Aging/Gerontology, Book Review, End-of-Life, Grief/Grieving/Bereavement

What to Do about Mama?- Book Review

Book Review- What to Do about Mama? By Barbara G. Mathews and Barbara Trainin Blank

What I like about this book is the different perspectives on caregiving as there are many contributors. This provides any individual or professional reading the book with different scenarios, which include common situations and feelings.

The authors also describe their own care giving experiences. For Barbara Matthews, she became a caregiver for her mother-in-law. Ten years after her father-in-law died, her mother-in-law came to live in her hometown. At first, the response was no, but as health problems began to appear, the move happened. A family meeting with all helped “seal the deal” for her to relocate and be closer to family to have assistance as needed.

Another health crisis occurred creating a cycle of hospitalizations and rehabilitations. She then moved in with Barbara and her husband on the first floor of their house. Increasing assistance was added as her mother-in-law required it. Eventually, hospice services were put into place which also gave Barbara a break (respite) from providing total care.

For Barbara Trainin Blank, she was the caregiver for her mother who lived quite a distance away.  After her father’s death, her mother began presenting with forgetfulness which progressed. Her mother did not want to go to a nursing home or residence and Barbara did her best to honor this by having assistance come to her mother’s home environment. She became a long distance caregiver, an advocate, an organizer, and in some ways an unpaid care manager-organizing all the details of her mother’s life from medical appointments, to home care workers, arranging transportation, etc.

Caregiving itself has a different definition for each individual providing it. It is hard work from what I have read in the book and witnessed myself in interactions with clients and family. While I have children myself, caregiving for an adult is very different.  The needs of a child can be more or less than the needs of an adult and much easier to carry/lift a child than an adult! Also, as Barbara pointed out to me, for her an important difference between caregiving for children vs. care giving for older adults is that the first is a hopeful process preparing the child for a good future and the second is a process of trying to make life as comfortable as possible for the aging adult as they proceed toward the end of life.

Some common themes in the book are:

Care giving responsibilities:

Local or long distance caregiving?

Alone in acting as a caregiver or shared responsibility?

Potential tasks: financial care, physical care, respite, paid caregivers, volunteers, professional assistance.

Caregiving profiles:

Some quit their jobs to provide caregiving to a spouse or other family member. Some are trying to balance work with raising a family and caregiving (sandwich generation), some are alone in their caregiving role while others have siblings or other family member’s support/assistance. Some are caregiving locally and some long distance.  It is difficult to watch a parent, spouse, child or friend deteriorate and age, just as it is difficult for the person this is happening to, to admit they are aging and deteriorating, and need help.

Roles and Responsibilities:

If you can, define what the person needs assistance with: IADL’s Instrumental Activities of Daily Living; cleaning, meal preparation, shopping, transportation, finances, medical appointments, medication management, communication and/or ADL’s- Activities of Daily Living; bathing, toileting, dressing, feeding, ambulating(mobility). Determine who is assisting with what and whether the individual in question will allow the assistance.

Caregiver emotions and need for self-care:

This to me should be a no brainer; everyone needs some help and should be open to accepting and asking, but it is not easy for everyone to do so.

Self-care should be regularly scheduled as much as possible into the daily and weekly routine.

  • Arrange or accept assistance from family, friends, agencies/organizations, paid companions or homecare workers, and perhaps volunteers.
  • Take vacations or days off if you cannot go away on vacation (financial reasons, other commitments)
  • Give yourself a night off every once in a while.
  • Schedule your own appointments and keep them for medical reasons and check-ups, beauty salon appointments, to go grocery shopping, etc.

Regarding emotions and support for the caregiver:

  • Look into support groups whether run by professionals or volunteers.
  • Seek assistance of a counselor or therapist if you think it would help.
  • Call or schedule coffee breaks or lunches out with friends to talk.

