We highly recommend completing the activities in a Word document first, then copying and pasting your responses into the provided spaces. This ensures you retain your answers and reflections even after the course concludes.

1.  Understand the process of grief and loss.

Introduction

Loss is part of life. In fact, we experience loss daily of all things that have occured in the past (McCoyd, Koller & Walker 2021). Consequently, grief becomes a natural response when someone or something significant is lost. It can happen to anyone, regardless of how long they have known a person or how long they have known that something was going to happen. A person may be grieving the loss of a person, relationship, event, or circumstance that has occurred in the past. How we respond to loss, depends on our life stage and when it is experienced. Importantly, grief cannot be avoided. This means that when working with people who may be experiencing grief, it is important to work through the process of grief alongside moving forward – which includes finding a meaningful relationship with the deceased as we move forward in our lives. 

In intergenerational practice, there is an increased likelihood that death will be experienced due to the ages of participants and natural life circumstances. In addition, participants may experience loss because of the program ending and strong bonds forming that could not be continued. Understanding how loss and grief is experienced across the lifespan is essential to providing support, comfort and communicating appropriately to all involved.  

Understanding Grief and Loss

Losses are things that have happened to us. They may be physical in nature (e.g. death, loss of body part or stolen items) or psycho-social, which is intangible and symbolic (e.g. unemployment, divorce, or retirement) (Goldsworth, 2005). They may be perceived or felt losses of events, ancestral losses, contemporary losses, expected losses (e.g. children leaving home or terminal cancer patients), or they may be sudden/unexpected losses (e.g. the sudden death of someone). Grief is associated with any loss, although most people associate grief with just death (Goldsworth, 2005). The reality though, is that loss becomes an unavoidable fixture in life (Thompson,1998). Losses occur routinely – some with no impact, whereas others have a significant impact on our lives. Moreover, the significance of losses are individual in nature – meaning that how one perceives a loss is very different to how another perceives the same event, and as such the grieving process is also different.

Theories and the grieving process

During the grieving process, we need to acknowledge that the brain and its functioning is impacted, which makes life even more messier during this time.

Watch this short video outlines how grief and loss affect the brain.

The following brief overview, outlines some of the main grief theories that have been proposed over the years. 

Freud argued people must engage in a cognitive process of mourning to recover from losses experienced (Freud 1929 cited in Goldsworth, 2005; Freud, 1957). Linderman’s (1944) theory of grief extended Freuds’ views by arguing that the acute grief response should be completed within a 4–6-week timeframe and go through three stages: 1. emancipation from bondage with the grief; 2. readjustment to life without the deceased and 3. the establishments of new relationships. Linderman’s approach argued acute grief could be short-lived, but this was later reconsidered. 

Kubler-Ross’s (1970) stages of grief theory is often the most cited theory in grief, despite it being the most criticised for being rigid and linear in nature. In this model, mourners of loss experience different stages in grief and must pass through all stages to fully grieve the loss that was experienced. These stages are; denial and isolation, anger, bargaining, depression, acceptance, and hope. 

Bowlby (1980) identified four phases of grief. These included: 1. numbing, 2. yearning and searching, 3. disorganisation and despair and 4. reorganisation. and that everyone would experience these phases differently, depending on the relationship between themselves and the “thing” that was lost. 

Worden (1991) introduced the task theory of grief and loss. In his theory, there were four tasks’ mourners had to perform: 1. accepting the reality of the loss, 2. working through the pain of grief, 3. adjusting to the new environment and 4. emotionally relocating the deceased and moving on with life. Unlike Kubler-Ross, these tasks do not assume a linear process and that individuality, autonomy and choice exist in the grieving process. 

