Helping Kids Deal with Grief – Podcast
LifeStance provider Jae Swanson explores how grief shows up in children, navigating the grief process for adolescents and how to help kids deal with grief and loss.
Nicholette Leanza:
Welcome to Convos from the Couch from LifeStance Health. For each episode, you’ll hear engaging and informative conversations with leading mental health professionals that will help guide you on your journey to leading a healthier, more fulfilling life.
Nicholette Leanza:
Hello everyone, and welcome to Convos from the Couch by LifeStance Health. I’m Nicky Leanza. And on today’s episode, I’ll be talking with Jae Swanson, a clinician from one of our Philadelphia, Pennsylvania offices, and we’ll be having a conversation about helping kids deal with grief. So welcome, Jae. Great to have you on.
Jae Swanson:
Thanks so much for having me.
Nicholette Leanza:
This is really a significant conversation for us to be having, because we know it’s so important to talk about talking to kid, adolescent about grief and lost. So I’m really appreciating that we’re having this conversation today.
Jae Swanson:
Absolutely. Right.
Nicholette Leanza:
And let’s start with you telling us a little bit about yourself.
Jae Swanson:
Yes, I’m Jae. I use they, them pronoun. I live and work in Philadelphia. I’ve lived in Philly for about 13 years. I have a background in music therapy and I’m also a licensed professional counselor in PA and I spent the last 10 or so years mostly in hospice work, so I have a lot of experience with hospice and terminal illness and the last six years working with kids to are grieving the loss of a loved one.
Nicholette Leanza:
So, you definitely bring to the table lots of experience with this topic. And it definitely sounds like one of your specialties.
Jae Swanson:
Absolutely. Yep. And it’s a very under talked about very common thing.
Nicholette Leanza:
Right. Right. No, I agree. Which again is why it’s so important that we’re having this conversation to help guide others, caretakers, parents, whoever have children or adolescents in their life to talk about this. So to get us started, let’s start with, what does grief look like in children and adolescents? And I get developmentally, it might look different in children and adolescents, but you can take it from however you want to divide that.
Jae Swanson:
Yeah, I’ll talk about mentally in a little bit, but for now, just focusing more narrowly on how does grief show up in kids, which is surprisingly not all that different from how it might show up in adult, except that depending on age, kids have less of a filter. Kids are more likely to respond naturally and immediately to what’s happening, especially younger than say 12, but what they need and how we approach working with kids is not that different from working with adults. So I wanted to talk about two specific models that I really think are valuable. One is from 1985, someone whose last name is Fox, and he talks about the four tasks for bereaved children, which these are not supposed to necessarily happen in any order and just like anything with grief, we’re going to go, we’re going to do one thing and maybe it’s going to be last the next day and we’re going to do the next thing and come back to the first thing.
Jae Swanson:
So, not necessarily in order, but the forecasts are to understand and make sense of the loss, make sense of what happened, how it happened. The second is express reactions to loss in some constructive way, so that can be just talking, that can be emoting, that can be using different expressive, like arts mode. The third task, learning how to keep on living and learning how to keep on loving other people. And the fourth task is commemorating that life that was lived. And that is something that you can do, especially as a child. You’re going to maybe do that for a very long time to come over the course of your whole life. So, learning how to do that and learning that it’s okay to do that at a young age is really important and will help kids in their adult life when they have to of course have another loss in their life.
Jae Swanson:
And then another model, which is more common with also adults is called the dual process model. Stove and Shoot are the authors of this. I think starting in the late ’90s and the dual process model is the idea that in grief we oscillate between loss oriented modes of being and restoration oriented modes of being. Loss oriented meaning actually really grieving and mourning and maybe experiencing tearfulness or anger being in counseling, doing memorial services, any kind of commemoration. And restoration oriented is having to do your daily living tasks. Maybe sometimes having to do some of the tasks that deceased person used to do, learning how to love other people and continuing relationships with other people. Rebuilding a different life that you’re now going to be living without that person. And we’re going to naturally oscillate between all those things within… In the beginning. It might be within an hour or minutes that you’re oscillating. And as you move forward in grief, you might spend more time in restoration oriented, but your whole life, you’re going to spend some time and loss oriented and that’s normal.
Nicholette Leanza:
And I think you’re bringing up such a good point, because I think people think you just move through stages of grief just very literally. And that’s not the case at all. And I like how using that word oscillating. I think that’s very important for people to understand.
Jae Swanson:
Exactly. Yeah. A lot of people have tuned into the Kubler-Ross model, which does, I don’t know if she intentionally wanted people to think about it linearly, but people do. And then they feel like they’re failing if they don’t meet those tasks.
