family has suffered a wound almost as mortal as my daughter's. Yet,
I was in no position to offer more than a Band-Aid. My family was drowning
and so was I.
- mother of a murdered child
changing roles + relations
After a murder, the family unit undergoes permanent changes that are
difficult for the surviving members to accept.
As each member of the family struggles with his own pain and grief,
offering emotional support to the other members of the family network
can be challenging. Not only must each member navigate her own feelings
about the murder, she must also deal with the way her loved one died.
Familial roles undergo major transformations; family members - relationships
will face challenges for reconstruction.
The murder may trigger other types of losses a family has had that may
need to be reprocessed. The way the family deals with the murder of
a loved one can range from them becoming increasingly chaotic to increasingly
No other experience has prepared the family or its members how to deal
with the homicide. There is a sudden uninvited intrusion in their lives
that changes their existence from private to public.
One study reports that the quality of the interface between the criminal
justice system and the family is a major key to the family's impact
and future resolution.
Marriages and family units are unique and have their own culture, identifiers
and rules fro existence. They also have various levels connection with
Little else competes for attention for months or years to come. Without
a choice, murder becomes an unwelcome guest existing in each family
relationship to the victim can impact
Each co-victim within a family experiences a different relationship
with the victim and sometimes with the perpetrator. These relationships
can influence the intensity and expression of grief for each family
Family members may begin to assume new roles because the dynamics of
the family have changed. Charles Figley (1997) describes two rules:
- Family bond rule - The stronger the interpersonal connection (bond)
among family members, the greater the impact of shared or secondary
traumatic stress reactions; and
- Traumatic bond rule - When one family member is affected by a traumatic
event, other family members become affected as well and in direct
proportion to their interpersonal bond.
I thought it was my job to protect my parents. They
would cry when I cried, therefore I tried not to cry in front of them,
then I broke out in hives from the stress. Doctors told me not to
do that anymore.
- Sister of a murder victim
influence of family
The issues of strength and weakness are key concepts in all intervention
strategies for co-victims. Other issues that families commonly struggle
with have been noted:
- Death and conversations about death are taboo;
- Someone must be to blame;
- Things must go on as before; and
- All must function with openness and a sharing of feelings
implications for caregivers
It is important that all members of a family should be given support
and assistance as one entity, even the most reluctant. This may not
always be possible, but every effort should be made to include as
many members as possible.
Systemic treatment through one or more members can be also effective.
Some of the goals of systemic therapy include:
- Reinforce existing strengths in family;
- Empower and promote family social support; and
- Help establish new patterns, rules, expectations,
Family therapy is ideal for working through traumatic
grief, yet many service providers continue to view the individual
client without consideration of the family dynamics. I would hope
that there would be greater interest and utilization of the systemic
model in dealing with co-victims in the future.
Part of the family has died along with the victim. This missing piece
can never be restored. As such, treatment models need to be adapted
to address this issue. In order to provide appropriate interventions,
caregivers will need to understand several distinct familial subsystems
within the context of the unique victim to co-victim relationship
- Significant others; and
- Extended family.
The role that the murdered loved one played in the family
will have various impacts on the family.
There have been numerous studies on parents who have lost a child,
which find that many parents never heal. They believe that they have
failed in a major parental role - that of protector, even if their
child was an adult:
- Demographically largest group of co-victims by relationship;
- Death of a child rated as most stressful life event;
- The issues and emotions revolve around the loss of
the relationship not the age of the child; and
- There is no word in the English language to define
a parent whose child has died.
the parental dyad
One of the greatest problems experienced in parental bereavement is
that although parents are viewed as representing a dyad, they are
two distinct individuals. These disparities can be especially profound
when it comes to gender differences in grieving.
One member may show her distress more visibly than the other. One
may sacrifice and put on hold his needs in the service of the other.
Misunderstandings may occur with accusations regarding their depth
of love, putting wedges instead of bridges between the couple in its
attempt to cope.
Responders are cautioned against referring the most visibly distressed
family member for individual treatment in place of a more appropriate
recommendation for couples or family treatment to minimize the widening
of wedges between them.
Grief work must occur almost entirely after
a violent death, as differentiated from a natural, anticipated
death. In a violent death, the grief work occurs almost entirely after
the death, rather than being anticipatory as in the death of a child
from an illness.