The social constructivist approach (Neimeyer, 1999) to grief and loss is more wholistic. This approach suggests that grief and loss:  

• should reveal the reality of loss to the individual – noting each experience is different;  
• people are active participants who have a choice in the grief process; 
•  there is a need to find meaning association with loss, and as such there is no such thing as “normal” grieving.  
• focus on the meaning of the loss allows people to shape the emotional, behavioural and somatic responses experienced during the grief process;  
• loss leaves people forever changed, and that through loss, people should ‘relearn’ and ‘make sense of loss’ to be able to move forward; 
• grief should be considered part of wider systems and contexts, as well as individual in nature, which means the loss will change identity and the webs of connectedness that link us with others. Consequently, responding to the loss is as important as growing connections to move forward (Neimeyer, 1999). 

Delve Deeper:

WATCH: What nobody tells you about grief and loss. It describes grief and life moving forward and reminds us that grief and loss are natural occurrences that we shape as we move forward. 

Different experiences of death 

We also know that how one approaches grief to a loss depends on how close the situation was to them. How many other stresses they have experienced if they have pre-existing mental health issues or have established coping skills prior to the event. How much social support they have – including at work and in their broader life. Whether the loss is understandable and how much control or responsibility they had in the situation leading to the loss. These mitigating factors will change the reaction one has to the grieving process, and how intense and long grief is experienced. Consequently, when facilitating conversations around grief and loss it’s important to understand that people will respond to these conversations differently and provide a safe space for that to occur. 

For facilitators of intergenerational practice initiatives, this may mean: 

• If a loss event occurs during your program, be conscious of your participants group needs. For example, if someone in your group has experienced loss previously or has anxiety, they may need to be taken aside and spoken to before the group is told to allow them to digest the news in their own time. Alternatively, they may wish to just be included in the group news and be supported as such. 
• Ensure that your orientation program includes content acknowledging the likelihood of this occurring and answering questions as they come through. 
• Regularly check in with participants to ensure they are ok with how the program is progressing and allowing them time to talk through concerns. 
• Provide updates on what participants have been up to between sessions to alleviate any anxiety about grief and loss occurring if there is a lengthy time between sessions. 
• Consciously prepare your participants for the end of the program and encouraging them to continue an individual relationship with participants outside of the program should they wish to. 
• Be cognisant as to what life stage the loss was experienced. Further information on this can be accessed in the delve deeper section below. 
  

2.  How to facilitate discussions around grief and loss to participants

How do losses experienced across the lifespan impact the grieving process

Grief and loss in 1–5-year-olds

In general, all children benefit from direct and clear communication about death. The concept of death is only understood by about the age of 3. Importantly, all caregivers must provide attuned, nurturing and consistent care including keeping routines predictable and consistent and allowing for regression behaviours as they work through grief over their lifespan (Alvis et al., 2023; Hames, 2003). Children from aged 4 can understand the finality of death (Danielson & Colman, 2023; Gutiérrez et al., 2014; Martinčeková et al., 2018). However, at this age, children do not understand the abstract nature of death and direct and clear communication is best (Rosengren et al., 2014).  

Grief and Loss in 6–11-year-olds

Grief and loss experienced in children under 5 are exhibited very differently than those over 5 (McCoyd, Koller, Walter, 2021). For example, children from ages 6-11 may express sadness and grief in intense and alternating bursts of energy and may distract themselves more readily than adults. 6-8-year-olds tend to talk more about the pleasant memories of the deceased and remember their appearances more than other qualities (Christ, 2000; Christ & Christ 2006). While children aged 9-11 want more facts about the loss experienced and tend to avoid expressing emotions (Christ, 2000). Developmentally, memory acquisition and recall are better developed by this age and as such they remember more abstract qualities of the deceased and may choose to discuss these when processing their grief (Christ, 2000). During 6-11, it is common for children to lose a pet, which is often the first death a child experiences. The reactions and allowance for discussion and processing of this loss often set the scene for future grief perceptions. Thus, it is important to hold space and allow children to grieve their pet completely regardless of the life stage, but in particular at this age (McCoyd, Koller, Walter, 2021; Sable, 2013). 

Delve Deeper:

For programs with younger children, these video resources may be helpful. Watch and listen to:

·     Why do I feel so sad?

