The Art of Traumatic Grief Counseling
Are you a mental health provider, social worker, psychologist, nurse, physician, spiritual leader/counselor, school counselor, or other licensed professional who wishes to learn how to truly help those suffering from the traumatic death of a loved one?
You can help in your community. The MISS Foundation has partnered with the Elisabeth Kubler-Ross Family Trust to properly train competent clinicians who can help guide individuals through the dark abyss of traumatic grief after suicide, homicide, accidents, or other losses. Unfortunately, there are few clinicians who specialize in this very unique and painful type of loss. Our foundations join together in order to bring this important, timely INTENSIVE four-day training in traumatic grief to providers around the world. It’s a RARE opportunity to become a Certified Provider in Compassionate Bereavement Care (R), a mindfulness-based non-medicalized approach to traumatic grief, with trainings held in stunning Sedona, Arizona (30 CEUs offered).
Please click on the image above in order to purchase the MISS Foundation's featured book: "Selah: An Invitation Toward Fully Inhabited Grief", written by MISS founder, Dr. Joanne Cacciatore.
This interactive book is a guide through traumatic grief that you can use in counseling or therapy to enhance coping with Dr. Cacciatore's published Selah model, a contemplative and gentle approach that includes being with grief, surrendering to grief, and then compassionate action, doing with grief.
Advice for Professionals in a Bereavement Case
Written and compiled by Sari Edber (firstname.lastname@example.org)
With additions from bereaved parents of The MISS Foundation
If you are a medical professional that works with bereaved parents, this guide was created especially for you. Because a patient’s grief journey often begins with you – in a hospital setting – you have a unique opportunity to offer the first bits of comfort, validation, support, sensitivity, and healing. Please read and use this guide often when working with your grieving patients.
1. Make sure everyone feels emotionally safe by acknowledging that there is no “right” or “wrong” when it comes to patients’ choices.
- Each person’s healing process is completely individualized. There isn’t just one way to feel or act, and every bereaved parent has to make choices that are right for them in the moment.
- Try to find a balance between listening to and guiding your patients. Remember that they are feeling devastated, lost, confused, afraid, and out of control. Most don’t know what to expect and they don’t know what questions to ask. Try to follow their lead based on their wishes and emotions while also encouraging them to be fully present in these precious moments.
2. *Don’t forget about the bereaved father. Both parents are grieving the death of their child – even if the dads may or may not show it publicly. Include him in the process as much as possible.
3. Encourage parents to seek out support groups or online support networks. Give them a CURRENT list of resources and follow up with them and see how they are doing even after they leave the hospital.
> “Attending our support group was the most life-altering, productive, and validating experience after our loss. There is something so special about sharing and healing with other bereaved parents. There is a mutual understanding of our grief, where we know each other’s true-selves in a way that non-bereaved individuals never can. The connections that we have formed run so deeply that I truly consider them to be some of my closest friends and my healing ‘soul mates’.”
4. *Acknowledge and validate not just the death of the baby, but also the death of what that child meant to his or her family and all of the hopes and dreams that came with the anticipation of that child’s arrival.
5. It is more than ok for you to show your own emotions while you care for patients experiencing the death of a child. Your humanity, empathy, and compassion will be remembered as a source of comfort as they grieve.
> “My doctor and nurse cried with us. They showed us that our son’s stillbirth was deserving of big tears and big grief, because it came with big love.”
6. *DO use the child’s name, if he/she was given one.
- There is a quote that says; “Mentioning my baby’s name might make me cry, but not mentioning his/her name will break my heart.” -Anonymous
7. Validate their feelings with comforting words about this child always being a part of their family, about how beautiful their baby is, about how much love you can sense between them, and about how these memories, as difficult and emotional as they are, will be remembered always, etc…
- *Avoid any and all clichés (or similar language) such as: “It’s for the best”; “Everything happens for a reason”; “Time heals all wounds”; “At least you’re young and you can have more”; “Be thankful for the living children that you do have”; or “You have to be strong for your family”.
- THESE ARE NOT HELPFUL and only add to the pain that the parents are already feeling.
FOR PERINATAL AND NEONATAL DEATHS
1. *The age of the child or gestation of pregnancy at the time of the loss does NOT determine how much a bereaved parent should grieve. This is their child that they carried, nurtured, and had longed and hoped for.