There are unique tasks that are required of the parents of a murdered
child, such as interaction with the hospital, medical examiner's office,
criminal justice system, and the media.
Depending on the circumstances, this process can take several years
or more to complete. It may also consume a lot of energy, often leaving
the parents little strength to focus on what is normally thought of
as grief work.
Depending on the specific personal situation - unmarried, divorced,
separated, or widowed - single parents will face a number of circumstances
that can further complicate their grief and trauma.
The burden may become heavier as they may have to deal with the various
systems alone. They may be estranged from the other parent, be thwarted
by the inclusion of the other parent, or unite as a "new" team.
Efforts to include the other parent should encourage the working with
one another in the face of this overwhelming ordeal.
It is a strong marriage, a different marriage. We
have been through a great deal and the murders played a very big part.
I wish I could say we are cohesive, sharing, aware. I think we have
dealt with it each in our own way.
- mother of two murder victims.
The bereaved mother is often the more verbal partner in articulating
her anger, her reactions to the murder, and any second injuries.
Mothers are more likely to show their emotions and to do so without
attempting to contain their feelings; they may cry, scream, keen,
The often strong reaction to her emotional displays and the attempts
of others to intervene may impart the impression to the bereaved mother
that there is something wrong with her or that she is "going crazy".
It is important to reassure the bereaved
mother that she is not "sick" and that others have had similar reactions.
Well-meaning family and friends often encourage the bereaved mother
to go to a doctor in the misguided idea that there must be a "pill"
that can be prescribed to anesthetize the pain.
This can lead to a plethora of secondary problems including the inability
of the co-victim to experience her grief and to actively participate
in the funeral and other rituals, which can have their own healing
Men are so strongly indoctrinated with the need to be non-emotive
in pain that they often feel greater pressure from within themselves,
than they do pressure from other people. It is not surprising that
many fathers express some resentment for this burden.
The father is expected to be "strong" and to cope with many of the
details that arise after the death. When parents are unable to cope
and to carry on their traditional roles, society tends to be less
forgiving of the father, which may help explain why men appear to
return to their normal day-to-day activities more quickly than women.
This, of course, varies within and between different races, ethnicities,
and socio-economic classes.
The expectation that fathers must be strong may deny them the opportunity
to be comforted by others and to express grief. In the aftermath of
a child's homicide, the father may perceive inquiries of, "How's your
wife/girlfriend doing?"as a denial of his pain and grief, hindering
his desire to discuss his feelings.
Isolating nature of grief creates unique issues for widow / widower.
Caregivers need to fully understand the isolating nature of widowhood
and the unique stresses surrounding the violent death of a spouse.
The recently widowed must learn new tasks and skills, regardless of
the cause of death.
"For most of us, our relationship with our mate
is .. .a central part of our self and our being in the world. As a
result, one of the major roles your spouse had was as someone who
affirmed your identity" (Rando 1988).
If a marital relationship is troubled at the time of
a murder, there may be residual feelings of guilt and anger.
A spouse may be angry that responsibilities, which were
formerly shared, are now greatly increased because the spouse is now
alone as a result of the murder. If the co- victim blames the murdered
spouse for behaving in a way the co-victim feels may have contributed
to the murder, the anger is exacerbated.
This blame can be extended to behavior as innocuous as working late.
The anger associated with blame often covers up other emotions that
may be too difficult to deal with at that time in the grief process.
Frequently children are forgotten, ignored or not included during
the overwhelming experience of the announcement of the murder. This
is often well intended, but there is convincing evidence that children's
exposure to violence puts them at risk for later violence, health
problems, and overall life adjustments.
Children must be included in the solution for helping them deal with
the impact of murder in their lives. There is inadequate research
on the impact of homicide on children and how birth order and their
relationship with the murder victim impacts them.
Children need to know the truth about death. Adults should try to
give children as much age-appropriate, factual information as possible.
Younger children do not need to know all the gruesome details of murder,
but they do need to understand the finality of death. Issues regarding
death should be death with concretely.
Small children may engage in "traumatic play." This creative enactment
is not inappropriate; in fact, such play can provide an opportunity
for further discussion with children about the murder.
On the other hand, older children and teens may not want to initiate
conversations about the murder and may need to be drawn out. Utilizing
other techniques such as inviting them to write or draw what happened
can be helpful.
The grief of child co-victims may be delayed until later on in life.
