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Chicago, IL 60654

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Featured this Month:

Watching for Depression in the Grieving Family
Saturday, March 01, 2014 by Cynthia Waderlow, MSE, LCSW
During counseling intakes for the LOSS Program for Children and Youth we often hear parents’ concerns that their child may be depressed or will develop a serious depression in response to the suicide loss of a parent, sibling or someone close to them. We are glad to hear caregivers express this concern at the outset because it conveys understanding that the loss can be life-changing and the needs of each person in the surviving family have changed. Watching and assessing grieving children is the right response, and distinguishing grief from depression calls for the experience of a clinician or good, basic mental health information. The caregiving adult who attempts to monitor the grief responses of children and adolescents needs a sense of what healthy grief involves and what could be problematic.

Whether for adult or young person, grief can be intensely painful, temporarily affecting appetite, sleep patterns, energy levels and the sense of future. But rather than a mental illness or pathology, grieving is a natural healing process. Children and adults can be changed by grief. Major losses can leave some scars, but healthy grief can also be a developmental pathway to increased adaptive skills, empathy, self-reflection and personal growth. Because grief can create a profound sense of vulnerability in surviving children and adults, it needs expression and at least one compassionate witness, even if the witness is only a journal or diary. The conditions for healthy grieving can be met with formal or spontaneous rituals and telling the story of the loss through conversation, art, music, any disciplined effort, especially efforts that involve repetition and mindfulness, such as swimming or running. Whether a child or adult, some type of narrative will be constructed regarding the loss and the survivor’s relationship with the person who died. Hopefully, the story will gradually include an explanation of the loss that is compassionate and understanding toward the deceased. And grief moves toward resolution when the narrative is balanced with a similar compassion for the ways children and adults may hold themselves responsible for the loss. This is not a minor task. It involves time, growth and awareness of our thoughts and feelings.

Caregiving adults should know how young people look different from adults in grief, and what undermines the grief process. Adults may be crushed for a significant period of time with sadness, longing and hopelessness. But children and teens tend to grieve intermittently, alternating play, sports, and study and socializing with periods of sadness, irritability or emotional neediness. Because grief is so highly individualized, and most grief responses are neither right nor wrong, a counselor would cautiously say that after several weeks, healthy grief would not debilitate an individual to the point that he or she is not basically functional. Adults sometimes return to work and caregiving (still grieving and coping) and children return to school. Grieving families require basic stability and some sense of normalcy in the midst of loss and change. The structure and safety in productive routine supports healthy grief. Trauma, upheaval and inconsistency are conditions that suppress the normal grief process and increase the risk for depression.

When signs of clinical depression are a concern after a major loss, focus is directed at how the person is taking in the impact of the death. A therapist will ask about prior coping, especially earlier coping related to disappointments, other losses, relationship problems, issues with authority. How is the grieving person communicating about the loss? Frequent behavior that numbs the grief response is a problem to watch for: drug use, alcohol, cutting, high drama involvement among peers and obsessive use of electronic devices are examples. Some children and teens are perfectionistic and insist that their sense of normal must remain unchanged.We notice that these children have high levels of denial, and dislike conversation that reminds them of the loss. They maintain high achievement levels while the grief goes underground. In families where grief processes are at the healthy end of the spectrum we often see dips in performance levels for a while. Although adolescents often prefer privacy in their grief process, there is some sharing of memories and comments about the loss, and sad feelings clearly rise up at different times. Perhaps a dream will be shared at breakfast. Reminders of the loved one who died are mentioned. Tearful moments are not exclusively in isolation. We hope that each person’s grief is recognized and respected and comforting is shared among the surviving siblings and caregivers.

