Children who suffer from grief or trauma related to the loss of a loved person experience various ways in which they manifest their pain. While some may experience posttraumatic stress disorder (PTSD), others may be resilient to the pain or may develop an avoidance behavior, sidestepping over everything that reminds them of the death of a loved one or the traumatic experience associated with such an event (Cohen & Manarino, 2004).
The treatments for the children who suffer from grief and trauma are varied. This report will focus on group therapy as a treatment for children who experience grief and trauma. One group treatment approach, developed by Layne, Pynoos et al. (2001) was conducted in a school setting, wherein Bosnian children aged 15-19 years old coped with the reminders of civil war experience through five treatment modules that included “ traumatic experiences, reminders of trauma and loss, bereavement and the interplay of trauma and grief, posttrauma adversity, and developmental progression”) (Cohen & Manarino, 2004, p. 822). The results of this study indicated that children who receive a five treatment module achieved improved results in resolving the child traumatic grief compared to the ones who only received trauma-focused treatment modules (Cohen & Manarino, 2004).
Group treatment for coping with grief and traumatic events is found to be more effective for adolescents. Young children are still highly dependent on their parents or caregivers, and they need to be joined by an adult in the treatment process, because they feel safer and more comfortable (The National Child Traumatic Stress Network (NCTSN), 2005).
Cohen and Manarino (2004) indicate that the group trauma and grief – focused interventions that are provided in schools are mostly effective for reducing the childhood traumatic grief and the posttraumatic stress disorder symptoms for teenagers exposed to war related events and community violence. A study conducted by Pat-Horenczyk and Gelfopf (2007 in Cohen, 2008), confirmed the fact that school based group treatments deliver reduced posttraumatic stress disorder and related symptoms for children exposed to terrorist attacks. The authors recommend this therapy module as a public mental help approach for dealing with children in the countries exposed to war and terrorism (Pat-Horenczyk and Gelfopf, 2007 in Cohen, 2008).
The benefits of group therapy for the participants suffering from grief or a traumatic event include the normalization of emotions shared through direct interaction and face to face feedback NCTSN, 2005). Group interaction allows exposure to other members’ experiences, the opportunity to talk about the pain, to receive constructive feedback, peer support and mutual understanding (NCTSN, 2005).
Klein and Schermer (2000) note that in the case of children experiencing grief and traumatic events there are two categories that need to be treated differently:
(1) the acute interventional debriefing groups (wherein therapy starts immediately after a disaster);
(2) support groups that offer consistent therapy for months or years after a disaster.
Cohen and Manarino (2004) underline the main effect of group therapy programs, namely reducing the posttraumatic stress and desensitizing the children who suffer from grief or trauma from their traumatic memories. However, Klein and Schermer (2000) indicate that in the case of children suffering from disasters the aim of the group therapy is not to address the early trauma or resolving the neurotic conflict, but rather to alleviate the suffering to improve functioning. In another study, Cohen, Mannarino and Deblinger (2012) indicate that the treatment for the children who suffered traumatic events begins with psychoeducation, provided in a school setting, meant to assess the children’s experience with a traumatic event they suffered and to deliver the treatment.
Another component of group therapy sessions for children who require treatment at the cause of grief and trauma is represented by the relaxation and stress management techniques. Participants learn to breath, to relax their muscle and interact in discussions related to other issues, such as sports, music, arts, for reducing their stress levels and for attaining relaxation (Cohen, Mannarino & Deblinger, 2012).
Cohen and Mannarino (2004) observe the positive effects that group therapy provided on the school setting generates for the participant students: improvement of the participants’ grades, a significant increase of the adaptive functioning or decrease of traumatic grief symptoms.
The National Child Traumatic Stress Network (2005) points that the group therapy is also beneficial for the participant children because it increases their self-confidence, their self-esteem, self-concept and it improves their interpersonal skills. These outcomes occur because children become involved in helping other participants who experience similar trauma or grief (NCTSN, 2005).
In relation to the interaction that appears among participants within a group therapy, Klein and Schermer (2000) suggest that the healing process starts when participants hear others talk about problems, emotions, fears or pain that they also experience. This experience makes them feel less isolated, less strange and more connected, identifying themselves with the group (Schermer, 2000). In a more advanced phase of the group therapy, the participants are introduced to narrative trauma, wherein they share their traumatic experiences individually with the therapist, allowing each participant time and privacy for developing their trauma narrative (Cohen, Mannarino & Deblinger, 2012).
However, Cohen, Mannarino and Deblinger (2012) observe that for children, it is rather complicated to express emotions, especially when they do not know the other participants, fearing that they will be ridiculed. For such situations, it is the group facilitator’s responsibility to engage the participants in a discussion for sharing their feelings about their grief and trauma, allowing others to identify with the exposed emotions (Cohen, Mannarino and Deblinger, 2012).
The member support is evident in the cognitive coping skill phase also. The participants learn to discern thoughts from behaviors and understand how their thoughts and feelings influence their behaviors (Cohen, Mannarino & Deblinger, 2012). With the help of their peers, they eliminate the unproductive and inaccurate thoughts, for learning how to manage the trauma induced thoughts (Cohen, Mannarino & Deblinger, 2012). The NCTSN (2005) study states that while the skills of the group therapist are significant for conducting a group therapy for children suffering from grief or trauma, the most important aspect is the interaction between the participants. Group interaction influences participants to achieve change through personal commitment in each other’s experiences. However, it is the facilitator’s role to enhance the interaction, and this can be challenging for two reasons:
(1) because they deal with children who suffer a traumatic event and are confused about what they feel and reluctant to discussing their problems with others;
(2) because the children who receive group treatment for grief or trauma are at the adolescence age, when they face various personality changes.
For this reasons, it is important that the therapy group coordinator should be aware of the child’s psychology, but also that he or she should understand the group dynamics, in order to form and develop groups that will deliver curative effects (Klein and Schermer, 2000).
Cohen, J. A. & Mannarino, A. P. (2004) Treatment of childhood traumatic grief. Journal of Clinical Child and Adolescent Psychology. Vol. 33, no. 4, pp. 819-831.
Cohen, J. A. (2008) Treating PTSD and related symptoms in children research highlights. PTSD Research Quarterly. Vol. 19, no. 2, pp. 1-8.
Cohen, J. A., Mannarino, A. P. & Deblinger, E. (2012) Trauma-focused CBT for children and adolescents: treatment applications. New York: The Guilford Press.
Klein, R. H. & Schermer, V. L. (2000) Group Psychotherapy for psychological trauma. New York: The Guilford Press.
The National Child Traumatic Stress Network (2005) The courage to remember. Los Angeles: NCTSN.