Family Relations:

Communication is important between family members, between professionals and family, between other caregivers, and one person needs to be the designated person as the main contact. As a professional, I can state it is easier to have one family member to talk to, to share information with. If a phone call will not work or is not possible, then a group email addressed to the main contact with the other family members cc’d is another option. This way everyone is in the loop and aware of what is happening and the information is written.

Each caregiver or main contact has their own definition of “doing one’s part.” Caregiving one’s parent(s) is not easy and can be difficult at times as the child-parent dynamic changes. It is reverse roles and now the adult child is parenting the adult parent!

I have worked as a case manager with older adults for 14 years and fortunately I have known most of my clients for that length of time. It is hard to watch someone become frailer. I imagine it is more difficult and more emotional for a family caregiver re: a parent, child, spouse or other family member.

Barbara Matthews shared with me that over the past year of working on her social media sites, this “caregiving in a nutshell” definition has evolved:

Caregivers get involved with care giving to meet a need, solve a problem, or deal w/ a crisis.  The situation often improves—for a while.  Many times caregivers do not take into account the process of aging cannot be controlled, needs will increase—sometimes over many years, or how heavy the burden can/will become.  Therefore, it is important:  to have realistic expectations about care giving, to be prepared for the unexpected, to communicate expectations clearly to the “others” and to develop a care giving contract of shared responsibility to be signed-off on by all.

The book is worth reading and is very comprehensive.

By Victoria Brewster, MSW

Education, Neuroscience, Neuroplasticity, Neurolinguistic Programming, Social Work/Helping Profession/Mental Health

Brain Matters: Youth, Learning, and Development

I had the opportunity to attend an excellent conference today put on by Quebec Federation of Home and School Associations, Inc. As I am a member of the Home and School Association at my kid’s school, I was made aware of this conference by an email and had the opportunity to attend representing our school.

The topic was Brain Matters: “Optimizing the Brain for Learning” by Michael Quinn, BSc. who is a Neuroscientist and Educational Consultant. The title hooked me in and I was not disappointed. He also had an amazing accent as he is originally from England; a bonus!

Neuroscience, the plasticity of the brain, and how the brain absorbs our memories, our emotions, and past experiences fascinates me. I took 4 pages of notes and now have a new ‘need to read’ book list. Brainwashed: The Seductive Appeal of Mindless Neuroscience by Sally Satel and Scott Lilienfeld, Moonwalking with Einstein by Joshua Foer, and Spark: The Revolutionary New Science of Exercise and the Brain by John Ratey- here I come!

Two reference organizations to review are: The Dana Foundation in the USA and The Wellcome Trust in the UK; focus of neuroscience to improve education and up-to-date research. A great way as a teacher or other professional in the school is to involve the emotions-tell stories, focus on positive things and point out the good-this goes a long way in helping students to remember what is being learned in the school environment. Exercise was also described as having an amazing effect on students learning. Kids cannot sit at their desk for 6 hours without movement or physical activity, and they need to take breaks; just as adults do in the work environment.

Some methods to help students learn (of any age) is to ‘chunk’ the information together, use elaborate encoding techniques and make it multi-sensory. The more senses used, the more likely one is to remember! Circadian rhythm was also discussed and in listening to how the body goes through the day in different temperature states along with optimal learning times being discussed made sense to me. It describes the ‘afternoon slump’ that students and adults might face in the school or work environment; the sleep-wake cycle. A “master clock” in the brain coordinates all the body clocks so that they are in synch. Circadian rhythms are produced by natural factors within the body, but they are also affected by signals/cues from the environment.

Optimal learning time is in 50 minute to 1 hour blocks with a 10 minute break. It was suggested to break down large projects into smaller segments, plan regular breaks, get up and move on your break, schedule meals and relax during this time or socialize-do not rush through eating.

I also learned that ‘blue light’ stimulates the brain and can assist in the learning process which is great during the day-but I did not know that computers, iPods, smartphones and such give off this blue light and if one is on electronics at night-it stimulates the brain and so one is less sleepy. Turns out there is an app/program that one can download to reduce this blue light on computers and laptops, F.lux and for the iPhone or iPad.

