This article was downloaded by: On: 20 December 2008 Access details: Access Details: Free Access Publisher Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Creativity in Mental Health Publication details, including instructions for authors and subscription information: http://www.informaworld.com/smpp/title~content=t792303984 Scrapbooking as an Intervention for Grief Recovery With Children Kristie Williams a; Jonathan Lent a Department of Counseling, University of Akron, Akron, OH a Online Publication Date: 15 December 2008 To cite this Article Williams, Kristie and Lent, Jonathan(2008)'Scrapbooking as an Intervention for Grief Recovery With Children',Journal of Creativity in Mental Health,3:4,455 — 467 To link to this Article: DOI: 10.1080/15401380802547553 URL: http://dx.doi.org/10.1080/15401380802547553 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. Scrapbooking as an Intervention for Grief Recovery With Children 1540-1391 1540-1383 WCMH Journal of Creativity in Mental Health, Health Vol. 3, No. 4, Oct 2008: pp. 0–0 Kristie Williams Journal of Creativity and in Jonathan MentalLent Health Kristie Williams Jonathan Lent Downloaded At: 16:15 20 December 2008 ABSTRACT. This article describes scrapbooking in the context of bereavement counseling. For the purposes of this article, scrapbooking combines many different types of art-related therapy interventions into one concrete format to utilize in counseling with children who are working to overcome grief or trauma related to the loss of a parent. A case illustration is provided, along with a sample scrapbook page, timeline, and the materials needed. KEYWORDS. Creativity, counseling, children, grief, loss, trauma, death of a parent, photos, scrapbooking OVERVIEW Childhood trauma is a serious social problem that more than 25% of American children experience by the age of 16 years (Pynoos & Fairbank, 2003). Trauma is defined as a sudden and extraordinary event that overpowers a child’s ability to cope and to manage the reactions that are aroused by the event (Dripchak, 2007). Examples of childhood trauma Kristie Williams and Jonathan Lent are doctoral students, Department of Counseling, University of Akron, Akron, OH. Kristie Williams is Disability Specialist, Office of Accessibility, University of Akron, Akron, OH. Address correspondence to: Jonathan Lent, University of Akron, Department of Counseling, 622 Portage Trail #2, Cuyahoga Falls, OH 44221 (E-mail: jl66@ uakron.edu). Journal of Creativity in Mental Health, Vol. 3(4) 2008 © 2008 by The Haworth Press. All rights reserved. doi:10.1080/15401380802547553 455 456 JOURNAL OF CREATIVITY IN MENTAL HEALTH may include loss of a loved one or significant other through death, divorce, or abandonment; sexual or physical abuse; or fear of death or injury. The focus of this article will be on loss of a loved one. Downloaded At: 16:15 20 December 2008 Children’s Responses to Trauma and Loss Children’s responses to trauma are subjective and multidimensional. It is common for children who have experienced a traumatic loss to suffer lowered self-esteem, narcissistic injury, and a sense of degradation (Mishne, 1979). For this reason, it is necessary after such a trauma for family members and practitioners to assist children in understanding this experience. Various factors influence how differently children and adults respond to trauma. These factors contribute to the way children grieve. These include, but are not limited to, the nature of the relationship, the manner in which the death or grief occurred, and whether the death or situation was expected or the result of sudden traumatic loss. Additionally, the age and developmental level of the child as well as their attitudes towards death contribute to the way the child grieves. There are four components to children’s understanding of death. These are the factors of irreversibility, finality, inevitability, and causality. Children have a difficult time conceptualizing that death cannot be reversed. Furthermore, they cannot understand the concept that death is permanent (Willis, 2002). Some children are “reluctant grievers” (Crenshaw, 2005), particularly those who suffer multiple or traumatic loss. Preteens and adolescents have more tools at their disposal than preschool and school-age children: more advanced language ability, cognitive development, emotional maturation, and social maturation; they, too, may find it hard to directly approach their grief or to find words to express their losses. This is particularly true of those adolescents who have suffered profound losses, often unrecognized by others and perhaps not even acknowledged to themselves (Crenshaw). The death of a parent is considered one of the most significant and stressful for both children and