III. Preparation of the Caregiver

This section is not designed as a primer on grief and trauma reactions. It is expected that caregivers who are working with children will have basic education and training on grief and trauma issues. Rather, the section is included in this guidebook to assist caregivers in clarifying their own responses to grief and trauma.

A. Grief and Loss

Most adults have lived through the death of someone they know. They realize the shock of recognition that they will never see that person again and often have endured disturbing thoughts concerning the dying process. But many consciously put aside their sorrow in order to "go on" with life and to maintain everyday functioning. As a result, many adults carry with them the pain of unresolved grief. Such grief may erupt unexpectedly when an individual is exposed to situations that remind him or her of the death and the loss. Even when individuals have made an effort to confront past deaths and actively mourn their losses, potent memories may be resurrected when they encounter other deaths. It is both unrealistic and undesirable to try to extinguish such memories and their consequences. The wisdom of Deitrich Bonhoeffer is compelling on this point --

"Nothing can make up for the absence of someone whom we love, and it would be wrong to try to find a substitute; we must simply hold out and see it through. That sounds very hard at first, but at the same time it is a great consolation, for the gap, as long as it remains unfilled, preserves the bonds between us. It is nonsense to say that God fill the gap; he does not fill it, but on the contrary, he keeps it empty and so helps us to keep alive our former communion with each other, even at the cost of pain."

Caregivers should take the time and effort to explore their own losses and the consequent grief in order to be able to control possible intrusive recollections which may interfere with their ability to be helpful to those they are trying to help in the present. To facilitate thi exploration, the following process may be useful. The process can be used with caregivers in training as a group or by individual caregivers in private. Caregivers should try to put their thoughts or memories into verbal or written responses because it helps give concrete form to their emotions and reactions.

1. Remember at least one of the most significant deaths in your lifetime. [It is useful for caregivers to identify all significant deaths they have survived, if they remember more than one.] With each death, try to:

a. Remember where you were when you were notified of the death. Describe the place.

b. Remember how you were told or how you learned of the death. Describe the words you read or heard.

c. Remember reactions you had when you learned of the death. Describe those reactions.

d. Remember what you and others did in the first twenty-four hours after you learned of the death. Try to develop a chronology of what happened. Describe any particularly powerful memories and the impact of those events.

e. Remember what you did from the time of notification until the funeral, burial or memorial service. Try to develop a chronology of what happened. Describe any particularly powerful memories and the impact of those events.

f. Remember what has happened since the death and how that death affects your life today.

2. As you think or talk about your memories, ask yourself how those memories relate to what is known as a common pattern of grief.

a. Denial -- Did you or others find the death hard to believe or accept?

b. Confusion and Protest -- Did you or others become angry about the death or try to argue about its reality? Did you or others become angry with what happened after the death? Did you or others feel anger at yourselves because of how or why the person died, or because of guilt or relief at the persons death?

c. Despair -- Was there a time when you or others were so sad that life didnt seem worth living?

d. Detachment -- Was it difficult to find energy to do things or to become emotionally involved with other people or current events in your life?

e. Integration or Resolution -- Do you remember a time when you realized that you could acknowledge what happened and knew that you were going to go on with life? Did you make changes in your attitudes, values, goals, behaviors, or lifestyle because of the persons death?

3. Describe ways you mourned for the deceased.

4. Identify thoughts, reactions, or feelings about the death that bother you now.

a. Are there regrets that you have about how the person died?

b. Are there regrets that you have about your relationship with the person at the time of death?

c. Did the death help to affirm or raise questions about beliefs you had about life and death before the person died?

5. Describe how the death of that person affects you today.

a. Possible negative effects.

Anxiety about your own death or the deaths of loved ones.

Fear for or over-protectiveness of your children.

Nightmares, thoughts or daydreams of death.

A sense that you or others will die soon.

Avoidance of death-related thoughts, images or rituals.

Withdrawal from relationships with others.

b. Possible positive effects.

A renewed sense of the meaning of life and its continuity.

Increased enjoyment of everyday life and experience.

A sense of connection with the deceased person.

Comforting memories.

Increased desire to become involved with others.

6. Describe your understanding of death -- your beliefs, concerns or fears.

7. Describe how you have planned for your own death.

8. Describe how your experience of death affects the way you live your everyday life today.

B. Trauma and Violence

"Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life."

-- Judith Herman

While most adults have experienced death in their lifetimes, many but not all adults have experienced a violent, traumatic event or series of events. Violent trauma ruptures an individuals psychic equilibrium and social environment. It fractures everyday existence and leaves the individual in a state of chaos and fear. It requires individuals to go beyond their normal resources to regain a sense of order and equilibrium and to restore value and meaning to their lives.

Caregivers who have experienced trauma may have sought help or found internal resources that gave them the strength to reconstruct their senses of safety, autonomy, trust, self-esteem, and ability to establish relationships with others. Caregivers who have not experienced trauma may yet have their lives tested. In either case, before caregivers begin to help trauma survivors, it is important to review their understanding of the impact of trauma and the processes of recovery. For those caregivers who have experienced trauma, it is also critical to identify vestiges of the traumatic experience that may interfere with their ability to provide care or non-judgmental support to victims.

