Seasons change, but what about my grief?

There can be a lot of emphasis on special occasions – anniversaries, birthdays, holidays, etc. when it comes to events that influence grief. Seasons and other markers of time can exert a similar effect, but can be confusing for those who are grieving – and those who support them. With an anniversary or a birthday, there’s a specific day to connect with an uptick in distress, but with a season, it can be harder to pinpoint. In this episode we talk about seasonal influences on grief and things to think about when navigating those changes. We highlight the approach of spring and how it can be particularly challenging time for those who are grieving. We also share ideas for ways to cope with the shift of seasons. 

If you are grieving, it can be helpful to think through:

• What are the associations you have with this season and the person who died? 
• What role did the person who died play in your life during this season?
• What traditions do you want to keep? What new ones do you want to make?

If you are in a support role, be aware of the events in each season that can be challenging for those who are grieving. 

Spring – 

• In the frenzy of excitement and high energy enthusiasm, grieving people can feel left behind, not wanting to bring other people down. 
• Being surrounded by the growth and change in the natural world can intensify a longing for grief to change. On the other hand, the march of time can be difficult as grievers worry they are leaving the person or their memory behind.  
• Season of school graduations. 

Summer – 

• Time of outdoor activities and family vacations. 
• With children out of school it can be a stressful time for solo parents and children too.  
• Tends to be the season of weddings. 

Fall – 

• Darkening days, Halloween and all the imagery of death and ghosts.
• The sounds and smells of the end of something. 
• Thanksgiving. 

Winter – 

• Winter holidays emphasis on family.  
• Hunkering down in the weather can make it difficult to connect with others. 
• Here in Portland, there can be solidarity in complaining about the weather and the ill effects of never seeing the sun. 

What helps?

1. Sometimes just knowing this is a common experience can bring relief. 
2. If you know someone who is grieving, ask them how the change of seasons is for them. Remember to avoid platitudes meant to reassure. 
3. If you’re caring for a grieving child or teen, open up a conversation about seasonal memories. Are there events or trips or other special parts of the season that your child is worried about missing or wants to skip?
4. Look over your calendar, take note of any dates associated with particular memories, and make a plan for what you want to do during the lead up or actual day/week. Often our bodies remember before our brains catch up, so can help decrease confusion by making it visible. 
5. Connect with others who are grieving, solace in community.
6. For kids/teens, the I Remember poem can be a good activity. Kids get to think of a memory or memories they have of the person in each season.  In the summer I remember… In the fall I remember… In the winter I remember… In the Spring I remember…
7. Think of what you enjoyed in the past, or what you would like to explore that connects to each season. Gardening, hiking trip, book club, class…etc.
8. Love music? Create a playlist for the approaching season. Can be something to turn to in times when you feel lost/untethered. 
9. Take advantage of the thaw to move – not your house (unless that’s what is happening). Move your body. Can be anything from a quick walk, to biking, to running to playing Frisbee in the park. Physical exercise is vital to taking care of your mental, emotional, and physical self. 

"The language we use to describe events not only reflects our own attitudes but influences those attitudes as well as the attitudes of others."

--Sommer-Rotenberg, D.

Donna Schuurman, Senior Director of Advocacy and Training at The Dougy Center discusses some of the difficulties of language and stigma surrounding deaths by suicide.

Living with an advanced serious illness

All in all, even under the best circumstances where families have substantial financial resources and savings, great medical and life insurances, medical knowledge,  access to great health care and multiple caregivers, an articulated living will or end of life directives,  and emotional/spiritual support, it will be an extremely challenging and life altering experience.

Challenges and complexities

This is not an all inclusive list, but meant to highlight only a few of the challenges:

• High Anxiety: Research has shown that children with an immediate family member who is dying have extremely high levels of anxiety and for good reason, death is ever present; Anxiety can be manifested in many forms; restlessness, “acting out,” anger, irritability, stomach aches,  nausea,  in-attention,  “on edge,” emotional distancing or clinginess to name a few.

• High Stress: Family members may respond to the stress with big energy and little energy or varying between the two extremes. They will also be trying to cope with the stress in various ways, sometimes those ways will conflict with each other.

• Exhaustion: There is usually complete emotional, physical, mental, social, and spiritual exhaustion.

• Role Conflicts: The demands of the illness almost always creates role conflicts for each family member whether that is between  the role as a spouse or the role of a parent, spouse or caregiver, son/daughter pr caregiver, employee or family member;  teen/kid or child. This is one of the greatest contributors of stress.

• Financial Setbacks: Loss of income and increased medical expenses & secondary care expenses usually confront most families.

• Relationship Issues:  Life with an illness usually demands drastic changes in where one can spend time and invest energy. Maneuvering through social, professional, and familial relationship can be a challenge, even in a supportive environment.