their families. This loss affects those involved as individuals and as a whole unit. To date, the loss of a parent or significant other occurs at such an increasingly high rate that it is becoming statistically normal (Zall, 1994). The loss of a parent represents a profound psychological insult that threatens the child’s social and emotional development (Kirwin & Hamrin, 2005; Osterweis, Solomon, & Green, 1984). The death of a parent also affects a child’s health, social, and economic status (Kirwin & Hamrin). Kristie Williams and Jonathan Lent 457 Due to the nature of the loss, and in the event that the death or situation is unexpected or perhaps goes unrecognized, children may be hesitant or ambivalent toward grief. This concept is known as disenfranchised grief, in which losses that are not publically acknowledged go unrecognized, causing fewer support systems to help with the grieving process (Crenshaw, 2005; Duffey, 2005a, 2005b; Vogel, 2005). In these cases, children’s losses may be devalued, trivialized, or not accepted. For example, children who lose a parent by suicide may have a challenging time expressing their feelings towards the death. Additionally, it may be hard for children to tell their friends, teachers, and family about what happened. Downloaded At: 16:15 20 December 2008 Developmental Stages and the Grieving Process Children require different methods of treatment contingent upon age and stage of development. Young children (age 0 to 12 years) may not have reached the developmental level in which they can express their inner responses regarding the loss that occurred. According to Crenshaw (2005), children, specifically “age 7 and under, frequently rely on symbolic play and artistic creations to express their grief. They play out funerals; [and] burials, [where] people or animals disappear and don’t come back” (p. 240). Young children are not able to use reason to find meaning in these life events, and they may use magical thinking or believe that they are the cause of the event (Dripchak, 2007; Timberlake & Cutler, 2001). Children in the older age range will be drawn to symbolic play possibly due to arrested development (Crenshaw). As children reach adolescence, they may be able to better verbalize their reactions to the loss (Dripchak). Depending on their level of maturity, some adolescents may be reluctant to address painful feelings related to grief. According to Crenshaw, most adolescents are capable of addressing these feelings when they can utilize creative expression along with direct verbalization. Swanson and Schaefer (1993) propose four stages adolescents go through corresponding to the loss of a loved one. The first stage is called pre-protest. In this stage the adolescent will display a lack of emotion regarding the loss. The second stage is labeled protest. This is a stage in which the adolescent rejects whatever new environment and individuals are substituting the for the loved one who has been lost. In the third stage the adolescent begins to exhibit despair, characterized by withdrawal and sadness. Finally, the adolescent experiences the fourth stage, detachment, in which the adolescent emancipates him or herself from the prior attachment and begins to adapt to the new environment and accept the substitutes. Downloaded At: 16:15 20 December 2008 458 JOURNAL OF CREATIVITY IN MENTAL HEALTH Children grieve differently than adults and often manifest their grief at home, at school, and with their peers. A bereaved child may lash out at well-intended peers who inadvertently upset him or her (e.g., by benign banter about a topic other than death) because the child is not capable of isolating intense hurt and feelings of anger. Grief is not an isolated event; rather, it affects transactions and circumstances in every environment (Eppler, 2008). Grief experienced by a child is usually cyclical with the child revisiting feelings and behaviors associated with the death or loss. Because children are often confused by the process of grief, they do not understand their feelings. As a result, the child may exhibit unacceptable behaviors that are expressions of their confusion about what has happened. In addition, children often experience difficulty understanding that things become easier with the passage of time. SCRAPBOOKING AS AN INTERVENTION FOR GRIEVING CHILDREN A review of the literature shows that most interventions for grieving children consist of support groups (McClatchey & Vonk, 2005). Other types of interventions include the use of art through drawing, creating collages, and painting. Another method that can be beneficial when working with grieving children is scrapbooking. This intervention may be used along with individual and/or family therapy. Scrapbooking is not a new