Will The Kids Be Alright?

In the weeks following the death of Elizabeth Edwards, there has been a lot of concern and questions expressed regarding her children, especially her youngest children, ages ten and twelve. Almost without fail, at the end of a news story about the Edwards’ family the commentators ask, “How are the children doing?” Really what they are asking is, “Will the youngest children be all right?” It is an understandable question. Given that the death of a loved one is so overwhelming for adults, how do we expect children (who seem so much more vulnerable) to cope effectively, especially after the loss of a parent? While it is impossible to say at this point whether the Edwards’ children will be “all right,” I can tell you what makes for a better outcome after the death of a parent.

1) Be Honest With the Children: If a parent is dying do not hide this from the children. The misconception is that by not telling the children the bad news that their parent is dying we are protecting them. In reality, what we are doing is confusing them. Children are very perceptive. They can see that something is wrong with their sick parent. When the people close to them refuse to discuss it or, worse yet, deny that anything is wrong, children feel confused and, at times, left out. Sometimes it is up to the parents to bring up the topic and to discuss it in an age appropriate way with their children but often the children will bring it up. When my father was dying, I asked my mother directly, “Is dad going to die?” She said, in an exasperated voice, “Oh, Meghan, we are all going to die someday.” She did not say yes or no but avoided the question. Her exasperated voice made me feel like I was being silly to ask. It was at that moment that I started to doubt my intuition and my judgment. I have since recovered, but it would have been more helpful had my mother just been honest, had she been able to confirm for me that my father was going to die. When a loved one is dying, during the months leading up to the death, (whether they realize it consciously or not) the surviving family members are preparing themselves, bracing themselves for the death. It is only fair to give children this warning to “get ready” as well.

2) As the Dying Parent Approaches Death Let the Children Know That the End is Near and Give Them the Option to Say Goodbye. When a family has been discussing the fact that a parent is dying throughout the days leading up to the death, it makes it a little easier when you have to tell the children that death is imminent. At this point the surviving parent (or other concerned adults in the child’s life) should tell the child what his or her parent looks like now. Be sure to let them know if medical devices are in place or if the parent looks a lot different then when they saw him or her last. The goal is to have the child prepared as well as possible for that last visit with his or her parent. If at this point children say that they do not want to go see his or her parent do not force them. Most children know what they can handle. If they say that they do not need to say goodbye, respect that wish. Even for the well-prepared child, going to say goodbye to a dying parent can be overwhelming and traumatizing, being forced to go say goodbye is doubly traumatizing. Also, if the child decides to go to say goodbye be sure that there is someone there who can take the child out of the room (or home) if the situation becomes too much for the child to bear.

3) After a Parent Has Died Tell the Children Directly and Avoid Using Euphemisms: Whether a death is sudden or expected, soon after it happens it is important to tell the children. It is best to sit them down in a quiet place and tell them directly, “Mom died this morning.” Often, with children, adults have the tendency to use euphemisms such as “Jesus took Mom to heaven last night.” We think that this will in some way lessen the blow of the loss. In reality, what it does is makes children afraid that Jesus is going to come for them the way that he came for mom. At this point each child will have a different reaction. Some will cry, others might faint, and a few might have no obvious reaction at all. The job of the adults at this point is to provide comfort and reassurance, and to answer questions. Some children might want to go outside to play with their friends or to be alone. Parents should allow this to happen as each child processes a loss differently. It is very common for children to grieve in dribs and drabs. One moment they might be crying over their dead parent while the next they might be outside playing with friends. It is important to give grieving children some space while being sure to check in with them periodically as well.

4) Let Children Decide Whether or Not They Want to Attend the Funeral Services: It is important to let children have a say in whether or not they want to attend the funeral service for their deceased parent. Many children will want to attend and some will even want to play an active role (i.e. do a reading, etc.). If the child decides that he or she does want to go to the services, it is important to prepare him or her beforehand for what he or she will experience (see, hear, smell, touch) at the services. It is a good idea to have somebody with you who can take the child outside or home should the service become too overwhelming. Many of the people I have spoken to reported that it was comforting to be at the services for their deceased parents but others told me that it was overwhelming, traumatizing, and embarrassing. Whether or not the child’s presence at his or her parent’s funeral is going to be helpful or hurtful depends a lot on the child’s personality, the support provided during the service, and the preparation he or she received beforehand.

