Teen Alcohol Use: Prevention Strategies for Parents

While parent-child conversations about not drinking are essential, talking isn't enough-you also need to take concrete action to help your child resist alcohol. Research strongly shows that active, supportive involvement by parents and guardians can help teens avoid underage drinking and prevent later alcohol misuse.

In a recent national survey, 64 percent of eighth graders said alcohol was "fairly easy" or "very easy" to get and 34 percent reported drinking within the last year. The message is clear: Young teens still need plenty of adult supervision. Some ways to provide it:

Monitor Alcohol Use in Your Home

If you keep alcohol in your home, keep track of the supply. Make it clear to your child that you don't allow unchaperoned parties or other teen gatherings in your home. If possible, however, encourage him or her to invite friends over when you are at home. The more entertaining your child does in your home, the more you will know about your child's friends and activities.

Connect With Other Parents

Getting to know other parents and guardians can help you keep closer tabs on your child. Friendly relations can make it easier for you to call the parent of a teen who is having a party to be sure that a responsible adult will be present and that alcohol will not be available. You're likely to find out that you're not the only adult who wants to prevent teen alcohol use-many other parents share your concern.

Keep Track of Your Child's Activities

Be aware of your teen's plans and whereabouts. Generally, your child will be more open to your supervision if he or she feels you are keeping tabs because you care, not because you distrust him or her.

Develop Family Rules about Youthful Drinking

When parents establish clear "no alcohol" rules and expectations, their children are less likely to begin drinking. Although each family should develop agreements about teen alcohol use that reflect their own beliefs and values, some possible family rules about drinking are:

  • Kids will not drink alcohol until they are 21.
  • Older siblings will not encourage younger brothers or sisters to drink and will not give them alcohol.
  • Kids will not stay at teen parties where alcohol is served.
  • Kids will not ride in a car with a driver who has been drinking.

Set a Good Example

Parents and guardians are important role models for their children-even children who are fast becoming teenagers. Studies indicate that if a parent uses alcohol, his or her children are more likely to drink as well. But even if you use alcohol, there may be ways to lessen the likelihood that your child will drink. Some suggestions:

  • Use alcohol moderately.
  • Don't communicate to your child that alcohol is a good way to handle problems. For example, don't come home from work and say, "I had a rotten day. I need a drink."
  • Let your child see that you have other, healthier ways to cope with stress, such as exercise; listening to music; or talking things over with your spouse, partner, or friend.
  • Don't tell your kids stories about your own drinking in a way that conveys the message that alcohol use is funny or glamorous.
  • Never drink and drive or ride in a car with a driver who has been drinking.
  • When you entertain other adults, serve alcohol-free beverages and plenty of food. If anyone drinks too much at your party, make arrangements for them to get home safely.

Don't Support Teen Drinking

Your attitudes and behavior toward teen drinking also influence your child. Avoid making jokes about underage drinking or drunkenness, or otherwise showing acceptance of teen alcohol use. Never serve alcohol to your child's underage friends. Research shows that kids whose parents or friends' parents provide alcohol for teen get-togethers are more likely to engage in heavier drinking, to drink more often, and to get into traffic crashes. Remember, too, that in almost every State it is illegal to provide alcohol to minors who are not family members.

Help Your Child Build Healthy Friendships

If your child's friends use alcohol, your child is more likely to drink too. So it makes sense to try to encourage your young teen to develop friendships with kids who do not drink and who are otherwise healthy influences on your child. A good first step is to simply get to know your child's friends better. You can then invite the kids you feel good about to family get-togethers and outings and find other ways to encourage your child to spend time with those teens. Also, talk directly with your child about the qualities in a friend that really count, such as trustworthiness and kindness, rather than popularity or a "cool" style.

When you disapprove of one of your child's friends, the situation can be tougher to handle. While it may be tempting to simply forbid your child to see that friend, such a move may make your child even more determined to hang out with him or her. Instead, you might try pointing out your reservations about the friend in a caring, supportive way. You can also limit your child's time with that friend through your family rules, such as how after-school time can be spent or how late your child can stay out in the evening.

Encourage Healthy Alternatives to Alcohol

One reason kids drink is to beat boredom. So it makes sense to encourage your child to participate in supervised after-school and weekend activities that are challenging and fun. According to a recent survey of preteens, the availability of enjoyable, alcohol-free activities is a big reason for deciding not to use alcohol.

If your community doesn't offer many supervised activities, consider getting together with other parents and teens to help create some. Start by asking your child and other kids what they want to do, because they will be most likely to participate in activities that truly interest them. Find out whether your church, school, or community organization can help you sponsor a project.

Adapted from Make a Difference: Talk to Your Child about Alcohol
National Institute on Alcohol Abuse and Alcoholism
NIH Publication No. 06-4314

Reviewed by athealth on February 8, 2014.

Teens: Deciding About Sex

As a teenager, you are confronted with significant challenges as you make your way through adolescence, and deciding whether to have sex is one of the most important decisions you will make. There is a lot you should know before you decide to have sex, so here are some facts to think about before you act.

Despite what the media leads you to believe, not everyone is having sex. At least half of all teens decide not to have sex. Saying "no" to having sex is the only 100% sure way to protect against the risk of pregnancy.

Although your sexual feelings can be pretty strong, you don't have to have sex to prove that you love someone. It's important to set aside those feelings and think about how having sex can affect your future. So, ask yourself these questions:

  • Am I prepared to accept the consequences of an unplanned pregnancy?
  • If I have a child, will I be able to provide for its emotional and financial support?
  • Is anyone pressuring me to have sex even though I'm not ready?
  • Am I afraid to tell my partner that I am not ready to have sex?
  • If I decide to have sex, how will I feel if the relationship with my partner doesn't last?
  • When I get married, will I regret that I didn't wait to have sex?
  • Will my parents be disappointed if I decide to have sex?
  • Am I absolutely certain that my partner does not have HIV/AIDS or another STD?

If you want more information or help, talk to someone who cares about you. Ask your parents or another trusted adult, like your family doctor, your priest, minister, or rabbi, or a school nurse or counselor - someone who will listen to you and give you good advice.

References:
Teen Talk #1, Office of Public Health and Science. September 2005.

Reviewed by athealth on February 8, 2014.

Ten Ways to Be a Better Dad

  1. Respect Your Children's Mother
    One of the best things a father can do for his children is to respect their mother. If you are married, keep your marriage strong and vital. If you are not married, it is still important to respect and support the mother of your children. A father and mother who respect each other and let their children know it provide a secure environment for them. When children see their parents respecting each other, they are more likely to feel that they are also accepted and respected.
  2. Spend Time with Your Children
    How a father spends his time tells his children what is important to him. If you always seem too busy for your children, they will feel neglected no matter what you say. Treasuring children often means sacrificing other things, but it is essential to spend time with your children. Kids grow up so quickly. Missed opportunities are lost forever.
  3. Earn the Right to Be Heard
    All too often, the only time a father speaks to his children is when they have done something wrong. That is why so many children cringe when their mother says, "Your father wants to talk with you." Begin talking with your kids when they are very young so that difficult subjects will be easier to handle as they get older. Take time and listen to their ideas and problems.
  4. Discipline with Love
    All children need guidance and discipline, not as punishment, but to set reasonable limits. Remind your children of the consequences of their actions and provide meaningful rewards for desirable behavior. Fathers who discipline in a calm and fair manner show love for their children.
  5. Be a Role Model
    Fathers are role models to their kids whether they realize it or not. A girl who spends time with a loving father grows up knowing she deserves to be treated with respect by boys, and what to look for in a husband. Fathers can teach sons what is important in life by demonstrating honesty, humility, and responsibility.
  6. Be a Teacher
    Too many fathers think teaching is something others do, but a father who teaches his children about right and wrong, and encourages them to do their best, will see his children make good choices. Involved fathers use everyday examples to help their children learn the basic lessons of life.
  7. Eat Together as a Family
    Sharing a meal together (breakfast, lunch, or dinner) can be an important part of healthy family life. In addition to providing some structure in a busy day, it gives kids the chance to talk about what they are doing and want to do. It is also a good time for fathers to listen and give advice. Most importantly, it is a time for families to be together each day.
  8. Read to Your Children
    In a world where television often dominates the lives of children, it is important that fathers make the effort to read to their children. Children learn best by doing and reading, as well as seeing and hearing. Begin reading to your children when they are very young. When they are older, encourage them to read on their own. Instilling your children with a love for reading is one of the best ways to ensure they will have a lifetime of personal and career growth.
  9. Show Affection
    Children need the security that comes from knowing they are wanted, accepted, and loved by their family. Parents, especially fathers, need to feel both comfortable and willing to hug their children. Showing affection everyday is the best way to let your children know that you love them.
  10. Realize That a Father's Job Is Never Done>Even after children are grown and ready to leave home, they still look to their fathers for wisdom and advice. Whether it is continued schooling, a new job, or a wedding, fathers continue to play an essential part in the lives of their children as they grow and, perhaps, marry and build their own families.

National Fatherhood Initiative. (n.d.)
10 ways to be a better dad [On-line]
Available: http://www.fatherhood.org/10ways.asp
Adapted from The Importance of Fathers in the Healthy Development of Children
Child Welfare Information Gateway
http://www.childwelfare.gov/pubs/usermanuals/fatherhood/append_e_4.cfm

Reviewed by athealth on February 8, 2014.

Test Your Own Marriage Satisfaction

Marital relationships are complex institutions! In order to improve the quality of a marriage, it helps to take a systematic look at how it is functioning. Here is a questionnaire you can use as a general guide for evaluating your marital satisfaction.

After each question below write down the number that most closely approximates your present feelings about your marriage or your spouse. On a scale of one to ten, 10 is "pleased," 5 is "half yes/half no," and 0 is "not pleased."

I am:

  • Pleased with the amount we talk to each other.
  • Happy with the friends we share in common.
  • Satisfied with our sex life.
  • In agreement with the amount of time you or we spend at work and at home.
  • In agreement with the way we are spending money.
  • Pleased with the kind of parent you are. (This refers to the way your spouse interacts with the children.)
  • Of the opinion that you are "on my team."
  • Pleased with our leisure time together (e.g., sports, vacations, outings, etc.).
  • Basically in agreement with your outlook on life (e.g., values, attitudes, religious beliefs, politics, etc.).
  • Generally pleased with the way you relate to members of your own family. (This refers to your spouse?s parents, siblings, etc.)
  • Satisfied with the way you relate to members of my family. (This refers to your own parents, siblings, etc.)
  • Pleased with your general habits, mannerisms, and overall appearance.

Add up your total score:

  • 84 and more means that you have a VERY GOOD marriage.
  • Between 72-83 reflects SATISFACTORY to GOOD feelings and interactions.
  • A score of 61-71 suggests that you need to make some basic changes.
  • Below 60 indicates a POOR level of marital satisfaction.

