Children in Grief Therapy. The Ways of Copping

Introduction

Unlike adults, children do not have the life experiences, emotional development or support that adults have when they are faced with grief (Noice, 2004, p. 562). Still, many children are faced with unexpected losses in life such as the death of a close family member or friend. Beem (1999, p. 81) notes that recent times have seen children experience severe life challenges like coping with divorce, coping with the departure of a parent (say through military deployment, work transfers and the like), residential relocation of even a change in a child’s lifestyle due to job losses. Ordinarily, these life eventualities cause grief to children.

However, grief is commonly associated with the loss of a loved one. This is probably among the most emotional experiences in a person’s life. It is proved that overcoming grief is not easy for either adults or children (Noice, 2004, p. 562). However, understanding the stages of grief is the first step to comprehend how to treat it. In understanding the correct way of treating grief (among children), it is important to highlight the difference between grief therapy and grief counseling. The main difference between grief therapy and grief counseling lies in their goals. Grief counseling is usually associated with the goal of facilitating the conclusion of the bereavement process and grief therapy is associated with the goal of resolving conflicts of separation after the end of the bereavement process (Noice, 2004, p. 562). Usually, grief therapy occurs when three events are realized – the grieving process extends beyond the normal time, the grieving process changes the character of the victim to manifest signs of somatic behaviors and the behaviors of the grieving patient manifests in signs of exaggerated grieving responses (Beem, 1999, p. 81).

Children may experience grief in several ways. Usually, grief occurs when children lose someone they love or when the loss of a loved one occurs in horrific circumstances. Often, horrific deaths happen in dramatic and unexpected ways, say through an accident, murder or violence. Grieving children are normally different from grieving adults because the symptoms of grieving (for children) normally interfere with their developmental process (Stuckey, 2009, p. 46). Therefore, children who experience grief at a young age, tend to experience a different cycle of bereavement (from adults). In some cases, it is seen that a child may experience a severe combination of trauma and grief such that any thoughts or memories of the departed person may cause sleepless nights, shocks, fear and such like symptoms (Beem, 1999, p. 81). In such circumstances, the perception of death is more traumatic for a child when compared to the cause of death. Therefore, the developmental symptoms of a child’s grief are often associated with the perception of death as opposed to the cause of death. For instance, only some children develop traumatic grief when they lose a loved one in dramatic and traumatizing circumstances. In the same understanding, Eaton (2007) explains that, even in situations where the death of a person is anticipated (or expected), a child may still experience traumatic grief. However, because research on this field of psychology is still ongoing, the profile of children who experience severe grief is still unknown (Stuckey, 2009, p. 46).

The signs that a child is having trouble in coping with the death of a loved one may however manifest in a few months but in some circumstances, it may take a long time (say a year) for such signs to be seen. It is important to treat a child’s grief (usually in good time) because Metzl (2009) notes that if this is not done, a child’s developmental process may be severely affected, thereby influencing his future relationships, achievements, and effectiveness in life. There are many treatment methods that are used in grief therapy but this paper highlights the narrative treatment therapy, play therapy and art therapy as the main types of grief therapy treatment methodologies. This paper highlights grief therapy and its constituents as a precursor to understanding the outcomes of grief therapy among children. Occasional comparisons will be made to adult grief therapy so that we have a better conceptualization of the unique outcomes of grief therapy in children (viz-a-viz grief therapy outcomes in adults). The process of treating grief among children is useful information for not only psychologists, but parents, schools, caregivers and educators alike.

Grief Model

The Kubler-Ross model is a known model for analyzing grief through five stages of recovery. Elizabeth Kubler-Ross introduced the model in 1969 when she identified denial, anger, bargaining, depression and acceptance as the five main stages of grief (Metzl, 2009). These stages were developed from research studies done on 500 patients who were thought to be dying (Metzl, 2009). The research was aimed at evaluating the human response to grief. Emphasis was given to evaluate how humans cope with the news of horrific losses or the diagnosis of a terminal illness. Kubler-Ross identified that her model was not meant to be absolute because she acknowledged that not all people experience the five-stages of grief (Metzl, 2009). Her observation was true because people are often unique beings and everyone copes with grief in a unique way.

