Facilitating attachment between school-aged children and a dying parent.

A qualitative, community study of 58 parentally bereaved children and their 35 surviving parents illustrates how families take advantage of forewarning of death to foster connections between children and dying parents and prepare for youngsters' continued attachment to dying parents after the death. Children and parents displayed strong yearnings to remain connected during terminal illness, but fostering connections for attachment after the death was less intuitive and more emotionally fraught as it undermined coping strategies based on denial of impending death. Thus, although some may benefit from interventions aimed at anticipatory relationship facilitation, clinicians should respect limitations on what family members are psychologically able to bear.

Meeting the needs of parentally bereaved children: a framework for child-centered parenting.

This article describes the development and deployment of a framework for measuring parenting capacities in the context of bereavement. Grounded theoretical analysis of interviews with a community sample of 41 bereaved spouses with school-aged children elicited a set of nine bereavement-specific parenting tasks. A corollary coding system (covering all nine parenting tasks) was created to transform interview materials into quantitative data, thus permitting systematic empirical investigation of the parenting capacities of bereaved spouses. Parenting behaviors were coded on a 5-point scale ranging from least child-centered to most child-centered. Sex of surviving parent and circumstances of death proved to be significant mediating variables: mothers were more child-centered than fathers, and parents surviving sudden deaths more child-centered than those surviving anticipated deaths. Lengthy illness was associated with less child-centered parenting. The more child-centered the parenting, the less symptomatic the child as measured by parent report (Child Behavior Checklist) and child self-report (Children's Depression Inventory, Revised Child Manifest Anxiety Scale). Child-centered parenting was associated with more positive and fewer negative perceptions of the surviving parent by the child as measured by the Parent Perception Inventory. Implications of findings are discussed.

Managing traumatic stress in children anticipating parental death.

QUALITATIVE EVIDENCE drawn from a community study of 58 parentally bereaved school-age children and their surviving parents provides a descriptive exploration of one of the most difficult challenges faced by families in anticipated deaths: managing the stress of a child's exposure to the graphic physical, emotional, and mental deterioration of the dying parent. The concept of traumatic stress is broadly defined to include exposure to the "fact" of impending death itself, that is, the anxiety that comes from knowing that one may lose a close other. Included, as well, is an exploration of secondary traumatic stress, defined here to cover the notion of the stress of watching other loved ones in the family succumb to terror and anxiety about the impending death. Emphasis is placed on a child's unique vulnerability to traumatic stressors and on the role of parenting in mediating child exposure to parental decline. In contrast to the anticipatory grief literature which emphasizes the advantages of forewarning in cushioning postmortem adjustment, this study documents the adverse impact of a child's exposure to graphic stimuli. These findings underscore the need for clinicians to attend to the traumatic stress of "ordinary" anticipated deaths, rather than maintaining an exclusive grief orientation.