Marriages that are bankrupt usually call for divorce counseling so that the husband and wife part amicably. Usually, however, people whose levels of satisfaction are this low don't consult psychologists ? They head straight for the lawyers!

Many marriages can be improved so that couples can experience more joy than grief. People who believe that nothing can be done to improve a bad marriage are usually incorrect. It is difficult, but not impossible, to transform a poor marriage into a good one.
Adapted from Marital Myths Revisited: A Fresh Look at Two Dozen Mistaken Beliefs About Marriage, by Dr. Arnold A. Lazarus.

Available at online and local bookstores or directly from Impact Publishers, Inc., PO Box 6016, Atascadero, CA 93423-6016, http://www.bibliotherapy.com/ or phone 1-800-246-7228.
Page last modified/reviewed on January 23, 2014

The Death Of A Child

The Grief Of The Parents: A Lifetime Journey

Children are not supposed to die...Parents expect to see their children grow and mature. Ultimately, parents expect to die and leave their children behind...This is the natural course of life events, the life cycle continuing as it should. The loss of a child is the loss of innocence, the death of the most vulnerable and dependent. The death of a child signifies the loss of the future, of hopes and dreams, of new strength, and of perfection. - Arnold and Gemma 1994, iv, 9, 39

When a parent dies, you lose your past; when a child dies, you lose your future. - Anonymous

This space is with me all the time it seems. Sometimes the empty space is so real I can almost touch it. I can almost see it. It gets so big sometimes that I can't see anything else. - Arnold and Gemma 1983, 56

A wife who loses a husband is called a widow. A husband who loses a wife is called a widower. A child who loses his parents is called an orphan. But...there is no word for a parent who loses a child, that's how awful the loss is! - Neugeboren 1976, 154

Parental Grief

The theme of parental mourning has been a universal one throughout the centuries. In the literature on bereavement, writers repeat certain themes, thoughts, and reflections; they talk of the powerful and often conflicting emotions involved in "the pain of grief and the spiral of mourning; [they refer to] the heartbreak at the heart of things...grief's contradictions"; they speak of parents devastated by grief (Moffat 1992, xxiii).

It is frequently said that the grief of bereaved parents is the most intense grief known. When a child dies, parents feel that a part of them has died, that a vital and core part of them has been ripped away. Bereaved parents indeed do feel that the death of their child is "the ultimate deprivation" (Arnold and Gemma 1994, 40). The grief caused by their child's death is not only painful but profoundly disorienting-children are not supposed to die. These parents are forced to confront an extremely painful and stressful paradox; they are faced with a situation in which they must deal both with the grief caused by their child's death and with their inherent need to continue to live their own lives as fully as possible. Thus, bereaved parents must deal with the contradictory burden of wanting to be free of this overwhelming pain and yet needing it as a reminder of the child who died.

Bereaved parents continue to be parents of the child who died. They will always feel the empty place in their hearts caused by the child's death; they were, and always will be, the loving father and mother of that child. Yet, these parents have to accept that they will never be able to live their lives with or share their love openly with the child. So they must find ways to hold on to the memories. Many bereaved parents come to learn that "memories are the precious gifts of the heart...[that they need] these memories and whispers, to help create a sense of inner peace, a closeness" (Wisconsin Perspectives Newsletter, Spring 1989, 1).

Parental grief is boundless. It touches every aspect of [a] parent's being...When a baby dies, parents grieve for the rest of their lives. Their grief becomes part of them...As time passes, parents come to appreciate that grief is [their] link to the child, [their] grief keeps [them] connected to the child. - ARNOLD AND GEMMA, IN CORR ET AL. 1996, 50-51

Sociologists and psychologists describe parental grief as complex and multilayered and agree that the death of a child is an incredibly traumatic event leaving parents with overwhelming emotional needs. They also agree that this grief must be acknowledged and felt in its intensity. These experts repeatedly state that dealing with parental grief involves deep pain and ongoing work as the parents attempt to continue their "journey down the lonely road of grief" (Wisconsin Perspectives Newsletter, February 1997, 1).

Grieving parents say that their grief is a lifelong process, a long and painful process..."a process in which [they] try to take and keep some meaning from the loss and life without the [child]" (Arnold and Gemma 1983, 57). After a child's death, parents embark on a long, sad journey that can be very frightening and extremely lonely- a journey that never really ends. The hope and desire that healing will come eventually is an intense and persistent one for grieving parents.

The child who died is considered a gift to the parents and family, and they are forced to give up that gift. Yet, as parents, they also strive to let their child's life, no matter how short, be seen as a gift to others. These parents seek to find ways to continue to love, honor, and value the lives of their children and continue to make the child's presence known and felt in the lives of family and friends. Bereaved parents often try to live their lives more fully and generously because of this painful experience.

To those outside the family, the composition of the family may seem to change when a child dies. A sibling may become an only child; a younger child may become the oldest or the only child; the middle child may no longer have that title; or the parents may never be able to, or perhaps may choose not to, have another child. Nonetheless, the birth order of the child who died is fixed permanently in the minds and hearts of the parents. Nothing can change the fact that this child is considered a part of the family forever, and the void in the family constellation created by the child's death also remains forever.

In a newsletter for bereaved parents, one mother wrote, "It feels like a branch from our family tree has been torn off." Another grieving mother continues, "I felt that way too. A small branch, one whose presence completed us, had been ripped from our family and left a large wound. Without it, we were lopsided and off balance. When subsequent children are born, [they] do not replace the fallen branch, but create a new limb all their own" (Wisconsin Perspectives Newsletter, December 1996, 1).

Common And Individual Characteristics Of Parental Grief

Death is an experience that is common to all mankind, an experience that touches all members of the human family. Death transcends all cultures and beliefs; there is both commonality and individuality in the grief experience. When a loved one dies, each person reacts differently. A child's death, however, is such a wrenching event that all affected by it express sadness and dismay and are painfully shaken. Such a devastating loss exacts an emotional as well as a physical toll on the parents and family.

Bereavement specialists point to the commonalities of parental grief that may include an overwhelming sense of its magnitude, a sense that the pain will last forever, a sense that the grief is etched into one's very being. They explain that it is also important for these parents to express their anger outwardly so that it will not turn inward and possibly become a destructive force in the future. These specialists say that although there are many commonalities in parental grief, individual reactions often vary and that the same person may even experience contradictory reactions. They also say that the two responses experienced most commonly by bereaved parents are a baffling sense of disorientation and a deep conviction that they must never let go of the grief.

But there are also many unique ways that bereaved parents express their grief. These individual parental responses are influenced by many factors including the person's life experiences, coping skills, personality, age, gender, family and cultural background, support and/or belief systems, and even the death or the type of death that occurred.

Parental grief is boundless. It touches every aspect of the parent's being...The range of expression of parental grief is wide...Some parents will express tears and hysteria openly. Others will silence these expressions and grieve inwardly...Despite the volumes of work on grief, the experience of grief seems to defy description... Definitions touch the fringes of grief but do not embrace its totality or reach its core...Grief is a complicated, evolving human process. Grief is a binding experience; its universality binds sufferers together. More is shared than is different. - ARNOLD AND GEMMA, IN CORR ET AL. 1991, 50-52, 55

As part of the grieving process, bereaved parents experience ups and downs and a literal roller coaster of emotions. For these parents, a personal history includes a past with the child and a present and future without the child. For most grieving parents, it is vitally important to verbalize the pain, to talk about what happened, to ask questions, and puzzle aloud, sometimes over and over.

It is the nature of grief that feelings, thoughts, and emotions need to be processed and that those in grief must look into their hearts and souls and try to heal from within. Each does this in his/her own way. "Grieving parents are survivors" (Rando 1986, 176), and each survivor travels this lonely and painful road in a way each maps out. In traveling this road, parents often respond differently, learn to live with their grief separately, and express their sadness uniquely. Grieving parents can and often do feel alone, disconnected, and alienated. They need to know that there are many ways to grieve; there is no timetable for grief's duration; there are no rules, boundaries, or protocols for grieving.

Moreover, those who seek to comfort grieving parents need to recognize and understand the complexities of the parents' emotions and should avoid relying on preconceived ideas about the way a couple is supposed to grieve if their child dies. Reactions of grieving parents may seem overly intense, self-absorbing, contradictory, or even puzzling. For bereaved parents, the death of a child is such an overwhelming event that their responses may often be baffling not only to others but to themselves as well.

The sorrow for the dead is the only sorrow from which we refuse to be divorced. Every other wound we seek to heal, every other affliction to forget; but this wound we consider it a duty to keep open; this affliction we cherish and brood over in solitude. - WASHINGTON IRVING, THE SKETCH BOOK , IN MOFFAT 1992, 270

Parental Grief And A SIDS Death

The impact of a Sudden Infant Death Syndrome (SIDS) death presents unique grieving factors and raises painful psychological issues for the parents and family as well as those who love, care for, and counsel them. SIDS parents must deal with a baby's death that is unexpected and unexplained, a death that cannot be predicted or prevented, an infant death so sudden that it leaves no time for preparation or goodbyes, and no period of anticipatory grief. In many cases, parents of SIDS babies are very young and are confronted with grief for the first time.

SIDS often occurs at home, forcing parents and siblings or other children to witness a terrible tragedy and possibly scenes of intense confusion. In some cases, the parents themselves are the ones who find the child dead and they must always live with that memory. In other cases, the parents may feel overwhelming guilt or anger if the death occurred while the child was in daycare. They may feel that the baby might not have died if they had been caring for it. "All too frequently, a SIDS loss is not socially validated in the same way other deaths are. Others often fail to recognize that, despite the brevity of the child's life, the family's attachment to that child is strong and deep and has been present in various ways since the knowledge of conception" (Rando 1986,167).

SIDS parents must take a journey that "involves a trek through grief-a strange and hostile territory that no one would ever pass through if given the choice" (Horchler and Morris 1994, 17). SIDS parents often retain strong feelings of guilt and sometimes a sense of responsibility for what happened even though they've been told there was nothing they could have done to prevent the death. Sometimes, parents are the victims of undeserved suspicion from law enforcement personnel, even family members, neighbors, or friends. In the most difficult situations, the baby's death may cause parents to be subjected to grueling investigations and hostile questions; they may even face accusations of child abuse.

Probably the most stressful and anxiety-provoking act in human existence is the separation of a woman from her newborn infant. The response to this, which humans share with most of the animal kingdom, is an overwhelming combination of panic, rage, and distress. - RUSKIN, IN HORCHLER AND MORRIS 1994,16

SIDS parents, relatives, daycare providers, health care professionals, and other adults feel helpless in trying to explain the unexplainable to other young children who may have been present at the time of the baby's death. It is especially difficult for children to understand why a baby died when it didn't appear to be sick. Also, in some cases parents are required to explain SIDS to adults who are misinformed or know nothing about the syndrome.

Any infant or early childhood death forces adults to think about their own vulnerability, but a SIDS death also brings with it total mystery, an absence of answers, and a frightening loss of control. The chaos surrounding a SIDS death leaves most parents feeling that nothing in life is predictable; a SIDS death throws everything off balance.

