ed by the child after the loss, are substantially related to how children cope (Kalter, Lohnes, Chasin, Cain, Dunning, & Rowan, 2002). The surviving parent may be ill-prepared for managing his or her own reactions as well as the reactions of the child. Typical responses to the death of a spouse include feelings of guilt, anxiety, sadness, and preoccupation with thoughts of death or the deceased. Negative relations with the surviving caregiver has been shown to be more predictive of maladjustment for bereaving children than other factors; a positive adjustment of the surviving parent is necessary for a more positive adjustment of the child (Hope & Hodge, 2006).
Helping the surviving parent to implement positive parenting practices and foster a positive parent-child relationship is consistently regarded as important to the adjustment of parentally bereaved children (Sandler et al., 2008). Caregiver warmth includes displaying a positive regard toward the bereaved child, conveying acceptance, expressing affection, fostering open communication, and providing emotional support (Haine, Ayers, Sandler, & Wolchik, 2008). Additional support for both children and surviving parents (e.g., support groups, grief groups) may be beneficial to promote adjustment among grieving children and their families. The fact that bereaved children will likely experience a range of emotions like sadness, anger, guilt, and anxiety (Silverman & Worden, 1992; Worden, 1991) makes open communication imperative. More openness and frequency of communication is associated with less depression and anxiety in bereaved children (Hope & Hodge, 2006).
Adaptation to parental death can be facilitated by providing accurate information about the grief process (Corr, 1995) to decrease any maladaptive cognitions that may disrupt adjustment (e.g., feeling responsible for the death because of an argument beforehand). Educating children about death and bereavement may help reduce anxieties while also normalizing the grief process (Hope & Hodge, 2006).
Given the multiple changes associated with parental death, a stable environment is very important for positive adaptation (Haine et al., 2008). Implementing consistent discipline and routines, facilitating discussions of feelings, and appropriately interpreting acting-out behaviors may be beneficial to bereaved children's adjustment (Hope & Hodge, 2006). An environment with a predictable routine, clear and specific rules and expectations, and consistent follow-through has been associated with fewer mental health problems among parentally bereaved children (Worden, 1 996). Similarly, ensuring that a child's basic needs are met, helping children identify personal strengths, and promoting strong connections and social support for bereaved children are important.
Clearly, there are a number of factors that may influence the adjustment of parentally bereaved children. As a result, when working with these children and their families, counselors should consider influences from various levels (individual, family, environmental) in each child's life.
TREATMENT FOR PARENTALLY BEREAVED CHILDREN
Although studies of the use of empirically supported interventions with this population are few, some clinically relevant information comes from projects like the Family Bereavement Program (FBP; Sandler et al., 2003) that reiterate the importance of increasing children's understanding of their grief experiences.
Although researchers have examined intervention programs for bereaved adults, little is known about effective treatments for facilitating the grieving process in children, particularly children experiencing complicated or traumatic grief (Boelen et al, 2006). More research is necessary for gaining a better understanding of the consequences and outcomes associated with childhood grief, as well as the components of effective treatment (Thompson et al., 1998).
Because "grief refers to the child's personal experience of the thoughts, emotions, and behaviors associated with the loss" (Lampton & Cremeans, 2002, p. 468), a cognitive-behaviora