Art Therapy With Children Experiencing Grief Research Proposal

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Art Therapy With Children Experiencing Grief

This work seeks to answer the question of: "What is the effectiveness of art therapy with children that are experiencing grief?

Art therapy is a form of therapy that was first utilized by the mental health profession in the decade of the 1930s. Presently, art therapy is practiced in various hospitals, public and community agencies, clinics, wellness centers, educational institutions, business and private practices alike and involves the "application of a variety of art modalities including drawing, painting and clay sculpture."(Natural Standard, 2008) This work will explore Art therapy for used with children who are experiencing grief and will examine the effectiveness of this type of therapy for children dealing with grief.

According to the work of Busch and Kimble (2001) "One out of every 20 American children under the age 15 loses one or both parents due to death. It is estimated that in a secondary school of 800 pupils, 24 children will experience the death of a family member. Death of a sibling profoundly affects children, and its repercussion can be with the child throughout life." Children experience great difficulty in expressing their needs and feelings related to grief making it critically necessary that nurses, health care professionals and educators who work with grieving children understand how they can best support the child in coping with the grief in order that the child move on with their life rather than becoming disabled by their experience of grief.

LITERATURE REVIEW

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The work of Malchiodi (2003) entitled: 'Using Creative Activities as Intervention for Grieving Children' published by the National Institute for Trauma and Loss in Children states that the National Association of School Psychologists (2001) states that the range of children's grief reactions are as follows:

1) Emotional shock: Children may have a noticeable lack of affect, appear numb, lack reaction to events, or seem depersonalized. This behavior may serve as way to detach from the pain of moment or memories of loss;

Research Proposal on Art Therapy With Children Experiencing Grief Assignment

2) Regressive behaviors: Children may suddenly need to sleep in a parent's bed or may have difficulty separating from parents, family members, or caretakers, or may need to be held or rocked;

3) Repetitious behavior: Children may repeat play activities or themes or stories in their drawings. They also may repeatedly ask the same questions because a death has been hard to believe or accept; these questions, however, can help to identify any misinformation the child may have about the event;

4) Sudden mood swings or unusual behavior- Children may suddenly seem irritable, frustrated, fearful, or helpless, reflections of their internal feelings and their need to find control over a situation they have little control. (Malchiodi, 2003)

It is oftentimes assumed by adults that children "have little or no comprehension of death or dying and therefore believe that it is not important to talk with children about their feelings or beliefs about death." (Malchiodi, 2003) However, children, depending on their ages and stages of development "understand death and loss in different ways." (Malchiodi, 2003) Malchiodi states that the work of Webb (2002) differentiates the grief of children from that experienced by adults as follows:

Children's immature cognitive development interferes with their understanding about the irreversibility, universality, and inevitability of death;

Children have a limited capacity to tolerate emotional pain;

Children have limited ability to verbalize their feelings;

Children are sensitive about 'being different' from their peers; and Children are able to express their feelings in play therapy. (Malchiodi, 2003)

Children's understanding of death may be varied depending on the age and stage of the child's development in that young children "fall into Piaget's preoperational stage" which is a time when children "begin to represent their world with words, images, drawing and imaginative play activities." (Malchiodi, 2003) During this stage of development, because children this age are egocentric, the child may believe that they somehow caused the death of the individual. Furthermore, magical thinking that occurs at this age may cause the child to believe that the individual might be brought back somehow as they do not realize that death is irreversible. Children in the age range from seven to eleven years of age "...fall into Piaget's stage of concrete operations" which is a stage characterized by "reduced egocentricity and an improved capacity for reasoning." (Malchiodi, 2003) During this stage of development "children develop organizational skills, learn to read, and to use language more proficiently, signaling their developing cognitive abilities." (Malchiodi, 2003) During this stage children find difficulty in the irreversibility of death. Older children in the age range from eleven to fifteen years of age "are in Piaget's formal operational stage and enter a more mature time of thought and understanding." (Malchiodi, 2003) During this stage of development, "thinking becomes more logical" and children develop the capacity to "handle several variables at once, and they are capable of handling abstract ideas." (Malchiodi, 2003)

Malchiodi (2003) states that "drawings have proven to be a good reflection of children's abilities to conceptualize death in abstract terms." Malchiodi states that the process of grief is difficult in "normal circumstances" however it is "often more intense if a sudden, traumatic death is experienced." (Malchiodi, 2003) This is because death that is due to homicide or domestic violence is often "complicated by a legal inquiry, interactions with law enforcement, and sensational or even inaccurate coverage by law enforcement." (Malchiodi, 2003) Ongoing contact with the different agencies and investigators tends to "deepen the sorrow, confusion and suffering of survivors, particularly children who may be trying to make sense of what has happened.

Malchiodi states that drawing has been found in research studies to be "...particularly effective with those children who can make recognizable drawing of people, animals, houses, tree and other aspects of their environment." (2003) Furthermore, it is believed that drawing "may also be useful with younger children who still make scribbles, but can tell stories about their creations. The process of drawing provides a catalyst for discussion and an opportunity for trauma specialists to support and guide self-expression." (Malchiodi, 2003) the drawings of children literally illustrates."..their fears, adaptive coping skills, and beliefs about death and dying. They offer an avenue of information" which can assist in the formulation of interventions for the future and for recognition of grief responses that are more serious in nature. Malchiodi (2003) states that activities that are set out in the work of Steele, Malchiodi and Klein (2003) entitled 'Helping Children Feel Safe' include the following:

What's Your Worry? - Children are asked by therapists and counselors to draw their feelings, especially their worries and fears.

Transform Your Worry - a drawing of something such as a sorry may be utilized in assisting the child to transform what is worrying them into something less troubling or frightening.

Magic Book - This is a method used for empowering children in seeking their own solutions to that which worries them and helps children cope with their fears;

My Safe Box - This involves the creation of a memory box and is a process by which a box is used to contain the child's memories including objects fashioned from clay in representation of people or events, drawings of the deceased, family photos and other small mementos that are representative of the positive experiences the child had with the deceased. (Malchiodi, 2003)

Malchiodi (2003) states guidelines for assisting children with grief include the follows:

Allow children to be the "experts" about their art expressions and about their experiences. This allows the child to feel empowered through telling you the story of "what happened," recalling memories, and defining feels. It is important for trauma specialists to convey to children that they appreciate their expertise as well as courage in being able to share their experiences through drawing and talking about their loss. Identifying children as "experts" also allows helping professionals to be less anxious about knowing all the answers when it comes to traumatic death;

Assume that all children of all ages want and need to understand death. Sometimes trauma specialists shy away from discussing death, believing that children do not want or cannot understand the concept. However, it is important to give children information at the level they can understand. Use creative activities to explore their conceptualization about death;

Make sure that parents and families understand that their children may need further intervention in the months and years to come. Additional help may be necessary if children experience additional traumas or loss or when they reach a developmental milestone (such as becoming an adolescent); and Understand your own feelings about death, especially those associated with traumatic loss. All trauma specialists may struggle with making sense of the lives lost on September 11th, 2001. It is those deaths that are the result of what seem like random acts of violence that are the most important to find meaning and answers. Make sure you understand your own perceptions and beliefs before you begin work with children who have experienced traumatic loss. (2003)

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