The first stage of Kubler-Ross’ model (denial) is based on peoples response of failing to admit that a loss has happened to them. Often, people who are in this stage tend to believe that such losses cannot happen to them (or they do not understand why such losses happen to them). Stuckey (2009, p. 47) observes that this stage is often temporary and it is a defense mechanism against real loss. The second stage of Kubler-Ross’ model (anger) is often shrouded with questions regarding why a loss happened to the concerned individual. At this stage, people experiencing grief often realize that they cannot deny real loss anymore. In addition, people in this stage often have misplaced anger and frustrations, thereby making it difficult to talk to them or reason with them (Stuckey, 2009, p. 46).

The third stage of Kubler Ross’ model (bargaining) is characterized by feelings of helplessness, where the subject bargains to have the loss reversed. For instance, a person may strike an “agreement” with God to heal a brother (or let a loved one live) in exchange for something. Others may offer their life savings to a doctor or an individual of power to reverse a given loss (say in the case of a job loss). Many researchers often associate this stage with time buying (Metzl, 2009). The fourth stage of Kulbler’s model (depression) is also characterized with a strong sense of helplessness where people give up on life and ask themselves, “why bother?” In this stage, the certainty of loss usually manifests strongly in the persons’ life. People who are undergoing this stage also tend to disassociate themselves with things they care about (or the people they should show affection to). Usually, people experiencing this stage tend to isolate themselves and prefer minimal human interaction. Metzl (2009) advises that people who undergo this stage should be left alone because it is an important stage of processing grief. Finally, Kubler identifies explains the last stage of grieving as the acceptance stage where a person stops fighting and moves on from a loss. People who are experiencing this stage tend to move on from their loss and accept the terms that befall their lives (Stuckey, 2009, p. 46). This is the last stage of Kubler-Ross’ model.

Typical Grieving Process

Researchers such as Davidhizar (2002) note that people have different ways and lengths of grieving. There is no appropriate or normal length of grieving; every person has a unique way of grieving. However, it is established that as a child grows older the length and way of grieving may change accordingly (Davidhizar, 2002). Nonetheless, children often encounter new challenges and experiences that may help them to cope better with grief, but on some occasions, such experiences or challenges may remind them of earlier losses, thereby slipping them back into grief. For example, if a toddler loses a brother, he may have new questions regarding how his brother died (Davidhizar, 2002). Similarly, if a preschooler loses a father, he may miss him more when he knows how to drive, and if a woman gets married, she may have stronger feelings of grief when she longs for her mother during her wedding day. Therefore, as children grow up, they may relive a past loss in a different way. However, in the course of a child’s growth, he may develop new ways of coping with a loss but experts suggest a few preferable outcomes of coping with grief (Davidhizar, 2002).

Some of these desired outcomes revolve on the acceptance of death and the motions of grief such as sadness, anger, resentment and the likes. Experts also wish to see a positive outreach from a child’s support group by hoping to see deepening relationships between family members, and more importantly, between the family and the child (Davidhizar, 2002, p. 87). Some experts also propose the establishment of a healthy attachment to a departed person such as the establishment of a memorial date, reminiscing, remembering (and such like activities) (Davidhizar, 2002, p. 87). Davidhizar (2002) further adds that it is important to enable children to derive meaning from death by explaining why a person died, or the significance of such loss in the life of the child (or those around them). Comprehensively, it is the desire of most therapists to see a child go through the normal developmental stages that they are supposed to.