As is the case in most traumatic experiences, SIDS parents are likely to continually replay the events surrounding the death over and over in their minds and in their conversations. Whether the parents put a seemingly healthy baby down for a nap or for the night or took the child to the daycare provider, they assumed their child was well and in a protected environment. They felt secure; their family and their world were in order. Then suddenly, everything has been turned upside down. Even though there may be attempts to reassure the parents that the baby didn't appear to suffer, frequently they are not convinced. They repeatedly ask, "How can a perfectly healthy baby die?" Often these parents are told that SIDS doesn't carry a high hereditary risk; yet fears about having subsequent children haunt them.

[The grief SIDS parents feel is like a]...continuous, crashing waterfall of pain...SIDS is a forced separation that will last forever. In the beginning, survivors are so shocked that their bodies and minds cannot even begin to comprehend all that has been lost...Shock and disbelief overtake most survivors so they can only vaguely feel their own empty arms and the rage that will eventually come full force. ...SIDS parents attempt to transcend the awfulness of [the baby's] death by choosing to celebrate the dead infant's life while not denying the physical finality of the death...[After a SIDS death, parents attempt] to travel the long road of grief to a place of rest and hope...SIDS parents must [try to] actively seek peace and joy in life-even in the face of a grief that will never end... - HORCHLER AND MORRIS 1994, 2, 16, 17, 248

SIDS parents also are very often plagued by "if only's" that they are never able to resolve. They mentally replay such thoughts as: "If only I hadn't put the child down for a nap when I did." "If only I had checked on the baby sooner." "If only I had not returned to work so soon." "If only I had taken the baby to the doctor with that slight cold."

SIDS parents also need to know the value and importance of obtaining reliable information. They need to have access to professional support; and they need to be aware of the great benefits other parents have gained from attending support groups and sharing their experience or by expressing their thoughts and feelings in writing.

Moreover, bereaved SIDS parents often find that health care professionals are as perplexed as they are and cannot provide them with any explanation for the death. Although most health professionals know about SIDS, not all can provide parents with the information they so anxiously seek. They are unable to provide answers to questions such as: "Did my baby suffer?" "What are the possible causes of SIDS?" "What can I do to prevent another child from dying of SIDS?" "Are there symptoms I should have known about that could have prevented the death?"

In the case of some SIDS deaths, the autopsy findings may still leave unanswered questions, or the child's death may be attributed to causes that are problematic for the parents. Some families are subjected to agonizing doubts and delays from the legal system about the exact cause of death. The absence of standardized procedures for determining the cause of unexpected infant deaths brings added pain and frustration to parents already in the midst of a harrowing nightmare. Thus, SIDS parents are often denied the sense of closure that comes from knowing the exact cause of their baby's death.

A single SIDS death can have a ripple effect on as many as 100 people who came in contact with the baby or the family. "The expanded circle of concern" (Corr et al. 1991, 43) can include parents, extended family, neighbors, coworkers, child care providers, health care and emergency personnel, clergy, funeral directors, and other care providers.

SIDS parents and family members need to be around people who will offer them support in a nonjudgmental way; they need to know that some things in their lives are permanent and there are certain people on whom they can truly depend. Other family members, friends, or professionals can provide this sense of dependability and assurance by allowing parents both permission and ways to express their grief and talk about their confusion. SIDS parents need to talk and they need someone to listen-really listen-even if they tell their story, express their doubts and fears, and ask the same questions repeatedly. What SIDS and other bereaved parents are really saying is, "Let me tell you about my pain; let me talk about my child with you; please do call my child by name; please do not let my child be forgotten."

Friends and family members should try to do all they can to show their concern and help the parents in keeping alive memories of their baby. For most SIDS parents, it is also reassuring for others to try to mention special things they noticed about the baby and to remember the child's birthday or the anniversary of the death. By extending these personal and sensitive gestures, loving and concerned relatives, friends, and caregivers can become a source of reassurance and comfort for the grieving parents.

Some SIDS babies are so young when they die that family members and friends never had a chance to welcome them. They may have missed sharing the parents' excitement over the birth and affirming the child's existence. Many individuals do not understand the depth of parental attachment to a very young child. Bereaved SIDS parents should not be made to feel that others don't want to hear them, that others won't permit them to openly grieve. The parents of SIDS babies want their child's short life to matter not only to them, but to their families and friends, to the others in their "circle of concern," to the world.

The dynamics of a SIDS loss [mean]...there is no chance to say goodbye to the infant or to absorb the reality of the loss gradually over time; the unexpected loss so overwhelms people that it reduces their functioning and compromises their recovery...The physical and emotional shock of the infant's death undermines the [parents'] capacity for regaining a feeling of security; the SIDS loss evokes particularly problematic grief reactions, such as the abrupt severing of the mother and father infant bond. - RANDO 1986, 166

Fathers - The Forgotten Grievers

The death of a child is probably the most traumatic and devastating experience a couple can face. Although both mothers and fathers grieve deeply when such a tragedy occurs, they grieve differently, and it is most important that each partner give the other permission to grieve as he/she needs. This may be the greatest gift each can give the other.

Parental grief is strongly influenced by the nature of the bond between child and parent. Bereavement specialists actually speak of "incongruent grieving" patterns in mothers and fathers and of differences in the timing and intensity of the parental bond for mothers and fathers.

For the mother, the bond is usually more immediate and demonstrable, more intense at the beginning of life, more emotionally and physically intimate. The mother's bond with the baby is usually tightly forged from the moment of conception and continues through the pregnancy, the birth, and the nursing process. The maternal bond involves the present and the baby's immediate needs, while the father's bond with the baby more often concerns the future and dreams and expectations for the child. Today, however, many fathers are forging earlier and more intense prenatal bonds with their babies. Fathers also are often present in the delivery room for the birth. Some fathers become direct caregivers of the newborn, developing early and close bonds with their infants. Yet, still in many cases, "the father's emotional investment in parenting tends to occur later and less intensely than the mother's. This has implications for the way parents grieve" (Cordell and Thomas 1990, 75).

When is it my turn to cry? I'm not sure society or my upbringing will allow me a time to really cry, unafraid of the reaction and repercussion that might follow. I must be strong, I must support my wife because I am a man. I must be the cornerstone of our family because society says so, my family says so, and, until I can reverse my learned nature, I say so. - A FATHER, IN DEFRAIN ET AL. 1991, 112

In spite of the trend towards earlier bonding between fathers and babies, the influence of cultural expectations about men and grief persists and is powerful. Typically, the societal view of parental loss is not the same for the father as the mother. Most of the literature on parental bereavement still tends to focus on the mother's grief. Often, men are not acknowledged as experiencing grief; or more importantly, men are not taught that it's necessary to grieve and are discouraged from demonstrating signs of grief openly. Bereaved fathers frequently feel that they are the forgotten mourners and are often referred to as "second class grievers" (Horchler and Morris 1994, 72).

Fathers are expected to be strong for their partners, to be the "rock" in the family. All too often fathers are considered to be the ones who should attend to the practical but not the emotional aspects surrounding the death; they are expected to be the ones who should not let emotions show or tears fall outwardly, the ones who will not and should not fall apart. Men are often asked how their wives are doing, but not asked how they are doing.

Such expectations place an unmanageable burden on men and deprive them of their rightful and urgent need to grieve. This need will surface eventually if it is not expressed. It is not unusual for grieving fathers to feel overwhelmed, ignored, isolated, and abandoned as they try to continue to be caregivers and breadwinners for their families while their hearts are breaking. "Fathers' feelings [often] stay hidden under layers of responsibility and grim determination" (Staudacher 1991, 124).

Bereaved fathers often say that such strong emotions are very difficult to contain after their child's death. Fathers often fear that they will erupt like volcanoes if they allow themselves to release these feelings and so, too often, fathers try to bury their pain with the child who died.

It is most important that a father's grief be verbalized and understood by his partner, other family members, professionals, coworkers, friends, and by anyone who will listen. Fathers need to try to free themselves of stereotypes and societal expectations about men and grief; they must be able to tell others that their grief is all they have from their child's brief life. Fathers repeatedly say that for their own peace of mind, they (and those who care about them) need to move away from this mind set and allow them to grieve as they are entitled.

In too many instances, fathers' responses to infant loss tend to coincide with how they believe they should act as men, rather than how they need to act to confront and resolve [their own] grief. - CORDELL AND THOMAS 1990, 75

The Impact Of Grief In Special Parenting Situations

The tragedy of a child's death brings profound pain to all affected, and it presents incredibly difficult and unusual problems for grieving parents. For some parents, the effects of such a complicated and devastating tragedy can be further compounded when the death occurs in what are already trying family situations. There are some parents for whom there is no established "circle of concern"; there are some parents for whom there is no safety net; there are some parenting situations that are outside the domain of the typical support network; and there are some parents who choose to reject this network for their own reasons.

A child's death may present unique dilemmas for:

  • Single parents who are often self-supporting and may be more isolated and ignored
  • Unmarried parents who may already have experienced the disfavor of family and others
  • Teenage parents whose grief is often not validated because of their situation or their youth
  • Parents in stressful financial situations whose struggle to satisfy their most basic needs may cause them to stifle or ignore their need to grieve and for whom loss is a constantly repeated theme
  • Divorced parents and parents in blended or nontraditional families who may require unique responses or resources
  • Step-parents whose grief may not be understood or appreciated
  • Adoptive parents who may be expected to grieve less than birth parents because their "bond" with the child is perceived to be less intense n Foster parents who are not thought to have the same "right" to grieve as birth parents
  • Parents who experience the death of the only child they may ever have and who also grieve for the loss of their parenting role
  • Parents losing a child who is one in a multiple birth and who are faced with the double task of saying "goodbye to the baby who has died and yet...still loving and caring for the baby who is living" (Hosford 1994, 1)
  • Parents who are removed or estranged from typical and traditional support systems
  • Parents whose language, cultural traditions, and/or beliefs are largely unrecognized or misunderstood by the society
  • Parents in homeless shelters, prisons, jails, or other institutions whose needs require unique consideration and creative responses
  • Parents with substance abuse problems whose child may have faced medical and/or developmental problems and who often must deal with guilt and other complex and overwhelming problems when a child dies.

When a child dies, inevitably there will be additional factors that will impinge on the parent's grief experience. Some of these will be negative... [and] sometimes, these factors will be positive. - RANDO 1986, 31

All of the grieving parents identified above as well as parents in many other situations may find their grief unusually complicated. They may discover the responses of others to be less concerned and may find support networks less readily available. These parents may not receive the same validation as parents in traditional nuclear families, and the needs and wishes of parents in these unique and complex situations may sometimes be ignored or misunderstood. Parental experiences, coping strategies, and cultural differences vary widely. At the same time, these parents may not have the same access to, need for, or reliance on peer or other support groups. Obtaining transportation or babysitters so they can attend meetings may be an impossibility for some parents. Still others may reject such support networks and depend solely on family, neighborhood, or church networks as the best support system for them. Parental bereavement support groups are not for everyone.

