|Recognizing Complicated Grief|
|Increased Risk of Substance Use and Abuse|
|Interventions to Consider|
The death of a child is an unfathomable loss that creates a personal, psychological, and often spiritual crisis for parents. Bereaved parents may feel a paralyzing sense of sadness, trauma, and emptiness that may continue for many years. The intensity of their grief and the high potential for isolation can place many bereaved parents at risk of coping through increased substance use or substance abuse.
Hospital and hospice social workers often find themselves working with parents of a dying child and then continuing to support the parents in bereavement. Social workers also may work with suddenly bereaved parents in the emergency room, in victim services, in support groups, or in private practice.
As medical technology advances has made so many advances over the past several decades and fewer children die from illness that would have been fatal in the 1960s, for example, it is all the more unexpected and shocking when when parents do lose their child. Their grief is more is all the more intense. And, unfortunately, they are less likely to receive the support they need for the duration of their bereavement.
Bereaved parents may suffer even more because many of us are very uncomfortable discussing death. Therefore, may parents have said they have felt isolated and lonely because they are not encouraged to talk about their lost child. Research has shown that grief over the loss of a child is more intense and and long-lasting compared to other types of bereavement (Field & Behrman, 2003).
The death of a child increases the chance of parents experiencing what has been called complicated grief. While “common grief” reactions may include sadness, depression, anxiety, somatic concerns, and feelings of hopelessness, complicated grief is best understood as an extreme version of grief. Grieving parents may have difficulty functioning. Bereaved parents may:
- Experience intrusive thoughts about their child
- Yearn for their child
- Search for their child
- Feel excessively lonely and without purpose since the death.
- Feel numb, detached, and have difficulty believing or acknowledging their child’s death.
- Feeling that life is empty or meaningless
- Feel that a part of themselves has died
- Have a shattered world view
- Exhibit harmful behaviors
- Feel excessively irritable, or bitter or angry about their child’s death
Factors that can make a parent’s grief worse include:
- Loss of the their identity and role as a parent
- Loss of sense of self
- Secondary losses such as loss of hopes and dreams,
- Loss of a potential future caretaker, loss of a sense of immortality, intensified affective responses, Lack of social support
- Frequent and intense reactions on the anniversary of their child’s death
When a child dies, parents often experience traumatic symptoms and intense grief reactions that place them at high risk for complicated grief and mourning. This grief response, coupled with a lack of support, can increase the risk that a parent may cope with the loss through increased substance use or abuse.
In addition to complicated grief responses, some parents may have other risk factors for substance abuse, such as family history of substance abuse, depression, anxiety, current use patterns, previous addiction history, or extreme isolation and lack of support. Any of these risk factors, coupled with the recent death of a child, may signal the need for additional support and possible treatment.
Social workers may encounter parents at any stage of their grief, including before the child has died in the case of life-threatening illness and sudden accidents. While there is no one correct way to help a parent whose child has died, social workers should keep certain considerations in mind.
In the aftermath of a death, especially that of a child, there is usually an outpouring of support to the family. However, as time passes, most parents report a steady decline in the amount and frequency of informal support they receive. Community and family members “move on” and expect, usually unrealistically, that the bereaved parent will do so as well. Many bereaved persons report that their needs for support increase in the second and third year, just as the support is dwindling. These parents may turn to social workers for support.
It is important that grieving parents receive support from a professional like a social worker. Social workers should acknowledge the loss and provide support for the bereaved parent’s feelings. This is especially important in light of the often isolating nature of parental bereavement.
Grief counseling for the loss may include a review of the child’s life, an exploration of the circumstances surrounding the death, and support for the secondary losses that have occurred as a result of the death. Social workers can encourage bereaved parents to elaborate on aspects of the death that were particularly troubling, especially if the death occurred suddenly or traumatically.
Most bereaved parents need to deal with the feeling that they should have somehow prevented the death of their child. Parents need to have their intense grief reactions normalized and supported.
Sometimes bereaved parents may come to a social worker with a concern unrelated to their grief, such as marital difficulties, job-related problems, parental struggles with surviving children, or substance use concerns. The first intervention should be a full loss history on the client, regardless of the presenting problem. If the parent is using or abusing substances, it is important for the social worker to treat or refer to treatment. Social workers should also identify peer support groups for bereaved parents.
The death of a child is a devastating life event that causes parents extreme distress emotionally, physically, and spiritually for many years. Such a loss puts parents at risk for substance use/abuse. Social workers should assess, treat, or refer any potential substance use and abuse problems for this vulnerable population. Social workers should also conduct comprehensive loss histories to identify bereaved parents who may be in need of counseling for complicated grieving.