5) As Much As Possible Keep Everything the Same: When a parent dies young, leaving a family behind, often the survivors feel as if the rug was pulled out from under them. One of the things that parentally bereaved children reported as being the most helpful was when their surviving parents were able to keep routines, homes, schools, as much the same as possible. Sometimes this is not possible due to the financial changes that happen when a parent dies, particularly the death of a father. But when it is possible, keeping things the same seems to provide a sense of safety and continuity for grieving children. Unfortunately, a lot of adults (including adults in my own family of origin) have this feeling that they want to change everything to mark symbolically making a new start after the death. Eventually, this might be a healthy thing to do but to do it too quickly can tend to disorient children. At the same time, I am not advocating that we hold on to rituals rigidly. If, for example, it is too hard to sit around the dinner table without the beloved parent, it is adaptive to change where you eat dinner. For many of us losing a parent is enough without adding the loss of a home, school, routine, to the mix. Changes can be made but they should be made slowly, over time, rather than all at once.

6) Provide a Safe Place For Children to Process The Loss: Immediately, after the death of a parent everything tends to be turned upside down, there are not enough hours in the day to get everything done, and yet there are still children who need help processing their grief. As a rule, children cannot process their grief without the permission and the help of adults. So, what is a surviving parent to do? This is a hard time. As much as possible, rely on your community, your support network, for help. Hopefully, you have friends and family who pitch in without being asked. If not, reach out to your family, friends, and church to try to garner some support. Some people will not be willing to help (even when asked) but many people will be glad to help. I have often been surprised at who comes through in a time of crisis (and who fails to help). Once people agree to help allow them to do the food shopping, driving children to after school activities, cleaning, and food preparation. Having a break from the regular duties of running a household will allow the surviving parent some time to process his or her own grief and to attend to the emotional needs of the children. At times, for various reasons (most often not wanting to upset the surviving parent), the children do not want to speak to their parent about the death. This is yet another role that the helpers can fill. A concerned family friend can provide a listening ear for a grieving child. Children need people to contain their anxieties, provide a listening ear, help them to make sense of their thoughts and feelings, and to offer reassurance.

As a psychologist I would be remiss if I did not suggest seeing a therapist in individual, group, or family therapy as a worthwhile endeavor to help the child and/or family to work through his or her grief. This is something that is certainly not necessary for every bereaved child or family but some people, some children, do find it to be helpful to have a safe place to go to explore all of their feelings and thoughts surrounding the death of their parent and all of the changes and new challenges they have experienced as a result. Children have a lot to negotiate when a parent dies including how to interact with their peers now that they feel fundamentally different and how to negotiate new responsibilities they may have to take on at home. It can be tremendously helpful to have someone in your corner who is not affected by the death of your parent during this time of change. Children often have a hard time speaking with their surviving parents for a lot of reasons including not wanting to upset them – this is not something that they have to worry about with a therapist. Many of the adults who I have spoken to expressed that they wished that their parent had found a competent therapist for them when they were newly bereaved. It is always better to catch a problem with adjusting to the death of a parent early rather than letting it play out and influence the course of one’s life in so many different ways.

7) Try to Make the Transition Back to School Smooth: As a rule, following the death of a parent, many children immediately feel different from their peers. This makes for a difficult transition back to school. Most children are out of school for at least a couple of days after their parent dies. When it is time to return the surviving parent and the child need to negotiate a way to make the move back to school as easy as possible. Often, it helps if the parent can contact the teacher and let him or her know what has happened. The parent should also ask the child how he or she wants the death of his or her parent to be handled at school. Some children are embarrassed if it is spoken about in the classroom, while others feel hurt if their parents’ death is not addressed. While they are not therapists, finding an ally in a teacher, someone who can listen to the bereaved child, can go a long way in healing a broken heart.