Depression is not always easy to see, especially since symptoms of depression can overlap with those of grief. In most cases, time is instrumental in differentiating grief from depression. A surviving parent may need to rely on a sense that “something is not right” several weeks or months after the loss when depression or complicated grief is the concern. When a young person shows no reaction at all, or appears incapacitated by grief after more than a few weeks, an evaluation is recommended. Is anger the dominant feeling in response to the loss? Did the child or adolescent have a difficult relationship with the person who died? Are you noticing neglect of hygiene, eating or sleeping too little or too much? Was the young person traumatized by some aspect of the death? Is the grieving child surrounded by conflict, instability or adults who are incapacitated by grief? If any of these conditions are present, the parent or caregiver should ask for an evaluation for depression or complicated grief. Sessions or consultation with a licensed clinician who specializes in grief therapy can be helpful to a family for whom the territory of suicide loss is new, or becoming increasingly difficult.

As grieving parents, it is not uncommon to project our pain onto the way we see our children’s grief experience. This is another possible obstacle to differentiating grief from depression. When a family begins to grieve a primary loss, its members can appear fused and isolated at the same time because attachment anxiety is triggered, causing surviving adults and children to watch each other closely, yet possibly mask their own feelings. When loss is profound, attachments have been disrupted and emotions are intensified, the boundaries between self and other may become fuzzy. Initially, the grieving parent is shocked, preoccupied, perhaps, with the perceived mind and behaviors of the loved one who died by suicide, feeling estranged from the familiar sense of oneself and even fearing the risk of losing other children. Dynamics such as these can affect the perceptions of competent and attuned parents.

Because developmental stage, resilience and personality traits, such as introversion and extroversion are markers for how grief is experienced, each child and adolescent can look quite different in their grief responses. Still, the surviving parent’s coping style and interpretation of the loss will influence those of the children. Maintaining an outlook that we have been wronged, are failures, or will not survive will negatively impact our children. Developing hope, believing we can survive together and recognizing that human suffering exists beyond our own experience offers a reflection that is sustaining, and reinforces resilience and compassion in children and other family members.

Grief and family development is a natural process that is experienced with unique momentum and pace. Many families have survived profound loss over time by their intention to provide the safety that allows each survivor’s narrative to evolve, and to practice compassion for the deceased, the self and others.


Archives:

Watching for Depression in the Grieving Family
Saturday, March 01, 2014 by Cynthia Waderlow, MSE, LCSW
During counseling intakes for the LOSS Program for Children and Youth we often hear parents’ concerns that their child may be depressed or will develop a serious depression in response to the suicide loss of a parent, sibling or someone close to them. We are glad to hear caregivers express this concern at the outset because it conveys understanding that the loss can be life-changing and the needs of each person in the surviving family have changed. Watching and assessing grieving children is the right response, and distinguishing grief from depression calls for the experience of a clinician or good, basic mental health information. The caregiving adult who attempts to monitor the grief responses of children and adolescents needs a sense of what healthy grief involves and what could be problematic.

Whether for adult or young person, grief can be intensely painful, temporarily affecting appetite, sleep patterns, energy levels and the sense of future. But rather than a mental illness or pathology, grieving is a natural healing process. Children and adults can be changed by grief. Major losses can leave some scars, but healthy grief can also be a developmental pathway to increased adaptive skills, empathy, self-reflection and personal growth. Because grief can create a profound sense of vulnerability in surviving children and adults, it needs expression and at least one compassionate witness, even if the witness is only a journal or diary. The conditions for healthy grieving can be met with formal or spontaneous rituals and telling the story of the loss through conversation, art, music, any disciplined effort, especially efforts that involve repetition and mindfulness, such as swimming or running. Whether a child or adult, some type of narrative will be constructed regarding the loss and the survivor’s relationship with the person who died. Hopefully, the story will gradually include an explanation of the loss that is compassionate and understanding toward the deceased. And grief moves toward resolution when the narrative is balanced with a similar compassion for the ways children and adults may hold themselves responsible for the loss. This is not a minor task. It involves time, growth and awareness of our thoughts and feelings.

