Loss and Bereavement in Children and Young People
Ethical Considerations
The Ethical Framework for the Counselling Professions (BACP, 2018: 16) states:
27. Careful consideration will be given to working with children and young people that:
a. takes account of their capacity to give informed consent, considering whether it is appropriate to seek the consent of others who have parental responsibility for the young person, and their best interests
b. demonstrates knowledge and skills about ways of working that are appropriate to the young person’s development and how relationships are formed …
When working with children and young people, it is also vital to ensure that they understand the limits to confidentiality – and to be vigilant for signs of abuse (which may link to feelings of loss).
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Cognitive Development
Ensuring that you and your client have psychological contact is key to all modalities of counselling and psychotherapy.
Yet the ability to achieve this naturally varies in children, depending on their age and stage of cognitive development.
Before working with children, it is therefore vital to undertake specific training.
Children of different ages process – and so display – loss and bereavement in different ways, due to their levels of cognitive development. This affects how best to communicate and work with children in this situation.
While certain traits are common to children of each age range, it is above all important not to make any assumptions, but instead to work with each child as an individual, gently ascertaining their view and understanding of death, and how they are feeling.
In other words, do work hard to get into and stay within the child’s frame of reference.
Newborn to Three Years
A newborn can sense emotions such as excitement, anxiety and sadness in others around them; they can also sense that a significant person is missing, and that new people are present.
Although they can’t understand death, they can therefore absorb the emotions of others around them. This may make them irritable, affect their attachment style (possibly with long-term consequences) and lead to the formation of introjects.
Although you would probably not see such a young child in counselling, it’s important to ensure that bereaved people with very young children understand the importance of caregivers managing their own emotions when in the company of their infants.
Three to Six Years
Children in this age range may believe that death is reversible, like going to sleep or walking into another room. They don’t have the cognitive ability to understand the permanence of death.
This can lead to ‘magical thinking’: when the child thinks that their thoughts, words and behaviour can both cause death and bring the person back.
Again, the former can lead to introjects (e.g. the child believing that their parent died because they themselves behaved badly).
Children of this age may regress in terms of showing behaviours such as thumb-sucking and bed-wetting – or may become angry and aggressive.
Stealing can be another presentation. This is because they may struggle to express their feelings through language into words, leading them to ‘act out’ their feelings.
Other possible signs that children of this age are experiencing grief include:
- keeping asking the same questions as they try to understand their sense of loss
- being sad only for short periods of time, interspersing this with playing happily (sometimes talking to themselves as they do)
- having physical illnesses, pain and other somatic symptoms (sometimes related to the person’s cause of death)
- hungering for affection and physical contact, even from strangers
When a family member dies, the family technically becomes a new and different family – because it’s a family of one less. This takes some processing – and needs to be done alongside having a connection with the person who has died.
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Loss and Bereavement in Children
Six to Nine Years
Some children of this age range can understand the finality of death, but others might not.
Because children are very creative at this stage of development, they may become focused on the idea of monsters or ghosts relating to or even responsible for death.
They may also fear that death is contagious and that other loved ones will ‘catch it’ and die too.
Although working within the child’s frame of reference is important, if it becomes clear that they have false beliefs that are unhelpful to them, you may need to gently correct these and explain the truth to them.
Children of this age are often fascinated with the idea of dead bodies and how they look. Sensitivity is needed when answering questions relating to this.
They may also:
- ask very pointed questions about the cause of death
- connect death with violence and ask who killed their loved one
- blame themselves for the death (again as a result of the magical thinking discussed in the previous section)
- worry about how the deceased can eat, drink and breathe
- struggle to express their feelings verbally
- become agitated when faced with other changes
- behave angrily
- display physical symptoms such as feeling ill
- fear going to school (as this requires leaving loved ones)
- struggle with concepts such as heaven and spiritu
When working with children of this age, it’s important to help them to feel safe when talking about painful feelings and experiences: you may be the first person they have been able to share these with.
Building a trusting relationship is therefore vital – as is ensuing the child has continuity of care, so that they don’t have to keep retelling their story to new support workers if they don’t want to (which could even be retraumatising). It’s important to consider the impact of school holidays/breaks in this respect.
Because children of this age may not yet have a full range of vocabulary to describe emotions, it can be helpful to use creative, art-based approaches.
Nine to 13 Years
Between these ages, a child’s understanding is nearer to that of an adult. This means that they will probably be aware of the finality of death and how that feels for them – including how the loss impacts on their world (e.g. who will take them to their activities).
Other manifestations of grief in this age group include:
- having a fragile independence
- acting out
- becoming interested in religion or spirituality
- having disrupted relationships with peers (perhaps through friends’ insensitivity)
- experiencing heightened anger and/or guilt
- having bodily symptoms
- fearing school (again through not wishing to separate from other loved ones)
- feeling self-conscious and alone in relation to their death-related
13 to 18 Years
While most young people of this age range really have an adult understanding of death, they may grieve in different ways.
It’s important to try to dispel the idea that ‘big boys [or girls] don’t cry’, showing them that grieving is a natural process through which humans move forward following loss.
Just as for adult clients, it’s important that young people understand that people grieve in different ways: there is no right or wrong way, so long as it’s not self-damaging.
Family Systems
For those aged under 18, the family unit is particularly significant – and so it’s important as a counsellor to look at how this has been impacted by the loss.
The family is likely to have to reorganise their roles within the unit.
It is particularly challenging for a young person to expect themselves – or to be expected by others – to take on a role that doesn’t really fit for them (for example, if a teenager is expected take on the tasks of the parent who has died).
When a family member dies, the family technically becomes a new and different family – because it’s a family of one less. This takes some processing – and needs to be done alongside having a connection with the person who has died.
Working with Grief
In addition to the various approaches suggested for children of different age ranges, various general strategies can be helpful in counselling:
- making a memory box (perhaps including photos and personal possessions – maybe a piece of clothing in a sealed plastic bag, so that it retains its unique smell)
- modelling healthy coping behaviours and good self-care yourself as a mental-health professional
- not using clichés and platitudes
- being honest and straightforward in your use of language, avoiding euphemisms
- offering stability and safety – which means not crying in front of child clients
- ensuring that you have processed your own experiences of loss before working with others (perhaps through personal counselling)
- attending clinical supervision regularly – increasing the length and/or frequency when this would be helpful to your wellbeing and the quality of your work.
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Loss and Bereavement in Children