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LOSS Program Office
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Featured this Month:

Caring for Trauma Reactive Children after a Suicide Loss
Wednesday, August 16, 2017 by Cynthia Waderlow MSE, LCSW
In a suicide bereaved family it is conceivable that each survivor bears some level of trauma. The sudden intrusion of paramedics, ambulances and police with flashing lights, witnessing distraught reactions of parents and especially, exposure to the scene of death will impact the central nervous system of every family member. Even those not physically present at the time the suicide is discovered may be disturbed by intrusive imaginary images and sounds. Parents who seek counseling for their bereaved children know that this loss feels incomprehensible and has far-reaching impact. Whether a child openly shows reactivity and emotional dysregulation or has learned to mask their distress it is smart to assess for trauma. Not all traumatic experiences meet the clinical level of Posttraumatic Stress Syndrome, as defined by the DSM-5, but the extraordinary and shocking nature of suicide loss can give rise to trauma symptoms, which include intrusive remembering, emotional numbing and avoidance as well as general hyper-arousal. Intrusive remembering can look like recurrent disturbing dreams, flashbacks of the experience or heightened reactions to reminders of the loss. Persistent avoidance and emotional numbing present as:

Efforts to avoid thoughts, feelings and activities related to the trauma, inability to recall an important aspect of the trauma, markedly diminished interest in significant activities, feelings of detachment or estrangement from others and restricted range of emotional expression. Hyper-arousal can include sleep disturbance, irritability or anger outbursts, difficulty with concentration or exaggerated startle response (Shapiro, 1994, p. 270).
Any individual, of any age, many have some or all of these symptoms after surviving a suicide loss. Trauma recovery means rebuilding shattered patterns of understanding the world, managing emotions and relating to others Shapiro, 1994, p. 270). ). When trauma symptoms begin to recede children will have increased tolerance for telling their story about who their loved one was, and how they understand the loved one’s death.
Because grief demands attention to our memories, our relationship to the person who died and to the loss event itself, trauma symptoms can obstruct the grief process in adults as well as children. Parents and clinicians together can support children and teens after a traumatic loss. Bereaved parents will need to find good therapeutic care for themselves so that they are better able to continue to actively parent traumatized children. It is the support and connection with primary figures in the child’s life that are essential in helping the child process emotions and rebuild a sense of safety.
Whether adult, adolescent, or child, some aspects of trauma may heal with time as long as the loss is not part of a larger and continuing complex of other traumas. More impactful trauma is healed with approach and mastery. Many clinicians concur that trauma work is detail work, involving the cognitive and emotional capacity of the person to stay with the work and become familiar with details that he or she would otherwise avoid. Telling the story in detail allows the surviving person to acknowledge the loss experience as reality, to “wear it out” as old material and, once integrated, to send it to the part of the brain where old memories stay. Needless to say, children and teens are vulnerable. We don’t want to add pain or re-traumatize. Competent trauma interventions involve reestablishment of safety and close, reliable relationships at home and in the therapy room, time for maturation of the child’s narrative and language skills as well as careful pacing of difficult material.
The interim goal is for children to feel safely connected to caregivers and therapist, to feel respected and supported in their ability to be in charge of their traumatic memories and feelings of loss. While this is going on, children may play, write, draw and talk. A child may cry or show avoidance during this time, but a good therapist will help him or her to recover and feel good about the work they have done by the end of the session. Therapeutic work with grieving children is slow, incremental and allows the young person to grow into healing. When a child approaches any aspect of the trauma in collaboration with a supportive parent or therapist, the process of mastery has occurred. Resilience is experienced.
A father brought his three year old daughter to the LOSS children’s program after she saw her mother die. The child clung to her dad and distrusted the therapist. She needed more time.
Six months later she returned. Very slowly over two years of weekly play and fantasy and storytelling, this child made huge gains in emotional security. She no longer avoids references to what she experienced. She can say what she saw and what she felt.
Her father helped tremendously. He participated in individual grief counseling. He prioritized his daughter’s needs and put resources into her enrichment. He moved to another house. He gifted his child with meaningful tokens belonging to her mother; he displayed pictures of her mother and told stories about her that are balanced. Some are cute and endearing, others are more straightforward about her mother’s struggles. His message conveyed a living presence of his daughter’s deceased mother. It is part of their shared life together. Gradually, this child developed a real sense of who her mother was, and ways in which she is like her mother. Recently, she was able to share her loss with other children who had a similar loss. She is mastering her trauma story so that she can continue to savor memories and new stories about her mom. The trauma work will eventually recede, while her loss will be reprocessed and reintegrated with each passing developmental stage. Metaphorically, she and her father are partnered in a delicate dance about past and present, with a light touch and deep bass tones.
Grief as a Family Process, Shapiro, 1994, The Guilford Press, New York, London, was the basis for information regarding trauma symptoms.