phenomenon. Throughout the world, the craft has achieved increased popularity amongst adults and children and has developed into a nearly 3-billion-dollar industry (White, 2005). The collection of photos within albums has served various populations as a medium for preserving family history. Scrapbooking adds the use of story to the traditional photo album while also serving as a creative art form. The incorporation of photographs, creative writings, journal entries, news clippings, poems, song lyrics, and other mementoes gives voice and story to the authors, allowing the expression of feelings associated with lost loved ones. In addition, by providing narration to photographed memories, the scrapbook becomes a way of making meaning of the experience of grief and its impact on the client. The scrapbook also provides a way to honor and memorialize the loved one or provides a space to express words that were left unspoken. The use of grieving and memorial activities helps children to relocate the individual within the child’s life Kristie Williams and Jonathan Lent 459 by acknowledging the death, honoring the deceased, and obtaining comfort and support (Howard, Matinhure, McCurdy, & Johnson, 2006). Lowenstein (1995) utilized scrapbooking with children in the forms of a life book and a resolution scrapbook. The life book is often used for children in out-of-home placements, such as foster care, to assist the child in having tangible memorabilia to carry with them. In contrast, the resolution scrapbook serves as a compilation of the therapeutic activities completed by the child throughout the treatment and serves to provide an illustration of the child’s progress (Lowenstein). Downloaded At: 16:15 20 December 2008 Benefits of Scrapbooking with Grieving Children Before using scrapbooking as an intervention to honor children’s loved ones, it is necessary to assess their level of trauma, level of development, and understanding of the death and grief process. The developmental level can be determined during the intake. Determining the child’s knowledge of the grief process can be accomplished by asking open-ended questions in therapy and also by incorporating bibliotherapy, using age-appropriate stories to assist in the client’s awareness of the topic (Lowenstein, 1995). According to Briggs and Pehrsson (2008), manifestations of grief may include responses that are emotional, physical, behavioral, and spiritual. Emotional symptoms may be varied and may include depression, anxiety, confusion, fear, and rage. Physical symptoms may include weight gain, weight loss, insomnia, and increased risk for illness. Behavioral responses may include withdrawing from activities and rejecting support systems. Spiritual responses include the questioning of belief systems. There are many benefits gained when creating a space to grieve through scrapbooking. The first is that the process allows for additional insight into the feelings about the death of the loved one. Second, as children intentionally engage in the creative process by selecting photos and expressing their thoughts, conversation is stimulated to assist them in understanding the grief process. Another benefit gained through this interactive process is the creation of a bridge of conversation with family members who were also affected by the trauma. This assists in creating a stronger, more cohesive system of support. If the child chooses to share his or her scrapbook with other members of the family, this allows for open lines of communication to assist the family in understanding how the death has impacted them individually and collectively. Finally, the utilization of art assists in providing a mode of tactile and visual expression for children in areas where they may be limited in verbal and cognitive functioning (Grebin & Vogel, 2007). 460 JOURNAL OF CREATIVITY IN MENTAL HEALTH This allows a method of expression that children may be otherwise unable to access due to their developmental level. Because it is important to assess the developmental level of the child when determining appropriate interventions, scrapbooking should only be used when it meets the direct needs of the child. Scrapbooking may be used in any stage of the grieving process as an intervention to help the child explore his or her feelings. Downloaded At: 16:15 20 December 2008 Suggested Process for Using Scrapbooking with Grieving Children There are a variety of activities that may be chosen to aid the child in overcoming the grief and loss that is being felt. The first step requires the counselor to select scrapbook activities that are tailored to the child’s needs (Lowenstein, 1995). After it has been determined that scrapbooking is a viable treatment option, the next step would be to introduce the