This paper was difficult to write because I had problems finding a topic that would fit my professional identity, include the population I will be working with for at least the first two semesters I am doing my practicum, and the new theory I decided to utilize. I chose to focus on the population I will be working with during practicum because I still have not figured out what population I want to work with after I graduate.
After I am become firm with the decision not to do person centered therapy, I was struggling to figure out what direction to go in. I was trying to learn and work with cognitive behavioral therapy, but it just did not connect with me like I had hoped. Part of it was because it pays little attention to the entire person: emotions and their environment. It does not take a biopsychosocial model, which I think is important when working with clients. That is what originally drew me to person-centered therapy, but that theoretical orientation just does not work for me. While doing research on a new theory, it seemed to me that reality therapy can be considered a medium between the humanistic approach to theoretical orientation and the behavioral approaches.
With further research, the aspects I appreciated most about Reality Therapy was how it directed the counselor to help the client focusing on fulfilling the five basic needs: power, love and belonging, freedom, fun, and survival, (Glasser 2010). It highlighted that behavior is associated with an individual’s choices and that individuals need to take responsibility for those choices, (Glasser 2010). Reality therapy is the approach I would have like to have researched for this paper, but it was difficult to find enough research that would enable me to write it. Since the research was difficult to find, I then tried to write this paper based on the theory that has been assigned to me at my practicum site, which is solution focused therapy. Unfortunately, it was also difficult to find enough research done about solution focused therapy and working with children. I think I ended up changing my topic about three or four times.
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I attempted to connect this paper to the population I will be working with at my practicum site for the next two semesters. This practicum site works with children and adolescents going through loss either through a parent’s divorce or having an absentee parent. I decided to focus on child bereavement and the grief process because it is an issue it is a more prevalent issue than I thought. I was doing research for an interview at a different practicum site, and it made me think more about a child’s developmental age and how that affects processing and the ability to grieve. Grief and bereavement might not be the topic that is regularly discussed at the site I hope to do practicum at, but the children will have dealt with loss. Learning how to discuss most topics in a way that is consistent with a child’s developmental age will be helpful in the immediate future and post-graduation. I wanted my topic to be associated with children in some way, so I can gain a better understanding of facilitating a group with children. Odds are, that because children are involved, some sort of play or art therapy will be involved. So, I ended up doing research on this topic may not be directly involved with the theory I want to work with, but it does involve the population I will work with. It is unfortunate I am not given the opportunity to work with theory I have decided on for the time being but, I can always continue to do research about the topic. Practical application will just have to come later.
Grief is described as working through a loss and it may be manifested through physical, cognitive, or emotional means, (Kandt 1994). Trauma that has occurred due to the loss of a loved one can be detrimental to a child’s social and emotional development, (Siegel, Mesagno, and Christ 1990). If children suffer a loss at a young age, there is a strong correlation between the loss and behavioral manifestations and internalized struggles, which can impact multiple parts of a child’s life. This can include problems in a child’s academic functioning, self-concept, self-esteem, and their relationship with family, friends, and other loved ones, (Ener and Ray 2017). There can also be somatic symptoms of grief as well, that can be misinterpreted, making grief even harder to identify and take care of, (Chen and Panebianco 2017). If the symptoms of grief are not attended to while they are occurring, they can lead to the potential development of psychiatric disorders later in life, (Riley 2003). When a child suffers a loss, helping the child through the mourning process becomes the best sort of preventative care, (Riley 2003).
Dealing with loss and grief can be difficult because the child might not understand what is happening or the concept of finality when dealing with loss. A child’s developmental age and level of cognitive and emotional development plays a factor in how a child understands and makes sense of a loss, (Ebner and Ray 2017). Circumstances of the death, whether it was sudden or expected, and social, cultural, and familial contexts also have an impact, (Ebner and Ray 2017). Other factors that affect how children will grieve include how close they are to the deceased, if the death was sudden or not, and the reactions of other family members to death, (Kandt 1994). Children that are in the age range of 3-5 years of age have difficulty grasping how final and irreversible death is. Older children, those 6-11, might not have developed the ability to adequately express the emotions they are feeling, (Samide and Stockton 2002). Some children may not be aware of how deeply their emotions can impact them, which can lead to an internal struggle, (Ener and Ray 2018). Their attempt to cope can be disruptive to others because they are not aware of what they are feeling.
