162: Supporting children through grief with Katie Lear

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Hello and welcome to the Your Parenting Mojo podcast. And today we're going to build on an episode we did quite a while ago actually when I interviewed Dr. Atle Dyregrov on the topic of how to talk with children about death. That episode focused on supporting children in understanding more in general about the topic of death, as well as helping them through those first few days after the death of a parent or somebody close to them, or even a pet. A new book by Katie Lear called, “A Parent's Guide to Managing Childhood Grief,” goes beyond those first few days so parents can understand, and then support their children through the grieving process that may unfold over a period of months or years. So Katie, is a licensed Clinical Mental Health Counselor, a registered Drama Therapist, a registered Play Therapist certified in trauma focused Cognitive Behavioral Therapy for children with Post Traumatic Stress Disorder. My goodness, she got more qualifications than I do. She's also trained in child parent Psychotherapy for preschoolers with trauma symptoms and holds a Master's in Mental Health Counseling from Brooklyn College. Welcome, Katie. It's great to have you here.

Thank you so much. It's so nice to be here. Yeah, it does. The letters start to get long, we'd love an acronym in therapy. So I feel like that just the string of the letters becomes longer and longer.

Yes, it does. And so your book largely consists of a set of 100 activities to help children cope with grief that they're feeling and so I decided to structure our conversation today by talking about the phases that children pass through on their grieving journey, and then how the activities fit into that. But before we sort of go into that, I wonder if you can maybe sort of talk us through a little bit of the beginning of the book, where you help us understand what grief actually is?

Yes, absolutely. The first two chapters of the book and in the final chapter of the book are more informational, they're more designed for parents to read before embarking on these activities with their children, because I think for many of us, we don't have that preparation in advance for how do we speak about grief? How do we manage our own grief? How do we speak about this incredibly heavy and abstract, and existential concept with little kids, and I think for some of us in kind of common use, I know I do this, sometimes we use grief as sort of a synonym for sadness, we think of crying, we think of despair, we think of those empty feelings, we think of it as being a lot like depression, which it can be, but grief and the grieving process really encompass a whole spectrum of feelings, and really almost developmental milestones that have to be passed through as somebody mourns their loss, and adjusts to this new indifferent reality where their loved one isn't physically present, and that's true for adults, and it's also true for children. So in those first couple chapters of the book, we talk a lot about what grief looks like for children and the ways that it isn't, isn't like adult grief.

Okay, and so can you talk us through some of those differences and also similarities, right? here are a series of tasks and I know that a while ago, people's even psychologists didn't believe that children could actually grieve. So what are the what are the tasks and what how is our understanding change?

It is almost a new concept that children are capable of grief in the way that we think that adults grieve. There were some studies that were done in the 40s and 50s, about grief that concluded that children couldn't really conceptualize death and so they couldn't really grieve in the way that we would expect them to. I know Freud was very clear on saying kids don't grieve, I think his daughter Anna Freud was one of the first people to start to suggest that, “Yes, children experienced this.” And it is true that up until a certain age, little children really can't grasp typically the finality of death, what it really means, they can't project into the future the impact that this may have on the rest of their lives. However, we know now that even infants are aware when a caregiver has left them, they can sense when a familiar person is no longer there, and they feel that loss. So even toddlers, preschoolers, early elementary children can and do grieve the loss of somebody close to them. One way that I think children's grief is different, that's helpful for parents to know is that we tend to think of grief as a fairly static state. For adults, we remember it all the time, it feels overwhelming, it's with us when we wake up, it's with us when we go to bed. It's not necessarily that way for children if you think about the emotional capacity of an adult, and the emotional capacity of a child is being like an eight-ounce glass and a shot glass. Kids have a much lower capacity for these feelings and so they tend to jump in and out of grief, like people will use the analogy of jumping in and out of a puddle where we'll see a child be very emotional, very tearful, really deep in their grief feelings one moment, and then the next it's almost like they've snapped out of it. They're playing with friends, they're socializing, they want to do something else, that would be jarring for an adult, but for children, it's really normal because they've reached their capacity for what they can process for now, and they will come back again later, when they're ready and pick up that grief again, we may also see delayed grief that children can really be in shock when a loved one dies, they don't have a framework for death the way that adults do. It may take them longer to process what has happened and to start showing those feelings at least above the surface where we can see that, I know that you're probably aware of just sort of the shock and the numbness that can also come with grief. Grief can be an absence of feeling and that's really a protective way for children and adults to hold off on feeling some of those deeper feelings until it feels safe to do that. I think those are two big ways I know that parents that I have worked with have sometimes wondered if their child is still grieving or is grieving at all because they're not speaking about their loss, or they outwardly seem fine. It is often true that children may not speak directly about their loss for a long time but we may see the grief coming out in other ways like sleep disturbances, regressions, and behavior are things like sleeping with mom and dad, thumb sucking, bedwetting or angry outbursts at school, difficulty paying attention in class. We can see it come out in these nonverbal ways that might be a little harder to link to grief.

When I imagine that leads to some confusion down the road and I think we're going to talk about that a little more. So I wonder if we can maybe start out and could you help us to understand what are these four tasks of a Grief that Dr. William Worden propose and then we can use that to dig deeper into each one as we go through it?