Normal Outcomes in the Event of Death

As noted in earlier sections of this study, death can be a difficult event to cope with (for adults and children alike). However, certain reactions are common in the event of death. Grief is one such reaction although the levels of grief often vary with a child. These variations may depend on several factors but experts such as Seligman (1995) propose that the variations depend on the child’s developmental stage, life experiences, and emotional stability. However, the outcomes of bereavement is classified by Seligman (1995) as falling into two categories – complicated and uncomplicated. Uncomplicated emotional reactions may be emotional to show feelings of sadness, anxiety, anger (and the likes). Uncomplicated emotional behaviors may also manifest in changes in behavior such as the lack of participation in events (which the child would ordinarily have done), poor self-hygiene and personal care, loss of sleep, loss of appetite and similar behaviors. Poor interpersonal relationships are also identified as a common reaction to grief (Seligman, 1995, p. 98).

Children who exhibit the above symptoms often show signs of social isolation, aggressiveness, and little interest in other people. This outcome is often coupled with undesirable changes in thinking. This symptom is often seen in older children although it manifest in poor decision-making, extreme concerns for a loved one, constant thoughts and memories about a departed loved one and disillusionment (Seligman, 1995, p. 98).

In extreme cases, patients may exhibit signs of altered perceptions about life, like imagining (or believing) that a dead person is still alive, seeing images of the dead person or believing the dead person is watching over them. These signs are often coupled with signs of hallucinations and disillusionment.

Physiologically, grief can cause vulnerability to illness, poor physical health, loss of energy and poor eating habits (Seligman, 1995, p. 98). These reactions are often caused by poor self-care and decreased immunity. Finally, grief is known to cause poor academic performance because children who exhibit this symptom have a poor attendance record, lack concentration in class, and are often disinterested in schoolwork (Seligman, 1995, p. 98).

Uncomplicated outcomes of grief therapy may also include desired outcomes of the grief therapy process such as the patient being able to overcome the grief and move on with life. Here, children may be able to accept the loss of a loved one and decide to associate positive thoughts of a departed person as a tool to bridge their thoughts out of depression. Usually, children who succeed at overcoming grief in this manner tend to resume their normal duties quickly. It is crucial to highlight that this is the main aim of most grief therapies.

However, grief therapy is also known to yield complicated outcomes such as prolonged grief for bereaved children. In such circumstances, a child may exhibit signs of prolonged preoccupation with the news of a departed person (or its aftermath). Increased crying and excessive depression are typical behaviors for such types of children. Ordinarily, such emotions would disrupt the normal activities of these children and some would exhibit signs of increased emotional responsiveness (Seligman, 1995, p. 98). Other children would manifest signs of unresolved emotional burdens and prolonged anger or the need to exert revenge. Nonetheless, complicated outcomes of grief therapy may also include the failure of a bereaved child to communicate love to the departed person or the guilt that a child may feel for not communicating a history of depression for the departed loved one. This guilt is however common in older children. The above outcomes usually lead to grief. However, different children have different expressions of grief.

Expressions of Grief

Eaton (2007) says that breaking the news of death to a child may be a difficult task because it is important to be sensitive to the child’s developmental stage, culture, and capability to cope with the news. Eaton (2007) also notes that children are always sensitive to the reaction of older people as they decipher information regarding death or any other cause of grief. Emphasis is normally given to the parents’ reaction because it is observed that their reaction is determinant of the child’s perception of grief (Eaton, 2007). Nonetheless, children exhibit a range of reactions to grief. Emotional shock is one such reaction and it may manifest in a lack of feelings (which may be used by the child as a defense mechanism against grief because it helps them detach from the pain of loss). Some children may also exhibit signs of excessive immaturity or an excessive compulsion to have parental attention. For instance, children may demand to be rocked on the chair (always) or they may want to sleep with the parents. For some children, they may exhibit signs of explosive behavior like acting out on other people. This reaction is often associated with feelings of helplessness anger or frustration at a given event (that causes grief to the child). Eaton (2007) also explains that acting out may be a mirror of the child’s feelings but most importantly, it manifests feelings of insecurity where a child tries to take control over a situation that he has very little control of. Some children also tend to ask similar questions repetitively, simply because they find a specific piece of information difficult to accept even though they may receive explanations from older people about an incident that disturbs them. Usually, experts say that repetitive asking of information can be used to ascertain if the children are suffering from a simple lack of information or they are suffering from real trauma (Eaton, 2007). These symptoms usually demand the implementation of a comprehensive grief therapy session for children. One such methodology is art therapy.