·     Lost in the clouds

·     How to talk to kids about Death (child anxiety, Howcast).

Grief and loss in tweens and teens (11–18-year-olds)

Did you know that children aged 10-13 (tweens) process grief and loss very differently than those aged 14-18? As such, different strategies are needed (McCoyd, Koller, Walter, 2021).  Children aged 10-14 years tend to be more overwhelmed by loss than their older peers (aged 15-17), who instead revert to anger to camouflage their grief to others. Older adolescents tend to feel they must present as an “adult” and assume they must have little emotional expression when experiencing grief. In particular, grieving adolescents struggle with their agency and experience around being in control, being in grief and being different to others. In addition, adolescents are bounded by their peer relationships so peer support becomes more important in grief and loss during this period. Adolescents may avoid expressing their grief at home because they are conscious of others’ grief and fear of making their grief worse, or because they are not providing a safe space to express themselves. In these cases, facilitators are encouraged to provide a safe space to validate their grief experiences and find ways to allow the child to talk about the personal loss (Balk, 2011). 

For losses beyond parents or siblings, adolescents tend to hide their emotions and instead use online memorial sites to address the deceased (Willians & Merten 2009). Suggesting that written forms of communicating directly with the deceased provide a place to process grief. In studies of adolescents who loose friends during this period of development, the evidence suggest that they become resilient after the loss (de Moor et al 2019) and that the process of writing assists them process their grief (Barclay & Skarlicki, 2009; Neimeyer, Van Dyke, & Pennebaker, 2009). In addition, music has been found to provide a window into grief and allow adolescents to process their feelings positively (McFerran et al., 2019). 

As facilitators, adolescent participants may express challenging behaviours and choose to withdraw from the program. While it is tempting to encourage this, instead you may wish to sit the participant down and: 

• Reassure the young person that they are safe and cared for. 
• Listen and talk to the young person about the trauma. Like adults, young people often find what they don’t know to be more frightening than reality. 
• Encourage the young person to express their emotions—this is part of the healing process and can happen through a variety of creative ways, like painting or music. Art and music have been an integral part of Aboriginal and Torres Strait Islander cultures. 
• Encourage the young person to participate in activities with their family and/or community. 
• Keep family roles clear. Don’t expect young people to take on too much responsibility, but don’t become overprotective either. Try to be understanding of where they are in their journey of recovery. 

Delve Deeper:

Phoenix Australia is a centre of excellence in posttraumatic mental health and provides guidance for children and teenagers who exhibit challenging or withdrawn behaviour while undergoing grief or loss or intergenerational trauma events. This is a resource that may be useful for parents, should the need arise but also helpful to remind ourselves that providing safe places and the ability to be heard is an essential part of our role as professionals. 

FOR FACILITATORS

For facilitators, the website Wombats Wish also has useful guides to discuss grief and bereavement with children and teenagers. We know that loss and grief experienced at different life stages in our lives impact us differently. To assist facilitators, in understanding how to best respond to participants during their program, please read this excellent resource provided by Generations United on this topic. We also know that all participants experiencing loss will grieve differently so space is needed to be given to allow this to occur. This resource assists us in understanding how to talk to children about death.

While formal avenues through counsellors and professionals, are encouraged for all. Informal avenues through helping others around you are incredibly important. As intergenerational facilitators, we are one resource that participants may feel safe around to be an informal network, but we also know they may not want to talk to us. This is particularly the case in adolescence as peer groups play a stronger role. That said, it is recommended that we do play a role in providing the space to talk if they wish it. Or connecting them into professional services as they need. Grief and loss experienced across adulthood present differently and how we react and support people differently throughout these periods.

Young adulthood

Those aged 30-45 years, involves searching for meaning and purpose (McCoyd, Koller & Walter, 2021)). Levinson (1986) argued this is the time prior to pursue major life goals. This is also why, during this period quality of social activity becomes more important than the quantity experienced (Carmichael et al 2015). Unexpected death of a loved one during this time period is most likely considered the worst traumatic experience they dealt with and are more likely to result in major depressive episodes, anxiety and PTSD (Keyes et al 2014). However, death is not the only loss experienced this time (McCoyd, Koller & Walter, 2021). During this time, loss and grief treatment is best sought by professionals however, support groups with likeminded peers can also help and play a role in quality socialisation to normalise their processing of grief.