A child's ability to utilize fantasy will help him cope with what
has happened, but may also but together connections that debilitate
Attention to the needs and assessments that show the potential for
maladjustment is needed to help families with support systems for
grieving patterns of children
Children mourn differently than adults and a child's
grief can be easily aborted and replaced by a variety of defensive
operations which can postpone indefinitely the process of mourning.
The grief of children extends across developmental stages. Current
needs or events will interrupt grieving. Children communicate their
grief differently than adults.
indirect + direct
INDIRECT: CO-VICTIMS WHO DID NOT WITNESS THE HOMICIDE
The extent to which violence reaches our children can be seen in a
study of inner-city elementary and high schools, where over 70% of
the students reported having witnessed the robbing, stabbing, shooting,
or killing of another person (Bell, 1991a, p. 2).
Today, with the increase in the homicide rate of young African American
men in the inner city, African American children in the inner cities
are most likely to have had a sibling murdered, with the murder of
a parent being the second most murdered relative.
It is not unusual for children in the inner city to have had more
than one family member murdered.
DIRECT: CO-VICTIMS WHO WITNESSED THE HOMICIDE
Children who witness violence directly may be particularly
traumatized. They frequently exhibit posttraumatic stress symptoms
and other extreme reactions. Such stress may actively interfere with
a child's ability to reminisce or otherwise reduce the emotional resources
available to them throughout the grieving process.
The extent of stress largely depends on the type and amount of support
available to these children, and the ways in which the family interacts
as a result of the murder.
Traumatized children are typically haunted by intrusive images of
the violence, recurring traumatic dreams, and a preoccupation with
revenge fantasies. They may withdraw socially, act emotionally constricted,
lose interest in their normal activities, and perform poorly in school.
As Pynoos and Eth (1985) state these children are also at greater
risk to perpetrate violence as they grow older (p. 21). Child witnesses
of murder will be affected throughout their lives.
The murder of a loved one by another family member exacerbates
all of the issues that affect co-victims of homicide.
Furthermore, the stresses of an intra-family homicide may totally
destroy any semblance of family, at least as it existed before the
murder. In addition to the trauma, grief, and bereavement issues,
there are many other complex family system and legal issues, such
as custody, property matters, and concerns with social security payments.
It is not uncommon for the family to end up in criminal or civil court,
or both, locked in an adversarial stance.
Also common in intra-family homicide situations is longstanding issues
of distrust among family members.
beyond the immediate family
Although the immediate family of a murder victim may feel the greatest
impact from the death, there are others who experience its effect
as well: such as extended family members who often rally around the
immediate family and give support.
These co-victims may feel the loss as deeply or, under certain circumstances,
even more deeply than the identified family of grief. A part of the
family of the murder victim includes co-workers and friends, neighbors,
fiancee's, and so on.
The victim may have lived far from family members and learned to rely
on friends and colleagues as a surrogate family. Or, perhaps, a family
estrangement may have led to the strengthening of other non-familial
Estimates have been attempted that suggest for the 30,000 homicides
annually in the United States there are between 120, 000 and 240,000
relatives and other co-victims making homicidal bereavement a major
public health problem (Rynearson, 1997).
The term significant other can be applied to a number of different
relationships: fiancés, live-in partners, and gay or lesbian partners,
who are all relegated to the position of secondary mourners.
They are left to believe that their pain can be considered only after
that of the more immediate family. Blood relatives especially often
wrongly assume that their relationship is less meaningful than that
of other family members.
Furthermore, these relationships may not have met with the approval
of some family members, and exclusionary practices can be wrenching
for these co-victims.
Socially forbidden relationships or relationships that are not publicly
acknowledged Significant others include those who are engaged in extra-marital
affairs or in a gay or lesbian relationship with the murder victim
at the time of the death.
According to Fowlkes, "In the socially forbidden relationship of an
extra-marital affair, special stigma is attached to the 'other woman
[or man]'. Secrecy obscures the ending of such a relationship socially
just as it obscured its existence. There is no satisfactory outlet
for the expression of loss and grief" (1990, p. 645).