To make it easier for children to process their loss and the emotions that come with it, there will be a utilization of person centered grounded expressive arts therapy. Person-centered therapy is based on building the client-therapist relationship in an individual or group setting. Counselors practicing person-centered therapy let the client explore their needs and help them discover their own direction, (Rogers 1961). The conditions for person-centered therapy are genuineness or congruences on the part of both the counselor, creating a climate of unconditional positive regard, building a basic sense of trust the counselor has in the client, and an empathetic relationship that permits a facilitative understanding of the client, (Rogers 1961). This understanding will enable the ability of the counselor to have a true helpful and therapeutic relationship with the client. Another element is having a presence in the therapeutic relationship, (Rogers & Kirschenbaum, 1989).
Change is achieved through a therapist’s use of active listening, clarifying, accurately reflecting, and accepting, (Goodman, Morgan, Juriga, and Brown 2003). Aspects mentioned above were expanded upon by Natalie Rogers for use in expressive arts therapy. The empathetic relationship that is built between the client and counselor will produce a feeling of safety, so the group members can feel they are truly being listened to and understood, (Rogers, Tudor, Tudor, and Keemar 2012). Person-centered therapy allows the group members to feel more open in their expression of thoughts and feelings in an individual or group setting because the facilitator builds a sense of trust through empathetic understanding. Using expressive art therapy means being able to discover your inner feelings and being able to express them in a visual form. It allows the client the ability to access feelings they may not have been aware of. This potentially gives a client more personal insight into what they are feeling, and that can be expounded upon by the group facilitator, (N. Rogers, Tudor, Tudor, and Keemar 2012).
Aspects that need to be covered during group counseling for grief and bereavement are accepting the reality of loss, working through the pain of grief, adjusting to an environment with the deceased missing, and finding ways to cope with the loss of a loved one, (Worden 1996). Expression of emotion through expressive arts therapy can help a client work through pain and grief and help with adjusting to the loss of a loved one. An important consideration for conducting group therapy for grieving children is getting the best balance between use of expressive arts therapy and verbal counseling. Children find it difficult to sit down and talk for long periods of time, especially when painful topics are involved, so using expressive art therapy will be beneficial in working with children in a group setting, (Samide and Stockton 2002). It is important to remember that no person, adult or child, grieves in the same manner, (Worden 1996).
Letting children create a piece of art, through expressive art therapy, can allow a child to express what they are feeling, even if they do not understand what they are feeling. This allows for more open communication, (Finn 2003) between other group members and with the group facilitator. The facilitator of the group can then assist the children that are in counseling in processing their feelings that have expressed non-verbally through expressive art therapy, (Finn 2003). To allow for verbal communication of what the group members are feeling, the facilitator of the group will need to first build a sense of trust, empathetic understanding, and unconditional positive regard that is necessary in the person-centered approach, (Rogers 1951). This can be done modeling these attributes, so all group members understand that there is a safe space, (Killick, Feeney, and Rhinehart 2017). This will help the group members feel comfortable when and if they decide to share.
In a study done by Samide and Stockton (2002), found that children benefit by sharing their feelings grief with their peers in a safe space. Children rely heavily on their peer supports, since they spend much time interacting with their peers, (Finn 2008). Talking with peers allows for clients to normalize their feelings, (Finn 2003). A counselor skilled in grief counseling can help the clients express the emotions by being an active listener, (Kandt 1994). The match between a person-centered therapy approach, with its emphasis on being deeply empathetic and forming a strong therapeutic relationship (Rogers 1951), can be an effective means for treating children and adolescents who are experiencing grief.
Use of group intervention for bereaved children, according to Huss and Ritchie (2008), provides a sense of commonality and relieve a sense of isolation that is common. Research conducted by Armstrong, Birnie-Lefcovitch, and Ungar (2005), highlighted the importance of developing strong peer relationships to be able to positively adjust to the loss of a loved one. If children have the ability to express themselves and be understood by peers, they can begin to understand that what they are experiencing is normal and okay. The person-centered group facilitator can encourage group members to connect with the emotions they now realize they are feeling and associate it with other group members. By linking the group members together, it will allow for the children to understand they are not alone with what they are feeling, (Samide and Stockton 2002). This can allow for expression of thoughts and feelings to be done in an appropriate manner which can facilitate the process of letting go and the acceptance of loss, (Riley 2003).