Delve Deeper:

In addition, the following short by Travis Goodman (grief therapist) briefly explains 4 ways to cope with grief. 

All of these suggestions remind us that it is important to take care of yourself during the grieving process. Remember that every grief response is a new process, so it's okay to feel new emotions during the process. Also, don’t compare yourself to others – remember even if those around us are experiencing similar losses, we each grieve differently and at different time points so walk your own pace, even if they seem to be coping differently from us.

Great textbook

• Grief and loss across the lifespan : A biopsychosocial perspective (Third). by Judith McCoyd, Jeanne Koller & Carolyn Walter (2021).
• Children Also Grieve. Talking about Death and Healing by Linda Goldman (2006).
• What’s dead mean? by Doris Zagdanski (2001)

YouTube

• How to talk to kids about Death (child anxiety, Howcast).
• LIFETIMES (The beautiful way to explain death to children)
• Death: how to talk about it with children
• Coping with Grief (video for children)

Articles

• Saying Goodbye: Talking to Kids About Deat
• How to Talk to Kids About Death
• Talking to children about death.
• Helping your child deal with Death.

Middle adulthood (45-65)

Is distinctively different, as the focus is on caring for others and contributing to society through work and other pursuits during this life stage (McCoyd, Koller & Walter, 2021). reached the peak of their career, this is not true for all who This age group often find themselves the primary caregiver of both older and younger generations (also known as feeling “sandwiched”). Middle adulthood is also fraught with significant changes in the relationships with children, partners, spouses, siblings, parents and others around them. Resulting in increases in caring roles during this time, while balancing their work responsibilities. However, how individuals process these changes is dependent on their culture. For example, collectivist cultures expect adult children to care for their parents. However, those from an individualistic culture feel less responsible for their parental care. Regardless, flexibility and support is required during this time. 

Death of a loved one experienced at this age while more common, is still significant (McCoyd, Koller & Walter, 2021) Especially if the death was of the last surviving parent (Scherer, 2019). Similar to middle age, death of a sibling or friend may be disenfranchised, and the death of a child is a significant loss during this time. Other losses include: parental decline, care of disabled children, divorce or relationship breakdowns, loss of work / career transitions, loss of health, loss of dreams, and downsizing. As losses have usually been experienced at least once during life at this point, expected losses are easier to navigate than unexpected losses, the ability to bounce back is higher due to life experience.  

Retirement and older adults

Grief and loss in retirement and older adults’ hits differently. People see this life stage as a stage to pursue hobbies, travel, renew relationships, enjoy grandchildren, and relax without work demands (McCoyd, Koller & Walter, 2021). Losses in retirement include: loss of structured time and schedules, losses of identity, losses in health and cognition, changes in significant relationships and housing, losses of financial flexibility and losses of work colleagues. These losses often require a “reinvention” period that re-frames the purpose and meaning of this stage of life to the retiree but also those around them, and may include an increased likelihood of volunteering in meaningful roles to bring back some time structure and purpose to their lives. 

Loss in Intergenerational Practices

Intergenerational practice is a time of sharing and involves bringing together two or more generations for a defined period of time. This means that there is a beginning, a middle and an end point to these programs. During such time, there is a natural cycle of programs and participants may experience loss in many ways.

Some examples include:

• Loss of the activity they were doing at that time prior to the program starting
• Loss of the connections made during the program, after the program ended
• Loss of items of significance or time
• Death of a participant or their family member
• Withdrawal of participants during the program unexpectedly
• Loss of friends outside the program, which may impact the program participants
• Unexpected events or changes during the program

3.  The importance of upfront education for students involved in intergenerational programs about grief, loss, death and dying.