The trauma, the loss, and the grief, are thus complicated which makes
the mourning, "perhaps the loneliest and potentially most destructive
grief of all (Fowlkes, 1990, p. 644)
These mourners are also co-victims, but their status is often misunderstood
or denied. They suffer from what Doka (1988) refers to as "disenfranchised
grief," and they may not feel that they have permission to grieve
It is not unusual for someone to remark to such a co-victim, "What
are you so upset about?" It makes co-victims feel even worse when
they do not receive the necessary acknowledgment and support from
others around them.
Caregivers, members of the criminal justice system, and even victim
advocates may not think to include or invite this group of co-victims
to court proceedings or support groups or to offer them any standing
in the case. This is an area for growth.
I always thought that life-endangering oppression
happened to people different than me. To heal, I had to acknowledge
the world as a place that includes the possibility of getting shot
and killed at any moment.
- lesbian lover of murder victim
- from Family Recovery From Terror, Grief
recovery over time
Traumatic events usually lead to a variety of internal changes in
the family. Such changes include changes in outlook on life and expectations
about the future, there may be a development of subtle posttraumatic
reactions that continue to influence a person's life, i.e. at anniversaries,
or for some years of continued longing and searching for the lost
Over time, however, most families, even those who lost a loved one,
are able to establish new continuity, and live on with both happy
and sad memories. The long and tiresome task of establishing new meanings
and verifying old may go on for years.
In the following section, I will focus on some of the
challenges for families in dealing with the event, with ensuring that
adults and children continue to communicate in ways that benefit them
in the long run.
The changes and problems that occur in families do not necessarily
lead to dysfunction at work or in school, but continue to influence
the family. For many, the loss of a loved one means that some life
spheres never will be as before, while others will normalize over
time. Some survivors are able to return to normal fairly soon, while
others struggle for a long time.
While much is known about the factors that influence individual recovery,
less is known about the factors that influence family adaptation to
trauma and grief over time. Family recovery will be determined by
the interplay of factors such as:
- the nature of the disaster and one's exposure to it;
- the family's prior history of trauma and loss;
- the prior and current functioning of the family;
- family coping resources; and
- availability of help and support.
In the following some aspects of family functioning
will be given particular attention, and some suggestions to help foster
adaptive coping outlined.
family dynamite: internal dynamics
When a traumatic situation strikes a family member or the whole family,
the entire family experiences the aftermath.
Traumatic events have the capacity to disturb vital functions within
the family such as parenting functions including emotional nurturing,
education, and protection. Children may be particularly at risk when
trauma occurs in the family, as traumatized parents often reduce physical
contact and try to shield their offspring from facts.
Communication, intimacy, expressiveness and role-distribution may
be affected, resulting in a reduced capacity to cope with internal
and external demands.
Single parents may be at special risk.
Parents and other adults that are aware of their tendency to overlook
children in this period can try to balance their absorption with what
happened with nurturing their children 's need for more presence and
internal dynamics: fact-sharing
From more than twenty years of experience from working with grief
and trauma, I have realized that the first and following days following
a traumatic event often are extremely important in how individuals
and families can cope and recover over time.
Not only is this related to the traumatic impact of this day, but
also to the resulting cognition regarding one's own and other's reactions,
and the secondary trauma that family members may experience in their
meetings with responding organizations and other members of their
family or social network.
These problems are very often related to the provision of facts to
the family or to communicating these facts within the family. The
immediate handling of information to and within the family can influence
communication patterns, cohesion, and the internal dynamics of the
family and their long-term recovery.
It cannot be emphasized strong enough how important it is to try to
foster a climate where facts and information can float freely within
the family, and where difficult facts and issues are dealt with in
an open and direct manner.
Parents and other adults are role models for how their offspring with
deal with difficult situations later in life. At the same time experience
shows us that traumatic events often become the starting point for
the formation of family secrets.
Secrets are a minefield in families, especially between parents and
After the death of a father one mother held back from her two boys,
twelve and sixteen years old, the fact that he had a child with another
woman. At the funeral this now pre-adolescent girl turned up, to the
surprise of the two boys. In a family session following this, where
this and some other secrets were dissolved, the twelve year old said:
"Are there more secrets now?"
Family secrets can create walls of silence within the family, walls
that are difficult to tear down when solidified over time. When facts
about a trauma are hidden from parts of the family system, this can
greatly affect the trust and stability in the system over time.
