What is the standard procedure for dealing with a young (junior in
high school) person who has abruptly lost a best friend?  How do
schools deal with the individual and how do psychologists try to help
the person?

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Request for Question Clarification by politicalguru-ga on 01 Nov 2002 08:04 PST

Are you a psychologist or is this a hypothetical question?

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Clarification of Question by monsterhero-ga on 01 Nov 2002 08:20 PST

This is hypothetical… for a narrative. To be more specific: the
patient here, the bereaved, is very much depressed.  He has other
issues (abusive alcoholic father, mother who left at a very early age)
and his now his only friend has died. I’d like any information that
would help me write dialogue and etc. for the psychologist.  I want to
know what he would say and do more than why.

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Request for Question Clarification by fsw-ga on 01 Nov 2002 10:27 PST

Hi,

I can provide you with sample assessment questions the psychologist
might ask the bereaved adolescent. But I'm not sure what you are
looking for when you asked "How do the schools deal with the
individual ..."  Can you clarify that for me?

Thanks,
fsw

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Clarification of Question by monsterhero-ga on 01 Nov 2002 11:39 PST

By "How do schools deal with the individual..." I mean do they accept
long absences? Do they recommend therapy? How do they involve parents
if at all? Things like that... What is normal school procedure in
dealing with the death of one of its students?

Hi monsterhero-ga

Here's a good site detailing how a caregiver should deal with a child
in mourning:

http://www.childtrauma.org/ctamaterials/Loss2.asp

The following site, taken from a course educating pre-service
teachers, looks useful to your needs. Included are sections on how
children express grief, questions they ask, helpful things teachers
can say and things not to say:

http://www.sidhe66.atfreeweb.com/childgrief1.htm

The following site, 'Childhood Grief And The School Teacher', offers
some good points, and provides a host of other, relevant links also:

http://www.motheroaks.com/resources/manual/teacher.htm

Remember, each case of bereavement has many subjective qualities, and
the above sites are intended to provide you with guidelines for how
the psychologist/teacher should act.

Regarding time off school, please see the 'Going Back To School'
section:

http://www.uuhsc.utah.edu/pated/handouts/pdfs/handout1812.pdf

Note that the other sections of the above page are useful to your
needs too.

I searched extensively for situations regarding suicidal tendencies in
children, but found nothing of great relevance.

I hope this helps. If you need clarification, don't hesitate.

Best Wishes

sim-ga


Search Engine: Google

Search Terms:

"child psychiatry" mourning

://www.google.com/search?q=%22child+psychiatry%22+mourning+&hl=en&lr=&ie=UTF-8&oe=UTF-8&start=30&sa=N

"dealing with grief in children"

://www.google.com/search?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=+%22dealing+with+grief+in+children%22

child "absent from school" grieving

://www.google.com/search?q=child+%22absent+from+school%22+grieving&hl=en&lr=&ie=UTF-8&oe=UTF-8&start=10&sa=N

Very useful links that I completely missed in my own searches.

Regarding Schools;
Depends on the school, of course.  General procedure in my experience
has been 1) Absolutely no response by the officials.  or 2) Statement
that the 'Counselors' are available to help.  It is unlikely that the
counselors at a school have received any training which would make
them 'qualified' to help the student through the problem.  On the
other hand, a caring adult with good people skills is going to be
quite helpful, in itself.

  The school might also have a school psychologist, who probably
(well, hopefully) has some training in therapy.  To be true, I think
this is probably in the best interest of all for the school to make a
statement, and then retreat on such issues.  Students generally don't
have great feelings about their schools and are unlikely to be
welcoming towards an 'offering' of help.  Resentment is likely,
especially during a difficult time.

Regarding Psychologists;
Depends on the psychologist, and on the subject's individual needs. 
Did I say subject?  I meant patient.  My research orientation is
shining through.