 Commemorate the Dead Parent: Some children find it to be helpful to commemorate their deceased parent in some way, while other children want nothing to do with it. While children should not be forced to engage in these activities they should be given options for symbolizing their relationship with their deceased parents. People can commemorate their loved ones any way they want. Some children enjoy going to visit with their deceased parents at the cemetery. Other popular methods of remembering dead parents are through making scrapbooks and memory boxes. A memory box is a box within which they put different items, belongings, pictures, and memories of the deceased parent. It helps children to remember and to feel closer to their dead parents. It also gives them a forum within which to express and to explore their grief. Other children prefer to create a scrapbook of pictures and memories of their deceased parents. Some children want nothing to do with either of these activities. This is perfectly acceptable and to be respected.

While the loss of a parent during childhood is one of the most stressful and potentially traumatic events a child can experience, it will not necessarily result in a catastrophic outcome for the children. With the proper support children can not only survive but thrive after the death of a parent.

Those of you who were bereaved in childhood, what was the most and least helpful in terms of helping you to cope with the loss of your parent?

What Should I Look For In A Therapist?

So, you have a list of names and you are thinking of contacting therapists. What is the next step? First, timing is really everything. When a person decides that he or she wants to see a therapist it should be because he or she is ready to engage in therapy. Often, people show up on a therapist’s doorstep because someone else in their lives thinks that they need “help.” While this is not a bad reason to consider therapy (and if you are the friend or loved one it is not bad to make the suggestion of therapy) when a person actively begins a search for a therapist it should be because he or she wants it. While it is also important that the therapist desire to work with the patient, the therapist’s desire alone is not enough to keep the therapy moving forward. If the patient does not want the therapy, the therapy will likely fail.

What should I look for in a therapist? Just like in many other facets of life the most important thing to look for in a therapist is that there is a “good fit” between you and the therapist. I have heard of many instances in which the therapist was very competent and the patient was willing, however, the therapy did not work out well. The therapy will not progress if the therapist’s style or personality does not match what the patient needs. Therefore, it is important that you make a list of qualities that you will be seeking in a therapist. Do not settle. If you do not feel completely comfortable with the therapist you are seeing (outside of the normal anxiety that accompanies speaking about deeply personal issues), look for another one. There are a lot of therapists out there. I have known far too many people who have stayed in therapy too long with therapists with whom they were not making any progress.

During your first appointment, ask questions. Gather information about the person’s therapeutic style. What is his or her therapeutic approach (i.e. cognitive behavioral, psychodynamic)? Has he or she helped people with your problem before? If so, how many people and what was the outcome? How many years have they been practicing? Also, make sure that you understand the therapist’s policies and procedures. What is the fee for a therapy session? Does the therapist take your insurance? What is the policy if you have to miss a session? Finally, ask the therapist about his or her credentials. What type of training does he or she have (Ph.D., M.S.W, M.A., etc)? Upon asking some of these questions, if the therapist becomes overly defensive or critical of you, I might look for another therapist. At the end of your search for a therapist you want to make sure that you have found one that is credentialed, professional, and a good fit for you. Do not stop looking until you have found a therapist who meets these requirements – it will make the difference between a mediocre therapy experience and a wonderful one.

Anniversary Reaction

I was barely conscious as I heard a bystander shout, “Somebody call an ambulance!” As my body twitched on the floor of a deli in the Bronx, I muttered to myself, “Of course, something like this would happen now, this was the day that I learned that my mother was going to die three years ago.” In my case there was a physical reason for my collapse, however, the psychologist in me knows that physical and psychological health are inexplicably interwoven. They influence and are influenced by each other, often without our even realizing it. Likewise, after the death of a loved one, most people suffer anniversary reactions, which often operate outside of consciousness.

What is an anniversary reaction?