Art Therapy

“A picture is worth a thousand words” (Lusebrink, 2010, p. 102). This famous Chinese proverb conceptualizes the concept of art therapy in treating grieving children. More so, it emphasizes the importance of art therapy among children. Art therapy is appropriate for children because children love to draw and color. Based on this fact, Lusebrink (2010) explains that art is an effective way of curbing grief among children. Art therapy has been a critical component of grief therapy among children for a long time. Usually, when art therapy is employed, mental health professionals encourage children to express themselves (their grief) using existing tools of art. This approach is usually the first step of art therapy. It is based on the presumption that children find it easy to express themselves using crayons, pencils and paper (as opposed to expressing themselves using words). For instance, children are likely to have trouble expressing themselves in a “question and answer” type of interview especially because they are equipped with very little vocabulary. Kim (2008) explains that when children experience traumatic events in their lives (like the loss of a parent), such emotions are buried deep in their subconscious but they eventually play out in the child’s distant future. Cases have been reported of intense emotional issues playing out in the course of a child life when such traumatic events occur (Lusebrink, 2010, p. 102). Art therapy facilitates the treatment of these complex emotions because it motivates young victims to express themselves. Art therapy therefore substitutes the communication process between the children and the therapist.

Nonetheless, experts note that art therapy poses more benefits to the children than just substituting the communication process between children and therapists. For example, Bar-Sela (2007, p. 980) reports that, art therapy creates a sense of self-awareness and relieves stress and anxiety among children. Other experts such as Collie (2006) also say that art therapy is associated with low incidences of autism and learning disorders because it better facilitates the proper development of children. Moreover, art therapy stands superior to other forms of grief therapy because it builds on the children’s strengths and competencies – artwork and creativity.

The main approach of art therapy is because art is therapeutic in itself. Collie (2006) reports that art is a healing process because when children create their grief on paper, they are in therapy. This approach is known as the Kramer approach and it is defined by the concept of art as therapy (Collie, 2006). Deane (2000, p. 147) also explains that the outcome of art therapy can be psychoanalyzed because the symbolism of art therapy is very important when compared to the process that creates it. Comfort is identified as a common benefit for children who are subjected to art therapy, but more importantly, therapists are equipped with the right analytical tools for grief therapy. These tools are known to work because through the therapeutic process, children can be able to envision their progress from their art, as opposed to constant evaluations by the therapist (Doric-Henry, 1997, p. 163).

Though art therapy has been known to work, people often ask what the unique therapy involves. Usually, a therapist can include several activities in the art therapy, depending on the interest of the child. However, just to get the attention of the child and to enable them to open up, a therapist may prefer to include a scribbling session (Doric-Henry, 1997, p. 163). Usually therapists tell a child to scribble what they feel (on paper) for three minutes (or more) without stopping so that they are able to capture what the child feels during the initial stages of the therapy (Stuckley, 2010, p. 254). After the drawing (or painting) is completed, the therapist and the child may discuss the outcome of the process. However, the main therapy usually starts when the therapist has established a positive rapport with the child. Normally, the therapist would ask the child what would make him (or her) feel better about his (or her) grief and usually the child would respond by drawing a picture of the deceased person (coming back) or a picture where revenge is manifested on the person who did harm to the deceased. Normally when a child draws a picture of exerting revenge on the murderer, the therapist may conclude that the action is not bad but acting out against the entire incident may be problematic. These drawings would give the therapist an idea of what the child truly feels (Appleton, 2001, p. 6).

Any drawings that may be produced during the art therapy process should be treated with utmost reverence and care. In fact, it is best if the drawings are categorized into one portfolio so that the collection may act as a reminder of the child’s developmental process or a memorial of the departed person. Upon termination of the therapy, it is not harmful to give the child this collection of drawings so that he/she uses them for personal reflection (Orr, 2007, p. 350).