Yeah, I love Dr. Worden's work. I was actually just thinking the other day about how my very, very first internship placement was that when I was a Baby Therapist, I was running an art therapy group for grieving children and at that point, I had not encountered grief at all and somebody handed me his book, and I opened it up and I felt so taken care of because he's just such a warm, wise writer, he's so thorough, and he set out these four tasks that children need to work through as they move through the grieving process. Listeners may have heard of stages of grief, right, different feelings that people move through, and there used to be a sense that we all did this in order, and it was a linear process. We now know that that's not true. Dr. Worden's work is much more actionable and it's almost realizations or work that has to be done. It's an active process to grieve. So, the first task is accepting the reality of the loss. This really needs to be done first, it is really, really hard to wrap one's mind around the enormity of what happens when somebody dies and that's especially true for kids. In kids we might see a lot of repetitive question asking during this process, children may be in an information gathering phase where they're trying to understand what exactly has happened and asking those repeated questions is sort of a way of testing that the story is still there, we see this in all kinds of traumatic events with kids, they’re testing that the story is still true, we may see children in this space seeming very numb, seeming like they're not having a large reaction, and the first step is to accept that death is permanent and final, and develop some sort of age appropriate awareness of what it means. The next step is to experience the different emotions that accompany grief and this can be a really hard one for parents, because I think as parents, we don't want to see our children in pain, we don't want to see our children suffer there's a huge impulse when you see a child in that deep pain to try to take it away, but with grief the only way out of it is through it, and so when an extent we have to let children feel the anger, feel the guilt, feel the emptiness and feel the anxiety that accompanies grief, and guide them through that process so that they can fully mourn after that children need to adjust to the environment where the deceased dismissing, this is how he does ascribe the space. This is sort of what we might describe as like a new normal, returning to our daily routines, and we're starting to figure out who am I now that my loved one is gone, what is my family look like now that my loved one is gone, and acknowledging that it's never going to be exactly the same as it was before, but this can also be a stage where children start to identify a sense of hope for the future, start to think about new positive things they can do as a family again. And then the last one is maintaining some kind of a connection to their deceased loved one. In the future, many grief therapist will say that your relationship with your loved one who has died does not end with death but it does change, and children need to find a way to carry that relationship within them and allow it to continue to grow as the child grows, and so this can look like memorial services, it can look like family rituals, it can look like letter writing, visiting the grave site, finding ways to continue to include and remember their loved one, not just in the short term when the funeral happens but really throughout their life as milestones happen that their loved one won't be there for.

Cool. Thank you. Okay, so that sort of gives us an overview of where we're going. Now we have a roadmap. And so now I want to dig a little deeper into those stages because your activities are really designed to be used at each of those stages, and to support children going through that process. So I wonder if we can now sort of head back to the first of the tasks by accepting the reality of the loss. I imagine that things like participating in the funeral to the extent that they want to is really helpful in that stage. What activities are things that everybody does as part of the grieving process are helpful here? And then which kinds of activities from your book would be useful in supporting children through this stage?

Yeah, you're right, that the funeral is huge. We don't have a ton of rituals in our western culture for dealing with grief, the funeral is kind of it. That's the big one that's what we have. And so I know that sometimes parents are very hesitant, should I bring my child to the funeral? Should my child attend the wake? Generally? The answer is that yes, if the child wants to go, they should go. If a child is adamant that they don't want to attend, we should never force a child. But funerals can be really healing for children, it can help them accept the reality that the loved one is gone and seeing everybody there together, and having a chance to say goodbye can really help. If a child wants to view the body they should have that chance and it's possible that children may be able to tolerate some of the funeral, but not all of it. So especially with younger children if having them there is important that they can't sit through the entire service, it can help to have maybe a support person who can bring them home. It's also an option these days sometimes to watch on Zoom. As far as activities from the book go, I love reading stories about grief during this early phase in the process just because it's such a gentle way to introduce the topic. There are so many beautiful picture books about death and loss per kid and they can serve a few functions. It can provide factual information about death in a way that kids can understand. It helps normalize the feelings of the grief process, so that children are reassured that any emotions that are coming up for them are not unique to them that we all feel this way, and it's all right. And it helps children start to dip their toe into the topic of grief without having to refer to their own personal experience, it's removed, which makes it feel a lot safer. There are a few other activities in the book in my early chapters that can be helpful. I have something called toy funeral which is a way of helping children prepare for what they're going to see in advance, because I think it is important for kids to go but they also really need to know what to expect before we get there, and reenacting that through play can be really helpful. This is also a chance that you can start to introduce some common facts and maybe even misconceptions about grief so there's an activity in the book called True and False toss where you're sort of reading out statements that are true or false and helping a child physicalize it a little bit by getting into their body, and deciding by where they toss a ball whether this is a true thing or not, so we can help teach things like all living things die, death is permanent, people can die at any age, but usually they're very old when this happens, and also throw out some things like do we think that death is contagious? Can you catch it from somebody else? Can misbehaving cause a person to die? So it's a really good chance in a way that's still not personal to the child to start testing their understanding?

Okay, and you mentioned some books that I know as soon as you said that sort of thing. Which books? Are there one or two favorites that you have?

There's so many. Oh my gosh, for a very factual look at death, I really like when Dinosaurs Die, almost a comic strip format that talks about many different aspects of causes of death, grief reactions, funeral services. Ida, always is a really beautiful story about polar bears at the Central Park Zoo, that looks more at death from kind of an experience of prolonged illness through the grieving process, which I love. The Endless Story is a much more philosophical look at death that speaks a little bit more about the afterlife in a way that I think is appropriate for all spiritual beliefs. And then for little, little, little kids the Dead Bird or Goodbye Mousy both use the depths of animals to start to explore grief, which I love.

Hmm, I'm just noticing as I'm jotting these titles down, I'm not sure about the Endless story, but the other four of the five are all about animals. Do you think that that's a way of sort of engaging children but also making it seem sort of less threatening?

Yeah, it's another level of remove. I had not thought of that, that it's either the animal has died or the characters are animals, but I think that does make it feel one degree less reality-based tickets.

Yeah. And that maybe helps them to navigate the feelings without it feeling so close and personal.

Absolutely.

Yeah. Okay. Do you ever recommend not telling the child the whole truth about a parent died? I'm thinking about how parents can provide age-appropriate information for children and potentially not withhold information for the only reason that it's difficult for the parent to talk about, and maybe a specific example would be suicide which is not culturally acceptable here, and which parents may have a hard time explaining to their children?