- Do not refer to a baby as a fetus, no matter the gestation of a pregnancy.
2. Treat a deceased child with the same tenderness, care, and dignity that you would a live baby. Use gentle hands, soft voices, and sensitive language.
> “One of the greatest gifts that we could have received during this devastating time is watching our L&D nurse cry while cleaning and wrapping our son in a blanket. She talked to him and called him ‘sweet baby’. And, when she handed him to us, she said, ‘Your son is absolutely beautiful.’ In that sentence, she validated my motherhood and allowed me to look past the visual effects of death to see his natural beauty. I will always be grateful to her for that.”
> “One of the most memorable moments of my whole experience was hearing the nurse in my ear saying "look at her, she's so perfect, she's just perfect." She gave me the reassurance that my baby was just that - my baby.”
3. Allow parents to be involved in as much of the caretaking process as possible.
- No matter if the baby was stillborn or in the NICU, give the parents a chance to “be parents” – this includes bathing, dressing, holding, hand/footprints, molds, etc. (as long as the condition of the baby’s skin can tolerate the particular action).
- Encourage skin-to-skin contact and let parents know that they can unwrap their baby if they so choose.
- Never put a time limit on how long parents can spend with their deceased baby. Let them know that they can hold their child for as long as they’d like.
- Tell your patients that some parents choose to spend many hours (even keeping the baby with them overnight) together and others choose to have a shorter goodbye because the emotions in the moment are just too difficult. This lets them know that whatever they choose, they are not alone in feeling that way.
4. Though sadness, loss, and anger are the most known and assumed emotions that bereaved parents experience, don’t lose sight of the fear and/or guilt that may also be present.
- Depending on the situation, parents may be feeling afraid of the birth process, afraid to see their child after death, afraid to disconnect life support, afraid to watch their child suffer…
- They may also be feeling guilt – that their body didn’t do what it was supposed to, that they couldn’t protect their baby, that they may have done something wrong…
> Validate all of these feelings by saying something like: “I can’t imagine what you’re going through. But, I’ve heard many other parents in this situation talk about similar feelings. Once you’re discharged it might be a good idea to reach out to other bereaved parents to talk about these things. But, for now, know that you’re not alone. I’m so sorry.”
- Do not tell them not to feel a certain way. That will only make them feel judged and self-conscious through the rest of the process. Never let a patient believe that they are doing or feeling something in a “wrong” way.
- If you sense fear in a patient because they are unsure about what their baby is going to look like, use reassuring language when you speak to them. Try to validate their feelings while also encouraging them in this process. In the moment, you can say something like this:
- If the baby hasn’t been born yet:
> “You don’t have to make any decisions right now. Let’s take this one step at a time. After the birth, if you’d like, I can describe the baby’s condition to you. But, I can assure you that no matter what physical characteristics may be present, he/she will absolutely be beautiful.”
- After birth, while holding and lovingly looking at the baby:
> “Your son/daughter is beautiful. You’ll notice some slight skin discolorations and a bit of bruising from the birth process. And, you’ll see an increased red pigmentation in his/her lips. These are very common. (You can gently add in any physical anomalies here, as well; however, keep your explanations brief). But, despite these slight differences in appearance, he/she looks like a perfect sleeping baby. I would love for you to see his/her beauty for yourself and spend some time together for your own memories.”
5. It’s important to understand that despite these difficult emotions surrounding death, there is still so much love, pride, awe, and joy that bereaved parents still feel in these moments. They are still giving birth to a child, seeing that child’s face for the first time, figuring out whose features the baby has, and discovering a new sense of self as parents.
- Having to say hello and goodbye to a child in such a short time period is one of the most complex scenarios to imagine.
- This is another reason why it’s so important to allow parents to be involved in the hands-on aspects of caring for their baby (wrapping, bathing, dressing, etc).
- These are the things that they had long envisioned and hoped for during their pregnancies.
6. If the parents do not have their own camera with them, offer to provide them with one to take their own pictures while spending time with their child.
- Even if a patient declines a photo of their baby, take a few of your own after the parents say their goodbyes to keep in the patient’s file. Hold on to all keepsake items for at least one year, in case the parents change their minds later.