• Ethical Dilemmas: Most families will be confronted to make decisions that they never thought they would have to make or having to decide between options that are not favorable or agreeable. There may be differences of opinion within the immediate family. In addition,  many others will offer unsolicited advice when those dilemmas arise.

So what can a family do?

• Keep open, honest, and clear communication in all directions. This includes between adults but also between adult caregivers and children. Most often adults refrain from sharing the truth with children because of our own fears rather than because of their lack of ability to handle the truth. As long as we are sincere, open to answering questions, repeatedly at times, and keep it to their age level, the long-term benefits of sharing the truth far outweigh the immediate benefits of concealing information or misrepresenting the truth.  Never lie to a child.

• Communicate often.  Share what you know as you know it, even if that means you need to share that you don’t know anything.  You build trust with children when you communicate often about what it is going on and what you do know.

• Give children tasks and responsibilities to reduce feelings of helplessness. No one likes to feel helpless, even kids. Soliciting their help and offering choices to help care for the person with the illness can help foster a sense of empowerment.

• Provide structure and routine. Children and adults both need routine, especially in the midst of the chaos that so often ensues around medical issues. Provide as much structure as you can.

• Leave room to be a kid/teen. The person who is dying is important, but they are one aspect of the child’s and/or teen’s life. Children need opportunities to play, have fun, be loud, and enjoy the company of other children. Teens also need opportunities for independence and socializing with other teens.

• Role model being ok with not knowing. There will be a lot of unknowns.  Children need to see that it is ok not to know everything but still have confidence that something can be done, whatever that something may be.

• Advocate for your child, your partner, and yourself. Unfortunately, the medical system is not entirely person-centered. Furthermore, our society doesn’t handle death, dying, and grief issues well. Therefore, you may have to step outside your comfort zone and speak up for what you and your family may need.

• Acknowledge and validate emotions including guilt, fear, and anger. There will be many thoughts and emotions that each family member will experience at differing levels and at various times. All of them are normal and ok!

• Forgive.  Families are not perfect. When we are in relationships with others, we are bound to disappoint and be disappointed. Acknowledging your human limitations and giving yourself permission to not just disappoint others but also yourself at times, can address some of the guilt one might experience.  

• Anticipate future needs/wants. If it is possible, this would include preserving conversations between the person who is dying and the surviving family member and keeping memorabilia.  If it is a parent who is dying this could include writing letters of memories or videotaping advice for future milestones and events.

• Finally, find allies and peers. This might mean finding new people or touching base with people you might otherwise may not know, but surrounding yourself and the children in your care with people who understand and empathize with your situation, can be the best medicine we can think of! If there was something else, we do be pursuing that.

What can someone else do who wants to support a family that has someone dying?

• Be open.  Take a posture of listening without trying to fix, judge, rescue, minimize, advise, or silver line.  If one can do this, and do it well, it will go along way in changing a family’s experience.

• Take your cue from the family; Each family is unique and each family member is unique and what works in one situation may not work in another. So what may have helped you may not help someone else, so be open to doing or being whatever the family might need at the time.

• Only offer your advice/opinion if it is asked for. As much as we might want to share with the family our thoughts and opinions, that is not what most families need or want. We may be disappointed if they don’t ask us, but we should leave the opportunity to ask, rather than for us to share.

• Offer to help with specific tasks. Offering to transport family members, mow the lawn, care give, or go out for a cup of coffee are great tangible ways to say I care.  

• Don’t have any strings attached when you do offer support or communicate your care. Be flexible and patient. If you are not taken up on your offer or responded to, wait a few weeks and reach out again.  A simple “ I am thinking of you” communicates a lot without any added burden or pressure for the family to respond.

• Provide opportunities for respite and normalcy. Restaurant gift cards, coffee breaks, watching a movie/ sports, etc… whatever the family interests were before the illness will be a challenge to do in the midst of the illness. Providing opportunities to reconnect back to those things, however creative it might have to be,  are generally appreciated.

For more information about our Pathways Program or how to support a family with an advanced serious illness, please contact us pathways@dougy.org

Understanding And Supporting The Grieving Teen

If you know a teen who is grieving a death, you may wonder what responses or behaviors you can expect to see and how to help.

Grief is a holistic experience

Grief can affect teens in many different ways: emotionally, behaviorally, cognitively, physically, and spiritually. The following are examples of how grief might look in these realms. Keep in mind that this list is just a sample of the indicators: 

Emotional: Every emotion imaginable can be associated with grief. The most common ones include sadness, anger, confusion, fear, agitation, depression, relief, apathy, joy, restless, guilt, regret, irritability, yearning, increased appreciation, and gratitude. 

Behavioral: Dropping activities/hobbies, difficulty sleeping, clingy behavior, regressions, aggression, withdrawal, nightmares, diminished/increased performance at work or school, decrease/increase in social engagement, substance use, over-planning/scheduling of activities.