All of the parents exemplified here find themselves in special situations affecting their personal grief experience, how others react to their grief, and the type of support and/or intervention needed to help them resolve their grief. However, these parents are the fathers and mothers of the child who died; they are the ones who have nurtured, cared for, and loved that child. The sense of absolute emptiness, the lack of wholeness, and the feeling of diminishment after the death of a child are felt by all parents, regardless of marital status; age; language; financial or social circumstances; biological relation to the child; or cultural, racial, or religious background. Despite the differences among these groups in their responses and needs, all have one major need in common-their grief is intense and must be acknowledged.

There is no relationship like that of parent and child. It is unique and special...The bond between parent and child is so powerful that its strength endures time, distance, and strife. No loss is as significant as the loss of a child...On the death of a child, a parent feels less than whole. - ARNOLD AND GEMMA 1994, 25-27

From One Grieving Parent To Another

You will always grieve to some extent for your lost child. You will always remember your baby and wish beyond wishes that you could smell her smell or hold his weight in your arms. But as time goes on, this wishing will no longer deplete you of the will to live your own life. - HORCHLER AND MORRIS 1994, 158

  • Parental grief is overwhelming; there is nothing that can prepare a parent for its enormity or devastation; parental grief never ends but only changes in intensity and manner of expression; parental grief affects the head, the heart, and the spirit.
  • For parents, the death of a child means coming to terms with untold emptiness and deep emotional hurt. Immediately after the death, some parents may even find it impossible to express grief at all as many experience a period of shock and numbness.
  • All newly bereaved parents must find ways to get through, not over, their grief-to go on with their lives. Each is forced to continue life's journey in an individual manner.
  • Parental bereavement often brings with it a sense of despair, a sense that life is not worth living, a sense of disarray and of utter and complete confusion. At times, the parent's pain may seem so severe and his/her energy and desire to live so lacking that there is uncertainty about survival. Some bereaved parents feel that it is not right for them to live when their child has died. Others feel that they have failed at parenting and somehow they should have found a way to keep the child from dying.
  • Grieving parents often have to adopt what one parent called a "new world view" (Wisconsin Perspectives Newsletter, December 1996, 7). Each parent must almost become a new and different person.
  • Grieving parents should learn to be compassionate, gentle, and patient with themselves and each other. Grief is an emotionally devastating experience; grief is work and demands much patience, understanding, effort, and energy.
  • Parental grief can and often does involve a vast array of conflicting emotions and responses including shock and numbness, intense sadness and pain, depression, and often feelings of total confusion and disorganization. Sometimes, parents may not even seem sure of who they are and may feel as if they have lost an integral part of their very being. At other times, parents may feel that what happened was a myth or an illusion or that they were having a nightmare.
  • Typical parental reactions to a child's death often involve emotional and physical symptoms such as inability to sleep or a desire to sleep all the time, mood swings, exhaustion, extreme anxiety, headaches, or inability to concentrate. Grieving parents experience emotional and physical peaks and valleys. They may think life finally seems on an even keel and that they are learning to cope when periods of intense sadness overwhelm them, perhaps with even more force. (Experiencing any or all of these reactions does not mean permanent loss of control or inability to recover and are usually part of the grief process.)
  • The death of a child can and often does affect not only personal health but sometimes the marriage, the entire family unit, other relationships, and even plans and goals for the future.
  • Grieving parents need to know how important it is to express their pain to someone who will understand and acknowledge what they are feeling and saying. They should be honest with themselves and others about how they feel. These parents should allow themselves to cry, be angry, and complain. They need to admit they are overwhelmed, distracted, and unable to focus or concentrate. They may even need to admit to themselves and others that they might show physical and/or emotional symptoms that they don't want or can't even understand.

When are you ready to live again? There is no list of events or anniversaries to check off. In fact, you are likely to begin living again before you realize you are doing it. You may catch yourself laughing. You may pick up a book for recreational reading again. You may start playing lighter, happier music. When you do make these steps toward living again, you are likely to feel guilty at first. 'What right have I, you may ask yourself, to be happy when my child is dead?' And yet something inside feels as though you are being nudged in this positive direction. You may even have the sense that this nudge is from your child, or at least a feeling that your child approves of it. - HORCHLER AND MORRIS 1994, 158

  • Each bereaved parent must be allowed to mourn in his/her own way and time frame. Each person's grief is unique, even that of family members facing the same loss. Bereaved parents shouldn't expect or try to follow a specific or prescribed pattern for grief or worry if they seem out of synchrony with their partner or other grieving parents.
  • Bereaved parents need to know that others may minimize or misunderstand their grief. Many don't understand the power, depth, intensity, or duration of parental grief, especially after the death of a very young child. In some instances, bereaved parents are even ignored because some individuals are not able to deal with the tragedy. They find the thought of a child's death too hard, too Inexplicable, or too threatening. Many simply don't know what to say or do and so don't say or do anything.
  • Most grieving parents experience great pain and distress deciding what to do with their child's belongings. Parents need to under-stand that this task will be most difficult and that different parents make different decisions. They should be encouraged to hold onto any experiences, memories, or mementoes they have of the child and find ways to keep and treasure them. These memories and mementoes-their legacy from the short time they shared with this very special person- will be affirming and restorative in the future.
  • Most grieving parents also experience considerable pain on special occasions, such as birthdays, holidays, or the anniversary of the child's death. Parents will need to find ways to cope with these events and should do what feels right for them, not what others think they should do.
  • Many bereaved parents find solace in their religion. Not only will these religious beliefs significantly alter the meaning that the parents give to life, death, and life after death, they will also affect their grief response. Grieving parents with a religious background should be encouraged to express these beliefs if this is helpful. Some grieving parents without a formal or organized religious background may maintain a spirituality or a personal faith that is also a part of their lives and that gives them comfort. They, too, should be encouraged to express these feelings. Seeking spiritual comfort in a time of grief does not mean repressing the grief. (It is important, however, that others offering support to grieving parents should not try to dismiss or diminish their grief by using religious or other platitudes or by forcing religion on parents who are uncomfortable with a particular belief system.)

Bereaved parents will recover and reach a place of rest and hope... [They] will never forget [their child], but rather will find ways to keep [the child] a cherished part of [their] inner selves forever. - HORCHLER AND MORRIS 1994, XIX

  • Many grieving parents also find comfort in rituals. Funerals or memorial services have served many parents as beautiful and meaningful ways of saying goodbye, providing a sense of closure after the child's death. For others, sending announcement cards about the baby's death, writing poems, keeping journals or writing down personal reflections or prayers, or volunteering with a parental bereavement group become ways to remember and honor the child who died.
  • Grief is the natural response to any loss. Parents need to be reminded how important it is to process all feelings, thoughts, and emotions in resolving grief. Bereaved parents must look within and be prepared to deal with the past and present. They need to talk about their loss, and the loss must be acknowledged by others. They need to tell others about what happened to their child; they need to talk out and through their thoughts and feelings from the heart, not just from the head. Healing for bereaved parents can begin to occur by acknowledging and sharing their grief.
  • Probably the most important step for parents in their grief journey is to allow themselves to heal. Parents need to come to understand that healing doesn't mean forgetting. They need to be good to themselves and absolve themselves from guilt. They should not be afraid to let grief loosen its grip on them when the time comes. Easing away from intense grief may sometimes cause pain, fear, and guilt for a while, but eventually, it usually allows parents to come to a new and more peaceful place in their journey. Allowing grief's place to become a lesser one does not mean abandoning the child who died.

In the end parents must heal themselves. It was their baby; it is their loss; it is their grief. They need to gain closure, to experience release, to look to their new future. - NICHOLS, IN RANDO 1986, 156

Some Thoughts From Grieving Parents

  • Bereaved parents face a devastating and difficult journey; expressing grief is the normal response to such a loss; unexpressed grief can be devastating and debilitating.
  • An intense parental attachment has been formed between parent and child no matter how young the child is at the time of death. Others need to try and understand the intensity of this attachment, the depth of the parents' grief, and the magnitude of their sorrow.
  • Grief is exhausting and demanding work. Grief is also a process, not a single timed event. Bereaved parents appear to exhibit different reactions at varying points in their grief and to grieve differently even when they belong to the same family.
  • There are no easy ways to deal with grief, there is no one correct way to grieve, and no set time frame for grieving parents.
  • Caregivers need to know there are no exact or right words or expressions when comforting grieving parents. Neither should caregivers try to take away the parents' grief. Most of all, they should try to speak from the heart and show their care and concern. Sometimes it may seem that they say the wrong thing.
  • The caregiver should try again, using different words, or admit confusion about what to say. The pain must be walked through by the bereaved parent and also by those who seek to help them.

There is a need to talk, without trying to give reasons. No reason is going to be acceptable when you hurt so much. A hug, the touch of a hand, expressions of concern, a willing listener were and still are the things that have helped the most...The people who [were] the greatest help... [were] not judgmental. It's most helpful when people understand that [what is needed] is to talk about it and that this is part of the grief process. - DEFRAIN ET AL. 1991, 158, 163

  • Bereaved parents need to find ways to keep the memories alive and also find ways to create memories. Memories are all they have left from the child who died. Bereaved parents often need to establish unique rituals to memorialize the child and in some cases, others may find this process puzzling.Grieving parents need to be allowed to set the tone and direct others about how to help them in their grief. Parents need validation as they attempt the process of healing.
  • Friends and caregivers should try to help grieving parents express their grief. They should try to be a safe place for them-a place where they can be themselves, where they can be confused, where they can express their pain, sadness, and even anger. Those who care should grieve and mourn with the parents; they must also be willing to listen.
  • In most cases, bereaved parents don't want to be avoided, but they may be hesitant to let others know they are needed. Usually, they are most grateful for the kind expressions and gestures of love and support.
  • Bereaved parents need to know that the support of family, friends, and others will continue after the commotion and busy days immediately following the death and funeral. Their grief continues forever. One bereaved father said, "the period following the funeral is perhaps the most difficult time for the bereaved...[This is the time that parents must] absorb the magnitude of their loss and begin to integrate it into the rest of their lives" (Bramblett 1991, 39). Bereaved parents need to have extended remembrances of their child for a long while after the event, especially on anniversaries, birthdays, holidays, or special events, such as Mother's Day or Father's Day.
  • Bereaved parents need to know that their child will be remembered, not just by them but also by family and friends. They need to have the child acknowledged and referred to by name. They want that child's life to matter. They do not want to forget and they don't want others to forget. One bereaved parent said, "The mention of my child's name may bring tears to my eyes, but it also brings music to my ears" (Anonymous).

