clinical Psychologist described what the 3 main ‘clusters’ of symptoms are:
- Re-experiencing of the trauma in the present
- Avoidance symptoms, including use of alcohol or drugs
- Alteration in arousal and reactivity ranging from sleep disturbance to reckless behaviour
‘Trauma obstructs the grieving process. The traumatic nature of the death and the symptoms of PTSD may inhibit grieving. If a person is experiencing PTSD then bereavement support will not be effective until the trauma has been processed.’ (CBUK referencing Trickey, 2013)
Some children and young people are more at risk of traumatic bereavement such as
- those who have had early experiences that have been traumatic
- females
- those living in poverty
- those who have had psychological issues prior to the event. Some children and young people will struggle to process trauma as a one-off event. Their previous experiences have influenced their perception and they think this event will negatively impact their future.
- those with families that are functioning poorly or where there a parent has psychological issues.
It was explained that there is evidence that the brain gets traumatic memories into our memory system in a different way to non-traumatic ones.
Central to trauma is the avoidance of processing and so the support needed is CBT based, where memories can be looked at in a very safe and structured way. This will then help the individual to reprocess, lay down memories and then put them away, just like any other non-traumatic memories.
For professionals, exposure to others’ trauma can impact noticeably (vicarious trauma where empathy exceeds emotional capacity) and so self-care is vitally important.