An anniversary reaction is a set of unsettling memories or feelings (anxiety, anger, sadness, fear) that you can trace to an unpleasant event (the death of a loved one, an accident, a robbery, a natural disaster). At times it can be difficult to make the link between the unpleasant event and the feelings you are experiencing for a number of different reasons. Firstly, the fact that this is an “anniversary reaction” can be buried deep in the unconscious and disguised in various ways (as a somatic complaint, as vague unpleasant feelings that are hard to pinpoint). Thus, it might be hard to figure out why we are feeling bad; it can be difficult to link it to an event that might have happened many years ago. Second, sometimes the anniversary reaction happens on the actual date that the traumatic event occurred, while at other times it might be triggered by something else, like the season of the year. When it is linked to a season rather than a day or date, it can take a lot more self-reflection to think about, “Why do I feel bad every summer?” For example, all of my loved ones died between April and July. Summer happens to be one of my least favorite seasons. I wonder if it is influenced at all by having experienced so many deaths in the late spring and early summer. It is almost as if as spring ends I feel the need to brace myself for whatever catastrophe summer might bring.

Experiencing an anniversary reaction is a normal part of the grieving process. All that it means is that the traumatic event has not been fully processed yet; something from your past is asking for attention. Once it is “worked through” the anniversary reactions should become less and less intense until they no longer carry the same power.

What can we do if we suspect that we are experiencing an anniversary reaction?

1) As each month begins think about the significant dates so that you are prepared, and so that if you start to feel out of sorts you know where it is coming from. Having an idea of the past event that is causing your current bad feelings can help you to process them. Remember that you can experience an anniversary reaction on the days leading up to the significant date or anytime during the season of the year that a trauma occurred.

2) When you are experiencing an anniversary reaction be sure to find an outlet to express your memories, thoughts, and feelings. You can do this through speaking (to trusted friends or a therapist), writing, painting, drawing, making music, or praying. The goal is to try to put words to, to try to express in some way, your trauma, and what it meant for you and your life.

3) Make a special effort to take good care of yourself while trying to work through a trauma. Eat a lot of fruits and veggies, drink plenty of water, and make sure to get enough sleep each night. If you feel like you are drowning in your trauma, seek out the help of a grief or trauma specialist. It often helps to have a steady companion as we journey through the darkness of our trauma to the light on the other side.

Have you ever experienced an anniversary reaction?  If so, what was it like? How did you get through it?

I appreciate that so many people are taking the time to read my posts.  I will continue writing about my interests but I am also interested in addressing your questions and concerns.  In an ideal world, I would like this to be a discussion about death and dying. So, if you have any comments or questions, please feel free to ask, either in the form of a comment below or, if you feel more comfortable, via email: docmeghan@gmail.com! Thanks! 

Saying Goodbye

“Meghan, w-w-w-w-hat are your wishes?” My mother asked, her brain tumor making her speech halting, and, at times, unintelligible. The words that I wanted to say seemed to get stuck in my throat but eventually I was able to cough out “I wish that you could live.” This began one of the many conversations that my mother and I had between the time that she was diagnosed with colon cancer and brain cancer, and the time that she died.

My mother was sick for a long time – six years – before she died. Thus, I had adequate time to think about all of the things I wanted to say to her. As it turned out, my mother had one health crisis after another during those years so I ended up speaking with her a lot. In a perfect world, we would do this in each of our relationships. It would deepen our relationships if we consistently honestly communicated with each other instead of waiting until a moment or two before death. In my mother’s case she was dying a slow death so there was plenty of time to tie up loose ends. In the case of sudden death a lot can be left unsaid unless we have been telling the person all that he or he means to us throughout the relationship.

At any rate, when facing a loved one who we know is likely to die shortly, our own anxiety coupled with the anxiety of the dying person can cause all potential communications to come grinding to a halt. One of the big questions is always: Can we talk with the person about the fact that he or she is dying? We are afraid that we are going to upset the dying person if we speak about his or her death. Often, the dying person finds himself or herself in the same boat. He or she often wonders if relatives know what is happening (i.e. that the person is dying) or whether he or she needs to protect them from this truth. This is an awful bind for a dying person to be in because instead of focusing on what he needs to do for himself during these critical moments, he ends up spending his energy on protecting his loved ones, protecting them from something that they probably already know, that he is dying.