Caregiving adults should know how young people look different from adults in grief, and what undermines the grief process. Adults may be crushed for a significant period of time with sadness, longing and hopelessness. But children and teens tend to grieve intermittently, alternating play, sports, and study and socializing with periods of sadness, irritability or emotional neediness. Because grief is so highly individualized, and most grief responses are neither right nor wrong, a counselor would cautiously say that after several weeks, healthy grief would not debilitate an individual to the point that he or she is not basically functional. Adults sometimes return to work and caregiving (still grieving and coping) and children return to school. Grieving families require basic stability and some sense of normalcy in the midst of loss and change. The structure and safety in productive routine supports healthy grief. Trauma, upheaval and inconsistency are conditions that suppress the normal grief process and increase the risk for depression.

When signs of clinical depression are a concern after a major loss, focus is directed at how the person is taking in the impact of the death. A therapist will ask about prior coping, especially earlier coping related to disappointments, other losses, relationship problems, issues with authority. How is the grieving person communicating about the loss? Frequent behavior that numbs the grief response is a problem to watch for: drug use, alcohol, cutting, high drama involvement among peers and obsessive use of electronic devices are examples. Some children and teens are perfectionistic and insist that their sense of normal must remain unchanged.We notice that these children have high levels of denial, and dislike conversation that reminds them of the loss. They maintain high achievement levels while the grief goes underground. In families where grief processes are at the healthy end of the spectrum we often see dips in performance levels for a while. Although adolescents often prefer privacy in their grief process, there is some sharing of memories and comments about the loss, and sad feelings clearly rise up at different times. Perhaps a dream will be shared at breakfast. Reminders of the loved one who died are mentioned. Tearful moments are not exclusively in isolation. We hope that each person’s grief is recognized and respected and comforting is shared among the surviving siblings and caregivers.

Depression is not always easy to see, especially since symptoms of depression can overlap with those of grief. In most cases, time is instrumental in differentiating grief from depression. A surviving parent may need to rely on a sense that “something is not right” several weeks or months after the loss when depression or complicated grief is the concern. When a young person shows no reaction at all, or appears incapacitated by grief after more than a few weeks, an evaluation is recommended. Is anger the dominant feeling in response to the loss? Did the child or adolescent have a difficult relationship with the person who died? Are you noticing neglect of hygiene, eating or sleeping too little or too much? Was the young person traumatized by some aspect of the death? Is the grieving child surrounded by conflict, instability or adults who are incapacitated by grief? If any of these conditions are present, the parent or caregiver should ask for an evaluation for depression or complicated grief. Sessions or consultation with a licensed clinician who specializes in grief therapy can be helpful to a family for whom the territory of suicide loss is new, or becoming increasingly difficult.

As grieving parents, it is not uncommon to project our pain onto the way we see our children’s grief experience. This is another possible obstacle to differentiating grief from depression. When a family begins to grieve a primary loss, its members can appear fused and isolated at the same time because attachment anxiety is triggered, causing surviving adults and children to watch each other closely, yet possibly mask their own feelings. When loss is profound, attachments have been disrupted and emotions are intensified, the boundaries between self and other may become fuzzy. Initially, the grieving parent is shocked, preoccupied, perhaps, with the perceived mind and behaviors of the loved one who died by suicide, feeling estranged from the familiar sense of oneself and even fearing the risk of losing other children. Dynamics such as these can affect the perceptions of competent and attuned parents.

Because developmental stage, resilience and personality traits, such as introversion and extroversion are markers for how grief is experienced, each child and adolescent can look quite different in their grief responses. Still, the surviving parent’s coping style and interpretation of the loss will influence those of the children. Maintaining an outlook that we have been wronged, are failures, or will not survive will negatively impact our children. Developing hope, believing we can survive together and recognizing that human suffering exists beyond our own experience offers a reflection that is sustaining, and reinforces resilience and compassion in children and other family members.

Grief and family development is a natural process that is experienced with unique momentum and pace. Many families have survived profound loss over time by their intention to provide the safety that allows each survivor’s narrative to evolve, and to practice compassion for the deceased, the self and others.