When should a referral to professionals be made for a grieving teen?
It can be difficult to separate normal teen behavior from that of a grieving teen in trouble. Some of the indicators that let you know when a teen needs more than the help of group or peer counselors offer are:
Dramatic behavior changes A teen's home, school, and social life are the arenas for observing behavior changes. Listen and take notes if comments and concerns are being expressed.
Extraordinary pressure Get to know the teen and invite discussion regarding his or her activities at home or at school. Find out if keeping up with work is a problem or if the teen is feeling overwhelmed with what needs to be done. Ask if there is some time to spend alone or with friends.
Isolation Is the teen spending too much time alone, canceling out on dates and parties, or dropping out of after-school activities?
Depression Discuss the differences between bereavement depression and clinical depression. Encourage the teen to consider further help, if indicated. Supply information about where to go to get counseling.
Death wish Always take any talk of dying seriously and explore the teen's thoughts and feelings on the matter. Listen carefully to messages from the teen indicating there is a death wish. When a loved one has died, it isn't uncommon to make statements such as, "I just wish I could go to sleep and not wake up in the morning," or "I don't care if I get in a car wreck." These are passive death wishes - something or someone causing a death.
On the other hand, if a teen starts talking about when, where and how to do "it," or if there is a history of depression or suicidal behavior, this is a much more serious matter and needs immediate attention. Get prompt professional help.
Anger Anger can often create problems at home, at school or with friendships. Anger needs to be expressed, but in appropriate ways. Unspoken anger can become depression. If the angry teen is creating problems, and normal ways of expression are not helping, this teen may need further counseling for anger management.
Guilt Feelings of guilt often leave the teen isolated and alone, with an absence of self-esteem. The shame that accompanies guilt takes the form of deep, dark secrets - a very heavy weight to carry around. You can help the teen find some relief from these feelings by being a good listener and by not trying to talk him or her out of it. Suggest writing a letter to the person who died asking for forgiveness, perhaps even taking that letter to the grave and reading it out loud. Or list the things that are most guilt inducing on a biodegradable helium balloon and let it go. If measures like this don't help, don't hesitate to refer the teen for further therapy.
Substance abuse Have information about the perils of substance abuse available. There are times when teens use drugs or alcohol to try to take away the pain. Look for denial, anger and guilt with teens you suspect are using drugs or alcohol. When referring such a teen for additional help, find a therapist who specializes in grief and substance abuse.
Skipping school or dropping grades A normal part of grief is not caring about anything and a lack of motivation or interest. Help the teen understand that these intense feelings of grief are temporary, and that the more they skip school or don't do their homework, the harder it will be to catch up. Teens who are staying away from school may not know that, if this continues, they could be brought before a judge and sent to a probation home or juvenile detention center.
Acting out sexually The pain of grief is so great and the emptiness so profound, it is not uncommon to look for a warm body to fill the void. This closeness is only a temporary fix that usually leads to regret, shame, and fear of disease and pregnancy. If a girl is thinking that sex will make her feel better, help her understand her displaced needs and what she may get herself into. If a boy is showing the same tendency, help him understand that the issue goes beyond contraception; what is involved is his own need to address his grief in way that will bring him real relief.
Making Referrals and Offering Resources
Develop a list of mental health centers and know what services they offer. Put together a list of private therapists who specialize in adolescents, grief, substance abuse and depression. Update this list yearly.
Working with teens is both challenging and rewarding - challenging because you need to break into their world and develop a trusting relationship; rewarding because of the pleasure you will have in being a confidante to their secrets and concerns, seeing smiles and cheery greetings gradually replace those frowns and stares. Becoming a part of a teen's life as he or she struggles with life-shattering grief is a privilege to be exercised with care, but a privilege all the same.
Content provided with permission from The American Hospice Foundation.
By Helen Fitzgerald, CT
Training Director, American Hospice Foundation
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This content was last modified on: 08/26/2008