Narrative Therapy

The objective of narrative therapy is not different from the objectives of art therapy. Both therapeutic methods are designed to bring emotions to the surface. However, their methodologies differ. Narrative therapy uses written or spoken word to facilitate the expression of emotion while art therapy uses artwork to express emotions. Fish (1993) explains that narrative therapy is an effective methodology in grief therapy (among children) and suggests that “the use of narrative approaches that use journaling, memorials, scrapbooking and writing the Letter to the Lost in creative interventions are effective mediums of narrative therapy” (Fish, 1993, p. 112).

The notion of narrative therapy is mainly based on the premise of listening, telling and retelling stories about a loved one (or the loss of a loved one). Usually therapists often use narrative therapy to (also) explain stories about life problems. However, narrative therapy is often problematic in instances where extremely young children are involved and they have to tell or retell stories about painful experiences. Skeptics of narrative therapy often cast doubt on the fact that telling or retelling stories can shape new realities, but it is proved that they do (Fish, 1993, p. 112). Narrative therapy helps to make meaning from grief and instead of making such events wither and disappear in the minds of children, it helps them develop and become stronger from such experiences. Therefore, narratives help to shape past events into unquantified hope.

Narrative therapy is based on our human evolution to use mental prowess in making sense of grief and other life events characterizing our experiences on earth. The choices we make are therefore a product of our perceptions of significant life events. Moreover, the problems we face have a multifaceted nature in the sense that socio-cultural intrigues, political undertones, psychological developments and biological roots characterize them. Sometimes, some of these problems are a combination of the above factors. The main problem in handling the problems that face young people and children is the fact that children do not have control of the issues that face them. However, there is a catch in this statement because Minuchin (1998) states that, “Experience is not what happens to you. It is what you do with what happens to you” (p. 397). This statement shows that even children have control over what decisions they decide to take.

Research shows that children are very astonishing in the manner they grieve (Fish, 1993, p. 112). Using narratives and language to explain children’s grief is a lighthearted approach to grief therapy because it separates the seriousness that emanates from horrific life experiences. Narrative therapy is therefore considered a platform where adults and children can interact in a playful manner because it inspires children to actively contribute to the therapeutic process by bringing their resources to grief therapy (thereby increasing the effectiveness of grief therapy). Narrative therapy has a special way of isolating grief from the child’s experience in a way that makes the child evaluate his (or her) relationship with grief (Fish, 1993, p. 112). Usually, this action is very intriguing for adults, but most importantly, it is meaningful to therapists (and it is not boring to children too).

Narrative therapy also has a special focus on the fact that “a person is never a problem but the problem if often the problem” (Fish, 1993, p. 112). This maxim has traditionally been used in narrative therapy to uphold the principle of externality, which separates people from problems. This concept is normally advanced as a playful strategy to help children face and diminish grief.

Group work is also a common feature of narrative therapies because therapists usually design narrative therapies according to the appeals of a specific age group of children.

Narrative therapy has been identified to have different positive outcomes such as the “purging of negative thoughts, deriving meaning from loss/death, and to commemorate the relationship from the survivor to the deceased rather than focusing on the need to recover, per se” (Fish, 1993, p. 112). Usually the desired outcome of the narrative therapy process may occur in a short (or long) time. For instance, the desired results may be realized during the course of the therapy or during external interactions with friends and family (especially friends who have experienced similar events).

A blame and shame approach is normally used in situations where people want to immobilize a problem (its success has been evident in family therapy sessions) (Fish, 1993, p. 112). This observation is normally true for people who perceive problems to be an eminent component of their personalities and therefore, they feel hopeless at the prospects of changing such behaviors. Therefore, the concept of differentiating the problem from the person is an effective way of minimizing a person’s defense mechanism and reducing blame for a person’s character or actions. Therefore, if a child is externalized from the problem, he may develop a different relationship with the problem (usually one that does not exhibit intense grief). This position usually makes a child to be more reflective and critical of the problem as opposed to personifying the problem as a part of the child’s life. Moreover, parents can equally revisit their relationship with the problem and reconsider contributing their resources to facilitate the quick recovery of their child from grief. Merely differentiating grief from the child is a sure way of introducing a sense of responsibility and expanding the field of choice and personal agency in the grief therapy process (Fish, 1993, p. 112).