I plan to go back to my kid’s school and share all the information I learned with our Home and School Association and am eager to see it be implemented in the classroom environment. Teachers, professionals, and principal’s need to hear this presentation and be open to change. It is amazing what can happen when parents and teachers are focused, willing to work together, and learn together; it is for the betterment of the kids and makes learning easier and fun.

By Victoria Brewster, MSW

Aging/Gerontology, Book Review, Social Work/Helping Profession/Mental Health

Recovering from Genocidal Trauma: Book Review and Author Interview

Recovering from Genocidal Trauma: 

An Information and Practice Guide for Working with Holocaust Survivors

Myra Giberovitch, MSW, PSW

Book Review and Interview

While the book focuses primarily on Holocaust Survivors, it can be used and associated with other individuals who experienced genocide or mass atrocity crimes. Mass atrocity crimes include genocide, crimes against humanity, and war crimes. Acts include: murder, extermination, enslavement, deportation or forcible transfer, imprisonment, torture, rape, prostitution, or persecution based on gender, religion, race or culture. If we fast forward to modern times, examples of this would be Rwanda, Darfur, and the current situation in Syria and Iraq.

Holocaust Survivors lived through what many term as one of the ‘darkest times in history.’  They have much to share with and teach current, and future generations. Although many suffer from post traumatic symptoms such as anxiety, depression, sleep disturbances, recurring traumatic memories, and a variety of health conditions; these co-exist with their strengths, adaptive coping abilities, and perseverance to rebuild their lives after the war. They settled in new countries, learned new languages, trades and professions, started new families, and built new Jewish communities.

Holocaust survivors have much in common with current survivors of mass atrocity crimes. They were not greeted well or received with ‘open arms’ when they immigrated to new countries and communities after the war. Instead they were greeted with denial, non-acceptance, ignorance, indifference, avoidance, silence, and suspicion about their experiences. Most people did not want to listen to their stories and experiences or did not believe what they heard.

And yet, in spite of this rejection, survivors turned to each other for support and action. They created a host of new organizations and contributed to the cultural, educational, religious, and institutional development of the Jewish community. They institutionalized Holocaust education and remembrance and committed themselves to fight racism and social injustice.

Today, many survivor families consist of four generations – older adults, adult children, grandchildren, and great-grandchildren. The author points out that recovery is a lifelong process. Intrusive memories, guilt, sadness, and longing for family and friends who were killed prevail, at the same time that  holidays, life events, and accomplishments are celebrated.

This book is an informative and much-needed resource and guide for practitioners, medical professionals, spiritual leaders, community leaders, and students. The author documents her strengths-based approach that stresses listening to and learning from Holocaust survivors. She draws upon current research and practice literature from social work, sociology, medicine, neuroscience, and gerontology that have helped her to develop innovative service models and programs, and apply practical techniques, and individual and group interventions to empower survivors as they recover from tragedy and adversity.

The author writes about her own family history which provides a foundation for this book. Both of her parents are Holocaust Survivors and she was born after the war in a displaced persons camp in Germany. The offspring of Holocaust survivors experience first-hand their parents’ traumatic memories through their upbringing. While some parents shared their war experiences, others did not.

Such a horrible event in history should never happen again and yet genocide and mass atrocity crimes are still committed today. Has the world not learned? Remembrance is important along with leaving a legacy for future generations through books, video testimonies, movies, documentaries, poetry, art, and discussions, and interactions with youth. In so doing, the world and future generations will learn about events that happened more than 70 years ago.

What inspired you to write this book?