Archives:

Caring for Trauma Reactive Children after a Suicide Loss
Wednesday, August 16, 2017 by Cynthia Waderlow MSE, LCSW
In a suicide bereaved family it is conceivable that each survivor bears some level of trauma. The sudden intrusion of paramedics, ambulances and police with flashing lights, witnessing distraught reactions of parents and especially, exposure to the scene of death will impact the central nervous system of every family member. Even those not physically present at the time the suicide is discovered may be disturbed by intrusive imaginary images and sounds. Parents who seek counseling for their bereaved children know that this loss feels incomprehensible and has far-reaching impact. Whether a child openly shows reactivity and emotional dysregulation or has learned to mask their distress it is smart to assess for trauma. Not all traumatic experiences meet the clinical level of Posttraumatic Stress Syndrome, as defined by the DSM-5, but the extraordinary and shocking nature of suicide loss can give rise to trauma symptoms, which include intrusive remembering, emotional numbing and avoidance as well as general hyper-arousal. Intrusive remembering can look like recurrent disturbing dreams, flashbacks of the experience or heightened reactions to reminders of the loss. Persistent avoidance and emotional numbing present as:

Efforts to avoid thoughts, feelings and activities related to the trauma, inability to recall an important aspect of the trauma, markedly diminished interest in significant activities, feelings of detachment or estrangement from others and restricted range of emotional expression. Hyper-arousal can include sleep disturbance, irritability or anger outbursts, difficulty with concentration or exaggerated startle response (Shapiro, 1994, p. 270).
Any individual, of any age, many have some or all of these symptoms after surviving a suicide loss. Trauma recovery means rebuilding shattered patterns of understanding the world, managing emotions and relating to others Shapiro, 1994, p. 270). ). When trauma symptoms begin to recede children will have increased tolerance for telling their story about who their loved one was, and how they understand the loved one’s death.
Because grief demands attention to our memories, our relationship to the person who died and to the loss event itself, trauma symptoms can obstruct the grief process in adults as well as children. Parents and clinicians together can support children and teens after a traumatic loss. Bereaved parents will need to find good therapeutic care for themselves so that they are better able to continue to actively parent traumatized children. It is the support and connection with primary figures in the child’s life that are essential in helping the child process emotions and rebuild a sense of safety.
Whether adult, adolescent, or child, some aspects of trauma may heal with time as long as the loss is not part of a larger and continuing complex of other traumas. More impactful trauma is healed with approach and mastery. Many clinicians concur that trauma work is detail work, involving the cognitive and emotional capacity of the person to stay with the work and become familiar with details that he or she would otherwise avoid. Telling the story in detail allows the surviving person to acknowledge the loss experience as reality, to “wear it out” as old material and, once integrated, to send it to the part of the brain where old memories stay. Needless to say, children and teens are vulnerable. We don’t want to add pain or re-traumatize. Competent trauma interventions involve reestablishment of safety and close, reliable relationships at home and in the therapy room, time for maturation of the child’s narrative and language skills as well as careful pacing of difficult material.
The interim goal is for children to feel safely connected to caregivers and therapist, to feel respected and supported in their ability to be in charge of their traumatic memories and feelings of loss. While this is going on, children may play, write, draw and talk. A child may cry or show avoidance during this time, but a good therapist will help him or her to recover and feel good about the work they have done by the end of the session. Therapeutic work with grieving children is slow, incremental and allows the young person to grow into healing. When a child approaches any aspect of the trauma in collaboration with a supportive parent or therapist, the process of mastery has occurred. Resilience is experienced.
A father brought his three year old daughter to the LOSS children’s program after she saw her mother die. The child clung to her dad and distrusted the therapist. She needed more time.
Six months later she returned. Very slowly over two years of weekly play and fantasy and storytelling, this child made huge gains in emotional security. She no longer avoids references to what she experienced. She can say what she saw and what she felt.
Her father helped tremendously. He participated in individual grief counseling. He prioritized his daughter’s needs and put resources into her enrichment. He moved to another house. He gifted his child with meaningful tokens belonging to her mother; he displayed pictures of her mother and told stories about her that are balanced. Some are cute and endearing, others are more straightforward about her mother’s struggles. His message conveyed a living presence of his daughter’s deceased mother. It is part of their shared life together. Gradually, this child developed a real sense of who her mother was, and ways in which she is like her mother. Recently, she was able to share her loss with other children who had a similar loss. She is mastering her trauma story so that she can continue to savor memories and new stories about her mom. The trauma work will eventually recede, while her loss will be reprocessed and reintegrated with each passing developmental stage. Metaphorically, she and her father are partnered in a delicate dance about past and present, with a light touch and deep bass tones.
Grief as a Family Process, Shapiro, 1994, The Guilford Press, New York, London, was the basis for information regarding trauma symptoms.