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Startts - NSW Service for the treatment and rehabilitation of torture and trauma survivors  

It is not uncommon for us at STARTTS to see children who have experienced the death of someone special under traumatic circumstances. In some cases, these children develop symptoms of post-traumatic stress that interfere with their ability to grieve and to call up comforting memories of the person who died. As therapists, this presents us with a unique challenge.

The term traumatic grief has been proposed as a description of this diagnostic entity. Speaking to a colleague about it this week, she remarked that – among our refugee population – traumatic grief presentations are most common. It’s not hard to see why: by definition, all refugees have experienced traumatic losses, and thus are at increased risk for developing difficulties with grief.

The pieces in this edition all explore some of these issues, especially in relation to helping young people recover. I hope you find them interesting and helpful and look forward to your feedback.


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Deb's digest
Deb Gould
> Deb Gould is a STARTTS Clinical Psychologist and
clinical supervisor.

Most counsellors who work with refugees will agree that there is little grief without trauma and little trauma without grief.
Over the last decade there have been many attempts to bring together a conceptualisation of the process that many of us see – where the loss of another is itself traumatic and/or takes place in traumatic circumstances.

Learn more >>

> Dr William Steele is the Founder and Director of
The National Institute for Trauma and Loss in
Children, established in
the US in 1990.

Dr Steele, how did you begin your work in the field of trauma?
In the early 1980s, I took a leading role in helping schools across the US develop crisis response teams in answer to the epidemic of suicide among young people. Since then, I have been involved in assisting professionals following such tragedies as the bombing of the Federal Building in Oklahoma; 9/11 in New York and Washington DC; Hurricans Katrina and Rita; to name but a few. In 1990, I established the National Institute for Trauma and Loss in Children (TLC) and two years ago In 2009 TLC joined the Starr Institute for Training, an international leader in transformational programs for children, families, schools and communities since 1913.
Learn more >>

> Max is a Child &
Adolescent Counsellor at STARTTS and the service's School Liaison Officer.

Ali, a 12 year old Iraqi boy, was referred to STARTTS by a student welfare teacher following concerns about reported headaches and nightmares as well as low motivation and difficulty concentrating in class. The teacher also commented that Ali at times displayed aggressive behaviour, was restless, anxious or teary, and seemed to have attachment issues - sometimes appearing clingy and dependent with others and at other times appearing very self-sufficient and avoidant.
Learn more >>

I am counselling a refugee student whose father was violently and unexpectedly killed during the war in Iraq. My client seems to have developed symptoms suggestive of post traumatic stress disorder and we are working on these. However, I have started to wonder about his grief and loss issues also, and whether I have paid enough attention to these during our counselling time...

The death of a significant attachment figure due to a violent act can raise a number of complex issues for young survivors. The grief process is often very different from that of an expected or anticipated death. In your work with your client, keep in mind is that his post-traumatic stress reactions will likely be compounding the grief response for him. So while you should address the PTSD symptoms, don’t forget to incorporate into your treatment strategies to help him with his grief. We have found that, for young survivors in situations similar to your client’s , grief is often intensified because there is little or no opportunity to prepare for the loss, say goodbye, finish unfinished business or prepare for bereavement. This type of loss can generate intense grief responses including shock, anger, guilt, sudden depression, despair and hopelessness.

Consider also that what may at first appear to be symptoms of PTSD are in fact traumatic grief responses. Check your client’s intrusive and hypervigilance symptoms for clues. If his intrusions are about distressing preoccupation with his father, rather than with the terror or horror inducing elements of his death, addressing the traumatic grief should be your goal (rather than straight PTSD work). Likewise with hypervigilance: find out if he is scanning the environment for potential threat/danger or for cues of his dad. The latter, again, would point you to focus on his loss and grief difficulties.

Hints for Healing welcomes readers’ questions on issues related to supporting refugee young people. Email Max Schneider with the header ‘Hints for Healing Question’. Include your name and contact details - these will not be published.


Max Schneider
> Max is a Child & Adolescent Counsellor at STARTTS and the service's School Liaison Officer.

Interview with
Dr William Steele

Case Study - Ali

Regular Features

Reader's Question

From the Editor's Desk

Deb's Digest

Sticky Notes

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Reader's Question

Childhood traumatic grief may occur following a death of someone important to the child when the child perceives the experience as traumatic. The death may have been sudden and unexpected (e.g., through violence or an accident), or anticipated (e.g., resulting from illness or other natural causes).

The distinguishing feature of childhood traumatic grief is that the trauma symptoms interfere with the child's ability to go through the typical process of bereavement. The child experiences a combination of trauma and grief symptoms so severe that any thoughts or reminders―even happy ones―about the person who died can lead to frightening thoughts, images, and/or memories of how the person died. Source: The National Child Traumatic Stress Network. Materials and information available online at www.ncts.org


Disclaimer The information contained in Hints for Healing is provided as an information source only. The views expressed by contributors do not necessarily reflect the position or views of STARTTS.  The material is provided on the basis that readers are responsible for making their own assessments of the issues discussed, and always work under clinical supervision.

© 2011 STARTTS  Contact: hintsforhealing@startts.org.au
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