Absolutely. I think the way that you're describing it as the whole truth is really helpful. There are absolutely times when the full story of a cause of death is not age appropriate. It could even be really traumatic for a child because it's too much for them to understand. But ideally, we want to offer part of the truth as opposed to a story that's completely different. We never want there to be a time when a child's entire understanding of what happened changes. We don't want there to be a day when they discover that actually what they thought was not true, but we can offer a very short explanation to start and build on that over time with the understanding that by the time a child is in their teen years, they have the full story and we've expanded with time. If parents are not sure what a child needs to hear you can start simple and then let your child's own questions guide you if a child can ask the question, they're typically ready to hear the answer, but there are some definite drawbacks to really withholding the story if it's just based on your own comfort level with sharing.

Okay. So really using the child's questions as a guide, which we use in many aspects of the show, sex educational kinds of things. Other difficult topics that again, want to reiterate your point, if the child is asking the question, they're probably ready to hear the answer and to recognize that we may have a certain discomfort talking about certain aspects of death and that's kind of our thing to navigate, right? And supporting the child.

Yeah, and it's true that withholding when a child is ready for that information can really have a negative impact because it leaves room for a child to fill in their own blanks about what happened to their loved one. Children need some sort of factual answers so that they don't make assumptions that are untrue, teenagers, in particular, may start to withhold things if they feel like there's a family pattern of withholding and it's just not okay to talk about this stuff, so they won't either. And with suicide in particular, I think education for children is really important to help children stay safe. We need to talk about why it does and doesn't happen and the fact that help is available for people who are feeling suicidal to support them through that,

Yeah, great. Thank you for that. And so we talked a little bit at a high level about some of the feelings that children commonly have when they learned that someone close to them or a pet even who that's close to them has died, you talked a little bit about numb and stunned, and the idea that it prevents overwhelm, and prepares them to deal with what's coming. What are some of the other common feelings that children have at this early stage?

Sadness is a big one. Sadness is probably the most common feeling and then kind of related to that is anguish, which is sort of that emptiness, that aching empty feeling when we've experienced a loss, anger is really common. Kids can be angry at themselves, they can be angry at God, and they might be angry at the person who has died, and sometimes kids may even put blame on a helping person, like a doctor for maybe not doing enough or thinking that maybe if somebody had done something differently, their loved one would have lived. I would say those are really big ones and then another one we really want to look out for with children is guilt, children are really prone to overestimating the power that they have in situations and assuming that there are things that they could have said and done differently that would have prevented the death.

Also, I saw in Dr. Worden's work that the reaction of the surviving parent - he focuses specifically on children who have lost a parent has a huge impact on the child's behavior, and seeing their surviving parent experiencing these super strong emotions for the first time, I think was really dysregulated for some children, right?

It’s scary. Yeah, if your parent is your safe place, and the person who is there to protect you in these incredibly traumatic moments, there probably are going to be times when a parent is so emotionally overwhelmed that they're not able to be that stable base for you for a short amount of time because they're grieving when you're grieving. Usually, if a child has experienced grief, so has the parent there is also a wonderful opportunity for parents to model how to care for their own grief for children. So it's a tricky balance where, “Yes, seeing this can be incredibly painful.” And also parents showing that they are having these feelings, naming them, and modeling how to take care of them makes it much more likely that children are going to do the same for themselves.

Can we make that a little more practical? I'm just thinking parents might be feeling, “Well, I'm grieving and I shouldn't show it because I don't want to overwhelm my child. But also, I want to model the right thing to do,” like what practically should parents do to support that process?

Yeah, I think kids often know. Kids are so perceptive and especially in times of intense stress they are so attuned to their parents that they know when their parents are going through a hard time, and one of the common refrains that I hear from grieving children is, “I can't tell these things to my mom or to my dad because they just can't handle it right now. It's just too much for them.” And sometimes they're right, but often they're not, and what they're seeing is that they know their parent is grieving but they don't know that their parent is managing that grief - naming the feelings can be really helpful, “Man, I'm so mad today. I'm so angry about this. You know what's weird, like, I'm almost mad at the doctors today. I'm wondering if there were things I could have done differently. I'm just really sad.” I think also naming the things that you're doing for your own self-care whether that is saying you're going to take a minute to go to your room and pull yourself together before you come back out, going out with friends, bringing in support people, maintaining time away from children where the parent doesn't have to be in that caregiver role. Any activities that a parent is doing to refill their own cup, children are noticing and I think it is such a hard thing for parents in grieving times to really, really have to be caregiving all the time that anything they can do to carve out their own self-care and point that out to children is helpful. Then yeah, I think allowing your child to see you cry and to see you grieving is really helpful.

Okay, and so I think that another really common way that children express the way that they're feeling is one doctor, Dr. James Fogerty described commotion, I was like, “What's commotion? Oh, it's what parents call acting out.” So, hy the children act out when they're in this grieving process?

Yeah, we see this with all kinds of huge traumatic life stressors, right? With death, divorce, with trauma, a lot of times kids will show these behaviors that we don't immediately connect. Something that's interesting to me is that often this really closely mimics ADHD, so it can be things like getting into fights, sassiness at home, or not following directions, but it can also be in attentiveness, dropping grades, hyperactivity, not being able to sit still, all of this behavioral stuff comes out in children maybe because these experiences emotionally are so vast, but kids don't have the language yet to put them into words to say, “Hey, this is what I'm thinking about.” There are these huge almost philosophical questions that are hard to verbalize for children and so they have to come out in other ways through their bodies, kids are also a lot more prone to somatic symptoms in grief, like headaches and stomach aches because it's got to come out somehow. But there's also a thought that this kind of acting out behavior can help children get the support that they need, if we think about children who are crying, parents are more likely to offer care, acting out as a way of sort of saying, “Hey, I'm over here, I need some attention, I need some help.” It's a way of pulling support in that may or may not work but it’s an attempt at connection, we're just not the kind of connection that we would necessarily look for, and if you think about how powerless we all are over death, how powerless does a child feel when a loved one has died? They have no control, they have no say over what happens, and usually, their routine and their structure have been completely turned upside down, and so children are going to try to regain that control and a sense of power over their own environment, however they can to try to feel more safe.

