scrapbooking as an intervention for grief recovery with children

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Scrapbooking as anIntervention for Grief RecoveryWith ChildrenKristie Williams a & Jonathan Lent aa Department of Counseling , University of Akron ,Akron, OHPublished online: 12 Dec 2008.

To cite this article: Kristie Williams & Jonathan Lent (2008) Scrapbooking as anIntervention for Grief Recovery With Children, Journal of Creativity in Mental Health,3:4, 455-467, DOI: 10.1080/15401380802547553

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Journal of Creativity in Mental Health, Vol. 3(4) 2008© 2008 by The Haworth Press. All rights reserved.

doi:10.1080/15401380802547553 455

WCMH1540-13831540-1391Journal of Creativity in Mental Health, Vol. 3, No. 4, Oct 2008: pp. 0–0Journal of Creativity in Mental Health

Scrapbooking as an Intervention for Grief Recovery With Children

Kristie Williams and Jonathan LentJournal of Creativity in Mental Health Kristie WilliamsJonathan Lent

ABSTRACT. This article describes scrapbooking in the context ofbereavement counseling. For the purposes of this article, scrapbookingcombines many different types of art-related therapy interventions into oneconcrete format to utilize in counseling with children who are working toovercome grief or trauma related to the loss of a parent. A case illustrationis provided, along with a sample scrapbook page, timeline, and the materialsneeded.

KEYWORDS. Creativity, counseling, children, grief, loss, trauma, deathof a parent, photos, scrapbooking

OVERVIEW

Childhood trauma is a serious social problem that more than 25% ofAmerican children experience by the age of 16 years (Pynoos & Fairbank,2003). Trauma is defined as a sudden and extraordinary event that over-powers a child’s ability to cope and to manage the reactions that arearoused by the event (Dripchak, 2007). Examples of childhood trauma

Kristie Williams and Jonathan Lent are doctoral students, Department of Coun-seling, 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, Departmentof Counseling, 622 Portage Trail #2, Cuyahoga Falls, OH 44221 (E-mail: [email protected]).

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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. Thefocus of this article will be on loss of a loved one.

Children’s Responses to Trauma and Loss

Children’s responses to trauma are subjective and multidimensional. It iscommon for children who have experienced a traumatic loss to suffer low-ered self-esteem, narcissistic injury, and a sense of degradation (Mishne,1979). For this reason, it is necessary after such a trauma for family membersand practitioners to assist children in understanding this experience.

Various factors influence how differently children and adults respondto trauma. These factors contribute to the way children grieve. Theseinclude, but are not limited to, the nature of the relationship, the mannerin which the death or grief occurred, and whether the death or situationwas expected or the result of sudden traumatic loss. Additionally, the ageand developmental level of the child as well as their attitudes towardsdeath contribute to the way the child grieves.

There are four components to children’s understanding of death. Theseare the factors of irreversibility, finality, inevitability, and causality. Childrenhave a difficult time conceptualizing that death cannot be reversed. Fur-thermore, they cannot understand the concept that death is permanent(Willis, 2002).

Some children are “reluctant grievers” (Crenshaw, 2005), particularlythose who suffer multiple or traumatic loss. Preteens and adolescents havemore tools at their disposal than preschool and school-age children: moreadvanced language ability, cognitive development, emotional maturation, andsocial maturation; they, too, may find it hard to directly approach their grief orto find words to express their losses. This is particularly true of those adoles-cents who have suffered profound losses, often unrecognized by others andperhaps not even acknowledged to themselves (Crenshaw).

The death of a parent is considered one of the most significant andstressful for both children and their families. This loss affects thoseinvolved as individuals and as a whole unit. To date, the loss of a parentor significant other occurs at such an increasingly high rate that it isbecoming statistically normal (Zall, 1994). The loss of a parent representsa profound psychological insult that threatens the child’s social andemotional 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).

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Kristie Williams and Jonathan Lent 457

Due to the nature of the loss, and in the event that the death or situationis unexpected or perhaps goes unrecognized, children may be hesitant orambivalent 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’slosses may be devalued, trivialized, or not accepted. For example, childrenwho lose a parent by suicide may have a challenging time expressing theirfeelings towards the death. Additionally, it may be hard for children to telltheir friends, teachers, and family about what happened.