Grieving keeps memories alive for bereaved parents and retains a place in their families and in their hearts for the dead child...[it is] a continuous process with peaks, valleys, and plateaus; it is a complex process that varies with each individual. - Arnold and Gemma 1994, 1994, 28

When Trying To Comfort Grieving Parents

DO:

  • Acknowledge the child's death by telling the parents of your sadness for them and by expressing love and support; try to provide comfort.
  • Visit and talk with the family about the child who died; ask to see pictures or mementoes the family may have.
  • Extend gestures of concern such as bringing flowers or writing a personal note expressing your feelings; let the parents know of your sadness for them.
  • Attend the child's funeral or memorial service.
  • Remember anniversaries and special days.
  • Donate to some specific memorial in honor of the child. Offer to go with the parent(s) to the cemetery in the days and weeks after the funeral, or find other special ways to extend personal and sensitive gestures of concern.
  • Make practical and specific suggestions, such as offering to stop by at a convenient time, bringing a meal, purchasing a comforting book, offering to take the other children for a special outing, or treating the mother or father to something special.
  • Respect the dynamics of each person's grief. The often-visible expressions of pain and confusion shown by grieving parents are normal. Grief is an ongoing and demanding process.

DO NOT:

  • Avoid the parents or the grief. Refrain from talking about the child who died or referring to the child by name.
  • Impose your views or feelings on the parents or set limits for them about what is right or appropriate behavior.
  • Wait for the parents to ask for help or tell you what they need.
  • Tell them you know just how they feel.
  • Be afraid to let the parents cry or to cry with them.

How Grieving Parents Attempt To Cope With The Loss And Move On

  • Bereaved fathers and mothers try to cope with their grief by:
  • Admitting to themselves and others that their grief is overwhelming, unpredictable, painful, draining, and exhausting-that their grief should not be diminished or ignored.
  • Allowing themselves to be angry and acknowledging that they are vulnerable, helpless, and feeling disoriented.
  • Trying to understand that to grieve is to heal and that integrating grief into their lives is a necessity.
  • Acknowledging the need and desire to talk about the child who died as well as the moments and events that will be missed and never experienced with the child.
  • Maintaining a belief in the significance of their child's life, no matter how short.
  • Creating memorial services and other rituals as ways to commemorate the child's life.
  • Deriving support from religious beliefs, a sense of spirituality, or a personal faith.
  • Expressing feelings in journals, poetry, prayers, or other reflective writings or in art, music, or other creative activities.
  • Trying to be patient and forgiving with themselves and others and refraining from making hasty decisions.

When you accept what has happened, you aren't acknowledging that it is okay but rather, that you know you must find a way to keep growing and living-even if you don't feel like it...[Don't let] grief be your constant companion...Realize that your grief is born out of unconditional love for your child and rejoice in that love which will never end... Embracing life again is not a sign that you have stopped missing your baby, but an example of a love that is eternal. - WISCONSIN PERSPECTIVES NEWSLETTER, SPRING 1989, 3

  • Counting on, confiding in, and trusting those who care, listen, and hear, those who will walk with them, and not be critical of them, those who will try to understand their emotional and physical limitations.
  • Increasing their physical activity and maintaining a healthful diet.
  • Volunteering their services to organizations concerned with support for bereaved parents.
  • Obtaining help from traditional support systems, such as family, friends, professionals or church groups, undergoing professional counseling, joining a parent support group, or acquiring information on the type of death that occurred as well as about their own grief.**
  • Reassuring themselves and others that they were and still are loving parents.
  • Letting go of fear and guilt when the time seems right and the grief seems less.
  • Accepting that they are allowed to feel pleasure and continue their lives, knowing their love for their child transcends death.

** Grief support groups are often available through area hospitals, churches, or local chapters of national organizations, such as State SIDS or SIDS Alliance programs or through support organizations, such as SHARE, Resolve Thru Sharing, Compassionate Friends, and others.
When children die, the bond doesn't break... [But] the parents face two mutually exclusive facts. The child is gone and not coming back, and the bond is...as powerful a bonding as people have in their abilities... [Bereaved parents attempt] to let go, not of the child, but of the pain. - FINKBEINER 1996, 244, 249

Conclusion

Children are valuable and precious symbols of what lies ahead. Children are considered the hope of the future. When a child dies, that hope is lost.

Two universals stand out when reflecting on parental grief-a child's death is disorienting, and letting go of a child is impossible. Parents never forget a child who dies. The bond they formed with their child extends beyond death. As survivors, bereaved parents try to adapt to the new existence forced on them. They try to pass on to others the love and other special gifts they received from their child; they try to make the child who died a part of their lives forever; they constantly try to "honor the child who should have lived" (Finkbeiner 1996, xiv). Bereaved parents encourage others who care for and about them to do the same. They ask others to help them, to be for them "a lifeline of support, a lifeline to survival [and to understand]...the crying of their souls" (Donnelly 1982, ix).

Bereaved parents say, "Our children are in our blood; the bond with them doesn't seem to break [and they attempt to] find subtle and apparently unconscious ways of preserving that bond" (Finkbeiner 1996, xiii, xiv). Bereaved parents need to do this to deal with what seems like an endless roadblock of loss and sadness. One bereaved parent expressed it by saying that the wound heals, but the scar remains forever.

What has happened to these parents has changed their lives; they will never see life the same way; they will never be the same people. As they attempt to move forward, bereaved parents realize they are survivors and have been strong enough to endure what is probably life's harshest blow. By addressing their grief and coping with it, they struggle to continue this journey while making this devastating loss part of their own personal history, a part of their life's story, a part of their very being.

Bereaved parents learn to live with the memories, the lost hopes, the shattered dreams. [They] never 'get over' the death, but [they] do recover, adjust and learn to live with [the] pain. - DONNELLY 1982, X

In writing about bereavement, Rollo May, the religious psychologist said that the only way out is ahead and the choice is whether to cringe from it or to affirm it. To be able to continue this lifetime journey and to make it manageable and productive, bereaved parents must move ahead and affirm this loss while also affirming their own lives.

Eventually, time will cease to stand still for these parents. Painful and terrible moments will still occur-striking, poignant, but in some ways comforting, reminders of the child who died. There will also be regrets for experiences that were never shared. But at some unknown and even unexpected point, these parents will come to realize that there can be good moments, even happy and beautiful moments, and it will not seem impossible or wrong to smile or laugh, but it will seem right and beautiful and a fitting way to honor and remember the child who died. One day, bereaved parents may come to be "surprised by joy" (Moffat 1992, xxvii).

But in time... nature takes care of it; the waves of pain lose intensity a little and come less frequently. Then friends and relatives say the parents are getting over it, and that time heals all wounds. The parents themselves say that as the pain lessens, they begin to have energy for people and things outside themselves...This is a decision parents say [they] must make to live as well as they can in [their] new world... They can come to be happy, but never as happy. Their perspective on this and everything has changed. Their child's death is the reason for this and is a measure of the depth and breadth of the bond between parent and child. - FINKBEINER 1996,12, 20, 22, 23

References

Arnold, J.H. and P.B. Gemma. A Child Dies: A Portrait of Family Grief. Rockville, MD: Aspen Systems Corporation. 1983.
Arnold, J.H. and P.B. Gemma. A Child Dies: A Portrait of Family Grief. Philadelphia, PA: The Charles Press Publishers. Second Edition. 1994.
Bramblett, J. When Good-bye Is Forever: Learning to Live Again After the Loss of a Child. New York: Ballantine Books. 1991.
Cordell, A.S. and N. Thomas. "Fathers and Grieving: Coping with Infant Death. Journal of Perinatology, Vol. X, No. 1, March 1990.
Corr, C.A., H. Fuller, C.A. Barnickol, and D. M. Corr (Eds.). Sudden Infant Death Syndrome: Who Can Help and How. New York: Springer Publishing Company, Inc. 1991.
DeFrain, J., L. Ernst, D. Jakub, and J. Taylor. Sudden Infant Death Syndrome: Enduring the Loss. Lexington, MA: Lexington Books. 1991.
Donnelly, K. F. Recovering From the Loss of a Child. New York: Macmillan Publishing Co. 1982.
Finkbeiner, A. K. After the Death of a Child: Living with Loss Through the Years. New York: Simon and Shuster Inc. 1996.
Horchler J. N. and R.R. Morris. The SIDS Survival Guide: Information and Comfort for Grieving Family and Friends and Professionals Who Seek to Help Them. Hyattsville, MD: SIDS Educational Services. 1994.
Hosford, C. Fact Sheet: When a Twin Dies. Baltimore, MD: Maryland SIDS Information and Counseling Program. 1994.
Moffat, M.J. (Ed.) In the Midst of Winter: Selections from the Literature of Mourning. New York: Random House. 1992.
Neugeboren, J. An Orphan's Tale. New York: Holt, Rinehart & Winston. 1976.
Rando, T.A. (Ed.) Parental Loss of a Child. Champaign, IL: Research Press Company. 1986.
Schiff, H.S. The Bereaved Parent. New York: Penguin Books. 1977.
Staudacher.C. Men and Grief: A Guide for Men Surviving the Death of a Loved One, A Resource for Caregivers and Mental Health Professionals. Oak-land, CA: New Harbinger Publications, Inc. 1991.
Wisconsin Perspectives Newsletter. Milwaukee, WI: Wisconsin Sudden Infant Death Center, Spring 1989.
Wisconsin Perspectives Newsletter. Milwaukee, WI: Wisconsin Sudden Infant Death Center, December 1996.
Wisconsin Perspectives Newsletter. Milwaukee, WI: Wisconsin Sudden Infant Death Center, February 1997.

Acknowledgments

Staff of the National SIDS Resource Center (NSRC) collaborated in the preparation of this publication. We have tried to express our own thoughts and ideas, but most especially, we have drawn from our experiences with bereaved parents, whether in person, by phone, or from their own writings and reflections. We have learned from these parents, and we would like to share what we have learned with others.
We hope that this publication will help our readers better understand the magnitude of parental grief and its aftermath. We also hope that we may help others hear what grieving parents mean when they speak about "the crying of their souls."

We are deeply grateful to the many parents and caregivers who have been willing to share such sensitive and personal reflections with others. We have freely quoted from them and acknowledged each source whenever it was identified. A few citations remain anonymous because we were not able to identify their source.

NSRC staff also wish to thank the following two individuals who graciously offered their comments and suggestions and from whose publications we have quoted liberally:

Joan H. Arnold, PhD, RN
Associate Professor, College of New Rochelle, School of Nursing; Consultant to the New York City Information and Counseling Program for Sudden Infant Death Syndrome; and coauthor with Penelope B. Gemma of A Child Dies: A Portrait of Family Grief.

Joani N. Horchler
SIDS Parent; Executive Director of SIDS Educational Services Inc., Hyattsville, MD; and coauthor with Robin R. Morris of The SIDS Survival Guide: Information and Comfort for Grieving Family & Friends & Professionals Who Seek to Help Them.
Source: National SIDS Resource Center

September 1997

Page last modified or reviewed on January 23, 2014

The Disneyland Daddy: A Case Study

by James Lehman, MSW

Vicki is the single mother of Alex (12), Ryan (8) and Jessica (6). To make ends meet, she works two jobs-as a receptionist during the week and part-time catering on weekends. She has been divorced from Mike, a supervisor for a building contractor, for two years. Her relationship with Mike is strained at best, hostile at worst.