Yeah, I think that's such a good point about the an attempt for connection and we see that in children's behavior in so many situations that they'll jump up and down on the sofa, which you've told them not to do 100 times or they'll hit a sibling, and ‘stop hitting your sibling,’ and the child is trying to make a bid for our attention and connection with us, and they don't see - where I guess they see what's coming is not necessarily going to be the kind of attention, the kind of connection they want, but they'd rather have that than, no attention, no connection. I think it's really a skill to look beneath that behavior and see what is the child actually trying to do. What need are they trying to meet through this behavior? And see that, rather than just see, you know, ‘stop misbehaving, stop doing the thing I've told you to do.’

My toddler has started pulling the cat's tail a lot and I'm just like, “So It’s up again, like, all right, got to take a deep breath. It's a bid for connection.” How do we proceed? It is hard. It's really hard.

Yeah, yeah, to do that constant reframing. But it's so helpful when you can put it into practice and see what's really underneath of what is my child really needing, and then once you meet that need a lot of the time the behavior that the parent is finding difficult is sometimes resolved. So you're talking about ‘Magical Thinking’ so let’s drop it like a little nugget, and that sent down a whole rabbit hole of exploration. Can you tell us what magical thinking is and how do these thoughts are.

Well, it's such a fun term to say. Magical thinking is a term that pops up in child development and it also pops up again in a lot of studies of grief. Magical thinking is something that all young children experience. There's a book called, The Magic Years by Salma Freiburg. She was like a kind of Psychodynamic Therapist who looked at kids from birth to age six, and it's just a part of how kids develop in its like simplest form - magical thinking is the belief that we can say or do, or think things that cause things to happen in the world outside of us that's not directly connected, and it's children's way of trying to make sense of the world when they don't fully understand how things work yet. So a lot of forms of magical thinking are very cute and things we might remember fondly about childhood, like wishing upon a star or stepping on a crackle break your mother's back, or thinking about fairy tales as being potentially real, or magical creatures as existing in our world, it can be a really beautiful part of childhood, and it can also lead children to think that they have a lot more direct influence on their environment that thinking things and feeling things inside could cause good or bad things to happen to people outside of themselves so that they could make things true about themselves, and so because we know that children tend to be the center of their own universe, and they believe that they are the ones that are kind of causing things around them to happen when a loved one dies, kids are really, really prone to over attributing what their role in this was, “If I thought something angry about my loved one, did I make this thing happen? If I ever thought I wished my brother wasn't here, is that why God took him away? If I had better behaved, would it have made dad happier and he would still be here today?” And then kind of building on that even older kids like this is really common in preschool early elementary aged children, but even older kids preteens and sometimes adults who are grieving will experience some amount of magical thinking in the form of almost superstitious beliefs, or some part of them believe that, “Gosh, if I had done something differently, or if I do something differently now, could I somehow bring them back?” There's that wish for the loved one to return, so really throughout our lives we can experience this but with kids, it can lead to tremendous guilt and shame that somehow it was their fault.

Yeah, just want to track back to the beginning of what you said, you actually sparked a current memory, my daughter asked me probably a year ago, “Are fairies real?” and so I, you know, we looked it up. Happened upon a video where somebody had photoshopped a fairy into a video and the child sleeping in a little baby monitor video, and so you see the fairy come in and take the tooth from under the pillow, and the child who's in the video is now convinced that fairies are real and of course, my daughter has now convinced fairies are real and uses that video as evidence because on video it's real. So, an example of magical thought is there but of course, it can also have this flip side, and some of the examples I found to be really helpful are things like, “Well, dependency makes me feel safe.” As a magical thought, and so then to extrapolate from there - so to feel safe, all I have to do is be dependent. And another one, you know, “I’m perfect. My parents feel better and they respond more positively to me and I need people to respond positively to me, so I'm just going to be perfect.”

Right. If I’m always perfect, mom and dad will always be happy with me, right? They'll always love me and if I'm not perfect, they might not love me anymore, right? Those kinds of thoughts. Yeah, we even see this in other like mental health stuff, like it's common in OCD, this idea that you know, “If I don't flip the light switch three times, something terrible could happen to somebody far away,” right? We see it there or even like, we've all had the friend who's like, “Oh, as soon as I lose 20 pounds like everything's going to be great in my life.” It won't be. It's not going to magically fix things but we all to some extent have this sort of like wish fulfillment or this idea that things we do, I think about the secret a lot when I think of Magical Thinking to that manifestation idea of like, “If I think about this thing every day, then it will come to me in my life,” like a law of attraction, which really works out for some people but it's also sort of a, it's a magical thinking idea of like, “If I think this enough, It will come to me in real life.”

Somebody actually told me to do that because I'm writing a book as well, and I need a title. And the whole thing is written, it has no title and somebody told me, “You know, think of it this every day and the idea that there is a title out there for your book every day for 20 days, and you'll have a title.”

We all have some of those superstitious beliefs and it doesn't necessarily cause harm, but when you're in this high-stress situation, it may not be helpful.

Yeah, and so adults do this related to death as well, right? Some of the things that we do as we're trying to cope with death can be classified as magical thinking, what are some of the things that we do?