I faced the same dilemma with my mother. One night that I was spending sleeping in the hospice with her she asked me point blank, “Meghan, how is my health?” Not really sure how direct to be, I said, “I am not sure, how are you feeling?” She started screaming, “Oh my God, I am dying” over and over again for what seemed like hours. It felt almost unbearable to sit there and hold her while she screamed out in anguish over the realization of her impending death. At the same time, it was a moment of sadness that we shared. It opened the door to further communications between us. My mother knew that I knew that she was dying and I knew that she was aware of it as well. From that moment on whenever I would leave the hospice in the morning (I would sleep there overnight) as I would lean over to kiss my mother good-bye (which is derived from God be with you) she would say, “I will miss you.” I would tell her that I would miss her too knowing full well that we were not just speaking about the daytime hours during which I would not be with her. I am quite sure that the conversation would have been shut down had I answered her question, “Am I dying?” by saying, “No.” She was testing me to see if we could speak about her death, and by not saying “No” outright I gave her the green light to speak about her fears. This then led to a conversation about our relationship.

People often ask, “What should I say when speaking to a dying loved one?” While we can really speak about anything, some of the things that seem to be most helpful to discuss are providing reassurance to the dying person, asking forgiveness from the dying person (and granting forgiveness to the dying person), telling the person how much you love them, thanking them for various things, reminiscing about the past, and letting them know that you will keep them alive through your memories after their death. As my mother approached death she became preoccupied with a decision she had made that directly affected me. She wanted to reverse that decision but it was impossible. I reassured her repeatedly that it was OK, that I was not angry. I forgave her. She also was worried about me. I was single and she did not want me to be alone as a result of her death. She kept repeating, “Meghan, alone,” “Meghan, alone,” over and over again. I reassured her that I would be okay, that I would not be alone. Neighbors, friends and relatives also reassured her that they would not leave me alone. This seemed to allow her to rest more easily.

A lot of the conversations that loved ones have with the dying are about reassurance, especially when the dying person is leaving young children behind. They need to know that their children are going to get the care and attention that they need. And, while no one can ever fill the role of a beloved deceased parent completely we can work to sew up the gap. My nephew had just been born a year before my mother’s death. At one point she said, “I wish I could see all of the babies.” I said that I wished that she could see all of her grandchildren too. Then, I told her that we would make sure that they knew all about her through us, and through our memories of her. It was in no way acceptable to her or to me that she would not be there to get to know them herself but at least I could reassure her that she would not be forgotten. This seemed to give her some peace. And, it made me feel better that this intense love that I had for my mother did not have to die, but could live on through memories shared with others.

It is best to have these conversations early and often but sometimes that is not possible. It often happens that by the time someone reaches their loved one’s bedside they are in a coma or otherwise seem out of it and unable to communicate. At this point people sometimes feel, why bother saying anything at all, he or she cannot respond anyway. I would urge people to say what they need to anyway. Hearing is believed to be the last sense to go, so often dying people can still hear what people are saying. This theory also applies when you are speaking to others while you are around the dying person’s bed. Do not say anything that you would not want them to hear. My mother seemed to be in a coma for her last ten days of life but I spoke to her anyway. I kept the same routines that I had been keeping prior to that time. I believe that she was aware of my comings and goings, especially because she decided to die shortly after I returned for my evening shift. I believe that her death was something that she wanted to share with me. She knew that I would be able to comfort her and pray with her as she died. She knew that I would tell others about her death. In sharing my experience of her death I would make it meaningful in some way, it was not for nothing. As long as the person is alive, it is never too late to say goodbye.

This blog post has been all about how to “say” goodbye to our dying loved ones. It was sparked by a question from a reader whose brother is dying. While it is important to try to put into words our thoughts and feelings when a loved one is dying it hardly ever feels adequate. Sometimes what is right is to say nothing at all but to simply hold our loved one close as he or she approaches death. Often the work of saying goodbye has to continue after death. We continue to speak with our deceased loved ones. We continue to try to make the ending right in our minds. They continue to be the sparkle in our eye and our lantern for the dark.