Williams 1 Running Head: MOURNING THE CHILD

Mourning the Child: Helping Parents Express Their Grief Through Art Making Allison Williams Marylhurst University August 28, 2009

Williams 2 Mourning the Child: Helping Parents Express Their Grief Through Art Making Bill and Martha have sought treatment one year after the death of their son Michael, who died at the age of 22. His death came after suffering for most of his life from severe and lifethreatening asthma. For Bill and Martha, the loss presents its own unique complexities and it will be important to recognize their unique struggle, particularly in regards to the way this kind of loss has most certainly impacted their family system and their views of the world. The loss of a loved one can be a difficult burden to bear. It often leaves the living with many unanswered and unanswerable questions. Yet there is something exceptional to the experience of those who lose a child. While many different experiences of loss come with secondary losses, when parents lose a child, the most significant secondary loss they face is the loss of ones story about life and what it is all about (Becvar, 2001, p. 113). Parents who lose a child must rethink their orderly assumptions about the way the world works, namely, the idea that the young will outlive the old (Becvar, 2001). For them everything they knew about life becomes turned upside-down. Even when the death arrives at the end of a long journey through severe illness, the loss of a child wreaks havoc on our universal truths. In studying parental loss, researchers have found that the age of the child at the time of death is not relevant to amount grief experienced by the parent: the loss of a child at any age is significant (Wijingaards-de Meij, et. al. 2005; Wijingaards-de Meij, et. al., 2008). Howeveras it impacts Bill and Marthait is important to note that Wijingaards-de Meij, et al. (2008) did find that as the age of the child at the time of death increased, the amount of depression experienced by the (depressed) parents also increased. Depression was also found to be greater

Williams 3 among women than men (Wijingaards-de, Meij, et. al., 2008). For Bill, and particularly Martha, it will be important to monitor for signs of depression, as several factors put the couple at a greater risk for developing the disorder. Although, the couple share many facets of loss together, it will also be important to support each partners individual grief journey. The dual processing model of coping with grief provides a relevant framework for understanding Bill and Marthas unique grieving styles. While the dual process model is primarily used to describe the oscillation of individuals between loss-oriented coping and restoration-oriented coping, couples may also gravitate towards opposite styles of coping (Hartsook, in a lecture at Marylhurst University, Summer 2009). On the one hand, Bill seems to display a restoration orientation. He avoidances or denies his grief by trying to adjust to reality by using positive thinking. Bill also focuses on the future and shows attention to life changes, wishing to redecorate Michaels room. Martha, on the other hand, seemed to be more loss-oriented. She avoids Bills more restorative approach wishing to keep Michaels room just as it is. Although the couple shows some oscillation between both orientations, each partner seems to stay predominately fixed in their respective orientation (as described above). This poses a problem, as Lister, Pushkar and Connolly (2008) cite that the oscillatory process explains how the bereaved person comes to find meaning. The couple spends very little time experiencing opposite coping orientations, which may explain why they feel stuck in a cycle of grieving that seem[s] unable to move forward. Stuck in their relatively fixed positions, the couple lacks the movement needed to begin to find meaning in their loss. While there are signs that Bill and Martha do make use of both grief coping styles, the couples system of interaction seems to be a major contributing factor to stagnation of their grief

Williams 4 work. In this case, a systemic art therapy approach might be useful in helping to disrupt the couples current cycle and introduce new patterns of interaction. The couple may also need help improving communication within the family system. Worden and Monahan (1993) point to several reasons why communication becomes incomplete for couples experiencing the loss of a child. For Bill and Martha the most relevant of these reasons might be: 1) that prior to Michaels death, his illness may have been the focus of most communication between Bill and Martha. Thus, after his death, there may not have been as much for Bill and Martha to communicate about. 2) When one of the partners is feeling especially pained (based on the couples history, this is likely to be Martha much of the time) he or she may not want to ruin the seemingly positive mood of the other person. And finally, 3) one parent might misinterpret the others grieving style. Becvar (2001) states two of the biggest challenges for bereaved parents include recognizing that each may grieve in a different manner and finding ways to support each other despite the differences. The job of this art therapist will be to collaborate with Bill and Martha in order to help the couple find ways to use art to interrupt this cycle of interaction. This collaborative art making process will also encourage complete communication in their relationship, and hopefully promote more healthy grief coping strategies. During the early phases of Bill and Marthas grief journey, the art therapist will also need to help them understand that each partners response to Michaels death, though perhaps very different, is equally appropriate. For the first phase of counseling, the focus of the art making will be on facilitating more complete communication within the family system in order to help Bill and Martha recognize different ways of grieving and find healthy ways of supporting each other. While the art making can naturally stimulate communication throughout the course of