I would say, for magical thinking for adults, let me think about this for a second. I know Joan Didion has that book, My Year of Magical Thinking, right, where I think a lot of her stuff was that idea of like, could I bring him back? Not wanting to give away a loved one's clothes, not wanting to rearrange a room because there's still some part of you that feels as if they might need these things again, giving them away would mean they're really gone. I know this is true for children, but I imagine it's true for adults, too, that a lot of kids will tell me that they think they've seen their loved one in a crowd, they've seen the dead person out of the corner of their eye or across a crowded room, it's almost like they're back again. And then I think it's not quite magical thinking but I had read in Fogarty’s book as well, like, that idea of like almost talking to the loved one as if they're still in their chair, right? Which is its sort of a shocking thing, but I think there's an element there to have, you know, maybe they really can come back.

Yeah, moving on to the next set of tasks and I think we've sort of talked about the reality of the loss and a good deal about experiencing the emotional aspects of the loss as well. And then so the third task is going to be adjusting to an environment in which the deceased is missing, and so what's the environment like for children?

Well, if a parent has died, it's a huge disruption in the family, there's a risk for kids, especially older children, and a family of becoming parentified after death - meaning that they start to take on more responsibility either kind of practically or emotionally for the family, it's a big risk that kids step into that parent role, so everybody sort of has to rediscover who they are, who's doing what in the home on a practical level, who takes care of what, but also on more of a philosophical level, like who are we and what does this mean now that our loved one isn't here? I really like what Fogarty says about attempting to recreate situations, like that all children will feel this need to do things that they used to do with their loved one, like go to the same vacation spot, go have the same tradition, go on the same family outings, try to make things the same again, and it's important that we allow children to do that because it's important for them in a way to fail to recreate the past, but we can still enjoy these things and we can remember grandpa when we do them, but it will never be like it was before because he's not here and having those experiences again, as a chance to mourn again, it's different now. In my book, I have a lot of kind of family bonding activities, a lot of ritualized ways of grieving, a lot of kind of identity work for children and for families to start thinking about how do we become cohesive again, and how can we celebrate what we have now, as we acknowledge that things are not going to be the same, we're not the same family we were before in some ways.

Yeah. What are some of those kinds of activities that we can do in that state?

I have a family, like a family crest, and the family flag activity for children and their caregivers to do together that I think can be really fun. I asked children to do a lifeline in this phase, often, where we have children mark important events in their life in the past, and then start to project into the future where they think they're going to go, like where do they think they'll be at 15? 25? 35? Do they think they want children? Where would they like to travel, I encourage children to start imagining a future for themselves that includes both positives and negatives but starts to introduce the idea that things are possible for them in the future even if they look different.

I guess, I also want to come back to the idea of ‘parentification’ and regular listeners know that my mom died when I was young, and I would say I absolutely fell into that I was the eldest of two siblings, I started cooking and cleaning for the family, and my father remarried again fairly quickly, and generally deemed that what I was doing was inappropriate. To me, it didn't feel inappropriate at all, it actually felt really good that place in the family felt like a positive shift for me. And I know that there are many cultures around the world where a kid age 10, or 11, is actually fulfilling that role. Can you speak a little bit more about why this is difficult in our culture?

You're right, it is really nuanced, too, that a lot of the kids that I see who are in parentified roles will say that they are getting something good out of it, it happens for a reason, it's good to feel valued, it's good to feel important, it can be helpful to take care of other people because it can help pull the focus away from your own pain, and to some extent, it's not a problem, realistically, if a parent has died and you're in a single parent household, things are going to look different than they were before children may have to take on more chores, they may have to watch younger siblings, what I'm usually more concerned with more so than the physical tasks, although that is a concern is the emotional tasks, sometimes children in these roles become the emotional confidant for their parents, and parents begin to treat their older children like they would a friend because they're so isolated, and they're so deep in their own grief, and a lot of times I find that parentified are very precocious, they're very mature, they're very naturally intuitive, and it can feel wonderful to take on that role for a parent and think, “Wow, I'm really trusted,” and it also is more than a child should handle and it shifts the dynamic of the relationship so that children feel that they can't confide in the parent because the parent needs to confide in them. So what we see is it sets up children for mental health difficulties later in life that predisposes them to anxiety and also to people pleasing because they may kind of internalize a belief that well, “I need to help people and care for people in order to be liked, and that's my job.” And so we see that play out in other relationships in adult life in ways that are not healthy, but you're right, that functionally, they’re probably going to be some amount of growing up and new responsibility that happens, and parents can try to keep an eye on does that feel reasonable? Does that feel equitable? And do I have other outlets for my emotional needs?

Yeah, that makes a lot of sense. And I wonder if there seems must be a difference in terms of how the family responds, and reacts, depending on which parent it was, who died, how close they were and what kind of relationship that family member had with the other family members. Can you talk about how those kinds of things tend to play out in families?

Yes, absolutely. We know that the relationship that parents and children have before a death can really influence the way that they grieve afterward, which is sometimes I think, hard to think about, because often we don't have this advanced warning that someone is going to die, so we're sort of looking back on the relationship and thinking, well, we have now what we have now, but we know that children who were really connected and close and already had a good level of communication with the surviving parent, they're better, they're able to talk more about their feelings, they're able to cry, they're able to show those emotions, and really move through those tasks of mourning more effectively, kids who had kind of a fraught relationship, maybe they weren't in the habit of sharing, maybe it was more of a complicated dynamic, it's much harder to get to that vulnerable place where you can talk about grief, and you might even see that those children start to feel like they do have to be the caregiver if the relationship wasn't already in that really balanced and nurturing place before. There is also a lot of study done on the gender of the parent who has died and how that affects a family, and that most studies show that the loss of a mother has a larger impact on children and the family at large than the loss of a father. Worden’s researches like, “Oh, not the most recent,” and so I wonder if some of these gender roles are changing, but oh, broadly, he said that, “When a father dies, often the biggest stress on a family is financial because they've lost the father's income. When a mother dies, the loss is largely emotional. She's the one that has provided most of the nurturing, she's the one that's done the emotional labor, she's the one that manages the family routines and traditions.” And so home life tends to shift more when a mother dies than when the father dies, although, whatever parent in a household does those things is probably the one that will have that effect. I think about this in my family, sometimes. I think my husband probably hold down the fort. Okay, he cooks and cleans, but we're living in a new world now.

