Clinical Tools to Facilitate Treatment of Childhood Traumatic Grief

Abstract

Cohen and Mannarino (2004) define childhood traumatic grief (CTG) as “a condition in which trauma symptoms impinge on children's ability to negotiate the normal grieving process” (p. 819). Brown and Goodman (2005) add further clarification, “According to our current understanding of CTG and normal grief, thoughts and images of a traumatic nature are so terrifying, horrific, and anxiety provoking that they cause the child to avoid and shut out these thoughts and images that would be comforting reminders of the person who died. In contrast, a child who does not have intrusive reminders, or who did not experience the death as traumatic, is able to access the person in memory in a manner that is positive and beneficial to integrating the death in his or her total life experience” (pp. 255, 257). The distressing and intrusive images, reminders, and thoughts of the traumatic circumstances of the death, along with the physiological hyperarousal associated with such re-experiencing, prevent the child from proceeding in a healthy way with the grieving process. In addition, while such children are ordinarily excluded from studies of empirically validated treatment studies because of severity and co-morbidity of their conditions, clinicians often see youngsters where traumatic death has been superimposed on a history of multiple losses and in some cases socio-cultural trauma and/or major psychiatric disorders in the child or family. The projective drawing and storytelling strategies and the evocative technique described in this article are intended to offer clinicians additional tools to deal with such seriously impacted youth so that the trauma work can be approached in the relative safety of symbolism and metaphor prior to directly confronting the trauma events.

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References

Allan

(1988). Inscapes of the child's world. Jungian counseling in schools and clinics. Dallas, TX: Spring Publications.

Benedict

H. E.

(2003). Object-relations/thematic play therapy. In Schaefer

C. E.

(Ed.), Foundations of play therapy. New York: Wiley.

Berger

, & Gehart-Brooks

D. R.

(2000). “Feelings Jenga”: Facilitating family communication through play. Journal of Family Psychotherapy, 11, 81–85.

Brown

E. J.

, & Goodman

R. J.

(2005). Childhood traumatic grief: An exploration of the construct in children bereaved on September 11. Journal of Clinical Child and Adolescent Psychology, 34, 248–259.

Burns

G. W.

(2004). 101 Healing stories for kids and teens. Using metaphors in therapy. New York: Wiley.

Cattanach

(1997). Children's stories in play therapy. London: Jessica Kingsley Publishers.

Cattanach

(Ed.). (2002). The story so far: Play therapy narratives. London: Jessica Kingsley Publishers.

Chang

(1999). Collaborative therapies with young children and their families: Developmental, pragmatic, and procedural issues. Journal of Systemic Therapies, 18, 44–64.

Cohen

J. A.

, & Mannarino

A. P.

(2004). Treatment of childhood traumatic grief. Journal of Clinical Child and Adolescent Psychology, 33, 819–831.

10.

Crenshaw

(1992). Reluctant grievers: Children of multiple loss and trauma. The Forum, 17, 6–7.

11.

Crenshaw

(1995). The crisis of connection: Children of multiple loss and trauma. Grief Work, 1, 16–21.

12.

Crenshaw

D. A.

(2002). Disenfranchised grief of children. In Doka

K. J.

(Ed.), Disenfranchised grief: New directions, challenges and strategies for practice (pp. 293–306). Champaign, IL: Research Press.

13.

Crenshaw

D. A.

(2004). Engaging resistant children in therapy: Projective drawing and storytelling techniques. In Mordock

J. B.

(Ed.), The child and family therapy guidebook series (vol. 1). Rhinebeck, NY: Rhinebeck Child and Family Publications.

14.

Crenshaw

D. A.

(in press). Evocative strategies in child psychotherapy. Lanham, MD: Jason Aronson.

15.

Crenshaw

D. A.

, & Hardy

K. V.

(2005). Fawns in gorilla suits: Understanding and treating the aggression and violence of traumatized children in child welfare. In Boyd

N. W.

(Ed.), Helping traumatized children and youth in child welfare: Perspectives of mental health and children's services practitioners (pp. 171–195). New York: Guilford.

16.

Crenshaw

D. A.

, & Mordock

J. B.

(2005a). A handbook of play therapy with aggressive children. New York: Jason Aronson, an imprint of Rowman & Littlefield Publishers.

17.

Crenshaw

D. A.

, & Mordock

J. B.

(2005b). Understanding and treating the aggression of children: Fawns in gorilla suits. New York: Jason Aronson, an imprint of Rowman & Littlefield Publishers.

18.

Doka

K. J.

(Ed). (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA: Lexington Books.

19.

Doka

K. J.

(Ed.). (2002). Disenfranchised grief: New directions, challenges and strategies for practice. Champaign, IL: Research Press.