Although it is crucial for the counselor be able to explain the concepts of death and grieving in a way a child can understand, (Samide and Stockton 2002). Meaning all words used need to have a concrete meaning, so nothing can be misunderstood by the children. The children will first need to be taught a vocabulary of emotion words that they can use because it is likely they do not have an adequate vocabulary yet, (Ener and Ray 2017). Knowing the proper vocabulary will allow children to accept what is happening because they will understand it, (Riley 2003). This will lead the group members in the process of having a heightened sense of emotional awareness, which is important in the process of grieving and accepting loss in a healthy way, (Tillman and Prazak 2018).
A good therapeutic group can also provide safe space, with the help of a good counselor, in which children can feel comfortable enough to ask questions about death and grief, (Riley 2003). All talk of death and grief should be done in an age-appropriate way, (Samide and Stockton 2002). This can lead to reminiscing about memories with the loved one that was lost, which will help with the grieving process. Talking it through with peers helps the children move on, heal, and go back to their daily lives, (Samide and Stockton 2000).
According to research done by Ener and Ray (2017), aggression is one of the most common behaviors seen in children who have not processed their grief in a healthy manner. When involved in a group for bereavement and loss it becomes easier to develop coping skills that will allow for healthier ways to express grief and loss, (Tillman and Prazak 2018). A child can have the opportunity to learn what is working for other children farther along in the grieving process, (Tillman and Prazak 2018).
The process of expressive arts therapy has been shown to improve a child’s ability to process grief and improve psychological functioning, (Chen and Panebianco 2018). A child being able to express and understand what they are feeling has been found to reduce behavioral and internalizing problems, (Chen and Panebianco 2018). Behavioral problems include aggression and lack of self-control while internalizing problems include nervousness fearfulness, withdrawal, sadness, inability to concentration and a lack of motivation, (Chen and Panebianco 2018).
Parents will also need to understand how symptoms of grief can be shown in grieving children and how best to discuss it with their grieving children. Due to the different ways that grief can be demonstrated in a child, it is difficult for parents or caregivers can recognize the symptoms of grief and know if they should be concerned, (Ener and Ray 2017). Grief and bereavement are a difficult topic to address, but it is important for parents to understand to remember that it is natural. Children will go through a grieving process regardless of whether a parent wants to address it or has the ability to do so, (Samide and Stockton 2002). Parents need to learn activities and behaviors that will encourage them to include their children and adolescents in conversations about loss and bereavement, (Riley 2003).
Parents who know how to best meet their child’s needs and allow them to express their thoughts will allow a child to have properly grieve the death of a loved one. The education factor for parents can be accomplished through a psychoeducation group for parents. Timing can be an issue, so it can run concurrently with the child’s bereavement group. It is also suggested by Siegel, Mesagno, and Christ (1990) that parents will only be as helpful in with their children in processing grief as they have addressed their own emotional pain and grief. If parents do not meet their own needs, it inhibits their ability to recognize and meet the needs of their children, (Siegel, Mesagno, and Christ 1990). By teaching enhancing parent’s knowledge of their grief, and their awareness of their child’s needs, it ensures that children will continue to have their needs met even after their group session has ended, (Saltzman 2016).
According to research conducted by Tifllman and Prazak (2018), that application of small group work with bereaved children may relieve some behavioral and emotional problems that result from the loss of a loved one. Only by recognizing that children grieve and allowing them an open discussion of it will children be able to successfully deal with the consequences of their loss. Allowing a child to understand how to talk about emotions and then allowing them to talk about those emotions with peers who can normalize their feelings, will allow for mourning that does not become traumatic and healthy adjustment after the passing of a loved one. Expressive art therapy can allow a child to explore what they are feeling, especially if they are not sure of it themselves. Person-centered therapy for bereavement counseling for children can help build a safe space for children to express what they are feeling.