Nicholette Leanza:
So that’s why I like the tasks that you brought up the forecast with the first model there. I really think that it really gives people a good idea of guidance. Both models are very good, but I like the idea with the task of what are we working on as we’re grieving through this process?
Jae Swanson:
Yeah. It’s a good model for therapist.
Nicholette Leanza:
Yeah. Oh, for sure. Good guidance for us-
Jae Swanson:
Yeah, exactly.
Nicholette Leanza:
… in helping others. So, can you give us some specific tips on how to talk to kids about death and dying?
Jae Swanson:
Yeah, absolutely. A lot of adults have an instinct to protect kids from things like death and dying because understandably we’re concerned that there it’s too much for them. They’ll be overwhelmed. We want them to keep their innocence. However, kids know what’s going on most of the time, regardless of what we say or don’t say. And when we don’t say things, we’re showing number one, there’s something bad about talking openly about this. And then number two, if kids don’t know what’s happening sometimes or even most of the time will imagine something worse, which can lead to a lifetime of anxiety.
Jae Swanson:
So, helpful to be very transparent in a developmentally appropriate way. So, kids who are under two really have no concept of death and dying, but they will feel the loss in their own way. They will feel the emotions of other people around them. And so you might see that impacting them in terms of their own moods and their own needs and things like that, and that’s normal. Ages two to five, that’s when you can already start using the word death and dying and we recommend using those words, otherwise it can be very confusing. So for example, if you say grandma went to sleep and she is never going to wake up, that’s going to make a child maybe scared to go to sleep, right?
Nicholette Leanza:
Right. Right.
Jae Swanson:
Or even that she went to heaven. Well, why did she go to heaven? Why did she make that choice? Why can’t I go there with her? Why can’t she come back?
Nicholette Leanza:
Got you.
Jae Swanson:
So, being straightforward about grandmother died, her body stopped working. She cannot come back. And then, if you believe in heaven or have religious beliefs, then you can certainly use them. But that being the first thing you say can be confusing. Ages two to five, they’re going to have a harder time understanding the permanence of death. So kids that age are going to need a lot of reminders that the person isn’t coming back, and that can be really hard, especially if you’re also grieving the loss as an adult, or if you’re a therapist and you feel like you’re, this kid should know this by now and you’re working on it, but they just need a lot of reminders. And over time, as they see that the person’s not coming back, they’ll start to understand that. Ages six to nine, there’s more of an emerging understanding of death and what that means. Something that can come up around that age is fear about their other loved ones dying or their own self dying, so it’s beneficial if they can talk about those feelings.
Nicholette Leanza:
And that it’s normal for them to be feeling like that. I think normalizing that, I think sometimes kids bringing that up might make the caregivers around them get even more worried like, “Oh, my gosh.” And it’s to kind of reminder, that might be just a natural worry that they’re going to have. It’s a normal, typical worry.
Jae Swanson:
Exactly. Yeah. Very, very common. For kids ages nine to 12, that’s when they can really start to understand that death is final and irreversible. And then 13 and up, they’re going to be thinking more about future implications of the death. So thinking about they’re not going to be at my wedding or my graduation, things like that. And in starting around age nine and up, you start to see kids maybe even thinking about it somehow their fault. And again, normal and something that they need to be able to talk about so they can actually process through. And just again, constant reminders that not their fault, they don’t have that much power and talking about what actually happens so they can see that more tangibly. Other things to keep in mind as an adult, caregiver or even as a therapist, showing your own emotion about one dying is okay. In fact, it models an appropriate response to grief and kids can see if you are hiding your emotions and not expressing them and then get a message that’s what you’re supposed to do, right?
Jae Swanson:
But as we all know, especially as clinicians, if we hold holding all those emotions in lead to problems in the future. And then, another thing is for caregivers and if we as therapists are counseling caregivers, offering kids choices around things like attending the funeral. Maybe participating in the funeral. If we’re approaching someone dying, do they want to see them? How much do they want to see them? When you’re talking about visiting, really being transparent about what that person looks like before that kid knows what they’re walking into and the kids can choose what they feel comfortable with. If a kid absolutely doesn’t want to attend a funeral, that’s okay. But most times they do. And sometimes parents think it’s protective or caregivers think it’s protective to not let them go to the funeral when actually sometimes that can lead to long time resentment.
Nicholette Leanza:
Right. I’ve worked with a lot of individuals who maybe when they’re younger was kept away from the funeral or just even allowed to speak about the person who had passed and how that still plays out, that it maybe even inhibited their own grieving process too. I think the more autonomy you can give kids to choose, do you want to go, do you not, do you want to see, do you want to go up and visit the body if it’s a showing things like that is so key that you’re bringing up for sure.