Sometimes it is a partner that keeps back information in relation
to a trauma or loss from the other partner with reduced trust or continued
suspicion that other facts also are held back as the result. For children
it is important that parents continue to speak openly and directly
about facts of the disaster that become known over time.
internal dynamics: handling of traumatic
Family members may hold very different views on what to do with the
personal belongings of a loved one, on how to deal with anniversaries
and rituals, and on how to approach or avoid symbolic places like
the scene of the event. An example will illustrate this.
Following the death of a young adult son, his parents gave his fiancé
a shirt that he always used to wear. This created strong tension between
the parents and their daughter, as she felt that they disregarded
her need to keep that shirt when they gave it away.
The sister felt she was higher in the grief hierarchy than the fiancé.
Not only did this create a tension within the family, but the sister
also started to feel anger towards the fiancé who also was her good
Dispute over personal belongings can take many forms, but are often
related to different needs in different family members regarding when
to take away, clean or organize all the belongings that are left from
the dead loved one.
One family member may be ready to put the belongings away while the
other needs them present for a long time. A mother who lost an adult
son demanded that the crumbs from his bread should be left on the
kitchen table and she commanded her partner to let some of his favorite
food be left in the fringe.
Imagine the strain upon her partner, not the father of the boy, when
this order still was in effect more than a year after the boy's death.
Be careful to include children in discussions about
what to do with personal belongings - they will very often have opinions
that should be listened to.
internal dynamics: lack of synchronism
When working with families it is obvious that while the immediate
reactions often are similar, involving shock reactions characterized
by unreality etc., reactions over time differ greatly due to differences
in personality, previous experience, age and interactions with the
wider social network.
If reactions are asynchronous this can cause problems and conflicts
in the family, i.e., lack of understanding from parents regarding
absence of strong emotional reactions in children, or inability of
members to support each other.
These aspects are also tied to different gender reactions in grief
and trauma. Women tend to experience more intense emotional reactions
that last over a longer time.
They also tend to use confrontational coping styles
where they want to talk about and share feelings around what happens,
while men use more avoidance strategies where they work through the
event alone, in a more private manner, often through activities and
This lack of synchronism can lead to blaming for not reacting enough,
for dwelling on the thoughts about the lost one, or for lack of understanding
of one's partner's reactions. Based on different reactions, the members
of the family can have different expectations for how they perceive
that other people should react and what kind of caring and comfort
they want from a family member.
When individual members of the family have been traumatized, there
may be large differences in the recovery time needed. This is difficult
as the different members may be at different stages in the recovery
Children grieve differently than adults, although the types of reactions
are similar. They are able to distract themselves and be absorbed
in other activities, while in the next moment being very aware, even
overwhelmed, by the thoughts of what has happened. Children's emotional
span is shorter than adults, they usually are not very sad for long
periods of time, and may shock adults with their questions and behavior.
Do not put pressure on them to behave or grieve in a certain fashion.
Many children use time before they are able to confront the loss,
and may be unwilling to talk about what has happened (this is especially
so for boys).
If the child is doing okay in school, does not withdraw
from friends, and does not evidence major personality changes, have
patience, but use natural opportunities to start a conversation about
what has happened.
internal dynamics: sub-level conflict
A trauma shatters the illusion of invulnerability and makes the parents
and children very prone to expect the worst. In parents this often
leads to a need to control, restrict and limit the child in a way
that sometimes preclude them from developing autonomy and independence,
or make them prone to develop into more anxious children.
This overprotection can limit the child's development and make them
However, anxiety in children can develop as a consequence of misperception
and fantasies on their behalf as well. Only by being interested in
and asking about their perceptions can adults understand what goes
on inside children's heads.
Both following non-death trauma, but especially following bereavement,
roles within the family may be transformed. A traumatized parent may
be unable to fulfill his or her role obligations, both regarding practical
tasks in the family, but also in providing the emotional support that
children may need.
While the effects of depression in parents on small children are well
researched, less is known about what effects trauma in parents has
Parental trauma may sometimes result in too much pressure
Following the accidental death of her father, a teenage girl, an only
child, had to make dinner for her mother every day as the mother became
dysfunctional at home, returning exhausted from her workday. In a
joint session with her mother, about one and a half months following
her father's death, she exploded and accused her mother bitterly of
ruining her life.