I was encouraged by requests from colleagues, students, and survivors to document my professional, volunteer, and personal experiences with Holocaust survivors and their families. They helped me realize that many service providers lack knowledge about survivors’ history and diversity, their psychosocial functioning, the impact of aging on traumatic memory, and specialized survivor-assistance resources. In my research, I found books and articles about the Holocaust, the theory and pathology of severe trauma, the psychosocial effects of such experiences, and clinical treatment of associated symptoms; but not much information about survivors’ adaptation and resilience, or programs focused on recovery.

I wanted to fill this information gap by writing a practice guide for communities, health care providers, survivors, academics, and students. I also wanted to broaden the perception of survivors that moves beyond pathology by discussing their adaptive coping abilities and achievements that co-exist with their physical and psychological vulnerabilities.

How can a book written about Holocaust Survivors be applicable to other individuals or groups of people who have lived through war, mass atrocity crimes, and other traumatic experiences?

This book is intended to reach a diverse audience from a variety of backgrounds using the experience of Holocaust survivors as an example. The practice philosophy, service models, and the programs and interventions can be replicated and adapted to survivors of other mass atrocities. Topics include:

  • A partial listing of mass atrocities committed during the past hundred years.
  • Part V summarizes major milestones that Holocaust survivors accomplished on their journey towards recovery that are applicable to other survivor populations. I also share my thoughts about creating a national resource to assist survivors of mass atrocities.
  • The discussion in this book follows a strengths-based framework when interacting with survivors and describes in detail, along with case examples, the specific skills and programs required to put this framework into action. This approach focuses on listening and learning from survivors, discovering their needs, recognizing their strengths, involving them in program creation, and encouraging them to participate in providing services and helping each other.
  • The impact of prolonged victimization and interventions such as empathic listening to modulate intense feelings and enhance well-being.
  • Environmental factors that reduce the impact of trauma.
  • A detailed description of specialized community-based services such as individual and group services that include a long-term group trauma recovery model.
  • Clinical interventions and therapeutic responses to survivors who encounter common issues, triggers, and emotional reactions.
  • Eclectic therapeutic modalities, including interventions ranging from complementary and alternative medicine (CAM) to techniques to help survivors achieve peace of mind.
  • Activities that bring meaning and purpose such as intergenerational programming.

Unfortunately, genocide and war did not end with the Holocaust. Mass murders continue to take place around the world. Those of us who work with Holocaust survivors have learned how to respond to individuals traumatized and displaced by war. This book transfers a legacy of knowledge and experience we’ve learned in working with Holocaust survivors to survivors of other mass atrocities. To these communities I want to put forth a message of hope – that recovery is possible.

Which chapter(s) in the book provide(s) a good foundation of information for an individual who has lived through/survived a traumatic event(s)?

I receive excellent feedback from survivors. Some tell me that reading this book has helped them to better understand themselves, especially the psychological impact of their traumatic experiences (chapter 5), the association between aging and traumatic memory (chapter 7), situations that may trigger memories of their persecution (chapter 14) and common issues unique to survivors such as impact of the past, bereavement and loss, significance of family, and religious faith (chapter 7).

Survivors tell me that this book makes them feel validated and understood. Some are buying copies for their children in the hopes of being better understood by them. One survivor thanked me for “understanding the soul of the survivor.”

Who is this book written for?

The intended audience for this book is: health-care and social service providers, survivors of mass atrocity, including their families, and communities, the academic community, including students, government agencies and policy makers, and others who want to understand this population and their special needs.

Parts I and II are intended for all readers and create a background and context for understanding the survivor population. Parts III and IV can be used by practitioners as a stand alone manual or guide for service delivery so that they can easily access this information and apply the interventions or replicate the programs. Part III discusses different services and programs for survivor populations along with suggestions on how to create them. Part IV identifies interventions used by professionals to respond to specific situations.

This book responds to both practitioner and student requests for a field guide written by an experienced practitioner who is also knowledgeable about the theory of social work practice. Frequently, students tell me that their studies over-emphasize theoretical research and lack practical applications such the development of service models, examples of clinical practice, specific interventions that focus on the helping relationship, and self-care techniques. I believe this book is well suited to university students who are training to become practitioners in the field and want to relate their academic studies to the practical world. For academic objectives, the book includes references to the literature for further study.