The process of externalization has been identified to share a close relationship with children’s identity formation because children are normally resistant to the fact that their identities are limited in formation. Interestingly, even adults find the limitation of their identities to be unappealing, considering this ideology does not support change in any way. This observation therefore poses a situation, which questions why children should accept the constant adult definition of a child’s identity. In support of this observation Madigan (1996) mentions that identity should be perceived to be a progressive concept that matures in adolescence. This relationship explains the relationship between children’s identity formation of narrative therapy.

Considering a child to be facing grief is therefore a different ideology from considering the child to be the problem. The concept of externalization in narrative therapy therefore seems to be the greatest strength of the grief therapy methodology because it strikes most researchers as a natural fit for children. Moreover, Doan (1998, p. 379) points out that this methodology resonates with the intrigues of a dynamic and multi-structural learning environment for children.

There is a close similarity in the externalization process of narrative therapy and childhood characteristics because externalization is very close to the concept of pretence. Most children like to pretend especially when they switch roles in plays or when they play interactive games like hide and seek. Practically, this concept is used in grief therapy by pretending that the problem (grief) is external to the child. This approach cannot be effective for adults because pretence normally confuses adults but it resonates with the reality of a child’s world (Madigan, 1996). This world reveals an environment of secret thought, and by extension, it can be used to reveal the secrets of a child’s grief because in the pretentious world, children find it easier to share their emotional secrets.

Therapists are normally equipped with the skills of using the correct language to bring out a person’s emotion but the use of the externalization technique has little to do with learning (and it has more to do with developing a specific way of perceiving the world).

Narrative therapy therefore uses the concept of externalization not as a technical tool but a concept of language that is able to facilitate the expression of emotions and feelings that define our everyday lives (in a respectful way). Narrative therapy also tries to expose the processes that children go through when they try to establish unique relationships (viz-a-viz the problems they experience) (Madigan, 1996).

Narrative therapy is designed to help children get over their grief but researches such as Etchison (2000) show that narrative therapy has also proved beneficial to therapists as well. For instance, it is proved that narrative therapy has assisted therapists to move from pathology related issues to issues built on values, hopes and focus (Etchison, 2000). Therapists are therefore inclined to find more relief in experiencing fewer obstacles from the challenges they experience in grief therapy. Moreover, narrative therapy assists therapists to have a better conceptualization of a child’s grief, thereby enabling them to focus on the child’s problem. Furthermore, it is easier to ask the correct therapy questions in this context. It is equally easier to establish a better relationship with the children here, but most importantly; this process is known to stimulate the creativity of the therapists as well (Etchison, 2000). Compared to other grief therapy approaches in children, narrative therapy is considered more open and unstructured. This observation is supported by the fact that therapists establish a more intimate relationship with their subjects, and similarly, they are in a better position of tackle grief head-on. Through this approach, it is established that the children’s role as active agents of change normally improves in the grief therapy when the therapists try to isolate the grief (problem) from the children. In a family setup (therapy), externalization/pretence is normally done with other family members but children are sometimes encouraged to adopt their preferable methods of externalization such as expressive play therapy in non-family therapies (Etchison, 2000).

Play Therapy

Play therapy is very liberal in the way it approaches grief because it allows children to connect with their feelings in their most native method. Usually, this treatment therapy is employed when the patients are between the ages of three and eleven (Ray, 2001). Play therapy is built on the fact that children like to play and therefore, it appeals to this “creative” aspect of children’s interests. Ray (2001) explains that play therapy may include the use of verbal or non-verbal methods of grief expression even when the therapist does not prompt them. Here, the role of the therapist is normally facilitative in the sense that their work is to ensure the children have the right environment to act out or express their grief. Sometimes, the grief therapist may use this methodology to encourage children to rebuild their experiences or re-enact what they wish should be done. This action is designed to instill values of self-soothing and self-efficacy through the redevelopment of skills, which the children already have (Ray, 2001). In addition, Ray (2001) emphasizes that play therapy is designed to improve a child’s social integration, and facilitate their growth and development process.