She complained that she had no time for friends, no time for her school
lessons, and she got no comfort from her mother at all. "I feel like
If possible a constructive discussion on what has happened
to the role functions that the deceased took care of, and in what
ways other needs of various family members are cared for in the present
situation could be talked about in the family, maybe with the assistance
of someone with experience in leading such family discussions.
family dynamite: social network problems
Family recovery does not take place in vacuum. How successfully the
family can deal with trauma and grief is partly dependent on the interaction
with their social network.
Although much of the grief and trauma literature specifies
the importance of the social network, there are reports from both
the trauma and the grief area that have pointed out some problems
that can arise between traumatized family members and their social
Too easily we tend to think that most families are met by understanding
from their friends and family, a network that will help them talk
about the event and provide support and understanding. As a clinician
I repeatedly hear how difficult this interaction with the social network
Although there usually is an immediate outpour of concern and an increase
of social attention immediately following a trauma or loss, many traumatized
family members soon perceive a lack of deeper understanding of their
reactions, both regarding type, intensity and duration.
Many describe how, sometimes already after some weeks, there is a
pressure to conform to a norm of rapid recovery where members of their
social network wants to hear that things are going better and everything
is returning to normal.
With a disaster of this magnitude, there will be more acknowledgement
of the depth of the tragedy and continued social support. However,
an inadequately understood social psychological process is at work,
where it seems that many people doesn't want to be reminded of the
fact that horrible things can happen to everyone.
Those who have experienced a trauma or a recent loss become a reminder
of our own vulnerability.
Therefore people often refrain from making contact over
time, or actively avoid traumatized people when they see them, leaving
the traumatized person and family in a social vacuum. This vacuum
can be reinforced by family member's own perception of not being understood
that leads to a withdrawal from the social network on their part.
As traumatic events often lead to a revaluation of values in life,
it is not uncommon that a different rate of maturation and growth
occurs in the family, compared to their former social network. Often
this leads the family to seek the company of other families with a
similar experience, i.e., through grief groups or survivor groups,
and to a gradual reduction in contact with their previous network
members or to a renewal of their network over time.
Traumatized people can find conversing with their old friends shallow,
as they sense that they are concerned with the trivialities of life
instead of more "real" issues. Social network problems can also lead
to blaming between the family and their social network.
The traumatized family members can blame their network for lack of
understanding, for not making enough contact, for forgetting them,
or for not helping enough. The social network can find the family
demanding; blame them for being to preoccupied or for nurturing the
loss or trauma, or for being to sensitive and moody.
Sometimes this can have a dramatic impact on close relationships.
This is a phenomenon that adolescents often experience
as well. They can find their friends and their friends activities
less interesting before and may gradually withdraw from what they
find are "empty" activities.
As adults we may have to explain to them why they experience this,
i.e., that the disaster has triggered a maturational "spurt" and that
they should keep up their social contacts even though they for a time
find them more "shallow".
intervention to promote family recovery
Immediately after a trauma, the family continues to be in a situation
where everything they experience is experienced with more intensity
than normal. This means that the caring climate around them has the
potential to be felt as very caring and helpful, or distant, cold
This makes it extremely important that the family is met by a good
system for immediate help.
Because of the heightened sensitivity to all aspects of their environment,
a high emphasis must be placed on establishing a caring climate. Parents
and siblings can years after an event return to this situation, either
with a positive focus: "The doctor had tears in his eyes. Can you
imagine that he cared so much for us that he cried?", or with strong,
negative intrusive memories: "I will never forget how we were left
waiting and waiting with no information at all."
It is very important to receive information about normal psychological
reactions that may be experienced by family members over time. Almost
every family return to the value of the information they received
about various reactions (thoughts, feelings, behavior) that are common
after a trauma.
Being mentally prepared for what is to be expected helps identify,
sort out and accept reactions as part of a normal reaction, and helps
in understanding what happens within themselves and in their relationship.
Parents should make sure that children and adolescents get the same
information. Many adolescents can be frightened by the intensity of
the emotions they experience, and may fear they are turning crazy,
others are amazed that their friends and teachers so soon forget what
they have been through.
handling traumatic reminders
Finding acceptable ways of handling traumatic reminders within the
family is very important. How are the family members able to deal
with the reminders, i.e. viewing the television coverage of the disaster
and the investigation? In what way are they able to modulate the strong
affect triggered by the reminders?
Talking about the reminders, identifying what triggers reactions,
and learning ways to gradually approach difficult reminders are crucial
for regulating emotions, and can determine how this is done for the
rest of a person's life.