Cognitive: Difficulty concentrating/confused thinking, forgetfulness, difficulty completing tasks, memory loss, narrowed scope of thinking, intrusive/repetitive thoughts, easily overwhelmed.

Physical: Loss of appetite, weight loss/gain, increased frequency of colds/flu, stomachaches, headaches, and nausea.

Spiritual: Questioning or loss of faith, anger at God or other higher power, strengthening of faith, questioning values, rethinking the meaning of life and/purpose. 

So what does this look like in day to day life?

• Grief can make everyone forgetful. Teens may need extra reminders about chores and plans. 
• School can become very challenging. Engage with teachers and administrators to help support teens. 
• Teens may be less able to modulate their emotions and have more frequent outbursts and easily feel overwhelmed.
• Some may grow distant, turning more to peers for support.
• May see swings of maturity as teens move between feeling like a six-year-old one minute and then speaking with the wisdom of an elder the next.
• Push/pull of emotional availability. They may want hugs one moment and then retreat to their room the next.
• Teens can take on additional fears and concern about how the family is doing in terms of financial security. May have questions about their future based on these changes.
• Strong feelings of wanting to feel and be seen as a normal teen. “I don’t want to just be that kid whose dad died.”
• Dislike sympathy, but appreciate acknowledgment of what has happened. 

Needs of Grieving Teens and Ways to Support Them

1. Assurances: Grieving teens need supportive and available adults in their lives. Reassure them that grief is unique and that there is no one right way to grief. Knowing that grief isn’t something they have to “get over,” but that it will change over time, can also be comforting. 
2. Boundaries: Reasonable and consistent boundaries provide safety and support during a time of disorienting change.
3. Choices: Teens are empowered when they have options and their choices are honored and respected.
4. Food, water, and sleep: Grieving takes a lot of energy, so it is important for teens to have nutritious food, hydrating drinks, and enough sleep.
5. Listeners: Not knowing what to say can leave us filling in the blanks with advice and words designed to make teens feel better. Practice listening and asking questions, allowing teens to talk and be heard. 
6. Models: Teens look to the adults in their lives to provide examples for how to grieve and express their emotions. Molly story
7. Privacy: Much of the grieving process is private including reflection, emotion, evaluation, and memorializing. Kelina story
8. Recreation: Grieving teens need “breaks” and chances to play, laugh, and be active. More than just their death. 
9. Routines: These create consistency so that teens do not have to constantly worry about what will happen next. Remember also to be flexible about your expectations.
10. Truth: Grieving teens appreciate truthful information related to the death and potential changes in their lives.

For more info, see our guidebook, Helping Teens Cope with Death, or the DVD Helping Teens Cope with Death.

Where did everyone go? How grief affects connections with family and friends. 

This episode grew out of a few questions from the community – 

1. Why is it common for communication to either lessen with family/close friends or strengthen after a mutual loss?
2. Why is it easier to connect with strangers?
3. In my family we don't talk about the person - How do I know if I can bring it up? How do I bring it up?

Grief affects our connections with others in many ways. Loss can foster a greater closeness with family and friends and it can also wreak havoc on existing relationships, leaving people unsure and disappointed. Many factors contribute to changes in relationships, particularly the role that the person who died played in your family and friend constellation. For some grieving people, especially children and teens, it can feel more comfortable talking with those they aren’t close to, including those who didn’t know the person who died. 

Suggestions for ways to make it easier to talk about the person who died in your family: 

• Let people know that you want to talk about the person. 
• Reassure them that talking about the person is helpful, even if you get emotional. 
• Provide suggestions for responses that you find helpful and those you don’t: “I like when people use his name. I don’t like when people tell me not to feel guilty.”
• Start a conversation about creating a ritual at family gatherings to include the person who died. 
• Examples include: set a chair or plate at the table for the person, invite people to bring favorite photos and create a family photo board, take videos of family members sharing memories of the person. 

Valentine's Day is one of the many holidays that shift and change while grieving. As with so many other holidays, the lead-up can be really hard. Advertisements and casual conversations about plans can leave grieving people left out, or eager to flee.

In this episode of Grief Out Loud, Jana and Brendon talk about strategies for approaching Valentine's Day in a way that opens up space to express love and appreciation.