Acknowledging any loss is important to ensure the ongoing health of all involved. As facilitators, ensuring we discuss loss and grief in orientation is to normalise loss and the emotions that come with that. After orientation it is also important to check in regularly with participants as the discussion of loss and grief in orientation may result in heightened anxiety in participants and that may be a time to intervene. If a participant passes during the program, weaving lifespan discussions in early childhood programs using insects or books may also help the discussions. A list of these is provided later. 

Losses of participants through natural deaths are unfortunately common in intergenerational programs involving the elderly and processing these deaths is an important part of learning.

Samantha Heron (Founder of Heart and Soul Story and The Seniors & Teens Empathy Program) who presented the previous module 2.3 on Teenagers ensures that there is upfront education about grief, loss and death prior to an intergenerational program beginning, and when somebody does die ensures, there is the appropriate support in place, including debriefing and always where possible a reflection including reminiscing and celebrating of life.

Below are some lovely examples of real-life experiences of grief and death in IGP

Aboriginal and Torres Strait Islander people should be aware that the following case studies include names, images and information of deceased persons.

Photo

First photos: Rory, Tash and Betty during the Seniors & Teens Empathy Program run by Heart& Soul Story with Annandale Grove Care Community and International Grammar School The other photos: With Rory and his Mum Alison at final session Tribute Gathering

In loving memory of our friend Patricia Burge

August 4, 1934 - November 6, 2023

An example of an update for students to honour the Life of their resident buddy Pat. Included with the blessings of the Burge Family

In 2023, students from IGS spent time having wonderful conversations and laughs with the spirited, wise, and very funny Pat Burge, and ex High School teacher. In particular, in term 2, student Mia spent a lot of time speaking with Pat over her 8 weeks of visits. Pat shared her love of the song Candle in the Wind sung by Elton John at Princess Di's funeral. She said it was such an emotive song it brought tears to her eyes every time she heard it. In term 2 Pat also recounted to Amy that she used to 'hide her Agatha Christie' detective books at boarding school because they were supposed to only read the 'boring' classics. In term 3, Liam and Milo chatted to Pat about all things from the first horses in Mongolia to looking after Greyhounds and the All Blacks 'destroying' the Wallabies. Student Lachie also recounted how privileged he felt to have had the opportunity to speak with her one week. Pat certainly has made a lasting impression on us and we feel honoured to have had the weekly benefit of her quick wit and cheeky sense of humour. We will always smile thinking of her. It was a privilege to attend her life celebration and meet some of the people in her life who loved her so much. Simon, her son, wrote and sang the Farewell Patty Blues. Vale Pat

Knowing the students would have so many more special memories of their time with Pat, Sam and her team encouraged students to talk about these with their families, and school teacher and seek support if they need from the school counsellor. A session was also organised to bring the students together at school to discuss grief, loss and her death. This provided the space and place to heal and remember Pat, which comforted all involved.

These examples are just two ways to respect, honour and remember those who have gone before us. Both examples show how important it is to recognise the contribution and acknowledge the loss to all participants involved. Indeed death is not the only loss experienced as mentioned earlier, however, it is often the one most people think of when participating in intergenerational practice. It is important to acknowledge and provide space for the other losses that are experienced such as:

• Loss of the activity they were doing at that time before the program starting
• Loss of the connections made during the program, after the program ended
• Loss of items of significance or time
• Withdrawal of participants during the program unexpectedly
• Loss of friends outside the program, which may impact the program participants
• Unexpected events or changes during the program

This may be in the form of connecting participants to future programs offered by other organisations through the AIIP networks or connecting to community support programs to assist in transitions.

4.  Learn how to look after your colleagues during a time of loss

People experience loss and grief differently and the need to support them at work/educational institutions and socially is important at each stage. While formal avenues through counsellors and professionals are encouraged for all. Informal avenues through helping others around you are incredibly important. This means understanding language nuances as we move forward in our grief. The following Ted Talk by Nora McInerny (2018) discusses the important nuance of not moving on from grief, but instead moving forward with it.