Williams 5 treatment, during this initial stage it will help build a solid foundation for delving deeper into each partners grief work later in therapy. In the initial session, the couple will be asked complete separate drawings in response to the question What brings you to therapy at this time? After Bill and Martha complete their respective drawings, they will be given time to study each others work. During the discussion that follows, they will be allowed to interpret one anothers work without interruption from the artist. Then they will be allowed to discuss whether these interpretations were correct. This intervention is drawn from Rileys (2003) work on using art therapy with couples. As an art therapist, Riley strives to help a couple visually see how each partner interprets a particular problem from their own unique perspective. This intervention (having the couple create separate drawings, then interpret and discuss the other partners art work) also helps the couple to see how they can misinterpret messages from one another or how the messages one partner is trying to convey may not be what the other partner receives (Riley, 2003). For Bill and Martha, this exercise will begin to prepare the couple for understanding how each partner can look at Michaels death in a different way and how the couple may misinterpret the others grieving style as the wrong way to grieve. After a few sessions of getting to know the couple better and finding out more about their story, it will be important to engage the couple in discussions about different styles of grieving. For this, the couple will be asked to each complete a drawing of what their grief looks like to them. Then, as in earlier sessions each will be given a chance to view one anothers artwork. For this drawing, unlike earlier artworks, it may be important to give the artist the opportunity to speak about his or her drawing first, given the sensitivity of the subject matter. This intervention

Williams 6 allows the couple to visually see and understand the differences in the way each partner grieves. The intervention can also lead to a discussion about the needs of each partner in their moments of grief. From this discussion, the couple can develop a plan on how each partners needs can be met, particularly at times when one partner might not be capable of providing for those needs. At this point, Bill and Martha may be ready to develop artwork that can be used in a ritual to honor Michaelart that can be used particularly once their sessions with the art therapist have ended. Bermdez and Bermdez (1990) stress the importance of providing opportunities for clients to make decisions in the therapeutic process, suggesting that the therapist be flexible enough to provide several therapy modalities. Lister, Pushkar, & Connolly (2008) also emphasize flexibility in working with grieving clients as their needs may change session to session, especially as the clients oscillate between the dual modes of grief coping. In light of this, the art therapist will provide Bill and Martha with the choice between making a doll with an environment or creating a shrine. These directives focus on helping the couple to begin to transform their relationship with their son Michael, and begin to explore their own new self-identities. In addition, the directives provide the couple with a transitional object (Kaufman, 1999) that can be incorporated into a commemorative ritual and taken home when therapy is completed. Doll making provides many opportunities for healing and can promote communication. Dru Ellings (in The art of the doll maker) began making simple dolls while accompanying her daughter to chemotherapy. Later, after her daughters death, the doll making projects helped facilitate communication within the family and gave them an activity to unify around. In interviews, the family describes how Drus doll making filled the missing place in their lives

Williams 7 after experiencing such a loss. For Bill and Martha, the project of making a doll with an environment may also help to facilitate their own communication, particularly as they struggle over what should be done with Michaels old room. In addition, the doll may also provide Bill and Martha with a way of having an at home funeral for Michael in a culture where such a ritual is not usually performed. In a study by Wijngaards-de Meij, et al. (2008), they found that couples in the Netherlands who were able to have their children presented for viewing in their own homes had less grief in the two years following the death than those who did not. The researchers speculate that this rite may help the parents:
Confront the childs death the process of recognizing (and accepting) that the child has died thereby furthered. More specifically, the parents will (have to) experience for some days in their own home, that their formerly living child is now cold and without motion Presenting the body at home might permit more contact with the deceased child at self-chosen moments thereby facilitating acceptance of the enormity of the fact their child has died. (p. 248)