The following exercise can be helpful in understanding and identifying trauma issues which may concern the caregiver. As indicated above, the exercise can be used with caregivers in training as a group or by individual caregivers in private. Caregivers should try to put their thoughts or memories into verbal or written responses because it helps give concrete form to their emotions and reactions.

1. Remember a violent event that was traumatic for you or someone you loved. As you remember, try to:

a. Describe where you were, who you were with, and what you remember seeing, hearing, smelling, touching, or doing in your immediate reaction to the trauma.

b. Describe what happened immediately following the traumatic event and your reactions and thoughts.

c. Develop a chronology of what happened and describe any particularly powerful memories and the impact of those events.

d. Describe what has happened since the trauma and how those events have affected your life today.

2. As you think or talk about your memories, ask yourself how those memories relate to what is known as a common pattern of trauma reactions.

a. Shock and disbelief -- Did you immediately understand what had happened? Did your sense of time change; e.g., did things seem to happen slowly or very quickly?

b. Anger -- Were you angry at what happened, who did it, people who came to help you, or others?

c. Fear -- Were you frightened? Did you fear for your life or the lives of others? Was there a particular point in time when you were most fearful? Was there a particular point in time when you believed you were safe again?

d. Confusion or frustration -- Did you become confused about what to do? Was there a period of time that went by when you didnt know what had happened, how it had happened or why it had happened?

e. Guilt or self-blame -- Was there ever a time when you thought that something you had done or hadnt done had contributed to the traumatic event? Did you ever worry that you had survived or been less injured than someone else?

f. Shame -- Did you ever think that somehow the event made you a bad or undesirable person? Did you ever think that someone else would think less of you for being traumatized?

g. Grief -- Were you very sad about what happened? Were you unhappy and sorrowful because of what you lost?

3. Describe ways that helped you get through everyday life.

4. Describe things you did or thoughts you had that helped you to begin to help others again.

5. Identify thoughts, reactions, or feelings about the trauma that bother you now.

a. Are there situations that you avoid or about which you have anxiety because they remind you of the trauma?

b. Are there people whom you avoid or about whom you have anxiety because they remind you of the trauma?

c. Are there times when the memories of the event are particularly difficult to live with?

6. Describe how the trauma affects you today.

7. Describe how the trauma affects your view of the future.

C. Alphabet of Positive Caregiver Attributes for

Working With Grieving Children

The following list of caregiver attributes and skills is presented alphabetically to help caregivers remember critical elements of supportive counseling for children.

A - Advocacy - The willingness to advocate on behalf of the best interest of the children throughout their trauma and grief.

B - Belief - The willingness to believe what children say and think.

C - Communication - The skills to communicate with children through expressive and verbal techniques in language appropriate to their ages.

D - Desire - The desire to learn from the children and their experiences and perceptions.

E - Empathy - The ability to recognize and sympathize with feelings of

children.

F - Feedback - The ability respond to children with validating reassurance.

G - Guidance - The ability to guide children as they clarify their thoughts

and concerns.

H - Honesty - The commitment to answer the questions of children as

honestly and factually as possible and never to make

promises that cant be kept.

I - Imagination - The ability to join in the fantasy and play of children.

J - Judgment - The ability to make good common sense decisions and to

judiciously solve problems that children may face.

K - Knowledge - The determination to seek new knowledge and information

about childhood trauma and grief.

L - Laughter - The capacity to express a sense of humor and join in the

laughter of children.

M - Memory - The ability to remember ones own childhood, traumas, and

griefs in order to better understand the reactions of children.

N - Non-judgmental - The ability to put biases, prejudices, and personal values aside in order to support children and their families.

O - Organization - The ability to prvide children with organized routines and structures to help them stabilize their world.

P - Patience - The capacity to be patient as children tend to grieve

sporadically.

Q - Quiet - The willingness to use silence as a method of communication

and to listen quietly and attentively.

R - Reliable - The commitment to being on time and true to your word to help

children rebuild their ability to trust.

S - Secure - To have self-esteem and a personal sense of security in order to

convey safety and security to children.

T - Thoughtful - The willingness to think through new situations and problems with a child-centered philosophy.

U - Understanding - The capacity to look at things and understand them both in a

broad context as well as in the narrow perspective of the

moment.

V - Values - A clear knowledge of ones own purpose in life and the

consequent values behind ones work.

W - Watchful - The ability to be attentive to the needs and reactions of

children.

X - XXX - The ability to know when children need physical comfort (hugs and kisses) and being comfortable with reaching out to children

physically (and knowing proper boundaries in providing physical comfort).

Y - Youthful - The maintenance of youthful attitudes and behaviors in response to suggestions and thoughts of children.

Z - Zest - A capacity for experiencing the zest of life with its joys and sorrows and most of all its hope!

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