I want to thank Myra for agreeing to a book review and for answering the interview questions. Too soon, future generations will have to rely on books, video testimonies, documentaries, and movies to learn about the Holocaust. The chance or opportunity to speak to and learn from a Holocaust survivor lessens each day as they continue to age and become frailer. Older survivors are in their late 80’s and early 90’s. Child survivors are in their 70’s and early 80’s. This book is all encompassing and provides a solid foundation for practitioners, students, and anyone interested in learning about the Holocaust while at the same time providing information, techniques, and resources that can be used to assist others who have been subjected to or witnessed violence, trauma, war, and genocide.

By Victoria Brewster, MSW

*First posted on:


Aging/Gerontology, Social Work/Helping Profession/Mental Health

Interview with Patrick Roden, RN, PhD, Certified Aging in Place Specialist

Aging and seniors/older adults are ‘hot topics’ right now due to the aging of our population. Is society prepared?  No. Many more services and innovations are needed to assist older adults while they age. For those that choose to remain at home for as long as possible, services must be bought to the home environment.

Below is an interview I conducted with a professional who has a passion for working with older adults.

What is your background?

I began my life crawling around the floors of a nursing home run by my Irish grandmother who was a nurse in Astoria, Oregon. This must have imprinted me for my life’s mission.

My Catholic upbringing taught me to come from a place of contribution in this life, so I too became a nurse. I worked my way through nursing school employed in a nursing home in Eugene, Oregon, then transferred to Linfield- Good-Samaritan School of Nursing in Portland, Oregon. I completed my Bachelor’s degree in nursing in 1985, applied for a critical care internship, and was awarded a position as a graduate nurse.

I’ve invested over two decades in acute care nursing; trauma center, coronary care, ICU, and recently working part-time for the last five years in post-surgical recovery. I also was a YMCA Cardiac Therapy volunteer in Portland for 10 years, helping people with heart conditions return to health through prescriptive exercise. This was my most positive nursing experience.

Along the way I’ve earned a graduate certificate in Gerontology and a Master’s degree in Adult Education from Portland State University–as well as a Master’s degree and PhD in Social Gerontology from Fielding University.

I enjoy speaking to business and civic groups on issues re: successful aging, aging and creativity, and aging in place. My volunteerism focuses on: Portland Marathon, Meals-on-Wheels, Habitat for Humanity, Central Oregon: Ramp-a-Thon, Relay for Life, and helping seniors in my community.

Why did you create the website; Aging in Place?

I created the website as a concept in the late 1990’s; I was studying environmental gerontology and the term “aging in place” was showing up in all the literature. I knew that someday soon this would be a MEGA trend. It has been said that if you want a BIG opportunity–find a BIG problem; aging in place was both! I knew this would be my life’s work after ICU nursing. And it has become a Magnificent Obsession. Home is fundamental to who we are; home-as-self, if you will. I saw first-hand what institutional settings did to the soul; the mind numbing routines that are essential in places where efficiency is required and accommodation of individual rhythms and needs can’t co-exist. I wanted to do what I could to keep people in their homes.

What is your mission?

The best definition of “healing” I’ve ever heard is: Healing is evoking the will to live in others. The home environment does that…To keep people home by choice; that’s my mission.

Why is a focus on aging and older adults important to you?

My focus on aging and older adults is important to me because as Stephen Covey once said: “What’s most personal is most universal–and most important (paraphrase)…If we are lucky, we will all age, it’s not guaranteed to anyone” God willing, I wanted to help create a more fulfilling future to grow old in. You might call it enlightened self-interest.