Generally, just talking to the client, about whatever the client wants
to talk about, would be the therapy in this case.  There would be an
assesment, probably informal, by the therapist.  If the patient was
exhibiting normal reactions then no diagnosis would be made, and
typical psychological discussion patterns would ensue.  At the door
the therapist would ask, 'How was your day?' and from there, the
subject would guide the encounter, talking about whatever they wanted
to talk about.  The therapist would feign empathy and understanding,
and ask open ended questions to keep the dialogue going.  If the
subject wanted, the situation would be 'talked through'.  The
therapist would mirror, simply meaning that he summarizes the
paragraphs the patient says into single sentences, 'So it sounds like
you've had a hard day?' or 'I guess you feel lonely now that...'

It is presumable that there would only be ~5 sessions during which the
therapist and patient would just talk, with no 'medicine' or
'therapy'.  Extended therapy for more than a month or so in such a
case would neither be recommended nor useful.  People tend to move
past traumatic incidents in their lives without coaxing, and the role
of the therapist in such a situation is to make sure that the subject
is not deteriorating, be a friend to the patient (most important!),
and guide discussions about topics the subject would like to explore.

Assuming the initial (probably informal) assessment causes the
psychologist to be concerned, some time would still be allowed to pass
to allow for normal grieving.  If the subject were not to improve
after a month, or if the situation were particularly dreary at two
weeks (with suicide ideation, etc.) there might be a more formal
assessment.  The more formal assessment would involve templates that
the therapist would go down, asking a list of questions and rating
responses.  There are countless templates for various suspected
disorders.  I don't know of any psychologists who actually use them
unless being forced to in order to defend a diagnosis to an insurance
company.  Other psychologists might administer a survey/questionairre
to the subject.  In the case of a minor, assuming the situation were
particularly dreary, the subject's parents might be asked to fill out
a survey on the subject.  This would almost certainly be at the
subjects discretion.

Now, assume a problem was singled out.  The psychologist would wait a
while to see if the situation improved on its own.  If it didn't after
a couple months, or if persisted in being particularly dreary at three
weeks, the therapist might begin a particular therapy depending on the
diagnosis, the individual, and personal preference on the part of the
therapist.  If the situation were EXTREMELY dreary (and this would be
REALLY unusual for someone who has recently suffered a loss to be
medicated), a referral to a psychiatrist might occur where the subject
would be written a prescription.  If the situation were UNBELIEVABLY
dreary, the subject might actually be sent for in-patient treatment.

The film, Ordinary People, 1980, Robert Redford, actually portrays the
therapy situation very realistically.

Ah, yes, I forgot, disclaimer-  I'm not a licensed psychologist.

Thanks codydane.  The unresponsive response given by schools does seem
correct.  In local news, whenever a young person has died, newscasters
state that 'counselors will be at the school ready to answer any of
the student's questions', and usually nothing more.  As far as
therapy, the subject here would deteriorate to extremely dreary and
eventually suicidal.  How psychologists pick up on these feelings, I
don't know.  What psychiatrists do to help prevent the suicide, I also
don't know.

Monsterhero,

I hope you will disregard much of the misinformation you were given in
the comment above. I take special exception to the notion that “The
therapist would feign empathy and understanding.” Most therapists I
know are geniunely empathic and caring people. They wouldn't have to
fake concern for a young man who has lost a good friend.

And there is more to meeting with the young man than asking, “'How was
your day?' and from there, the subject would guide the encounter,
talking about whatever they wanted to talk about.” Psychologists would
pick up on the suicidal thoughts by asking pertinent assessment
questions. And whenever an adolescent loses a close friend, suicide is
something most therapists will try to screen for.

I also object to this statement by the commenter: “Now, assume a
problem was singled out. The psychologist would wait a while to see if
the situation improved on its own.” If an adolescent is grieving, I
don't know any therapist of any discipline who would be so heartless
as to sit back and “wait” to see if things improved. And if the
therapist even remotely suspects that suicide is a possibility, he
wouldn't wait it out if he has any integrity or ethics. If an
adolescent is determined to be at risk of suicide, the school would
(or should!) get him as soon as possible to the closest ER or other
psych evaluation center to further assess for emergency
hospitalization. They can usually at least do the transport to the
facility based on parental consent for emergency medical care that
nearly all schools require parents to sign.