process to the client. To engage the child in the process, it would be important to explain the purpose of the intervention. This assists children in understanding that scrapbooking is an effort for them to express feelings in a safe way. Next, a description of what is necessary to complete the scrapbook may be important. In order to do this, the counselor must be aware of whom the primary figure of loss is and explain to the child that he or she should bring in artifacts that serve as reminders. In addition, the counselor should explain to the caretaker to be cautious about the items the child is allowed to bring in. This is so that the child is aware that expensive or rare items may need to be substituted. A picture or drawing of the item may suffice in this situation. Scrapbooking can be used as a therapeutic intervention with individual children or with groups, as well as in family formats. Some of the items the child may choose to bring include photographs or other important mementoes of the individual. This places the focus on the deceased individual and also allows an opportunity to work with surviving family members. In preparation for the next session, the counselor should have the materials needed for the scrapbooking process. (See Appendix for a list of materials and an outline of suggested procedures.) In the next phase of the scrapbooking intervention, the counselor talks with the child about the items for the scrapbook. The child may show objects one by one to the counselor and describe them. The counselor can prompt by asking the child, Why is this item important to you? Who is this in this picture? What were you and (person who has died) doing here? These questions should stimulate the child to tell more about each item. It is important here to be aware of the child’s reaction to telling about each Downloaded At: 16:15 20 December 2008 Kristie Williams and Jonathan Lent 461 item or photograph. It is important for the counselor to consider the skills of empathy and understanding when discussing these sensitive subjects. Journals, diaries, or corresponding items may be incorporated. These may include photos, poetry, song lyrics, or letters. They also may participate in enactments of “last conversations” with their deceased loved one, or do a writing assignment such as an essay on their father’s best qualities or their favorite stories of their mother (Crenshaw, 2005). This will also allow further exploration of the scrapbooking item and the importance that it represents. Once the child has shared each item, the next phase consists of constructing a timeline. The timeline provides a structure for the items and sets a parameter. With this in mind, based on the timeline, the child selects the event that he or she would like to memorialize within the scrapbook. To fully engage the child at his or her physical level, utilize a small table or work on the floor to spread out all the items for the staging phase. The staging component provides an opening for the child to create and share the story about the loved one who has died. This process provides limitless opportunities for imagination or creativity as the child may select themes, items, or materials that help in the recollection of the loved one. An example may be a preprinted themed page with toy boats, which may elicit a memory of the child’s first fishing trip with Dad or Grandpa. Encourage the child to explore these themes through the use of talk, art, or play. Additional accessories, mementoes, use of color, or decorative backgrounds may be used to further expand on the theme. This is the most significant part of the process: when children are given the opportunity to share their stories. The counselor prompts the child by asking questions such as, What story does this page tell? or What do you remember about that day? Children may not instantly respond, and time may be required for them to disclose feelings in any manner. Providing options for children’s communication in this phase is very important. As a mode of intervention, this process can be very rewarding for children and their surviving loved ones. The scrapbook may be continuously utilized throughout the duration of therapy with the child. It provides an outlet for expression that can be expanded as the child wishes, and it may expand to other topics of concern for the child. This intervention may be particularly helpful during the termination phase of counseling, because the child is able to retain the scrapbook for future use. An option at this stage of the process may be to use the scrapbook as part of the review process during termination. The 462 JOURNAL OF CREATIVITY IN MENTAL HEALTH scrapbook is also a tangible reminder of the therapy process and what has been learned throughout