Aging in website is pretty impressive and covers a wide array of services, products, and information. Aging in place tips, resources, design trends, products to assist older adults for the ADL’s, along with a newsletter, and blog. is a friendly, easy to use website dedicated to providing relevant information about the mega-trend of keeping baby boomers and older adults in their homes as they age; the term used worldwide for this is “aging in place.” When visiting the web site you will find out the What, Why, and How.

What: We answer the question; “What is aging in place?” by defining, explaining, and giving you the key ingredients.

Why: We provide insights on why aging in place is important for successful aging by giving both the emotional and practical reasons.

How: We give concrete information on the how-to of home modification and where to find help if needed.

Our blog is focused on entertaining and delighting you while keeping you informed on topics about aging in place and successful aging.

A special thank you to Patrick for agreeing to the interview and keep up the good work that you do!

By Victoria Brewster, MSW

Grief/Grieving/Bereavement, News

Grief in Children

Grief in Children 1

Rea L. Ginsberg, LCSW-C, ACSW, BCD- Guest Blogger

In the case of childhood bereavement, the death of a parent, the term “bereaved caregiver” no longer applies.  The tables are turned.  The child is indeed bereaved, but he himself is in need of a caregiver.

It seems senseless to debate which types of grief are the worst.  Which are the hardest to bear.  Every form hurts so very far beyond normal limits, beyond ordinary words.  Profound sadness.  It takes our breath away.  It aches that much.  Every form requires extraordinary coping skills.  Every form holds its hazards.  However, this childhood form does appear to be among the very worst.

“When his parent dies, a child finds himself in a unique situation because of the special nature of his ties to the deceased.   An adult distributes his love among several meaningful relationships – his spouse, parents, children, friends, colleagues – as well as in his work and hobbies.  The child, by contrast, invests almost all his feelings in his parents.  Except in very unusual circumstances, this single relationship is therefore incomparably rich and intense, unlike any close adult relationship.  Only in childhood can death deprive an individual of so much opportunity to love and be loved and face him with so difficult a task of adaptation….The death of a parent engenders a longing of incomparable amount, intensity, and longevity.” 2

The child’s loss of a parent is one of the most difficult forms of bereavement.  The mind of the child is immature.  It is filled with magic, denial, narcissism, and self-reference.  It says he is omnipotent and responsible for all external and internal events.  If he is omnipotent, all-powerful, then his thoughts and/or actions must have caused the death.  “Bad boy!” he imagines.  Furthermore, he may well believe that the dead parent left him because he is unlovable.  He may wonder about, and fear for, his own survival and death.  Annihilation fears.  Reality testing has not been mastered.  Abstract thinking is only embryonic.  The understanding of catastrophe has nothing much to do with reasoning.  It is completely a matter of emotion.  Emotional coping skills are primitive, undeveloped.  He is more likely to express his feelings in physical actions rather than in words.  Hyperactivity is a frequent defense against grief and anxiety.  Adequate, nuanced verbal vocabulary is still narrow and unformed.  The concept of “waiting” is virtually nonexistent.  Postponement of gratification is merely a work in progress.  It is not yet a reality.  All of these are some of the reasons that the bereaved child’s needs are so special.

“The ability to love – like other human faculties – has to be learned and practiced.  Wherever, through the absence of or the interruption of personal ties, this opportunity is missing in childhood, all later relationships will develop weakly, will remain shallow.  The opposite of this ability to love is not hate, but egoism.  The feelings which should go to the outside objects remain inside the individual and are used up in self-love.  This is not what we want to produce.”3

Death makes no sense in these formative years.  The child’s experience tells him: an object which disappears may eventually reappear.  Fear tells him otherwise.  Separation anxiety is intense.  This thought of reappearance co-exists with the fear and outrage of abandonment.  Fear of – and outrage about – abandonment become a sustained, screaming, breathless reality in the case of death.  The loss is far-reaching.  Recovery is arduous, exhausting, and hard to accomplish.  The death of a parent is life-altering on a permanent basis.  It is a severe emotional wound.  It is traumatic.