In the case of Bill and Martha, we are not given information surrounding the funeral rites of their son Michael. We are left to assume that Bill and Martha subscribe to current dominant American cultural norms, and were thus, unlikely to have presented the Michaels body in their home. Through doll making, then, Bill and Martha could create a similar ritual to help them cope with their loss. When not in use, the doll could be placed in a special place where each partner would be able to have contact with the doll, just as the Dutch parents had contact their child during the period the body was presented in the home. As an alternative to the doll making project, Bill and Martha will also be given the option to create a shrine or reliquary, essentially creating a piece using the box form to help set apart

Williams 8 or make special the things they wish to honor and remember about their son. This directive seeks to facilitate the grieving needs of both Bill (active; restorative-orientation) and Martha (ruminating; loss-orientation). The size and shape would be decided by the couple, but would include one side through which the contents could be viewed. Then the couple could create a collage/assemblage of pictures and items that reminded them of Michael, expressing a wide range of memories both happy and sad. In exploring the meaning of the box form, Kaufman (1996) found that, boxes, as a container, could mean both beginnings (as in enclosures like the womb) and endings (as in tombs, urns and coffins). Thus for Bill and Martha, this project not only helps them to deal with Michaels death, but also his life. The box form also provides a place where the often intense and varied expressions of grieve can be expressed and contained (Kaufman, 1996). Kaufman further contends, the process of being boxed transforms the contents, automatically suggesting that they are important to someone. Thus the box form allow Bill and Martha to create a piece that others will instantly recognize is important to them. The strong religious connotations of such a form may also be of particular use to Bill and Martha, as they struggle with spiritual questions about Michaels illness and death. In addition, Bermdez and Bermdez (1990) explain that shrines can give the illusion that the memorialized person (in this case Michael) is present in the room, and can also symbolize an externalizing of feelings, concerns and strengths, making it easier to talk about them. Through this externalization the artist (Bill and Martha) can begin to identify previously neglected, but vital aspects of lived experience (Bermdez and Bermdez, 1990, p. 339). For Bill and Martha this may mean that they will begin to experience and identify aspects of their grief that they previously denied themselves.

Williams 9 It is a hope that through the companioning of the art therapist, Bill and Martha will be able to unstick their grief process and, using effective coping strategies, begin to experience the full depth and breath of their grief. Perhaps as the art making begins to facilitate this process the couple will finally be free to find meaning and strength in their life long journey of grief.

Williams 10 References Becvar, D. (2001). When a child dies. In In the presence of grief: Helping family members resolve death, dying, and bereavement issues. New York: Guildford Press. Bermdez, J., & Bermdez, S. (2002). Altar-making with Latino families: A narrative therapy perspective. Journal of Family Psychotherapy, 13(3), 329-347. Crowe, L. (Producer). (2003). The art of the doll maker [Motion picture]. Chatsworth, CA: A Doll for Anne Production. Hartsook, M. (Summer, 2009). Bereavement and art therapy: Shatter and Repair. AT 583A: Marylhurst University. Kaufman, A. (1996). Art in boxes: An exploration of meanings. The Arts in Psychotherapy, 23(3), 237-247. Lister, S., Pushkar, D., & Connolly, K. (2008). Current bereavement theory: Implications for art therapy practice. Arts in Psychotherapy, 35(4), 245-250. Riley, S. (2003). Art therapy with couples. In Malchiodi, C. (ed.). Handbook of art therapy. New York: Guilford Press. Wijngaards-de Meij, L., Stroebe, M., Schut, H., Stroebe, W., van den Bout, J., van der Heijden, P., et al. (2005). Couples at Risk Following the Death of Their Child: Predictors of Grief Versus Depression. Journal of Consulting and Clinical Psychology, 73(4), 617-623. Retrieved August 25, 2009 from Ebscohost. Wijngaards-De Meij, L., Stroebe, M., Stroebe, W., Schut, H., Van Den Bout, J., Van Der Heijden, P., et al. (2008, March). The impact of circumstances surrounding the

Williams 11 death of a child on parents' grief. Death Studies, 32(3), 237-252. Retrieved August 25, 2009 from Ebscohost. Worden, J., & Monahan, J. (1993). Caring for bereaved parents. In Armstrong-Dailey, A., Zarbock Goltzer, S., & Zarbock, S. (eds.). Hospice care for children (pp. 132139). New York: Oxford University Press.