Mike gets the kids every other weekend and every Wednesday. The kids love going to Dad's because there are "no rules." They get to do pretty much whatever they want. Weekends are filled with video games, trips to the mall, pizza and movie outings. And candy. Lots and lots of candy. Wednesday nights are TV nights. The kids never do their homework on Wednesday nights because, after a long day, Mike wants to kick back. He doesn't want to have to deal with questions about homework. Vicki resents Mike's free-for-all parenting and calls him "The Disneyland Daddy."

When Mike drops off the kids at Vicki's apartment on Sunday night, they are wound up, bubbling about all the things they did with Dad over the weekend and not wanting the fun to end. Within minutes, excitement turns to disrespect, when Vicki asks them to help with chores and get to their homework. They talk back, act out and tune their mother out. Sunday nights with mom turn into screaming matches and tears. The anxiety always spills over into Monday morning, when she has to get the kids out of bed and get to work on time.

In her own words, Vicki's life is "a wreck." Her priority is to get the bills paid and provide for her kids. In doing so, she feels she is losing control of them at light speed. How can Vicki get back in control, when her parenting efforts are undone weekly by Mike?

Mike doesn't have effective parenting skills and tries to make up for it with deep pockets. He's also perfectly happy that the kids go back to their mother's and act out because it's gratifying for him. It's a way to act out his bad feelings toward his ex-wife. Vicki feels cheated, betrayed and resentful about her income disparity with Mike and for having to carry the whole workload of raising the children.

What they both need to understand is that in divorce situations, kids develop a sort of "extra sensory perception" about statements that reflect resentment, anxiety or jealousy. They already feel caught in the middle between their parents, and this heightened sensitivity to their parents' words makes it even more so.

Can Vicki stop the disrespect and chaos in her home and can Mike learn to be a responsible, effective parent? Yes. But here's what has to happen.

The simple fact is this: When the kids come back from Dad's, they need a structure to come home to, not a "mommy" to come home to.

  • The hard pill for parents, especially mothers, to swallow, is that they have to manage their feelings of resentment and anxiety. Kids do sense when daddy returns them that mom is resentful. This raises their anxiety and contributes to the acting out. One way to manage the resentment is talking about it straightforwardly. I recommend that mom sit down and talk with the kids when things are going well. She can acknowledge to them that sometimes she has a hard time when they return because daddy's able to give them things that she's not. So when they return home, there should be a half hour transition time, where they just go to their rooms and unwind and unpack and have a snack. They don't talk about the visit with daddy. They don't talk about the chores. They don't do anything. They just unwind. After that half hour of transition time, that's when she meets with the kids and sets up the structure for the night (homework, chores and TV time before bed) and the week (getting up, getting to school on time).
  • Mom needs to have a structure in the home with rules and very clear expectations. She needs to establish a culture in the home that says, "You're accountable to me." What happens at Dad's house is irrelevant. Mom needs to say this: "You're not at your father's anymore. The rules here are these." Then turn around and walk away. Mom can establish a structure by saying, "It's eight o'clock. You need to start getting ready for bed. If not, there'll be no TV tomorrow night." Or "If not, I'm taking your cell phone." The clearer that structure is and the more it's backed up by expectations, responsibilities and accountability, the better the chances the kids will respond to it. The simple fact is this: When the kids come back from Dad's, they need a structure to come home to, not a "mommy" to come back to.
  • At the same time, mom can set up a reward structure. The kids who do their homework on Wednesday nights when they're at Dad's get something extra. It doesn't have to be something that costs a lot of money. It can be extra computer time, extra phone time or staying up half an hour later the night they get back. There's also a much easier way to get the kids to do their chores. Give them a certain amount of time to complete a task. If they get it done, they get a reward. For example, if Ryan does the dishes within 15 minutes after supper, he gets an extra half hour on the computer that evening. Vicki should set the limits and make it the kids' responsibility to meet them. Why? Because they can do it. Kids show us this every day. Why do you think they go home and act out, then go to school the next day and behave themselves? It's because they can manage different environments effectively.
  • I think the "Disneyland Daddy" in this case needs to be challenged to take responsibility. If these parents are involved in family therapy or counseling, accelerating Mike's responsibility needs to be part of the structure. I've known families who have worked out an arrangement in therapy that if the child is acting out, the father has to come over and help restrain him. It puts some responsibility back on the father and discourages him from creating the problem. I've seen divorced parents make agreements that if the child comes home and is acting out, he goes back to the father's and stay an extra night. This can only happen if mothers are empowered through the divorce decree and custody arrangement or through regular or court-ordered family therapy. But it's important for mothers in these situations to have that empowerment, so that the family has a structure for the co-parenting task.

The Disneyland Daddy: A Case Study reprinted with permission from Empowering Parents. For more information, visit www.EmpoweringParents.com
Author: James Lehman is a behavioral therapist and the creator of The Total Transformation® Program for parents. He has worked with troubled children and teens for three decades. James holds a Masters Degree in Social Work from Boston University.

Page last modified or reviewed on April 11, 2012

The Incorporation of Holistic Treatment into a Brief Treatment Framework

by Tammie Byram Fowles, MSW, PhD

Sharon is 27 years old. She doesn't plan to be 28. She is lonely, and hurting and desperate. She's decided as a final attempt to seek counseling; however, the few counselors covered by her insurance company all have waiting lists. She also understands that her sessions might be limited to as few as three sessions. The soonest she can be seen is three weeks from now. She isn't sure how she will make it through the day. She contacted a crisis line only to find that the line had been disconnected.

Robert is 34. He is divorced with 3 children to support. After child support is taken from his check, and rent and other essential living expenses are paid for, he only has $21.00 a week left over. Therapy would cost him a minimum of $50.00 per session. He has a $200.00 deductible, and once this is met he will still be responsible for $25.00 a visit. Robert's anxiety is growing by leaps and bounds. He hardly sleeps, has lost his appetite, and has begun experiencing sharp pains in his chest. Twice last week he has had to leave work early because he thought he was having a heart attack. His doctor informed him that he was experiencing panic attacks and suggested counseling. He has no idea how he can afford it, however he feels as though he's running out of time faster than he's running out of money.

Both of these individuals are feeling out of control. Both seek counseling, yet it is unlikely that the traditional once per week session offered indefinitely will be available to them. While this is unfortunately the reality, there are other realities as well:

  1. They need help soon
  2. They are not alone; there are many Americans in similar positions
  3. We who live in this "kinder, more gentle nation" have some responsibility ("the ability to respond") to offer assistance

The days of close knit families and communities that provided ready-made support for just about every American are over for many of us. Instead, the average adult today must often find his or her own way, constructing a safety net piece by piece. Children are often required to fend for themselves as their parents frantically struggle to keep the family intact, the bills paid, and maintain the necessities. In this mobile and fast moving society where we have grown dependent upon grocery stores, electric companies, etc., we are required to develop a new kind of self-reliance these days. Often we must deal with the complexities of parenting, relationships and life crisis's without the loving concern of family, mentors, and old friends nearby.

More and more, individuals who used to turn to built-in support systems now seek the assistance of a stranger, a trained therapist during difficult times. It sadly seems that while a growing number of people are more amenable to utilizing such services; many individuals who are in need of psychotherapy cannot afford it. Those who are in a position to seek therapy all too often do so with the expectation that the therapist will somehow administer a cure while the recipient remains relatively passive. For some it's as if the therapist need only to hear their prayer in order for the answers to be provided. Others are prepared to work hard within the comfort of the therapist's office and then resume their normal activities once the session is concluded. Few recognize that healing requires as much and often more effort outside of the therapist's domain. Most who utilize the services of a psychotherapist are being forced to recognize the limits of psychotherapy, as (ready or not) the number of sessions available to those who rely on insurance to subsidize the cost are often dramatically reduced.

It is commonly believed that therapy occurs once per week. This is not necessarily so, and for some it is not even financially possible. Therapy can provide significant benefits without the old constraints of a 50-minute weekly session, particularly when utilized in conjunction with other resources. If the needs of individuals such as Sharon and Robert are to be responded to whole heartedly:

  1. We as therapists must offer alternatives to the traditional psychotherapy format
  2. Robert and Sharon must assume more responsibility than traditional psychotherapy clients have in the past
  3. A growing awareness must evolve within our society regarding the necessity of mutual support while assuming ("taking upon oneself") more fully that which is required of us to become more accountable ("liable to be called to account") for our own health and well-being.

As usual, times are changing. One of the changes that will be occurring more frequently due to the crisis in health care costs is the alterations in medical benefits increasingly overseen by managed care companies. In my own little corner of the Universe, this is most dramatically represented by the wide spread adoption of Brief Treatment methods. While the transition has created a number of challenges, like all transformations that are spawned by crisis, this shift also offers opportunities.

We are clearly not the only ones suffering the aches and pains brought on by the transformation of the health care system. Our clients are sustaining tremendous losses as well, and they should not be ignored. I have tried to minimize my clients' losses while ignoring the losses of the population at large for the most part. I busily redesigned my practice to some extent and repaired my lifeboat, so to speak, in order to survive the incoming tide of managed care. The truth of the matter is that my practice has grown as a result of my successful attempts to figure out the politics and win the favor of managed care companies. They really like me, and I am grateful. Perhaps too grateful! I have heard of the frustration of clients who were working with someone they cared about and trusted only to be informed that the therapist was not covered by their new and "improved" insurance policy.

I have witnessed the anguish of a severely depressed woman who's therapist informed her that weekly sessions would need to be reduced to monthly in order to ensure that her sessions would be covered by her insurance. I am aware of the many in need of services being placed on lengthy waiting lists. I have tried for the most part to not think about them too much. My own little lifeboat is solid and sea worthy, and I have places to go, people to see. I have tried until now to direct my energy elsewhere. Now I am forcing myself to look and see. During this health care crisis, we as providers are all preoccupied with saving our own practices and that is understandable; however, the dust has begun to settle, and it is time that we examine how we can individually and cooperatively create the most beneficial environment to our clients. The good old days may be over but the new ones hold great promise as well if we actively commit to exploring the possibilities.

Brief Treatment

Brief Treatment from my view refers to therapy which is conducted in as time-effective manner as possible ranging from 1 to 20 sessions. The rapid rise of managed care not only makes utilization of brief treatment methods desirable, but necessary. As more and more providers of health care find their referrals increasingly limited by managed care companies, we are responding by attempting to adapt and adjust to the requirements of managed care.