Some ideas mentioned in this episode:

• Decide on what traditions you and/or your children want to uphold and then figure out who will be responsible for what.
• Connect with others you find to be supportive - this might look like setting up a phone call, email chat,  or getting together for dinner.
• Schedule some self-care that feels replenishing: go for a hike,  check out a new movie, take a yoga class, meet up with friends,  journal, or cook a nourishing meal.
• Ask your kids what helps them feel energized or calm - we sometimes forget that kids need self-care too.
• Volunteer for an organization or event that is meaningful to you.
• Send cards, flowers, or an email to friends and family who might also be going through a hard time.
• If it feels right, create a ritual or activity connected to the person who died. Ideas include, make a meal they enjoyed, go to their favorite restaurant, make or buy a card for them.
• Many kids like to bring something - card, flowers, balloons, to the grave site. If there isn't one, you could put them where you keep the ashes or visit the place where the ashes were spread. Or if that's not possible, display an image of that place.
• Write a card or letter to the person who died. You might write about: events you want them to know about (your son's first soccer game, a promotion at work, a description of a sunrise you recently saw, etc), things you are grateful to them for,  ways in which you and your family have grown or changed, or anything that comes to mind. You can keep, bury, or burn what you write.

Whatever you decide, go easy on yourself. There can be so much pressure, both internal and external to think or feel a certain way. Know that it's okay to feel whatever you feel (sadness, anger, numbness, irritation, etc), leading up to and on the actual day.

Alternatives to “I’m sorry for your loss.”

This episode delves into that moment when you find out about a death. Most of us don’t know what to say or do, so we go turn to what we’ve heard others say in a similar situation, “I’m sorry for your loss.” While there’s nothing wrong with those words, especially when said with authenticity and full presence, it’s helpful to know how that phrase affects those who are grieving and what you can say instead. Whether it’s getting a phone call with the news, writing out a sympathy card, or learning about a loss during a casual conversation, everyone encounters the dilemma of what to say and how to communicate we care.

Alternatives

• “I was so sad when I heard the news about your mom’s death.”

• With children and teens, they appreciate an honest: “That totally sucks.”

• If you do go with “I’m sorry” expanding it to “I’m so sorry you have to go through this,” or “I’m so sorry this is happening.” can break up the monotony of “I’m sorry for your loss.”

If you’re talking with someone, try reflecting back what they’ve said, allowing them to say more:

• “Your dad just died last night.”

• “Today’s the anniversary of your sister’s death.”

When writing a sympathy card or email:

• Consider sharing a specific memory of the person who died: “I remember so clearly your mom’s smile, it made me feel so welcome.”

• “There are no good words, just want you to know you are on my mind and in my heart.” can acknowledge that words don’t always measure up in times of grief.

“How do I tell my child about the death?” This is the most common question we receive at The Dougy Center. Someone has died, leaving parents and other adult caregivers to struggle with finding the right words to say to their children. In this episode, we outline tips for talking with children about a death. Adults can start by attending to their own reactions to the death. Often the thoughts and feelings they experience can impede or enhance having an open, honest, supportive conversation with their children. As an adult, what do you need to sort out with feeling shame, blame, confusion, guilt, or other emotions related to how the person died? How can you keep that as your story and not put it onto your children?

Summary of tips for talking with children:

• Tell the truth
• Use concrete, age-appropriate language
• Allow for questions - in the moment and over time
• Be prepared to tell the story over and over, esp to younger kids
• Refer to The Dougy Center resources (below)
• Know that you are providing children with a safe, trusting foundation from which to experience their grief 

Bookstore: http://tdcbookstore.org

Tip sheets: http://www.dougy.org/grief-resources/tip-sheets/

Main site: http://dougy.org

In this episode, Jana and Brendon, answer two questions from the community. The first is from a mother of two young children who wonders what she can do with the ashes of her partner. The second from a young adult struggling with whether they should go to the funeral of a close friend’s mother. In this frank conversation, we discuss common and not so common options for what to do with ashes and outline some foundational questions to consider, both for adults and children when deciding.  

Two resources with ideas for what to do with the ashes of someone who dies:

• A long list of options for ashes from Mental Floss
• Another list of 27 options for ashes from Urns Online

In this episode of Grief Out Loud, Jana and Brendon discuss some of the current mythology surrounding grief timelines. We demystify the idea that there is a recipe for grieving or one right way to go about integrating a loss. Listen to learn new ways of conceptualizing the unfolding of grief. During the discussion, Jana mentioned a couple of relevant resources:

1. Getting Grief Right, a NYT Opinionator article about grief timelines and "stages of grief"
2. 5 Stages of Grief overview, which Jana noted is a familiar cultural landmark, but not a framework that The Dougy Center endorses for those who are grieving. While each of the stages involves thoughts and feelings that grievers may experience, it’s not a clear-cut linear process. Thinking that we need to achieve certain stages in order to grieve correctly can often create more suffering for those in grief.

In this inaugural episode of the Grief Out Loud Podcast, Jana and Brendon introduce themselves, talk about the history of The Dougy Center, and our work with grieving children and their families. Jana and Brendon also do a little housekeeping with respect to episode timing (weekly) and duration (aiming for 15-20 minutes), as well as what TDC can offer to the podcast community.

Resources mentioned in the show:

1. The Dougy Center for Grieving Children and Families