Jae Swanson:
Yeah, absolutely. And giving them a sense of some control over something in the process.
Nicholette Leanza:
Yeah, Right. For sure. Now you brought up some really great tips and how to start those conversations and have those conversations. So what about the actual navigating of the grief for kids and adolescents?
Jae Swanson:
Yeah. So again, not super different for adults and kids here. It takes time, sometimes a lot of time not pathologizing it, which the DSM has this new diagnosis that pathologizes grief a little bit which we have some conflict about that. One of the ways I started to think about how to help kids with grief is looking at a kid’s individual personality and looking at a kid and their tendency to be maybe more introverted or extroverted, because kids who are more extroverted will have more of a need to talk about it. And sometimes, maybe a lot. And sometimes adults feel like they’re making other people uncomfortable, but it’s actually, it’s good for them. They need to talk about it. And in talking about it, they’re normalizing talking about it for everyone, but more introverted kids might not want to talk about it as much. And they might benefit more from things like journaling or doing art about it, or listening to music, making playlists that maybe help them emote or help them think about the person. But in all regards, kids need opportunities to talk about it. So even if you have an introverted kid that you’re working with, letting them know constantly that you are there for them, that they can ask you questions, that they can tell you how they’re feeling, that you want to care for them.
Jae Swanson:
For introverted and extroverted kids, things like art drawing memories of the people and talking about them can be really nice, especially if a person was sick for a really long time, helping them remember before they were sick again or things like creating, taking a shoebox and decorating it in honor of the person and then that’s a memory box for the future. Music can be really helpful. Maybe writing songs about the person. Again, having playlists about different things that maybe that person’s favorite music, or again, a playlist that you want to listen to when you’re feeling sad about the person, a playlist you want to listen to if you actually want to bring yourself out of sadness.
Nicholette Leanza:
Yeah. I like the idea of different playlists. That’s actually really great idea.
Jae Swanson:
Yeah. And kids who are musically inclined really benefit from that stuff. My music therapy background, I would do a lot of music improvisation with kids and have them play out their feelings or even play a story out about the person writing journaling, writing stories about the person, things that are physical.
Jae Swanson:
So kids that are feeling a lot of anger about the person might feel you might start to see that show up and maybe they’re fighting kids at school. So getting them other physical release forms of relief. So, I’ve had some kids and teens end up taking up boxing and it being super helpful. Kids who are dancers, dancing it out. And I feel like physical movement is a sideways way to get emotions out and we want to help them have awareness of that is happening and how it’s happening and why and it’s such a healthy way to get stuff out. And even things like sports can be really helpful for people. Different types of memorializing. So the memory box is an example, creating a picture. So having a picture of the person and decorating a picture frame around it. Helping them figure out ways that they might want to memorialize on special days, so maybe the anniversary of the death or the person’s birthday or the kid’s birthday. They might want to bring the person into their birthday and in their own way or they might not. That’s okay.
Jae Swanson:
I can’t say enough. Normalizing, normalizing, normalizing, never minimizing. Helping kids understand that grief is going to kind of come and go probably for a long time. I did work with a lot of kids who had this narrative in their head that they should get over it. Sometimes after two months and helping them release that narrative because all that’s going to do is make them feel bad about themselves for continuing to grieve. And then peer support is really important. In Philadelphia, we have a few different resources for peer groups, for kids who have lost people. Unfortunately we have such a high rate of gun violence here that we have groups for kids who have lost people through gun violence. There are overnight summer camps for grieving use, most of which are free. So encouraging those opportunities and connecting kids to that kind of thing. One of the hardest things about being a kid that’s grieving is that they often don’t know a lot of other kids who have been through something like this. So connecting them to other kids who can be incredibly helpful.
Nicholette Leanza:
Oh, I would imagine so just how lonely could feel to think that you’re the only one to be able to connect with other kids who maybe experienced very similar feelings about who they lost and stuff. I agree.
Jae Swanson:
Exactly.
Nicholette Leanza:
Shifting gears just a little bit, let’s talk about how grief might manifest in different cultural communities.