Some experts observe that play therapy can also act as a diagnostic tool where a therapy observes the behaviors of a child while playing with toys to establish the root of his psychological problem (Ray, 2001). Several indicators can show signs of disturbing behaviors such as unequal play patterns and limited willingness to interact with the therapist (Ray, 2001). Furthermore, the therapist can also establish the rationale of the child’s behavior inside and out of the therapy room. Ray (2001) has introduced the psychodynamic view of play therapy, which establishes that children engage in play behavior so that they can work through their anxieties and obfuscations, which are associated with grief. This observation manifests the self-help component of grief therapy, which is associated with the improvement of a child’s psychological welfare. Furthermore, normal play is associated with the healthy developmental growth of a child, so long as the play is unstructured and “free”.

There are no limits or restrictions to the treatment options to pursue in play therapy but Ray (2001) supports the desensitization or re-learning technique to reshape rogue behaviors among children experiencing grief. There is no specification to the right type of environment where such actions need to be undertaken but it is proposed that informal settings are better than formal settings. Normally, this approach is considered appropriate for young children but research has proved that it can also be effective for slow children (or mentally impaired children) (Ray, 2001).

Play therapy has no restrictive time limit for the realization of its objectives because its objectives can be realized in a short or long duration. In addition, play therapy can also be direct or indirect, depending on the preference of the therapist. Nonetheless, the main goal of the therapist is to provide a conducive environment where children are able to process their grief. Most of the studies done on play therapy have reported high levels of efficacy (especially in studies done to evaluate the efficacy of play therapy on children and adolescents) (Ray, 2001). Most of these studies have been reported since the forties when the first studies done to evaluate the efficiency of the treatment method were undertaken.

Studies done by Jones (2003) on children aged 8-12 (who showed signs of excessive aggression and grief) registered signs of positive behaviors and decreased levels of aggression after being treated using play therapy. Similar conclusions have been reported on children undergoing their divorce; children who have experienced school mal-adjustments and pupils diagnosed with ADHD (Ray, 2001).

Some therapists have used the systematic model during the implementation of play therapy. This model includes the input of about three to five children in one session. These children are allowed to play together while the therapist watches their behavior. Unknowingly, a child may reveal his emotions during play and the therapist is able to make an effective diagnosis as a result. For instance, if a child is given toys to play with; the style and level of enjoyment during play may be used by the therapist as a baseline for determining the child’s level of emotions. Here, toys can easily be used to determine the level of concentration and stress. This observation is true because children are often inclined to work through their internal anxieties during play. In addition, through desensitizing grief from a child, a therapist is able to decrease the child’s stress levels.

Sandtray therapy is used to treat deep-seated grief among children (Ray, 2001). However, Leblanc (2001) also notes that adults have also shown high levels of efficacy using the same treatment method. Usually, sandtray therapy has been used to treat deep-seated anger among adults. The sandtray method is used to facilitate the development of a safe and supportive environment for children to deal with deep-seated grief. Leblanc (2001) notes that, this treatment method is highly effective in solving grief because it does not rely on “talk”.

Other Components of Grief Therapy

Though grief therapy is an effective way of enabling children to cope with grief, other strategies have also been suggested to parents and teachers to help grieving children overcome grief. Noice (2004, p. 562) proposes that children should be helped (regardless of their age) to understand grief, and more importantly, to understand loss and death. However, it is important for children to be given information that they can handle (or that is appropriate for their age). Noice (2004, p. 562) proposes that it is often a good idea to allow a child to ask for more information and the parents should respond by answering such information in the most appropriate way. In addition, it is important explain to a child that death and loss are part of the cycle of life and therefore they should be able to accept it as such. Parents should therefore not shy away from encouraging their children to ask questions regarding loss or death because the main aim of grief therapy is to help children to find their answers to grief and life in general. Parents should also be less anxious about the prospects of not knowing how to answer questions because they need to exhibit confidence when answering such questions from their children.