If an adolescent has grief issues, an abusive father, alcoholic
dynamics in the home, and probable abandonment issues, I'm not sure
how the commenter can say, “Extended therapy for more than a month or
so in such a case would neither be recommended nor useful.”

Please understand that I usually don't respond when I disagree with
commenters. But I felt there was so much mis-information given to you
above, I wanted to respond.

Best wishes,
fsw

monsterhero,

I would have to agree totally with fsw's comments. Please remember
that any member of the public may post in the "Comments" area, and
that any information posted there may or may not be accurate.
Hopefully, your answer will catch the eye of one of our crack
Researchers, who have been known to come up with amazingly accurate
and helpful Answers.

As with anything else, you should always exercise some of your own
judgment when it comes to accepting the opinions of others. Blind
acceptance of anything is never a good thing.

Regards,

aceresearcher

fsw: I appreciate your clearing up what was a fairly negative
portrayal of therapists by codydane.  I can imagine that some
therapists are this inept and uncaring, perhaps even many, but
certainly not the majority.

aceresearcher: I don’t appreciate being accused of  blind acceptance
simply because I thanked the poster for his comments. They may be
inaccurate, possibly even flat wrong, but codydane didn’t get paid a
damn cent for his thoughts.  I welcome any information and opinions
anyone has to offer, I will only expect accurate and detailed
information from an official answerer.

codydane: Thanks again for your post.

Monsterhero,

Hi again. Let's see how I or another researcher can help you. You are
looking to write a dialogue. Here's what you've told us so far about
this hypothetical bereaved adolescent:

--Very depressed, becomes suicidal eventually
--Father is alcoholic
--Mother abandoned him
--Socially isolated (only friend died abruptly)
--Father is abusive (unclear whether verbal, physical, or both)

My experience in trying to answer questions based on hypothetical
scenarios is that often the questioner leaves out important details
which negatively impact a researcher's ability to give a good answer.
So here's my advice to you  ...  Please give us as much information as
possible.

If there are portions of your dialogue that have you perplexed, try
giving us a few more details. If, for example, you have written that
the student tells the psychologist that he doesn't want to live
anymore, tell us that you don't know what a psychologist might say or
do at that point. Or maybe the student discloses to the psychologist
that his father beats him when he's drunk. What does the psychologist
do or say then? More specificity would take much of the guess-work out
of a researcher's answer.

When I considered answering your question, here were some of the
issues that came to my mind: Was the friend's death a suicide,
illness, an accident? That information could make a big difference in
the psychologist's discussion with the student. Does your dialogue
need to cover one session or several sessions? Does your narrative or
psychologist's dialogue have to end in a certain way? How long is your
dialogue with the psychologist supposed to be?

Those are examples of additional information you could provide which
may make a researcher feel more comfortable giving you an answer. In
closing, I'd like to mention two links I found. If you go through the
information on these sites, you should be able to write something
solid about the way a school does (or should) handle the death of a
student, etc.

School Psychologists Home Page
http://www.bartow.k12.ga.us/psych/psych.html

The site above has information about grief, crisis intervention
(specifically deals with suicidal students), and duties of a school
psychologist.

National Association of School Psychologists
http://www.nasponline.org/index2.html

The crisis resources and helpful information links at the above site
may be especially helpful.

Best wishes,
fsw

PS-- I don't think Aceresearcher was trying to accuse you of anything.
I think she was only encouraging you to exercise good judgment in
weighting the merit of comments. And you seem to have done just that
:-)

To specify: The father, when drunk, is both verbally and physically
abusive, though rarely resorting to the latter.  The kid's friend died
in a car accident with two cars involved; the passenger of the car
causing the accident died as well.

