factors that may influence the severity of traumatic symptoms include the presence of pre-existing conditions or psychopathology, the level of exposure to the traumatic event, the nature of the relationship to the deceased, the cause of death, and barriers associated with experiencing trauma as a child. Barriers for children in need of treatment include the necessity to disclose the trauma to an adult, the need for parents to recognize when atypical reactions warrant treatment, and parents' willingness to seek treatment.
FUTURE DIRECTIONS FOR RESEARCH
Although it is difficult to pinpoint the aspects of current treatment models that lead to positive outcomes, researchers suggest that treatment for childhood grief should incorporate interventions for both trauma and bereavement symptoms. However, there is little information about the optimal amount of treatment for reducing symptoms, and empirical studies are also needed to determine the components of treatment interventions that are most critical in producing positive outcomes in children.
Due to the association between adjustment and social support, it seems to be important to include surviving parents in the treatment of childhood grief. A lack of parental support and attention may hinder the adjustment of children to loss (Hope & Hodge, 2006; Tremblay & Israel, 1998). The emotional distress of parents and lower levels of social support for the child predict poorer outcomes for children (Cohen & Mannarino, 1996). Inclusion of a treatment component for parents may be beneficial for resolving childhood traumatic grief. Few studies have incorporated an active parental treatment component because most research examining grief in childhood is conducted at school.
Studies examining grief in children have several methodological problems. A lack of standardized assessment measures, failure to examine the link between parent and child adjustment (Kalter et al., 2002), and heavy reliance upon parent reports of child functioning (Thompson et al, 1998) have all been troublesome. Considering the frequency of parental death and its potential for traumatic impact on the psychological development of children, research is needed to better understand the consequences and outcomes associated with it and factors that moderate various reactions (Thompson et al., 1998).
Many researchers have examined the efficacy of treatment techniques for children who have been exposed to a variety of traumas. Therefore, examining the efficacy of interpersonal and cognitive-behavioral therapies for children experiencing normative and traumatic grief around parental loss should be a chief research goal. Similarly, studies are needed to determine the effectiveness of current treatment models for decreasing symptoms and increasing the adaptive functioning of children (Cohen & Mannarino, 2004).
The loss of a parent can have a devastating effect on the life of a child. When the grieving process is complicated, an inability to adequately navigate the normal tasks of bereavement can lead to negative psychological effects for children. Counselors who are sensitive to the importance of critical factors during the grieving and adaptation process for parentally bereaved children can provide valuable clinical services to families and child survivors. Creating a safe place for children and family members to mourn and providing an opportunity to build skills to manage stress are essential. Counselors should follow up with bereaved children for long periods of time because of the potential for delayed effects following parental death (Worden & Silverman, 1996). Finally, counselors should remain sensitive to the continuing and life-long nature of parental bereavement, particularly surrounding common life transitions for children as they grow into adulthood and beyond.
Boelen, P. A., van den Hout, M. A., & van den Bout, J. (2006). A cognitive-behavioral conceptualization of complicated grief. Clinical Psychology Science and Practice, 13, 109-128.
Bonnano, G.A. (2004). Loss, trauma, and human resilience: Have we underestima