Handling reminders often involve returning to places, meeting persons,
or confronting activities that involve the presence of emotional pain
resulting in avoidance.
After family trauma, we have found that a confrontational approach
to such situations benefits family members, adults or children alike.
Family members or individuals should be properly prepared for entering
the situation, be accompanied by others, and have control over the
tempo of approach, and be followed up afterwards.
Besides helping the family members with both their emotional and cognitive
work-through of the traumatic event helpers must focus on the sensory
impressions and intrusive recollections that result from the disaster.
Unfortunately, many families receive inadequate help in working through
their traumatic moments in a second by second, detailed fashion.
There is a need for professional competence in this area, as it is
not enough simply to tell one's story. If that is done, both important
thoughts and sensory impressions are often left out. Without proper
help in this regard, there is an increased chance of sensory impressions
turning into long-term traumatic recollections.
Lately, I have added what I find to be an important aspect to the
follow-up information I give to families within the two first weeks
following a sudden, traumatic event.
The family members who have been exposed to strong sensory impressions
are given advice on what they can do to take control of the intrusive
memories. I tell them to imagine that they see the image (or film)
on a television-screen. They are then instructed to imagine that they
have a remote control in their hand, and to turn the image off.
Alternatively, they are asked to see the haunting image in front of
them, and then to move it further and further away from them, until
it finally reaches the wall, or to change the image from color into
black and white, etc.
Such simple methods have been reported as very helpful for those who
struggle with memories they have no control over.
There is a variety of such "control methods" that can help family
members take control over intrusive images.
family dynamics intervention
Early on in the intervention, preferably within the first two weeks
of the event, but not in the first shock phase, partners must receive
information concerning usual gender differences. This may prevent
undue blaming between the partners, lessen potential conflicts, and
increase their sense of control. The information should be verbal
The following themes should be discussed to secure more understanding
between partners and within the family:
- Speed of recovery, intensity of reactions, anticipation of conflicts;
- Interpretation of partner-behavior, i.e., when men contain their
emotions to protect women from further hurt;
- Discussion of how to publicly display their reactions;
- Information on possible grief competition and grief ownership;
- Self-blame and blame of partner; and
- Differences in perception of appropriate reactions and grieving.
By giving such information and discussing these themes, men's sense
of incompetence at formulating own reactions into words may be reduced,
and they may feel more at ease in participating in the follow-up, though
they may not contribute as much as women in talking about emotions.
By helping the family members exchange information, express emotions
and listen to each other, intra-family cohesion is advanced.
Both from our empirical studies and my clinical experience I know that
the care and concern following tragic losses often focus on females.
This may stimulate men to disregard their reactions, leading to them
pulling themselves together and be strong for their partner.
Unfortunately such behavior can lead to more isolation and less emotional
support for men. Our interventions must take such experience into account
and make sure that the men's reactions are accepted, not rejected. Men
are not particularly good at asking for what they need, and maybe they
are more unaware of their own emotional needs.
Men have a different oral tradition than women.
While women more directly talk and confide in each other about emotional
matters, men more often tell stories. Men's stories can be action oriented
and are more seldom put in written form., i.e. in a diary. Rolf (12
˝ years old) lost his brother in an accident. When asked if he had written
about what had happened he looked at me as if I was from a different
It was obvious that writing a diary was something girls did. But when
I persisted asking if he in some way had written about his brother,
he said: "Do you mean on the PC?"
When I asked what he had written there he said he had written about
things that he and his brother had done together. He read this when
he missed his brother and it lessened the pain.
Another noticeable difference between men and women are that men tend
to give more advice; while women are less action oriented and listen
more. Men are usually less able to read non-verbal cues than women are.
In follow-up sessions it thus can be helpful to use some time explaining
and exemplifying non-verbal communication, helping men to become more
active in both seeing their partner's needs, and in expressing their
own needs. Low-conflict couples have been found to use non-verbal communication
and code words and signals to let each other know how they feel.