"The Provider," a newsletter distributed to providers by MCC Behavioral Care, recently published "Eight Characteristics of Therapy under Managed Care," based on the work of Michael Hoyt and Carol Austad. The eight characteristics established by Hoyt and Austad were:

  1. Specific problem solving
  2. Rapid response and early intervention
  3. Clear definition of patient and therapist responsibilities
  4. Time is used flexibly and creatively
  5. Interdisciplinary cooperation
  6. Multiple formats and modalities
  7. Intermittent treatment
  8. Results orientation

Clearly, such therapy is not always compatible with the traditional, open-ended psychotherapy that has so often been the treatment of choice. However, considering that the utilization of brief treatment methods is rapidly becoming a requirement of managed care, therapists are attempting in increasing numbers to respond to the demands this expanding trend involves. We make these adjustments for the most part in order to continue to serve our clients to the best of our abilities while also maintaining reimbursability by insurance companies. From my perspective, this is in some respects a time of reckoning (if we are able to put aside our indignation long enough to acknowledge the purpose of medical insurance in the first place)

Medical insurance was developed to assist subscribers in seeking treatment for illness, not subsidize explorations intended to facilitate growth or cover marital counseling. For a number of years that is exactly what insurance companies have found themselves doing all too often. Wide spread abuses of the system have contributed significantly to our current dilemma of our work policed by managed care. Therapists being forced in some ways to develop skills in brief treatment can be viewed as a positive trend. Clients have a right to expect services to be performed in a time-effective and cost-effective manner just as do insurance companies. However, if we simply scramble to incorporate the slickest brief treatment methods available in order to get the job done as expediently as possible, we run the risk of offering, in many cases, little more than a quick and all too often temporary fix.

Holistic Treatment

Brief treatment expects much (as it should) from both the therapist and the client, and it is here that I believe holistic treatment emerges as a compatible ally. In addressing holistic treatment as it relates to psychotherapy, I would like to first examine how the advent of holistic treatment creates a shift in roles and relationships. Traditional healthcare (the allopathic approach) places responsibility for cure in the hands primarily of the caregiver. The holistic approach returns it to its rightful owner, the client. While the caregiver clearly must take an active role in the resolution of the problem presented, clients are not expected to passively accept the ministrations of the provider, but must themselves work diligently to restore well being. The central concept of the holistic approach, according to Richard Miles, (1978), is that the individual is responsible for the development and maintenance of his or her health and well being.

Miles contends that the holistic approach does not focus on problems or symptoms but rather on clarity of intention and the development and maintenance of well being and self-responsibility. In this context, problems may be viewed as important feedback messages to be dealt with on a conscious level as part of the life process. A basic definition according to Miles, of the holistic practitioner, is one who provides the client with clear information about the processes of body, mind and spirit. The client can then choose to follow with the provider's assistance, a course of action that will offer more productive and healthy life experiences. In choosing a particular course of action, the client assumes ownership and thus places responsibility where it must reside--within the individual.

In accepting the holistic model, one acknowledges that everything effects our health and well being. All aspects of ourselves including, physical, emotional, cognitive, spiritual and environmental, play a role in the quality of our lives. This first premise is easily accepted; however, when one moves on to its implication that we must attend to all of these elements, the challenge is then presented. Placing our lives in the hands of experts to render solutions can seem far less daunting then the work involved in prevention and self-care. For example, it seems simpler to follow the latest fad diet to the letter than to address the wide range of issues connected to unwanted weight gain. Further, one is reinforced when the weight fades away with the use of such a diet. All too often, however, satisfaction eventually is followed by disillusionment later, when the pounds return or when some other difficulty moves in to take their place.

Our practices are filled with individuals who ask us in one form or another to take their pain away. We would gladly oblige and often try. We even succeed from time to time. The bottom line, however, as we all know, is that if our efforts are to be sustainable over the long haul, our clients must learn what is required of them to meet their own needs. They must also possess the motivation to act upon this knowledge. In spite of impressive techniques, modalities, and theories, there is no one magic bullet--no one particular insight, behavior, drug, or technique that results in lasting wellness. First of all, the very nature of life prevents this; we are always confronted with change and new challenges. Second, as stated earlier, and in line with systems theorists, we are all made up of parts intermingling with other parts comprising various systems that continually impact and are impacted by our environment.

Like the Mobile that John Bradshaw strikes during his presentation aired by PBS on the family, when one of our components shift, the others are also effected and respond. An argument here might be made that if we then simply impact one element of the system, then the others may also automatically benefit. While this is a distinct possibility, it also implies that while we might fix a system or person by adjusting one facet or problem, the entire system remains highly vulnerable to a break down in another part of the system. There is no avoiding this reality that we are all highly vulnerable, and while I welcome information to the contrary, I must operate within the context of this truth for now. Thus, in view of the fact that we are comprised of parts that make up our whole, with each segment being vulnerable to or positively impacted by the others, would it not then make sense to respond to the needs of all components to the best of our abilities?

Holistic treatment calls for the care of all aspects of a client; brief treatment requires that we offer services in as efficient, responsive, and timely manner as possible. Both of these requirements (at a glance) may not seem readily compatible, yet they still remain very clear obligations to me.

Page last modified or reviewed on January 24, 2014

The Magic of Dialogue

In philosopher Martin Buber's classic work I and Thou, he suggests that in authentic dialogue something far deeper than ordinary conversation is going on. The I-Thou interaction implies a genuine openness of each individual to the concerns of the other. In such dialogue, "I" do not, while talking with you, selectively tune out views I disagree with, nor do I busy myself marshaling arguments to rebut you while only half attending to what you have to say. Nor do I seek to reinforce my own prejudices. Instead, I fully take in your viewpoint, engaging with it in the deepest sense of the term. You do likewise. Each of us internalizes the view of the other to enhance our mutual understanding.

Buber voiced the stunning insight that, apart from its obvious practical value for problem-solving, dialogue expresses an essential aspect of the human spirit. He knew that dialogue is a way of being. In Buber's philosophy, life itself is a form of meeting, and dialogue is the place where we meet. In dialogue, we penetrate behind the polite superficialities and defenses in which we habitually armor ourselves. We listen and respond to one another with a kind of authenticity that forges a bond between us.

By performing the seemingly simple act of responding empathetically to others and in turn being heard by them, Buber observed, we transcend the constricting confines of the self. Instead of saying, "you or me," you hear yourself saying, "you and me." The act of reaching beyond the self to relate to others in dialogue is a profound human yearning. If it were less commonplace we would realize what a miracle it is.

Missing Skills

If the yearning for dialogue is universal, why is it so rare? Because it calls upon skills that impose a rigorous discipline on participants. Most people have not taken the time and effort to develop these skills. The reason is not lack of motivation. People have ample incentive to acquire the skills of dialogue. They have not done so for several reasons:

  • Models are lacking. Television, for example, resorts to the conflicting debate format when presenting politics and other serious subjects because of its entertainment value.
  • The skills of dialogue have not been clearly identified, so people who wish to acquire them do not know what they are.
  • There are no obvious consequences of failure to develop the skills. If you tried to swim or ski without knowing how, your lack of skill would be swiftly and dramatically obvious, perhaps fatally so. If you fail at dialogue, it is not at all obvious that the reason is lack of dialogic skill, or even that a failure has occurred.

Significantly, success at dialogue is much more self-evident than failure. When dialogue is done well, the results can be extraordinary: Long-standing stereotypes dissolved, mistrust overcome, mutual understanding achieved, visions shaped and grounded in shared purpose, people previously at odds with one another aligned on objectives and strategies, new common ground discovered, new perspective and insights gained, new levels of creativity stimulated, and bonds of communication strengthened.

I do not want to overstate the benefits of dialogue. Though I believe it sometimes has almost magical properties, it is not a panacea for all the problems that ail us. Faith in the ability to talk to solve problems is very American, and to some cynics, a sign of our cultural na?vet?. It's easy to poke fun at serious, well-meaning attempts at dialogue that miscarry, as many unfortunately do.

As our society becomes increasingly fragmented and pluralistic, we're likely to misunderstand one another more and more. Ordinary discussion is not powerful enough to break through these misunderstandings. We will need increasingly to resort to the more potent resources of dialogue. All of us will need to know how to initiate and carry out spontaneous dialogue.

Constant readiness is the key to success. You never know when an opportunity for spontaneous dialogue will arise. If you are not ready to take advantage of it, the opportunity will pass you by. Worse yet, you may get drawn into a dialogue that will turn sour, leaving the bad taste of failure.

Constant readiness means that you know the strategies for doing dialogue successfully, and feel comfortable in applying the most important ones. (See "Strategies for Successful Dialogue" on the next page) For example, you understand the core requirements for dialogue ? treating the other as an equal in every respect (part of what Buber meant by "thou"), being willing and able to bring everyone's assumptions ? including yours ? into the open without becoming judgmental.

Should the need arise you must be psychologically prepared to perform an act of empathy ? which requires both self-confidence and the lowering of defenses. If you are in full battle gear, as many of us are these days in our encounters with a self-absorbed world, it is easy to interpret an act of empathy as a loss of face, a deficit of macho. I suspect that most opportunities to initiate dialogue are lost because participants are not psychologically prepared to take this first critical step.

You must also be prepared to confront misunderstandings through focusing on assumptions ? both your own and others. Misunderstandings arise from many sources ? from friction between subcultures to differences in interests. The most complex of all are transference-driven distortions. When you misunderstand people from other subcultures, you may be transferring to them attributes, feelings, and beliefs that are part of your own subculture. When you misunderstand people from within your own subculture, you may be transferring to them interests and feelings more appropriate to the ghosts of your past than to them.

Test Yourself

Are you ready for dialogue? Test yourself by asking yourself some searching questions. Suppose, for example, you are an executive in a meeting attended by people of varied ranks within your organization ? some who report to you, others who hold a higher position. A discussion is in progress regarding a project that did not work out according to plan. Lots of criticism is being bandied about. Are you prepared to volunteer that you accept some responsibility because of erroneous assumptions you had made, and then to make them explicit? If not, you may want to do more to prepare yourself for dialogue.

Or suppose you are a married man and you have just had a quarrel with your wife. You tell a friend, who then asks you, "After your quarrel, did your wife feel you had listened fully and sympathetically to her side of the story?" If your answer is "no" or "I'm not sure," the chances are you are not quite ready to enter into dialogue with your wife.

Or suppose you are a woman with a younger sister whom you habitually treat as not quite equal to you in experience or smarts. Ask yourself if your attitude toward her reflects the person she is today, or whether you are still reacting to her as she was in the past. To prepare yourself for dialogue with her, you may want to divest yourself of some of the baggage of the past.

One should not underestimate how difficult it is to break ingrained habits of not-listening, to break out of your wall of guarded reserve in order to offer acts of empathy, or to develop the skill of digging out your own and other people's transferences in a non-judgmental fashion. But I'm convinced that everyone can learn to do dialogue, and that each one who does gives a gift to us all.

Strategies for Successful Dialogue

The following is a checklist of strategies for successful dialogue. Yankelovich's book, The Magic of Dialogue, explains each one in detail.

