While people in all age groups struggle with grief and loss, teenagers face particularly painful adjustments following the death of a loved one.
The teen years are already tumultuous, and the bereaved teen needs special attention. Under ordinary circumstances, teenagers go through many changes in their body image, behavior, attachments and feelings. As they break away from their parents to develop their own identities, conflicts often arise within the family system. Life becomes even more complex when a father, mother or other significant person dies - a shattering experience faced by one child in every ten before the age of eighteen. (See TEEN GRIEF: CLIMBING BACK, a video by Hospice of Metro Denver)
Teens grieve deeply but often work very hard to hide their feelings. Fearing the vulnerability that comes with expression, they look for distractions rather than stay with the grief process long enough to find real relief. Feelings can be turned off quickly, much like flipping a light switch. Teens can act as if nothing has happened while they are breaking up inside. You may observe teens who take on the role of caregiver to family members or friends, in effect denying their own grief.
Gender makes no distinctions when it comes to experiencing grief, but the outward signs may be different. Young men of this age may have a particularly hard time when they have been taught that showing emotion is something that girls do - but macho guys don't.
Teens often trust only their peers, believing that no one else can understand how they feel and how they react to life's problems. Relationships with friends can be deep and meaningful, sharing conflicts occurring at home and details of their love lives.
To gain the trust of teens, adults must become good, nonjudgmental listeners. Let teenagers know that you are interested in them, in their views, in their ideas and thoughts. Let them know that you like and care for them. Support their ideas or gently introduce new ways to approach their ideas. Acknowledge their grief and offer your thoughts of how to ease their pain.
Because teens are most open to fellow teens, one approach to providing help is through peers. And it works. Peer counseling is now an elective course in many schools for teens. Peer counselors are trained to look at all kinds of life problems on a personal level and then at ways to help their peers. They are introduced to different situations that may occur, and speakers are brought in to teach them about specific topics.
Because teens are willing listen to other teens, peer counseling can play an important role in establishing communication with distressed classmates and friends, as well as steering them to professional help if it is needed. Peer counselors learn about depression, grief, communicating with parents and other adults, suicidal ideation, etc. At the same time, they learn their limitations and are assured of the support and expertise of their peer counseling teachers for consultation.
Selecting the right teacher for this is of course critical, since he or she must gain the trust and respect of the students - just as students will seek the trust and respect of the peers they may be called upon to counsel.
Another approach is through grief support groups, and they work, too. By sharing feelings with one another, teens find out they are not alone and that others are also struggling to rebuild shattered lives. Grief groups help teens feel understood, accepted and supported.
Decide on the format that will work best. There are three possibilities:
Using this format, new kids can arrive at any time, and group introductions will need to be made often. The advantage is that teens have more time to work on their grief, especially after sudden, violent or traumatic deaths.
Time-limited. These groups work best in the school setting. School schedules often do not allow the flexibility for an on-going group. Teens may also be more comfortable knowing there is a beginning and an end to the group. The number of sessions is usually 8-12, but shorter groups could be offered along with the opportunity for teens to request an additional session or sessions.
Walk-in. This format frees the teen from any commitment and fits into the busy routine of school life. The difficulty is not knowing who or how many kids will attend.
Group leaders have to decide on the parameters of the group. Is this going to be limited to teens who have had a parent die, or will it be more general? If there are enough teens to do a group focusing on parent loss, this type of focused group may work best. Grief groups that are broader in nature work well, too.
The Loss Inventory (page 6 of the Grief at School manual) is a good tool in identifying bereaved teens. Other sources for referrals will come from teachers, coaches, counselors and parents. The PTA newsletter or the school web site can be a good place to advertise the group.
Teens will tell you that they just want to talk and not have any activities. For some grief groups this is true, but you need some ideas to fall back on if a particular group is silent and non-responsive. The following activity gets group members comfortable with each other because it immediately addresses the reason why they are there.