Improving family communication and cohesion is not an easy task. By
making the discussion of communication, role distribution, emotional
gratification, conflict, etc., part of the follow-up sessions, it is
possible to work directly to establish a favorable climate for recovery
In a similar manner we can help families understand social network reactions
and give them practical suggestions for how they can activate their
social resources. In an article published earlier this year I summed
up the knowledge we have about communicating with children about traumatic
events (Dyregrov, A. (2001).
telling the truth or hiding the facts
An evaluation of current strategies for assisting children following
adverse events. Association for Child Psychology and Psychiatry Occasional
papers nr. 17, 25-38.) Based on this the following recommendations can
be made for long-term caring for children: Adults need to continue to
communicate openly and directly with children.
Trauma and loss reactions take time, and thus they have a potential
need to talk about the disaster or its consequences long after it happened.
It is, however, not enough to point out the need for open and honest
communication, families need practical suggestions and role models for
how they can communicate about traumatic events, and the family changes
that can originate following such events.
Early intervention in families who experience trauma should include
helping families to develop constructive ways of communicating openly
and honestly about what happened and it's effects on the family.
By providing a model for emphatic listening, ways of asking questions,
clarifying affects, allowing children to have their say, providing feedback,
etc., a caring, supportive climate within the family can be established.
By making the discussion of communication, role distribution, emotional
gratification, conflict, etc., part of the follow-up sessions, it is
possible to work directly to establish a favorable climate for recovery
from loss or trauma. By regularly having family meetings, at increasingly
spaced intervals over an extended period of time, this supportive communication
climate can be sustained.
We need to educate adults on children's need to make sense of events,
by creating or constructing a narrative or total picture of what happened,
even when children are quite small.
For children more directly exposed (or having problems as a consequence
of the extensive media coverage), they should be allowed a chance to
describe what happened, the thoughts related to what happened, understanding
what caused the disaster and what they did to survive it, as well as
giving words or another form of expression (i.e., drawing) to the different
sensory impressions experienced during the disaster (or media exposure),
and the reactions that ensued.
This is recommendable to prevent the event from having unnecessary consequences.
If parents and children or adolescents experienced the disaster together,
this detailed review should be done with all persons involved present,
as this increases the chance of getting a full picture of what happened.
We need to talk to children directly about traumatic events.
This is the only way to ensure that we understand what children have
experienced, how they have understood their experience and the facts
they are missing to be able to construct a full narrative from what
happened. We also need to make sure that children are asked, or that
we listen carefully, about their understanding of "why" something happened.
Cause and meaning are important aspects of the reality construction
that takes place following adverse events, and this construction have
an important impact on the development of basic assumptions throughout
childhood. When telling the truth we do not need to hit the child over
the head with facts.
While the focus is on open, truthful and direct information, we need
not give them all details, i.e., about parental disputes that preceded
a death, etc. If children ask about details, however, I suggest we tell
the truth without deliberating on the grotesque or scary details.
Telling the truth is a good strategy also when it comes to more advanced
explanations for the background of a tragic event, i.e. why persons
can commit such atrocities.
Trauma will oftentimes affect the family system in different ways,
and thorough family intervention will need to explain family dynamics
to children and adults alike in addition to providing information on
common trauma reactions. The therapeutic tasks of preparation, explanation,
interpretation and teaching are activities that help foster the intra-family
environment and can prevent the development of blocks to recovery.
While there is a wealth of studies documenting the importance of preparing
children and adults for surgery, there is little written about the importance
of providing children and adolescents with a map of the terrain they
are going to walk in following the experience of traumatic events.
Good quality trauma intervention must be specific in providing children
and adolescents with advice on how to handle the after-effects of traumatic
events. This information will have to be provided both verbally and
written. We need to reconsider how we include children in rituals. Although
clinical experience and empirical research support including children
in such activities, we do need to put more emphasis on preparing for
and helping children through such activities.
Following a trauma it is hard to face the future, one dwell on what
has been (past), and the present is so painful. As helpers, friends
or family our role is to help the family to live in the present, not
being overwhelmed by the past, and build up positive expectations for
the future. Most people underestimate the time course for trauma and
Regardless of the time it may take to establish new meaning in life,
most families can learn to live with what has happened in a way that
ensures the continued health of all family members.
If the disaster is dealt with openly and directly within the family,
and children and adolescents' needs are acknowledged and met, they can
go on with the tasks of development in a constructive manner.
As adults we can help children maintain and develop the inner representations
or images of their loved ones, not embedded by the anger resulting from
the tragedy, but as good memories they can continue to experience in
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Family Recovery From Terror, Grief and Trauma