20.

Eth

, & Pynoos

(Eds). (1985). Post-traumatic stress disorder in children. Washington, DC: American Psychiatric Press.

21.

Freeman

Epston

, & Lobovits

(1997). Playful approaches to serious problems. New York: Norton.

22.

Furth

G. M.

(1988) The secret world of drawings: A Jungian approach to healing through art. Boston: Sigo Press.

23.

Gabel

(1984). The Draw A Story Game: An aid in understanding and working with children. The Arts in Psychotherapy, 11, 187–196.

24.

Garbarino

(1995). Raising children in a socially toxic environment. San Francisco: Jossey-Bass.

25.

Garbarino

(1999). Lost boys: Why our sons turn violent and how we can save them. New York: Anchor Books.

26.

Gardner

R. A.

(1971). Therapeutic communication with children: The mutual storytelling technique. New York: Science House.

27.

Hanney

(2002). Healing traumatized children: Creating illustrated storybooks in family therapy. Family Process, 41, 37–65.

28.

Hardy

K. V.

(2003). Working with violent and aggressive youth. Presentation at the Psychotherapy Networker Symposium, Washington, DC.

29.

Hardy

K. V.

, & Laszloffy

(2005). Teens who hurt: Clinical interventions to break the cycle of adolescent violence. New York: Guilford.

30.

Johnson

D. R.

(1987). The role of the creative art therapies in the diagnosis and treatment of psychological trauma. The Arts in Psychotherapy, 14, 7–13.

31.

Koslowska

, & Hanney

(2001). An art therapy group for children traumatized by parental violence and separation. Clinical Child Psychology and Psychiatry, 6, 49–78.

32.

Lankton

C. H.

, & Lankton

S. R.

(1989). Tales of enchantment: Goal-oriented metaphors for adults and children in therapy. New York: Brunner/Mazel.

33.

Larner

(1995). Narrative child family therapy. Family Process, 35, 423–440.

34.

Levine

(2005). Unattended sorrow: Reviving the heart. New York: Rodale Press.

35.

Malchiodi

(1997). Breaking the silence: Art therapy with children from violent homes. (2nd ed., rev.). New York: Brunner/Mazel.

36.

Malchiodi

C. A.

(Ed.). (2003). Handbook of art therapy. New York: Guilford Press.

37.

Mills

J. C.

, & Crowley

R. J.

(1986). Therapeutic metaphors for children and the child within. New York: Brunner/Mazel.

38.

Moore

M. S.

(1994a). Reflections of self: The use of drawings in evaluating and treating physically ill children. In Erskine

& Judd

(Eds.), The imaginative body: Psychodynamic therapy in health care (pp. 113–144). London: Whurr Publishers.

39.

Moore

M. S.

(1994b). Common characteristics in the drawings of ritually abused children and adults. In Sinason

(Ed.). Treating survivors of satanic abuse (pp. 113–141). London: Routledge.

40.

Newman

C. J.

(1976). Breaking the silence: Art therapy with children from violent homes. New York: Brunner/Mazel.

41.

Oaklander

(1978). Windows to our children. Moab, UT: Real People Press.

42.

O'Toole

(1995). Using story to help children coping with dying, death and bereavement issues. An annotated resource. In Adams

D. W.

& Deveau

E. J.

(Eds.), Beyond the innocence of childhood (Vol. 2; pp. 335–346). Amityville, NY: Baywood.

43.

Sarnoff

C. A.

(1987). Psychotherapeutic strategies in the latency years. Northvale, NJ: Aronson.

44.

Schavarian

(1992). The revealing image. London: Routledge.

45.

Smith

, & Nylund

(1997). Narrative therapies with children and adolescents. New York: Guilford Press.

46.

Stacey

, & Lopston

(1995). Children should be seen and not heard? Questioning the unquestioned. Journal of Systemic Therapies, 14, 16–31.

47.

Steele

(1998). Children of trauma. Tools to help the helper [video]. Grosse Pointe Woods, MI: The Institute for Trauma and Loss in Children.

48.

Stronach-Buschel

(1990). Trauma, children, and art. American Journal of Art Therapy, 29, 48–52.

49.

Udwin

(1993). Annotation: Children's reaction to traumatic events. Journal of Child Psychology, Psychiatry and Allied Disciplines, 34, 115–127.

50.

Waller

(1993). Group interactive art therapy: Its use in training and treatment. London: Routledge.

51.

Webb

N. B.

(Ed.). (2002). Helping bereaved children: A handbook for practitioners. New York: Guilford Press.

52.

Winnicott

D. W.

(1971). Playing and reality. London: Tavistock/Routledge