Jae Swanson:
Yeah. So I think about this a lot in terms of cultural humility. I’m a white person. I live in Philadelphia, which is, I guess they don’t say it’s a majority Black city because it’s not over 50%, but there are more Black people than white people or Asian people or Latinx people in this city. And therefore that meant when I was working with kids in Philadelphia, I was working with about 95% Black family. So it was really important that I put my own stuff in check that I was really aware of my own stuff. And that includes how I grieve and how do I think it’s normal to grieve so I can speak for my own. I grew up in the Midwest and in the Midwest, Midwestern white people. I don’t want to make a big, too big of a sweeping stereotype, but my family, we cover it and we keep it quiet and we keep it internal.
Jae Swanson:
And so I don’t really accept that anymore, but it might be harder for me. It is still sometimes harder for me to see people who are grieving really loudly in my mind. Especially when I was in hospice and working literally at people’s death beds, I would see a lot of white nurses, for example, feeling uncomfortable with big emotions coming out, which is sometimes maybe more common with people who are not white because that idea of keeping things to yourself and keeping things inside is part of whiteness and part of white culture, right?
Jae Swanson:
One of those pretty unhealthy in my opinion, parts of white culture culture. So I’d like to look at it from that lens rather than say that certain cultures that people grieve in certain ways, because nobody’s a monolith. So the most important thing is that you’re keeping… you’re aware of your own stuff so you can refrain from judgment and you’ll know if something is not okay, it’s going to be pretty obvious if that’s true. So, I think a lot about completely trying to avoid any assumptions, right? If you think what’s going to happen when you walk into the situation, especially if you’re walking into a family whose culture is not yours, you don’t know what’s going to happen, you don’t. And you got to put that stuff away before you walk in the door. And I also like to think about how culture will impact grief, but it’s not going to define grief, right?
Nicholette Leanza:
I like that. Mm-hmm.
Jae Swanson:
So the ways in which it might impact grief is different rituals that people will have because of their religions, for example. Different ways of memorializing people, different beliefs, about what happens when you die. Like I said before, different ways of emoting which is across all human beings. And then a couple of terms that I wasn’t taught in school. I learned them later, but there are different types of grief that can show up more commonly in marginalized communities. One of those is called disenfranchised grief, which is defined as grief that society is denying you. So, an example of that in my experience from working with kids, like I said in Philadelphia, we had such a horribly high rate of gun violence and unfortunately impacts Black communities quite a bit.
Jae Swanson:
And I worked with a teenager who lost her friend to gun violence and she was grieving him really hard and she was keeping it to herself because at school, this teenager who was killed was being seen as someone who chose this life for himself and was of the streets and he got what was coming for him. And those are the words from that. She said being said to her by other people. So she was being denied the right to really grieve him. And it was really important that I provide a really open contained space for her to feel like she could do that safely.
Jae Swanson:
And then another one is ambiguous loss and that’s grieving someone who actually is not dead, but maybe they’ve left your life. That’s something that I feel like can be very common in the LGBTQ community, for example. Your parent who doesn’t accept you because you’re somewhere in the LGBTQ spectrum. And while you’re angry at them, and maybe you have made the final choice to be to strange from them, you also are going to experience grief for the loss of them. And for the fact that they cannot understand you, which maybe we might not go to grief therapy for that, but we could. Yeah. Yeah. Or even a breakup, a really bad breakup. If the person is dead, but you might never see them for ever again or for a very long time.
Nicholette Leanza:
It’s part of the lost of even the relationship, right?
Jae Swanson:
Exactly. Exactly. Yeah.
Nicholette Leanza:
I hear you. Any other takeaways you’d like to share when it comes to helping kids with grief?
Jae Swanson:
I guess, I just wanted to share, I got to do grief work with kids before COVID then during the major part of COVID and then as we’ve been changing our attitude towards things, and it was interesting to see how our culture shifted a little bit during that time because we can’t avoid talking about death when we had a million people dying of COVID in our country. There was much more of a need for bereavement during that time in Philly. And I was hopeful that there might be a little bit more of a culture shift towards us talking more about death in a public mainstream way and talking about grief in a more public mainstream way, and I think that’s happened not maybe it with now pretend everything’s normal and maybe that’s the metaphor for how we to avoid death in US society, but it’s just been interesting to see and the need for grief and loss counseling right now across the board is very high.
Nicholette Leanza:
Yeah, I agree. I agree. 100%. Which again, I’m appreciative of this conversation we’re having Jae and you really shared with us a lot of additional knowledge about helping kids navigate. Just talking about death and dying and then how to help them navigate the grieving process. Again, so important to have these conversations and just having the conversations in general, more out there within our cultures too.
Jae Swanson:
Exactly.
Nicholette Leanza:
So, I appreciate exactly this conversation. So, thank you again. Love to have you back on sometime.
Jae Swanson:
Yeah. Thank you so much for having me. I enjoyed it.