Yeah, so whichever parent is fulfilling those roles is probably whichever is providing the financial income is going to be missed in that way. The nurturing is going to be missed in that way.

And exactly whoever is the primary caregiver in your home regardless of what your family structure is, is the one who's probably doing most of the day-to-day, face-to-face caregiving for kids.

Yeah, okay, and how important is age and all this stuff and how children navigate this?

It definitely is a factor in how children process grief. Worden has a really interesting observation that based on his research, children, I believe, from about five to seven seem to have the hardest time grieving more than younger or older children, because intellectually, they're old enough to start to really understand what death is, they know what it means they've seen animals die, they've watched movies where people die, they get it, but emotionally they don't have the capacity yet to regulate their feelings, so it's almost like their cognitive stuff has advanced before their emotional maturity has, and so it's just really hard to know what to do with that information, but in general, children, like under the age of 12, tend to be more heavily impacted by the death of a parent in particular than older children and we know that kids from like six to 11 tend to have more social problems, they tend to be more likely to sort of deny the reality of the death, and they might even have more physical problems in these studies that tracked kids over longer periods of time. Teenagers, in some ways, may fare better, because it's more likely that they were prepared, if it was an illness, or there was a health or mental health situation that contributed to the death, teens are more likely to pick up on that but they may also be more at risk of becoming parentified in a household.

Yeah, and potentially having conflict with parents as well, I would imagine, and potentially feeling as though they can't confide in their parents because the parent can't handle it, and it's their job to grow up or maybe even they're even told to grow up like your job now. The man to be the mother of the family.

Very much so, and I think there's sort of a double-edged sword with teens to where like, we hear a lot about the second family that teens develop outside of the house as they grow. Friends become so central, they're so important, and they can be this whole support circle that teenagers can lean on during this time, even if it's hard to speak to parents during that stage of life just even without grief, it’s harder to confide. But also, as teens, sometimes find that their peers just don't have the life experience to show up for them in the way that they need, and it can be really hard to watch peers complain about how their dad is always on their back or complain about how annoying their mom is when you're sitting there thinking, “Man, I would do anything to have my mom or my dad here,” and they just don't have the life experience to look at that situation and say, “Oh wow, this is probably really hard for my friend.”

Yeah, so relying on other teams to provide that support for our children is potentially putting them in a difficult situation.

It can be. Yeah.

Okay. So moving into the fourth of the tasks - finding ways to memorialize the dead person. I would say we didn't do this part well enough. What might that look like in a family that understands these tasks, and is able to support the child in moving through them?

It’s not actually an activity but something that I think can be helpful that I speak about at the end of the book is just wondering aloud and finding ways to share memories and casual conversation on an ongoing basis. I so often hear from parents, “My kid just isn't talking about it. I asked them how they're feeling, and they say they're fine. I asked them if they're thinking about that and they just say no,” then I know from sessions that this is not always the case, kids are thinking about it, they're not talking about it, and they are everybody in the family is waiting for somebody else to bring it up, and there's this fear that parents have that bringing up the person who died is going to re-traumatize the child or remind them when really the child has been thinking about it the whole time, and I don't think we want to grill kids and be like, “Tell me how you're feeling. Tell me how you're feeling,” like get into it, but sharing your own thoughts and memories as they come up in daily life can be really wonderful to keep that door open for children to speak if it's just like, “Oh, gosh, Dad loved this song. Oh, my gosh, you remember when we went to this restaurant and you spilled the gravy all over grandpa, and we had to go home?” Those silly things are like, “Man, I wish that dad was here today,” saying those things and just putting them out there can be healing for a child, and wondering aloud as somebody who is sort of the family historian about how your child might be feeling without putting words in their mouth, “You're graduating today and I noticed that you've been kind of grumpy with me all week. I wonder if it's hard that dad's not here. I wonder if it's weird for you to see all your friends going to this daddy-daughter dance.” And they can say no, and that's okay, and you don't say, “I don't believe you.” We let kids say what they're going to say, but you're letting them know that you are putting these pieces together and holding them, and it's okay for them to make those connections, too. I think that can be really helpful and I think rituals are something that we're really lacking culturally to remember these things. If you think about you know, other cultures have these wonderful ways of revisiting their loved ones on a regular basis, we see Día de Los Muertos in Mexican culture, we have all of these beautiful rituals around the world for honoring ancestors, and then the United States, we just have nothing. We just have maybe a Facebook post, that's about it. Nobody calls. And we get this message that you have the funeral and then there's some sort of prescribed amount of time, and then you're good to go, and we shouldn't talk about it again. But families can build these rituals for themselves and it can be silly things like it doesn't have to be some huge ordeal, but like, do we watch a favorite movie on their birthday? Do we light a candle and listen to their favorite song? Do we cook their favorite meal? Can we think about times throughout the year that we deliberately as a family remembers this person, I think tangible objects can be a part of that too. I have an activity for building a memory box where we have a Christmas ornament activity in the book that's sort of a commemorative ornament, bracelets for children that represent different memories with a loved one. We know that little children love their transitional objects, I'm sure you've talked about this before, if you're special, lovey, that is sort of a stand-in for mum or dad when you've got to be on your own, and even older kids can really benefit from objects that can be a stand-in for their loved one.

Yeah, and so you mentioned the idea that there's a death, there's a funeral, there's a prescribed period of time and you’re good. I wonder if you can give us a sense of how much time, and I know everybody's different, everyone's experience is going to be different, but what does the research say? What do you normally see about how long it takes most children to move through this process?