the experience. Downloaded At: 16:15 20 December 2008 CASE EXAMPLE Matthew is an 8-year-old child who came to counseling following the recent death of his father. Prior to counseling, Matthew’s mother noted he was not doing well in school, was having stomach aches and nightmares, and was withdrawn both at home and in school. Prior to this event, Matthew had never received counseling services. It was determined that Matthew may benefit from a more creative intervention than traditional bereavement counseling. Following a discussion with Matthew regarding the scrapbook process and obtaining his agreement, the process began. First, the counselor asked Matthew his age to establish the beginning for the timeline. The counselor then asked about Matthew’s earliest memory, which Matthew recounted as the birth of his brother Austin. The counselor then asked Matthew to discuss events that followed his brother’s birth. This provided a timeline that was used to identify key events during Matthew’s life up until the present (see Figure 1). FIGURE 1. Sample Organizational Timeline. Timeline Name: Matthew Today’s Date: 7/07/08 I was born. 2000 Daddy bought me Coda. 2002 Baby brother Austin born. 2004 Dad drove us to Disney. 2005 Went to visit with Grandma & Papa. Moved to Maine with Grandma & Papa. 2006 2007 Daddy’s plane crashed. 2008 Started a new school. Future Downloaded At: 16:15 20 December 2008 Kristie Williams and Jonathan Lent 463 Following the identification of important events and obtaining approval from his mother, Matthew brought in memorabilia, which included several photographs, drawings, and stickers. After being asked by the counselor to separate the items by theme or specific event, Matthew identified several items that reminded him of the day he received his puppy Coda and went to the park with his parents. Matthew and the counselor used these items and his recollections of this special day to create a scrapbook page (see Figure 2). Through the power of creativity and using art in the sessions, Matthew was able to recount and memorialize various events (e.g., family vacations, sports events, activities with his brother). Matthew’s symptoms began to subside over the course of the year he was seen in individual counseling that incorporated the use of scrapbooking. During this time, he created a number of additional pages in counseling sessions, as well as pages with his mother, brother, and even his grandparents. The scrapbook provided Matthew with an opportunity to share his story with his family as well as connect with new peers in school. He often brought in school assignments and mementoes from field trips to share with his counselor. In having the opportunity to share his experiences of adjustment, Matthew was provided a space and given a creative opportunity to grieve his loss as well as share his experiences in new events and relationships of importance. CONCLUSION Scrapbooking is an intervention that does not have to be limited to the time the child is seeing a counselor. The scrapbook may continue to be utilized beyond this point because of the ability to incorporate a wide array of different outlets through which the child can express emotions and thoughts. This can also be helpful for the child due to the cyclical nature of grief. Scrapbooking provides the child with something concrete that can be taken away from therapy sessions and kept with the child to revisit when going through a difficult time. It is important that we, as mental health professionals, consider different methods of working with child clients because of the differences between child and adult clients regarding the grieving process. This intervention provides an outlet for children that uses alternative methods instead of traditional talk therapy to work through the grief they are experiencing related to their loss. 464 JOURNAL OF CREATIVITY IN MENTAL HEALTH Downloaded At: 16:15 20 December 2008 FIGURE 2. Scrapbook Page Example. Kristie Williams and Jonathan Lent 465 Downloaded At: 16:15 20 December 2008 REFERENCES Briggs, C. A., & Pehrsson, D. E. (2008). Use of bibliotherapy in the treatment of grief and loss: A guide to current counseling practices. Adultspan: Theory Research & Practice, 7, 32–42. Crenshaw, D. A. (2005). Clinical tools to facilitate treatment of childhood traumatic grief. Omega: Journal of Death & Dying, 51, 239–255. Dripchak, V. L. (2007). Posttraumatic play: Towards acceptance and resolution. Journal of Clinical Social Work, 35, 125–134. Duffey, T. (2005a). Grief, loss, and death. In D. Comstock (Ed.), Critical contexts in human development (pp. 253–268). Pacific Grove, CA: Brooks/Cole – Thompson Learning. Duffey, T. (2005b). When the music stops: Releasing the dream. In T. Duffey (Ed.), Creative interventions