The dialogue would cover several sessions, the bereaved teen going
from bad to worse.  He hides his pain from the therapist and resents
seeing him, resents being asked questions and is very closed.  He
refuses to reveal things about his troubled life.  He becomes suicidal
in a matter of days if not weeks.

What I need to know is fairly general, how would the school and the
psychologist deal with this situation? What would he say to open up
the patient?  Since I haven't written this yet... what likely
directions would this go in?  Do schools force treatment? What would
the psychologist say and do if the patient revealed suicidal thoughts,
if he didn't?  What if he notices a scar on the patient?  What if he
revealed his troubling family situation, if he didn't?  What if the
patient refuses to say a word?  What if the student yelled at or hit
the psychologist? Etc… these are only examples of what I’m interested
in.  It’s a pain because it’s a hypothetical situation, and I don’t
expect you to show every possible situation, I just need to know
psychiatric guidelines for dealing with different outcomes.

I don't want to be too specific because I am not looking for you to
write the dialogue for me.  I just need information that will allow me
to write dialogue realistically, regardless of the psychologist's
character.

Monsterhero,

Hello again. A search using the terms “school + psychologist +
adolescent + suicidal + student” reveals the following sites which may
be helpful in writing your dialogue.

Suicide: Identifying High Risk Children & Adolescents
http://www.save.org/Identify.shtml
If you scroll down to “Asking the Suicide Question,” you will find
specific questions which the school psychologist might ask the student
in your dialogue.

How to Talk with Students in Crisis Situations
http://www.vcsnet.org/crisis/pages/appendix/how%20to%20talk%20with%20students%20in%20crisis.htm
This link may give you more ideas to adapt into specific questions
which the school psychologist in your dialogue can ask. You can adapt
the questions to refer to specifics, such as the recent death of the
friend.

National Association of School Psychologists
Preventing Suicide in Troubled Children and Youth
http://www.nasponline.org/NEAT/suicidept1_general.html
This site discusses warning signs and tips for staff to handle the
student at risk. You can include teen suicide warning signs from this
site, or any of these links, in your dialogue. You might find them
especially helpful in portions of the dialogue where the student will
not open up to the psychologist.

For example, let's say that the student has always excelled at math,
but the math teacher reported that the student failed a quiz this
morning. Often, when I have a client who will not open up and discuss
his/her situation, I will supportively confront him/her with facts or
observations from others. And then I will probe further. Here's an
example of incorporating the risk factor of an inability to
concentrate (expressed by a sudden drop in academic performance) in
the dialogue:

Psychologist: “Mr Jones tells me that you flunked your math quiz this
morning. That doesn't sound like you. You usually ace his class. What
happened?”

Student: “No time to study, no big deal.”

Psychologist: “No time because of the funeral?”

Student: “Yeah.”

Psychologist: “I can understand that. Is <friend's name> death
affecting your school work in other ways?”

The psychologist's goal would be to get the student to talk about the
ways in which the friend's death is affecting him. Since he's starting
to talk about school work, stay with that topic and ease into others.


Suicide and the School
http://www.ncpamd.com/Suicide.htm
This article discusses a number of topics relevant to your dialogue,
including warning signs and dealing with a suicidal student. It also
touches on the issue of impulsive vs. planned suicide, which would be
of interest to any real-life school psychologist who is assessing a
potentially suicidal student.

The Verbally Agressive and Potentially Violent Student
http://www.sa.ucsb.edu/distressedstudentsguide/emotionallydistressed/verballyaggressive.asp
This link is in reference to the question you posed in a comment,
“What if the student yelled at or hit the psychologist?” Although this
page discusses work with college students, there is much here that
applies to intervention with a high school student. Everything in the
“Don't” section could apply to your dialogue. In the “Do” section,
numbers 2-5 could apply to the psychologist's encounter with the
student.

If you will be using the Internet to search for additional material
for your dialogue, I recommend that you include “teen” or “adolescent”
in your search terms.

Good luck writing your dialogue!
fsw