I'm sure that there are different numbers out there, but I often see six months to two years, two years seems to be the length that a lot of these studies have followed, and it can be a multi-year process, especially because children may take some more time to begin the process. It's also interesting that with a lot of traumatic events, once children are ready to talk, they tend to move faster than adults do, sometimes kids are much more ready to talk about things than adults are at a given stage, but it is a long process, It's longer than people might anticipate, and we know that with children in particular even after that sort of initial morning phase has passed, children are going to re-grief their loss at higher levels of development as they develop that more nuanced adult understanding of death and milestones can really trigger that for kids so holidays, graduations, weddings, children becoming parents, right? And thinking about their parents, in a way, it's a lifelong process, and it doesn't end, and that can be really scary but it doesn't have to be a doom and gloom thing. It becomes a part of a child's life to have this relationship in a different way.

Yeah, and our culture doesn't really allow for that, right? It doesn't allow space for a person, you know who is becoming a mother, and who doesn't have a mother to understand that experience, and to express that experience. So, yeah, I actually ended up making a book for my daughter and I made it double-sided and made the letters on one side be ‘me’ and cut those letters out, and on the other side, the letters were ‘you’ and put those raised up, so it was always like you coming out of me kept it was like this dual journal of things I was thinking about myself and things I was thinking about my daughter, and I found that really helped me.

It's really sweet. I really love that. And I think that that technique can also be really helpful for grieving children that writing things can sometimes be easier than saying them out loud, putting things, or drawing things. There is a journaling activity in the book and there's also like a mailbox activity where you make a little shoebox, mailbox and have children have something that's too hard to ask or to say out loud, you put it in the box, it's helpful if you've got multiple kids because you get a little anonymity, and we can kind of not necessarily focus on one kid. But I love that you gave that to your daughter and that you have a way of connecting with her. That's so sweet.

Yeah, yeah, one day she will have it. So there's the sense in the literature that most children progress through grief kind of “normally,” and they go through the four tasks, but some of them don't, And there's this idea of complicated grief and I'm wondering if you can tell us what that is and how common that is?

Yeah, I may need to look up the static. And I believe it's that two-thirds of children would progress normally. So if that sounds correct to you, and what you saw.

It sounds about right to me;

I'll give a little air if we want to give it more definitively.

Yeah, that's close enough.

So, most of the research that I have seen suggests that about two-thirds of children, so most kids will work through grief on their own. Grief is not a pathological thing, I'm sure you have followed this, they recently just added the diagnosis in the DSM for prolonged grief, so there is a way now that we can diagnose people as grieving in a way that needs mental health help, but it was really controversial because a lot of people feel that grief is a part of life. It is natural and normal to grieve, it would be weird not to grieve, and so it is this complicated thing where often we need support, but also there's nothing pathological about the act of grieving, it's understandable to feel these things. For about 1/3 of the children, Worden found they are going to need some help to get through this, and there are some factors that make children more vulnerable, we've talked about a lot of them, age is part of it, relationships in the family are part of it, If you have a family - cultural style, where we don't talk about feelings that can add to it, the cause of death, if death was very sudden, or violent or traumatic, puts children at increased risk, and if a child has had previous losses, or traumas, all of that compounds and makes children much more vulnerable for this kind of complicated grief that doesn't resolve seemingly gets worse over time, isn't going to go away without some kind of intervention from caring adults, and so some of the signs of that happening can be a child really, really having a hard time talking about their loved one over a long period of time after that numbness phase has dissipated. Really aggressive behavior, really extreme anger, anxiety that seems to be getting worse instead of better, so not just like a brief period of clinging to mom or dad, but you know, having a hard time going on sleepovers, having a hard time getting to school, anxiety that seems to grow, stomach aches and headaches that don't go away and seem to get worse, sleep issues that don't go away over the first few months and seem to perhaps stay the same or get worse over time. And then like really big changes in behavior, like big changes in how a child eats, changes in a child's grades at school, a lack of interest in things they used to love, like dropping out of extracurriculars, or, you know, breaking things off with friends. If a child is talking a lot about their own guilt or blaming themselves that's a good indicator that a therapist could help, and then especially with older children and teens, one of the risks is that they have these less healthy coping mechanisms at their disposal more so than younger kids, so we may see teens trying to cope with their grieving feelings through cutting through substance use, we may see more thoughts of suicide and self-harm in that age group and we should always take that stuff really seriously, and that Worden said a mental health checkup too.

Do you see a lot of parents looking for these mental health checkups for their children? Or should we be doing that after they've experienced grief?

I think it's a wonderful idea. I know that Dr. Fogarty recommends this in his book, in my own very kind of individual experience, I see many, many parents bringing their children in immediately following a death, you know, within the first few weeks, which can be helpful, but children are often just not ready at that time to dig into things. They are still very much in shock. And so sometimes it's helpful to get started and sometimes kids just aren't ready. What I think might be trickier is to do those checkups, like he recommends, three months after, six months after, “Hey, it's been a year, how's everybody doing since this happened?” Especially if the signs that we're seeing that time either aren't externally visible or are harder to connect, and the kind of the further away we get from any traumatic event the more generalized the symptoms tend to become, and the harder they are to pin back to that original event. So we'll see a high schooler who's really struggling and it may take a little bit of like digging to really realize that, “Oh, my goodness that will this started much earlier with this death.”

And so are there specific activities that you do with children who are experiencing complicated grief?