“Although we know that, after such a loss, acute mourning will subside, we also know that a part of us shall remain inconsolable and never find a substitute.  No matter what we believe may fill the gap…we will nevertheless remain changed forever…” 4

From their many experiences with children, child psychotherapists tend to agree that the child’s mourning process never does entirely end, nor should it.  The mental representation of the lost loved one, the memories and an accompanying degree of longing, remain with the child through childhood and adulthood – throughout his lifetime.5   The lost parent remains loved and missed.  Of course the bereavement process evolves, and remaining fragments come under far better psychological control and management as the child’s thinking matures.  Mourning resolves but nevertheless, vestiges continue for a lifetime.

This troublesome outlook for the child can be mitigated by the understanding and compassionate presence of the other parent or another adult.  Even an older sibling can soften the hardship.  Someone must be there to receive and relieve the child’s distress.  The child cannot be left alone to cope with loss and still remain healthy – both in mind and in body.  Sorrow must be shared.  Every person needs to know he is not alone with grief.  The child is especially vulnerable and needy in this respect.

The optimistic side of this equation is the malleability of the child’s mind.  In important ways, he is easily influenced, persuaded.  His thinking and feelings can be shaped by sympathetic others.  The “bad boy” of the child’s imagination requires immediate recognition and attention by at least one caring adult.  If not immediate, the child’s sense of guilt and self-loathing over the death only grows stronger.  These feelings then become increasingly less open to remedy.  The fear and rage need the mature balance and moderation of others’ views.  To save life and sanity, it takes only one human being who cares.6

Children draw great strength from their caregivers.  The child needs the love and gentle guidance of a perceptive, patient, and capable caregiver.  The caregiver must have a strong, intuitive understanding of children and their varied ways of expressing emotions.  The adult was once a child.  The caregiver should be in touch with the child within himself.  That is one primary route to the necessary and sufficient comforting of the bereaved child.  Also, “the child…profits especially when the [surviving] parent can reassure him that the family will remain together, that his needs will be taken care of as best possible, and that he will be told step by step as each arrangement is planned.” 7

The caregiver, perhaps the surviving parent, functions as a protective “auxiliary ego” for the bereaved child.  The strength and reassurance of the caregiver deeply influence the child’s ability to cope with the loss.  Children in wartime have been the subject of many psychological studies.  We know from those studies that children were least traumatized when the primary caregiver – usually but not always the mother – remained close, loving, calming, and comforting.  Children’s reactions to loss depend mainly on the reactions of the primary caregiver.  “Analytic data show us, time and again, that the child’s healing process is greatly facilitated when the [parent] is not only physically available but emotionally aware of the child’s experience, active in assisting him with integration, and supportive of his efforts….Prevention is so much easier than cure….Not all but many traumas can be avoided.”8

Experiences tend to build on each other.  Certainly, if this is the child’s first major experience with bereavement, it may well set the stage for many future experiences with death and dying.  An appropriate grief experience could help the child to manage future loss experiences successfully.  The child at any stage of development possesses both character strengths and character weaknesses.  Those and the impact of the psychosocial environment determine the outcome of bereavement.

[The importance of chronological age and developmental stage are emphasized.]  “The total character of the child and…the totality of environmental circumstances…determine the outcome of the experience….The interaction between internal and external forces decides between the possibility of normal developmental progress and the incidence of pathological developmental distortion or arrest.” 9

If the child’s caregiver is the other parent, we have come full circle, returning to the bereaved caregiver.  Grief is not optional.10   The caregiver must attend to his own grief and to the grief of his child.  Perhaps, in some important sense, parent and child comfort, soothe, and reassure each other.  They support one another.  The feeling of deep sorrow is shared.  The process and progress of the caregiver’s bereavement is then highly significant not only for himself but also for his child.  The child’s mastery of his situation depends substantially on the caregiver.  It is a large responsibility. Honesty and openness are virtually always good policy with children.  The subject of death will carefully follow this pathway – when the caregiver is strong enough and wise enough to pursue it.  He will know intuitively how to listen well and respond to the child’s expressions of grief.