7. Offer professional bereavement photography as an option early in the labor process so that a photographer has a chance to arrive in time to take pictures and capture special memories.
> “The pictures that I have from our bereavement photographer are priceless treasures. I know other grieving parents that never knew these services existed, and they wish that they, too, had the quality pictures and special memories captured in this way.”
- Please see our resource list for organization names, websites, and contact information
8. Create a memory box with the baby’s footprints, handprints, lock of hair, weight/height, blanket, hat, etc. Again, if parents decline it at the time, hold onto it for at least a year.
9. ALL hospital staff should have knowledge about the patient’s loss (this includes doctors, nurses, lactation consultants, clergy, social workers, maintenance staff, wheelchair volunteers, billing specialists, insurance coordinators, etc.) so that the patient does not have to explain the situation more than once and so that everyone entering the room does so in an understanding and sympathetic way. Many hospitals have a special sign to hang on the door to signify a bereavement situation.
> “Lactation consultants should be specifically notified NOT to come to this patients room. One of the breastfeeding nurses still found me, even after I had been transferred to another floor to be away from the maternity ward. It was heart-wrenching.”
> “One of the maintenance staff entered my room and asked me where the baby was.”
> “I remember when I left the hospital, empty handed, and the porter who wheeled me out said, "congratulations". It wasn't his fault; he didn't know. But he should have and communication was lacking.”
> “I got a call a few weeks ago from billing at [our] hospital asking for the name of our child and asking if we had added him to our insurance plan. I explained that he died (the woman was very apologetic), but, last night we got the mail and sure enough there was a piece of mail from [our insurance company] addressed to [our stillborn son]. So, now I have to call them tomorrow and say, again, ‘our baby died’.”
10. Allow parents the opportunity to speak with all necessary specialists (as many times as needed in order to make informed choices) - perinatologists, neonatologists, OB/Gyn., or religious member
- Offer to call in a clergy person to provide guidance and support or to perform any religious ceremonies that the family desires.
- Provide the parents with resources and lots of time to make decisions regarding burial, cremation, and funeral homes.
- When it’s time for parents to say goodbye, allow the option for them to hand the baby to you or for them to walk their child to the morgue.
11 Try to give the family as much privacy as possible, with a corner room farther away from birthing moms and healthy newborn babies. It is very hard to hear the sound of another baby’s cry when your baby is born silently.
- Allow parents the choice of being in the maternity ward after their loss or the option of recovering on another floor. But, if they choose to recover somewhere else, make sure that the personnel are informed of the situation and know how to handle it appropriately.
12. Please choose a SENSITIVE way of transporting the baby to the morgue. A cardboard box, bag, or safety-pinned sheet are neither appropriate nor acceptable (especially in the presence of the parents). The deceased baby should be carried or wheeled in a newborn bassinet.
13. When discharging a newly bereaved patient, make sure that other patients with newborns are not being discharged at the exact same time. The experience of leaving the hospital without your child is difficult enough without seeing the smiles and joy of other new parents
14. Give practical guidance about how to take care of their post-birth bodies, bleeding, and/or scars, as you would any other patient.
- Please add helpful suggestions on how to stop their milk supply.
15. Be understanding of the complex emotions of a subsequent pregnancy or the process of giving birth to a subsequent child after a loss.
- Just the bereaved parents are either pregnant again or have thankfully welcomed a healthy child into their lives, do not assume that they have “moved on”.
- There are many juxtapositions that can accompany a subsequent pregnancy and/or child: joy & sadness; excitement & worry; gratitude & grief; being thankful for this new baby & still wanting their child that died; trying to be hopeful that everything will be okay & being filled with anxiety and fear at every moment that something could go wrong.
- Even once a healthy child has been fortunately brought into this world, there are usually bittersweet emotions that are tied to missing their child that died. In fact, some bereaved parents note that their grief takes on an entirely new meaning once they see and hold their healthy baby: it makes what they lost all the more tangible.
[*] “Being Effectively Present: An Invitation to Caregivers”
The MISS Foundation is a 501 (c) 3, volunteer based organization committed to providing crisis support and long term aid to families after the death of a child from any cause. MISS also participates in legislative and advocacy issues, community engagement and volunteerism, and culturally competent, multidisciplinary, education opportunities.