  • Check for the presence of all three core requirements of dialogue ? equality, empathy, and openness ? and learn how to introduce missing ones. This is the bedrock strategy; without it you do not have dialogue.
  • Focus on common interests, not the divisive ones.
  • Keep dialogue and decision-making separate and compartmentalized.
  • Clarify assumptions that lead to subculture distortions.
  • Offer your own assumptions before speculating on those of others.
  • Use specific cases to raise general issues.
  • Focus on conflicts between value systems, not persons.
  • When appropriate, express the emotions that accompany strongly held values.
  • Initiate dialogue through an act of empathy.
  • Be sure trust exists before addressing transference distortions.
  • Where applicable, identify mistrust as the real source of misunderstandings.
  • Err on the side of including people who disagree.
  • Encourage relationships in order to humanize transactions.
  • Expose old scripts to a reality check.
  • Minimize the level of mistrust before pursuing practical objectives. Daniel Yankelovich is the author of The Magic of Dialogue. This article first appeared in Spirituality and Health.Head Start Bulletin
    Issue No. 68
    Page last modified or reviewed on January 24, 2014

The Mind-Body Connection

Many of us frequently experience the connection between our state of mind and our physical health. Often, that comes in the form of mental stress impacting how we feel.

"A cheerful face is nearly as good for the individual as healthy weather," said Benjamin Franklin (1706-1790).

"True enjoyment comes from activity of the mind and exercise of the body; the two are ever united," stated Alexander von Humboldt (1769-1959).

Over 200 years ago, Benjamin Franklin and Alexander von Humboldt noticed the connection between our state of mind and our physical health. Whether we are aware of it or not, many of us frequently experience this connection. For example, have you ever found yourself feeling that you were on the verge of becoming sick or tired - and decided to fight it? Probably, you kept telling yourself over and over, "I don't feel sick" or "I don't have time to be tired."

What happened next? My guess is that some of you went on to become sick or tired and others did not. While there are physical factors such as genetics, our immune system, and overall physical health that can account for this difference, other factors, including our emotional state and beliefs about health and illness, come into play as well.

For many years, scientists have noted the "placebo effect." A placebo is defined as any treatment that does nothing to alleviate symptoms or disease, but somehow causes an effect. The effect results from the patient's belief in the medicine's efficacy, not from the medicine itself. What happens is this: While testing the effectiveness of a certain drug, one group of patients is given the drug, the other a placebo, which is often a sugar pill. At the end of the trial period, the group receiving the placebo experiences an improvement in symptoms or, on the other hand, feels worse or suffers side effects.

Studies show that between 60 to 90 percent of all physician visits are for stress-related complaints. For over 30 years, Dr. Herbert Benson, the founder of the Mind/Body Medical Institute in Boston and author of The Relaxation Response (2000), has studied how mind/body medicine can help treat stress-related conditions, including joint pain, hypertension, diabetes, migraine headaches, asthma, and allergies. Dr. Benson explains that stressful thoughts lead to the secretion of stress hormones that impede our natural healing capabilities. These hormones send the body into a state of arousal, causing metabolism, heart rate, blood pressure, breathing rate, and muscle tension to increase. The relaxation response - which produces a physical state of deep rest - is a simple breathing and concentration technique that is practiced for only 10 - 20 minutes a day. Dr. Benson's research shows that it reduces the harmful effects of the stress hormones.

What are some other ways to combat stress? Regular physical exercise helps. Yoga and meditation do, too. Although these methods are effective, they can take time and money for instruction and often may not be practical in the midst of a stressful situation.

So what else can we do? First, stop and take a deep breath - or two or even three! Turn your focus toward using the mind-body connection to produce a positive effect. For example, try using affirmations on a regular basis. Or, practice mindfulness.

Affirmations are a way of turning negative self- talk, which leads to stress, into positive, life-affirming statements. They are always stated in the present tense - I am, I have, I choose - and they reflect what we wish to experience. Think back to what we say when we might be getting sick or feeling tired: "I don't feel sick" or "I don't have time to be sick." What do both of these statements have in common? They are negative and focus on what we do not want to happen.

More positive and effective statements are, "I feel energetic and healthy," or "I am relaxed and have plenty of time to do what needs to be done." At first it may feel silly to state over and over the exact opposite of what you are feeling. But with regular practice, you will notice a change. The inner world of your thoughts and feelings will be in line with the outer world of your experience. Your mind and body will work together to produce a positive result.

In her book Emotional Alchemy, Tara Bennett-Goleman (2001) describes mindfulness as a "meditative awareness that cultivates the capacity to see things just as they are from moment to moment." In other words, we become fully aware, in a nonjudgmental way, of our thoughts, body sensations, and feelings as we experience them. For example, when you are showering, instead of allowing your mind to wander and worry about the busy day ahead, focus on the sensation of the water and the smell of the soap. When walking from the parking lot to your office, instead of anticipating the piles of paperwork you must wade through, listen to the sounds of your feet touching the pavement, smell the air, and feel the warmth of the sun. By practicing mindfulness regularly, we can live in the moment, feel content and peaceful, and experience joy in the process of doing all that we do. We use our minds to produce the positive results that we want.

Children can teach us a lot about living in the moment and practicing affirmations. Time and time again, in a classroom or on a playground, I have noticed how children approach whatever they are doing with joy and how they focus intently on their involvement. When they feel ready to do something else, they turn their attention and energy to that. Take a moment or two to watch young children during the day, and see if you notice this as well.

A while ago, my 13-year-old niece, Melanie, was visiting me. I was having a particularly stressful day. I found myself saying to her over and over, "This is ending up to be a really bad day." Finally, she turned to me and said, "Whenever I wake up and think it is going to be a bad day, I tell myself over and over it is a good day. And before you know it, it really is." I learned an important lesson from Melanie that day.

References

Bennett-Goleman, T. 2001. Emotional alchemy: How the mind can heal the heart. Nevada City, CA: Harmony Books.

Benson, H. & M.Z. Klippur. 2000. The relaxation response. Rev. ed. New York: Harper Torch.

Robin Brocato, Guest Editor, is a Health Specialist at the Head Start Bureau.

Head Start Bulletin
Issue No. 75
by Robin Brocato

Page last reviewed on January 24, 2014

The Truth About Bullies

by James Lehman, MSW

The public perception of bullying is that bullies are acting out to cover their own fears. They may indeed be afraid, but accepting this as a reason makes bullies sound like victims of their fears -- like we're supposed to feel sorry for them and not hold them responsible for their abusive actions.

The issue is not whether bullies are afraid. Bullies bully other people to feel powerful around them and to feel power over them. Bullies start out feeling like zeroes, like nobodies. When they intimidate, threaten or hurt someone else, then they feel like somebody. The key is the feeling of power.

We often think of the child bully as being male, but the percentage of girls who intimidate their classmates and siblings is increasing dramatically. Bullying doesn't stop at the end of the school day, either. Whether bullies are at home, at school, or they're threatening and intimidating other kids on the Internet, they're going to act out to make themselves feel powerful. Many kids who are bullies at school are bullies at home. The most common victims are their innocent siblings.

What are the consequences of bullying? You may have heard about post-traumatic stress disorder (PTSD) when it comes to sexual victimization or assault. PTSD can occur any time people feel they have no control over the way their pain is delivered. They live in fear, not knowing when they're going to be hurt. Kids who are constantly bullied and not protected will develop symptoms of PTSD -- constant anxiety, constant fear, idiosyncratic behaviors to compensate for those feelings. They'll fall behind in their development.

Dealing with bullies requires holding them strictly accountable for the abusive, hurtful or disrespectful things that they do to feel powerful. They need to practice appropriate ways to feel powerful -- using social skills, articulating their feelings, communicating honestly with others and solving problems. Those skills are difficult to develop. It takes work; it's like learning how to multiply or learning how to add. But it can be done. Holding bullies accountable for inappropriate behavior gives them boundaries and gives them a roadmap for doing that work.

There appears to be a link between ADHD and bullying. A 2008 study conducted in Sweden, showed that children with ADHD are four times more likely than their peers to bully other children, and they are almost ten times as likely than other children to be bullied.If your child is a bully

If your child starts to exhibit bullying behavior, the first thing to do is realize it's something you need to address. You can't kid yourself that it will go away on its own. If adolescent bullies are not stopped, and not taught more appropriate ways to solve problems, they become abusive parents, spouses and bosses. We all feel powerless at times, but there are better ways to deal with that than to abuse other people.

You as the parent have to set a standard: No excuse for abuse. There's no excuse for cursing someone out, for breaking something, for hitting anyone. The bully always has an excuse, a way to justify this behavior. This justification is so powerful that it takes the place of empathy for the other person. That's why you have to have a no-excuse standard.

A kid may curse out his sister and say foul things to her and then make up some justification about what she was doing to him -- "She went into my room again" or "She wouldn't get off the computer." Let the kid tell you the excuse, and then reiterate, "There's no excuse for abuse." Don't shut off communication, but don't validate the thinking errors that go into the justification of abusive actions. There should be consequences for abuse. Later, you can talk about appropriate ways to handle a problem.

If your child is bullied

If your child is a victim of bullying, it may be because he is the sort of child who has difficulty standing up for himself. Bullies look for easy targets, because that makes them feel powerful. If you can teach a child not to respond to bullying, to walk away, bullies are less likely to press that child.

The most effective strategies for dealing with bullies are "avoid" and "escape." These are things you can teach your children: Avoid bullies when you can. Walk away from them if they're in your vicinity. If you're being bullied and that doesn't work, you need to get help from somebody who has more power than the bully. You shouldn't have to fight because somebody else is a bully. Go to someone who has more power than the bully, like the teacher or the police. Teach your child that he has to hold that person responsible. Getting hit in school is still assault, and parents shouldn't back off if that happens. You want the other kid's parents down at the police station. You want them to be as uncomfortable as you are.

It hurts to be bullied, and this fact should never be minimized. Teachers, parents and school officials are sometimes inclined to say, "Well, they're only kids. It happens." It shouldn't happen, and it's adults' responsibility to provide a healthy environment for our children. The best schools are the ones who develop a zero tolerance for violence and zero tolerance for bullying, and parents should demand that and support it.

At the same time, if your child is experiencing abuse at the hands of another child, ask this question: "What would you find helpful?" Find out what your child would find helpful to improve the situation. Here's why this is important. If a child is being bullied at school and his parents just take over the situation, then he's powerless on both ends. Be encouraging, give him a chance to work it out, offer some help and ideas. But also let him know that if it's still a problem, you're going to step in and protect him.

The Truth About Bullies reprinted with permission from Empowering Parents. For more information, visit the Empowering Parents website.

Author: James Lehman is a behavioral therapist and the creator of The Total Transformation® Program for parents. He has worked with troubled children and teens for three decades. James holds a Masters Degree in Social Work from Boston University.

Page last modified or reviewed on January 24, 2014