The person who died in my life is______________________________________
The cause of death was____________________________________________
I found out about the death when_____________________________________
After death, I believe my loved one is__________________________________
My first feeling was _________________________because_______________
Now I feel ________________________________because_______________
What makes me most angry is_______________________________________
I worry about_________________________________because____________
The hardest thing about school is______________________________________
My friends are___________________________________________________
The adults in my life tell me__________________________________________
What helps me most is______________________________________________
What helps me the least is___________________________________________
It can be difficult to separate normal teen behavior from that of a grieving teen in trouble. Some of the indicators that let you know when a teen needs more than the help of group or peer counselors offer are:
A teen's home, school, and social life are the arenas for observing behavior changes. Listen and take notes if comments and concerns are being expressed.
Get to know the teen and invite discussion regarding his or her activities at home or at school. Find out if keeping up with work is a problem or if the teen is feeling overwhelmed with what needs to be done. Ask if there is some time to spend alone or with friends.
Is the teen spending too much time alone, canceling out on dates and parties, or dropping out of after-school activities?
Discuss the differences between bereavement depression and clinical depression. Encourage the teen to consider further help, if indicated. Supply information about where to go to get counseling.
Always take any talk of dying seriously and explore the teen's thoughts and feelings on the matter. Listen carefully to messages from the teen indicating there is a death wish. When a loved one has died, it isn't uncommon to make statements such as, "I just wish I could go to sleep and not wake up in the morning," or "I don't care if I get in a car wreck." These are passive death wishes - something or someone causing a death.
On the other hand, if a teen starts talking about when, where and how to do "it," or if there is a history of depression or suicidal behavior, this is a much more serious matter and needs immediate attention. Get prompt professional help.
Anger can often create problems at home, at school or with friendships. Anger needs to be expressed, but in appropriate ways. Unspoken anger can become depression. If the angry teen is creating problems, and normal ways of expression are not helping, this teen may need further counseling for anger management.
Feelings of guilt often leave the teen isolated and alone, with an absence of self-esteem. The shame that accompanies guilt takes the form of deep, dark secrets - a very heavy weight to carry around. You can help the teen find some relief from these feelings by being a good listener and by not trying to talk him or her out of it. Suggest writing a letter to the person who died asking for forgiveness, perhaps even taking that letter to the grave and reading it out loud. Or list the things that are most guilt inducing on a biodegradable helium balloon and let it go. If measures like this don't help, don't hesitate to refer the teen for further therapy.
Have information about the perils of substance abuse available. There are times when teens use drugs or alcohol to try to take away the pain. Look for denial, anger and guilt with teens you suspect are using drugs or alcohol. When referring such a teen for additional help, find a therapist who specializes in grief and substance abuse.
A normal part of grief is not caring about anything and a lack of motivation or interest. Help the teen understand that these intense feelings of grief are temporary, and that the more they skip school or don't do their homework, the harder it will be to catch up. Teens who are staying away from school may not know that, if this continues, they could be brought before a judge and sent to a probation home or juvenile detention center.
The pain of grief is so great and the emptiness so profound, it is not uncommon to look for a warm body to fill the void. This closeness is only a temporary fix that usually leads to regret, shame, and fear of disease and pregnancy. If a girl is thinking that sex will make her feel better, help her understand her displaced needs and what she may get herself into. If a boy is showing the same tendency, help him understand that the issue goes beyond contraception; what is involved is his own need to address his grief in way that will bring him real relief.
Develop a list of mental health centers and know what services they offer. Put together a list of private therapists who specialize in adolescents, grief, substance abuse and depression. Update this list yearly.
Working with teens is both challenging and rewarding - challenging because you need to break into their world and develop a trusting relationship; rewarding because of the pleasure you will have in being a confidante to their secrets and concerns, seeing smiles and cheery greetings gradually replace those frowns and stares. Becoming a part of a teen's life as he or she struggles with life-shattering grief is a privilege to be exercised with care, but a privilege all the same.
"The Grieving Teen" is reprinted with permission from the American Hospice Foundation. Copyright 2000 American Hospice Foundation. All Rights Reserved. Additional information is available at American Hospice's Foundation website.