Strategies to implement to reinforce self-care

Mindfulness 

Self-care was reported to be one of the most significant preventative measures health-care professionals could take to protect themselves from developing compassion fatigue and secondary traumatic stress (STS) from their environment (Sorenson et al., 2016). Coping with emotionally trying situations and self-efficacy, or an individual’s perceived ability to have some control over one’s behaviour, task, and environment. 

Mindfulness-based interventions (MBIs) are designed to teach participants to become more aware of thoughts, feelings and body sensations, while approaching these internal states with a non- judgmental curiosity (Gotink et al., 2015). Mindfulness and compassion-oriented meditation can reduce distress generated in the patient contact and foster interpersonal connectedness (Orellana-Rios et al., 2017). Mindfulness is often described as a feeling of being fully present and alive in the moment (Bishop et al., 2004). The cultivation of concentration, attention, and non-judgemental acceptance of whatever is being experienced in the present moment is central to the practice of mindfulness (Bishop et al., 2004). 

For intergenerational facilitators, you may wish to include mindfulness in your programs. This could be a group activity at the start of the workday or even a debriefing exercise together in your meeting times. Alternatively, you may wish to create a social support group that includes facilitators across the country or even just at your organisation to practice mindfulness to assist yourself and those around you in a supportive way. 

Looking after yourself

Upon undertaking your work or even in your personal life, you may experience loss along the way. There are many ways to deal with grief and loss. This video provides 12 suggestions on how to deal with grief and loss

SUMMARY

This module has touched base on many elements of loss and grief and provided suggestions for how to handle grief and loss in intergenerational programs. While it is not an end point, it begins the conversation and normalisation of grief in our programs. We encourage you to continue these conversations with past participants and invite them back if it has been a while, as often past participants feel they cannot re-participate in future iterations, but this may not be the case with your project. So don’t be afraid to reach out further to discuss or share with them other initiatives that are going on.

References

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Alvis, L., Zhang, N., Sandler, I. N., & Kaplow, J. B. (2023). Developmental manifestations of grief in children and adolescents: Caregivers as key grief facilitators. Journal of Child & Adolescent Trauma, 16(2), 447-457

Balk, D. E., Zaengle, D., & Corr, C. A. (2011). Strengthening grief support for adolescents coping with a peer’s death. School Psychology International, 32(2), 144-162

Barclay, L. J., & Skarlicki, D. P. (2009). Healing the wounds of organizational injustice: Examining the benefits of expressive writing. Journal of Applied Psychology, 94(2), 511.

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Bowlby, J (1980), Attachment and Loss (Volume III): Loss. Basic Books, New York

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Christ, G. H. (2000). Healing children's grief: Surviving a parent's death from cancer. Oxford University Press.

Christ, G. H., & Christ, A. E. (2006). Current approaches to helping children cope with a parent’s terminal illness. CA: A Cancer Journal for Clinicians, 56(4), 197–212.

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Martinčeková, L., Jiang, M. J., Adams, J. D., Menendez, D., Hernandez, I. G., Barber, G., & Rosengren, K. S. (2018). Do you remember being told what happened to grandma? The role of early socialization on later coping with death. Death Studies.

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McFerran, K. (2019). Crystallizing the relationship between adolescents, music, and emotions. Handbook of music, adolescents, and wellbeing, 3-14.

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Neimeyer, R. A., Van Dyke, J. G., & Pennebaker, J. W. (2009). Narrative medicine: Writing through bereavement. Handbook of psychiatry in palliative medicine, 454-469.

Rosengren, K. S., Miller, P. J., Gutierrez, I. T., Chow, P. I., Schein, S. S., & Anderson, K. N. (2014). Children’s understanding of death: Toward a contextualized and integrated account. Monographs in the Society for Research in Child Development, 79(1), 62–82.\

Scherer, Z., Berchick, E. R., & Kreider, R. M. Risk of Parental Death Across the Life Course.

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