in grief and loss therapy: When the music stops, a dream dies (pp.1–24). New York: Haworth Press, Inc. Eppler, C. (2008). Exploring the themes of resiliency in children after the death of a parent. Professional School Counseling, 11, 189–196. Grebin, M., & Vogel, J. E. (2007). Bereavement groups and their benefits: Enhancing connection through creativity. Journal of Creativity in Mental Health, 2, 61–73. Howard, B., Matinhure, N., McCurdy, S. A., & Johnson, A. (2007). Psychosocial disadvantage: Preparation, grieving, remembrance and recovery for orphans in eastern Zimbabwe. African Journal of AIDS Research, 5, 71–83. Kirwin, K. M., & Hamrin, V. (2005). Decreasing the risk of complicated bereavement and future psychiatric disorders in children. Journal of Child and Adolescent Psychiatic Nursing, 18, 62–78. Lowenstein, L. B. (1995). The resolution scrapbook as an aid in the treatment of traumatized children. Child Welfare, 4, 889–904. McClatchey, R. S., & Vonk, E. M. (2005). An exploratory study of post-traumatic stress disorder symptoms among bereaved children. Omega: Journal of Death & Dying, 51, 285–300. Mishne, J. (1979). Parental abandonment: A unique form of loss and narcissistic injury. Clinical Social Work Journal, 7, 15–33. Osterweis, M., Solomon, F., & Green, M. (Eds). (1984). Bereavement: Reactions, consequences and care. Washington, DC: National Academy Press. Pynoos, R., & Fairbank, J. (2003). The state of child trauma in America, 2 years out. The Brown University Child and Adolescent Behavior Letter, 19, 1–7. Swanson, A. J., & Schaefer, C. E. (1993). Children in residential treatment. New York: Von Nostrand Reinhold. Timberlake, E. M., & Cutler, M. M. (2001). Developmental play therapy in clinical social work. Toronto: Allyn & Bacon. Vogel, J. E. (2005). Overcoming heartbreak: Learning to make music again. In T. Duffey (Ed.) Creative interventions in grief and loss therapy: When the music stops, a dream dies (pp.135–154). New York: Haworth Press, Inc. White, T. (2005). Creating keepsakes encyclopedia of scrapbooking. Little Rock, AR: Leisure Arts, Inc. 466 JOURNAL OF CREATIVITY IN MENTAL HEALTH Willis, C. A. (2002). The grieving process in children: Strategies for understanding, educating, and reconciling children’s perceptions of death. Early Childhood Education Journal, 29, 221–226. Zall, D. S. (1994). The long term effects of childhood bereavement: Impact on roles as mothers. Omega: Journal of Death & Dying, 29, 219–230. APPENDIX MATERIALS NEEDED AND SUGGESTED PROCEDURE FOR GRIEF/TRAUMA SCRAPBOOKING Downloaded At: 16:15 20 December 2008 Materials Needed 1. Scrapbook • Various sizes include 12” × 12”, 8½” × 11”, and 6” × 6” • Assorted colored and textured acid-free, lignin-free paper (used to prevent deterioration of photos over the years) 2. 3. 4. 5. 6. 7. 8. Glue or adhesives Scissors (available with customized edges) Colored pens and/or markers (acid-free, non-bleeding) 12″ × 12″ paper trimmer Hole puncher Page protectors Additional embellishments (ribbons, stickers, buttons, die cuts, and rubber stamps) 9. Plastic storage box to protect photos when not in use Suggested Procedures for Grief/Trauma Scrapbooking 1. Introduce child to scrapbook process. 2. Gather photographs, mementoes, and other items of importance or value. • Process the objects: The creative power of scrapbooking brings healing in that its author is able to revisit the experiences and the feelings captured within the photos. • Client might have to look through old albums. • Client might have to gather items from family and friends. 3. Organizing or sort by theme, events, and/or dates of importance. • Have the child create a timeline and utilize this chart as a history for the assessment. Downloaded At: 16:15 20 December 2008 Kristie Williams and Jonathan Lent 467 • This would provide foundational information regarding the relationship between the child and the lost loved one. • This would also highlight important dates or things they enjoy that they may currently be avoiding as a result of traumatic memories (conflict). • As emotions and feelings emerge, ideas may be generated for other creative techniques that could be used (poems, songs, drawings). 4. Allow the child to choose paper colors for background layouts and framing. • This may include paper and artifacts with specific themes (sports, military, food). • Additional embellishments or mementoes may be added to highlight event (e.g., ticket stubs, cards, etc). 5. Determine desired staging of photos on page. It is during the assembly process and formatting of the page that the photos come together to provide a story of the events captured on paper. Assemble photos with glue or adhesive. 6. Include journal titles, captions, thoughts, and feelings about experiences.