"When the worst is happening"

Treatment for children who lost both of

their parents during a car accident

Dr. Adi Granat , Dr. Moshe Vardi

The Post Trauma Unit for children and adolescents,

Loewenstein Hospital

Rehabilitation center,

Raanana.

The initial Picture

Road accident

Death

Injuries

Trauma

The Second Picture

Children (age between 10 months to 12 years):

What to expect ?

Functioning: good/Bad

Are we dealing with Psychopathology (complex PTSD/

Bereavement )

The Second Picture

Care Takers & Community

Other family members Confused, Grief,

Community and Professionals:

The Dilemmas

Can we help?

What to do?

Should we treat or wait?

Who Should be treated?

How to treat?

Where to treat?

For how long?

How could we evaluated the results ?

There are many researches about children who loss one parent.

And very rare about children who loss both parents.

There aren’t many professional clinics that treat and follow-up

children who loss both parents for long periods.

A conference in Jerusalem 2006 about children and grief. the

expert panel concluded that 50% of children who had losed one

parent showed significant psychopalogy many years later.

Researches found a five fold increase in childhood psychiatric

disorder in bereaved children compared with the general

population.

Higher rates of dysphoria, dysthymia, mild depression

Specific anxieties (e.g. separation anxiety, afraid of death)

More temper tantrums, anger, guilt, despair, concentration

problems,

bed wetting, sleep problems, regression.

Generally boys more acting out, girls more internalizing.

20% of the children had symptoms that were sever enough in

order to refer them to treatment.

Some reactions and symptoms may increase over time.

Reactions generally decrease over time, but rates of problems

remain higher even after a year.

It is difficult to predict the loss outcomes on the children for the

long ran.

Also it is difficult to define what is “good outcome”.

we speak less about “cure and healing” and more about adaptation

and going on again with life.

“Helpful” things during trauma and loss may be absent or

compromised.

“Helpful” things during trauma and loss

may be absent or compromised

1. Reassurance of safety

2. Help and support may be temporary

3. Ability to trust others

4. Social support

5. Accepting & making sense of the death-Grief and

bringing memories of the parents.

Family dilemmas

Complicated mourning:

“I feel like crying but I have to laugh in the presence of the orphans….”-

The burden over time:

“Can I return to my life before the road accident….?

Conflicts between the couple (foster parents).

Our own children and the adopted children.

Other family members and the environment.

Children Dilemmas

Perception of death in children

loyalty

“To whom I’ll call mother or father now…?”

Reenactment

“If I will behave badly as I feel they will abandon me”

Implications -lessons from the families

Usually we try to decrease the patients distress. In traumatic bereavement treatments often requires creating situation where families can express sadness ,fear, pain.

sometimes the most potent thing we have to offer is simply support, and occasionally just professional company.

We need to be genuinely empathic, but not to exaggerate .

When someone’s world has fallen apart, our job is

not to put it back together, but to help them create a

new one.

At any stage of the rehabilitation process the equilibrium we already achieve may be disrupted again.

Implication-Therapist

Be prepared:

To be involved for a long time

To feel some times frustration and extreme distress

To be affected by the stories

To invest substantial resources and efforts in

developing rapport

You are not only a therapist but have also other

responsibilities, such as a case manager.