Yeah, I think oftentimes, these kids are experiencing emotions that are so overwhelming that they're not coping with daily life and so you'll see in the book that I've got some activities are sort of moving toward emotion, like, “How do we feel it? How do we express it? How do we let our child move through it?” And some of them are almost moving away from like, “How can we modulate this emotion? How can we turn down the volume so that a child can get through the day,” we have times when we need to lower the intensity and times and we need to let our child feel it. Kids in complicated grief need both, but they probably need some skills right away to cope with those feelings so you might see more CBT-type therapy being done with these kids, some real coping skills-based stuff. And I think creating a narrative is so important for children with complicated grief, it's a traumatic event, children may still be pushing those memories and those thoughts, so out of their minds, that they're popping back up in a way that's hard to control, and so telling that story from a child's perspective, finding ways to write it down, finding ways to have other people witness that story and make sense of it can be really healing. And so, there's a chapter in the book too, called healing through storytelling, where I look at different ways that little kids can do this, comic books, art, letter writing. I have some children who do zoom therapy with me who love to tell stories in the chat box and we've got an option for telling this over zoom in the book, but I do think for all kids, it's helpful for kids who are having that complicated grief, finding a way to tell the story, through words or through plays is really meaningful.

Yeah, and so what may look on the surface, like fairly simple activities actually have this really deeper meaning, this deeper purpose, and can really support children in their grieving. For parents who see that their child needs more support, are their specific ways that we should go about looking for somebody who is trained in grief therapy, you’ve mentioned in the beginning that grief and depression can manifest kind of similarly, and sometimes therapists will treat it the same if they're not trained specifically. So, that can apparently have not such good consequences. So how can parents find somebody who is really trained in understanding grief and treating grief?

I think that's a really good point. I was actually thinking about this today of sort of like differences between grief and depression. And with depression, often we're looking at like I almost imagined it was like this virus in the brain. That's like telling you not to do the things you need to do to get better, which is get out of the house and stop ruminating about all of these overly negative thoughts, we see these distorted thoughts about, “Nothing's worth doing, I'm not going to have fun if I leave the house today, I'm never going to feel better.” And there's a lot of kind of a need to stop listening to those thoughts and get out into the world and I think there's a risk in grief that yeah, like thought distortions can be part of it, and depression can be part of it but we do need to let children feel those feelings, and if we are just saying, like, “Get back out into the world, get out and do this stuff, find positive activities,” and not also incorporating that grief processing and that more meaning-making and storytelling part of things, we may be unintentionally teaching children to push down and deny those feelings rather than then let them out. Ruminating on depression isn't helpful, but feeling the feelings of grief really is so yeah, finding somebody who specializes in grief is great. You've mentioned a lot of real expert names in the field and I think it's okay in an initial interview, to ask a therapist, “What model do they ascribe to,” like, are they kind of working off Worden, and do they read a lot of Fogerty? The Dougy Center is a really influential organization that offers help for children, they offer a lot of resources for therapists, and they have a lot of kinds of sister programs throughout the country. That's another great name to hear if you're looking for a therapist, and they actually have a database on their site where you can find therapists, and they specialize in children's grief, too. They only work with kids and so they've got a database there of local clinicians or local groups near you, you can search for your zip code in the United States. There are also associations that therapists can join and so you can look through their rosters or see if a therapist mentions things like The American Academy of Bereavement, The Hospice Foundation, The National Center for Death Education, there are a lot of these professional organizations that have trained members. You can also get referrals from places like hospices or from doctors, they will probably know the people in your community who are really specialized in this if you contact a licensing board, they may be able to point you in the right direction. Asking about their therapeutic approach is really helpful, “How would you come up with my child's treatment plan? You Do you use these tasks of mourning? What model do you look at? Tell me what your goals usually are for kids?” You want to be able to hear some kind of coherent answer and there's not necessarily a right or wrong, but they should have a thought process through their approaches, and it should be something that you feel like you can get on board with as well. I also just think like, really, this is like a general therapy thing. But like, I want to see a therapist whose website talks about grief if you're looking for grief, or if you're looking for OCD, this may not be the time to go to somebody who says they treat infants through geriatrics and they deal with PTSD and Alzheimer's, and depression, and anxiety, and you look at the Psychology Today Profile, and there's like 100 things, they might be a fantastic therapist, and this might just be how they're prescribing things but when you have a specific need, it always makes me feel better to see a therapist where you know like they eat, sleep and breathe this subject and they've worked with kids like you.

To be clear for parents, you know, you don't necessarily need to be able to evaluate what the person is saying about their model and know whether they're describing the model correctly. The point of asking the question is, does the therapist have an answer? That sounds coherent, right?

I think so. It sounds good to you. Yeah, “Does it feel good to you that just what they're saying makes sense to you?” I think what you want to hear is, “Have you treated children like mine before? Have you gotten extra training and grief and bereavement? Like did you have a class in college like that you took as an elective? Have you pursued additional postgraduate training in this like, how did you learn about grief? Did you intern somewhere with grief?” Some sort of extra training, I think is really helpful in this because, at least in my program, we did not receive a ton of grief education. There was an elective you could take, but the core curriculum didn't really cover it. So yeah, “How did you learn this? What's your plan? Have you worked with children like mine?” Therapists should welcome those kinds of questions and most of us love to talk about it.

Awesome. Well, thank you so much for writing the book and for being here today. If parents want to find out more, where can they find you?

Absolutely. Thank you so much for having me. It's been really fun. They can find me at KatieLear.com K, A, T, I, E, L, E, A, R, if you go to KatieLear.com/book, there are links there to purchase the book. I have an extra resource bundle where if you send me your proof of purchase, I'll send you five more exercises that either came to mind after I sent in the manuscript or did not make the manuscript because we could only have 100 of them, so there are a few extra ones that I'm happy to send along. And the book is available at Barnes and Noble, on Amazon, and most of the major retailers, and then you can go to indie bound or sites like that if you'd like to order it through a local bookstore.

Yeah, and so once again, the title of that book is A Parent's Guide To Managing Childhood Grief, and links to all of the studies that we've referenced today, as well as the link to the book pages website, can be found at YourParentingMojo.com/childhoodgrief.

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