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The Courage to Remember
Childhood Traumatic Grief Curriculum Guide
From the
National Child Traumatic Stress Network
Childhood Traumatic Grief Working Group
Educational Materials Subcommittee
Robin F. Goodman, PhD
National Child Traumatic Stress Network
Judith Cohen, MD
Center for Traumatic Stress in Children and Adolescents
Allegheny General Hospital
Matthew D. Kliethermes, PhD
The Greater St. Louis Child Traumatic Stress Program
Julie Kaplow, PhD
New Jersey Medical School
Carrie Epstein, MSW
Safe Horizon
Christopher Layne, PhD
Brigham Young University
Robert Franks, PhD
National Center for Child Traumatic Stress, Duke University
Amy Blalock, BA
National Center for Child Traumatic Stress, Duke University
Lt. Christine Guthrie, MPH
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
National Child Traumatic Stress Network
NCTSN.org
2005
The National Child Traumatic Stress Network is coordinated by
the National Center for Child Traumatic Stress, Los Angeles, CA and Durham, NC
This project was funded by the
Substance Abuse and Mental Health Services Administration (SAMHSA),
US Department of Health and Human Services (HHS). The views, policies, and opinions expressed are
those of the authors and do not necessarily reflect those of SAMHSA or HHS.
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TABLE OF CONTENTS
Introduction 1
About this Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
About the National Child Traumatic Stress Network . . . . . . . . . . . . . .2
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Who Should Be Trained?
3
How Should This Training Be Used?
4
What Should You Learn or Take Away from This Training?
6
Overview Of Childhood Traumatic Grief 7
What Is Childhood Traumatic Grief? . . . . . . . . . . . . . . . . . . . . . . . . .7
Cultural and Individual Variations . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Overlap of Childhood Traumatic Grief, Posttraumatic Stress Disorder,
and Trauma Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
How Is Childhood Traumatic Grief Related to
Other Trauma Reactions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
How Does Childhood Traumatic Grief Differ from
Uncomplicated Grief? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Who Suffers from Childhood Traumatic Grief? . . . . . . . . . . . . . . . . .16
How Is Childhood Traumatic Grief Recognized? . . . . . . . . . . . . . . . .16
How Is Childhood Traumatic Grief Treated? 19
Principles and Overview of Treatment . . . . . . . . . . . . . . . . . . . . . . .19
What Are the Key Components of Childhood
Traumatic Grief Treatment? . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Individualized Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
What Role Do Parents Have in the Treatment? . . . . . . . . . . . . . . . .22
Structure of Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
What Are the Key Components of Childhood
Traumatic Grief Treatment? 25
Treatment Sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
1. Psychoeducation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
2. Affect Expression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
3. Stress Management Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
4. Cognitive Affect Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
5. Trauma Narrative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
6. Cognitive Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
The Courage to Remember: Childhood Traumatic Grief Curriculum Guide
National Child Traumatic Stress Network
NCTSN.org
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How Are Grief-Related Issues Handled in the Treatment Process? 39
7. Communicating about Death . . . . . . . . . . . . . . . . . . . . . . . . . . .39
8. Mourning the Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
9. Addressing Ambivalent Feelings about the Deceased . . . . . . . . .42
10. Preserving Positive Memories . . . . . . . . . . . . . . . . . . . . . . . . .43
11. Redefining the Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . .44
12. Committing to New Relationships . . . . . . . . . . . . . . . . . . . . . .44
13. Making Meaning of the Death . . . . . . . . . . . . . . . . . . . . . . . . .45
14. The Natural Evolution of Grief and Termination . . . . . . . . . . . . .46
Treatment of Childhood Traumatic Grief with
Young Children and Groups 48
How Is Childhood Traumatic Grief in Young Children Treated? . . . . .48
Why and How Is Childhood Traumatic Grief Treated in Groups? . . . .49
Conducting Group-Based Treatment for Childhood Traumatic Grief . .52
Concluding Thoughts: Recognize, Respond, Remember
54
Appendices: Handouts, Resources, References 56
Feeling Faces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Progressive Muscle Relaxation Scripts . . . . . . . . . . . . . . . . . . . . . .58
Learning to Relax through Imagery . . . . . . . . . . . . . . . . . . . . . . . . .63
Cognitive Triangle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Thinking, Feeling, Behaving Illustrations . . . . . . . . . . . . . . . . . . . . .65
Sample Trauma Narrative by School-Age Child . . . . . . . . . . . . . . . .67
Sample Trauma Narrative by Teen . . . . . . . . . . . . . . . . . . . . . . . . .70
Information for Parents on Childhood Traumatic Grief . . . . . . . . . . .72
Reference and Resource List . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Professional References — PTSD . . . . . . . . . . . . . . . . . . . . . . .76
Professional References — Bereavement . . . . . . . . . . . . . . . . . .77
Professional References — Childhood Traumatic Grief . . . . . . . .78
Books for Children and Teens on Trauma and Bereavement . . . . .80
Suggested Treatment Books and Supplies . . . . . . . . . . . . . . . . .81
Manuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
The Courage to Remember: Childhood Traumatic Grief Curriculum Guide
National Child Traumatic Stress Network
NCTSN.org
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INTRODUCTION
ABOUT THIS GUIDE
Children who have experienced the traumatic death of a person significant in their
lives may have reactions and symptoms that we are beginning to understand are
distinct from the grief following nontraumatic death. We believe that children who
have experienced traumatic grief and who are troubled by overwhelming traumatic
memories can be identified and helped to cope with traumatic reactions and
ultimately remember the person who died in a healthy, meaningful way.
The material presented in The Courage to Remember video and this companion guide
represents the results of significant advances in the field of childhood traumatic grief
and the unique collaboration of researchers and clinicians in academic and community
settings throughout the country. We developed the video and guide using extensive
expert involvement and commentary. Although the focus of these training materials
is on individual work with school-age children and teens, additional information and
resources are provided regarding work with young children and groups. The materials
provide specific guidelines and options for interventions to
• educate care providers about childhood traumatic grief,
• introduce others to principles of treatment that have been identified as helpful
in treating the condition, and
• offer practitioners an opportunity to enhance their treatment skills.
We hope to improve awareness about childhood traumatic grief as well as increase
the ability of clinicians to respond in the most effective way possible.
The Courage to Remember: Childhood Traumatic Grief Curriculum Guide
National Child Traumatic Stress Network
NCTSN.org
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