Children are resilient despite obstacles.  Grownups are, too.  Children draw healthy, lasting equilibrium from their caregivers and from the memory of the loved one.  Parent and child honor the life of the lost loved one with their enduring love and their continued lives.  Love is bigger than Death.11

“Feeling good is hard to describe and to define, but is readily recognized.  It is characterized by pleasure in living, is often accompanied by a heightened sense of bodily and mental well-being, by an ability to extend oneself to others and to initiate and enjoy harmonious interactions with them, by an ease and comfort in giving to and taking from life what it has to offer, and by being creative in thought, word, or deed, however humble a form it may take….It is a treasured feeling, and sorely missed when absent.”12   This feeling-good is the aim of appropriate grief resolution.  It is part of the transformation.

This childhood form of bereavement holds perhaps the greatest potential for healthy growth.  Pleasure in living.  Love of self and others. Creativity.  It is the hidden value of adversity.  The hint of later beauty, sensitivity, and wisdom in adulthood.  Grief – suffering – has its own very special, enduring bonuses.

No hurry to heal.  No pressure to “snap out of it.”  Honesty and openness.  Love.  Memory.  A firm, soothing hand to hold.  Talking.  It takes only one human being who cares.  That is the route to strength and growth.



  1. A group of highly sophisticated psychotherapists/researchers working with bereaved children wrote:


“Throughout the work, in our direct contacts with our patients and their families, in our private thinking and in our research discussions, we lived with the intense distress, pain, and anguish engendered by bereavement.  We have come to understand that this emotional distress is an inevitable burden for all who work with bereaved children.  It is essential in facilitating appropriate empathy and insight, and helpful in integrating an intellectual grasp of the psychic processes within the patients’ personalities.  Only those willing and able to bear the impact with feeling can hope to work with bereaved children fruitfully and to understand them scientifically.”


Erna Furman, A Child’s Parent Dies: Studies in Childhood Bereavement, New Haven and London: Yale University Press, 1974, p. 9.


  1. Erna Furman, ibid., p. 12 & p. 16.


  1. Anna Freud and Dorothy T. Burlingham, War and Children, New York: Medical War Books, 1943, p. 191.


  1. Sigmund Freud, letter to Binswanger, 1929, in: E. Freud, editor, Letters of Sigmund Freud, transl. Stern & Stern, New York: Basic Books, 1960, p. 386.

With special thanks also to Joanne Cacciatore, PhD, for pointing to this quote and for her uniquely beautiful word picture showing these thoughts: private e-mail communication, 28 June, 2013. [Please see picture below]


  1. Marie E. McCann and Edward J. Schiff, MD, “The Process of Mourning,” in Erna Furman, op. cit., p. 52.


  1. Elisabeth Kubler-Ross, MD, On Children and Death, New York: Macmillan Publishing Company, 1983, p, 19.

[Please see also:]


  1. Erna Furman, op. cit., p. 20.


  1. Erna Furman, “On Trauma,” The Psychoanalytic Study of the Child, New Haven: Yale University Press, volume 41, 1986, pp. 203 & 207.


  1. Anna Freud, Forward to: Erna Furman, A Child’s Parent Dies: Studies in Childhood Bereavement, New Haven and London: Yale University Press, 1974.


  1. Monica Williams-Murphy, MD, private e-mail communication, 5 July, 2013.

[Please see also Dr. Murphy’s blog at website:]


  1. Joanne Cacciatore, PhD, private e-mail communication, 4 July, 2013.

[Please see also the website of the MISS Foundation:]


  1. Erna Furman, “On Fusion, Integration, and Feeling Good,” The Psychoanalytic Study of the Child, New Haven: Yale University Press, volume 40, 1985, pp. 81-82.