Noice (2004, p. 562) cautions adults against thinking that children will always grieve in an orderly and predictable way because children are different and there is no appropriate way of grieving (even for adults). The main point for adults to understand is that they should be there to help the children cope with grief by understanding how they feel. Parents should also give children the necessary help that they need when they are grieving. However, there are unique circumstances, which have been identified where children feel upset, but they do not know what will make them feel better. In such type of circumstances Noice (2004, p. 562) proposes that parents should only lend an ear and hope the children share their feelings with them.

It is also important for parents to realize that children often need long-lasting support especially in situations where a child has suffered many losses. Children who have experienced several losses take a longer time to grieve or recover from grief. Usually, this observation stands true for children who have lost all their parents or if one parent was their main support.

With respect to prolonged grief, Noice (2004, p. 562) points out that parents and teachers should understand that the grieving process is a very complicated one. For instance, it is proved that losses arising from terrorist attacks or war often pose a big problem for therapists because the nature of the grief that is realized is often complicated. For instance, such grief may be compounded by the need for vengeance, hatred or justice and in some circumstances; the victims may still feel vulnerable to the enemy. Furthermore, most of the deaths that occur from such acts are often horrific and saddening. Similarly, the fact that some people may be missing or presumed dead (even if this is not the case) may also prove to be a big problem to tackle in grief therapy. Finally, Noice (2004, p. 562) notes that even though emphasis should be given to the child’s need to grieve, it is unwise to ignore our need to grieve as well. This observation is founded on the fact that adults who have processed their grief are in a better position to help their children do the same (as opposed to parents who do not cope with their grief). In such situations, Noice (2004, p. 562) proposes that it is important to evaluate the prospects of family therapy or individual support therapies.

Conclusion

The success or appropriateness of grief therapy emanate from the effectiveness of the grief therapy methodologies highlighted in this paper. Comprehensively, we can establish that narrative therapy, art therapy and play therapy are specifically designed to address the interests of young people. By extension, these therapies resonate with children’s interests. The appropriateness of these therapies makes their application specific to child therapy. In this regard, it is difficult to apply these therapeutic methods to adults. In addition, their appropriateness to childhood interests provides a good platform for children to express their feelings and grief to the therapist. These therapeutic methods make the children feel accommodated and they speak to their inner emotions. Evidence is given of how these therapeutic methods assist children to share their innermost thoughts about a specific loss.

In light of the findings of this paper, we can also establish that grief therapy (for children) focuses on providing the right environment for expressing one’s thoughts. This fact is supported with the objectives of narrative therapy and play therapy. The role of the therapist in grief therapy is therefore partially limited to providing the right environment for letting children express their feelings. Correctly, it is important to point out that the main task for the therapist is to observe the young ones and assess the extent and nature of their grief by evaluating their behaviors in grief therapy. Emphasis has also been given to show that the specific therapeutic methodologies in grief therapy (for children) can also act as a tool for undertaking the therapy. It has been established that through a child’s behavior (during these therapies), the therapist can be able to identify areas of interest (especially concerning the child’s behavior). Therefore, a discord in the child’s behavior is likely to be an indication of the emotional status of the child.

Through the analysis of children’s characters and emotional intelligence, different authors highlighted in this study have also recommended that children should be treated as intelligent people who should be told the truth regarding their loss. Emphasis is also given to expose the importance of answering all the questions posed by the children and the importance of encouraging the children to ask more questions regarding their loss. The role of the parent and any other support group (like teachers) is therefore highlighted as an important pillar of grief therapy. From this understanding, we can see that grief therapy is a multifaceted approach to dealing with stress. The input of all stakeholders in a child’s life is therefore important in achieving the desired outcomes of grief therapy.

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