Developmental Stages and the Grieving Process

Children require different methods of treatment contingent upon age andstage of development. Young children (age 0 to 12 years) may not havereached the developmental level in which they can express their innerresponses regarding the loss that occurred. According to Crenshaw (2005),children, specifically “age 7 and under, frequently rely on symbolic playand 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 lifeevents, and they may use magical thinking or believe that they are the causeof the event (Dripchak, 2007; Timberlake & Cutler, 2001). Children inthe older age range will be drawn to symbolic play possibly due to arresteddevelopment (Crenshaw). As children reach adolescence, they may be ableto better verbalize their reactions to the loss (Dripchak). Depending on theirlevel of maturity, some adolescents may be reluctant to address painful feel-ings related to grief. According to Crenshaw, most adolescents are capableof addressing these feelings when they can utilize creative expression alongwith direct verbalization.

Swanson and Schaefer (1993) propose four stages adolescents gothrough corresponding to the loss of a loved one. The first stage is calledpre-protest. In this stage the adolescent will display a lack of emotionregarding the loss. The second stage is labeled protest. This is a stage inwhich the adolescent rejects whatever new environment and individuals aresubstituting the for the loved one who has been lost. In the third stage theadolescent begins to exhibit despair, characterized by withdrawal and sad-ness. Finally, the adolescent experiences the fourth stage, detachment, inwhich the adolescent emancipates him or herself from the prior attachmentand begins to adapt to the new environment and accept the substitutes.

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Children grieve differently than adults and often manifest their griefat home, at school, and with their peers. A bereaved child may lash outat well-intended peers who inadvertently upset him or her (e.g., bybenign banter about a topic other than death) because the child is notcapable of isolating intense hurt and feelings of anger. Grief is not anisolated event; rather, it affects transactions and circumstances inevery environment (Eppler, 2008). Grief experienced by a child is usu-ally cyclical with the child revisiting feelings and behaviors associatedwith the death or loss. Because children are often confused by theprocess of grief, they do not understand their feelings. As a result, thechild may exhibit unacceptable behaviors that are expressions of theirconfusion about what has happened. In addition, children often experi-ence difficulty understanding that things become easier with the passageof time.

SCRAPBOOKING AS AN INTERVENTION FOR GRIEVING CHILDREN

A review of the literature shows that most interventions for grievingchildren consist of support groups (McClatchey & Vonk, 2005). Othertypes of interventions include the use of art through drawing, creatingcollages, and painting. Another method that can be beneficial when workingwith grieving children is scrapbooking. This intervention may be usedalong with individual and/or family therapy. Scrapbooking is not a newphenomenon. Throughout the world, the craft has achieved increasedpopularity amongst adults and children and has developed into a nearly3-billion-dollar industry (White, 2005).

The collection of photos within albums has served various populationsas a medium for preserving family history. Scrapbooking adds the use ofstory to the traditional photo album while also serving as a creative artform. The incorporation of photographs, creative writings, journal entries,news clippings, poems, song lyrics, and other mementoes gives voice andstory to the authors, allowing the expression of feelings associated withlost loved ones. In addition, by providing narration to photographedmemories, the scrapbook becomes a way of making meaning of the expe-rience of grief and its impact on the client. The scrapbook also provides away to honor and memorialize the loved one or provides a space toexpress words that were left unspoken. The use of grieving and memorialactivities helps children to relocate the individual within the child’s life

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by acknowledging the death, honoring the deceased, and obtaining comfortand support (Howard, Matinhure, McCurdy, & Johnson, 2006).

Lowenstein (1995) utilized scrapbooking with children in the forms ofa life book and a resolution scrapbook. The life book is often used forchildren in out-of-home placements, such as foster care, to assist the childin having tangible memorabilia to carry with them. In contrast, the resolutionscrapbook serves as a compilation of the therapeutic activities completed bythe child throughout the treatment and serves to provide an illustration ofthe child’s progress (Lowenstein).

Benefits of Scrapbooking with Grieving Children

Before using scrapbooking as an intervention to honor children’s lovedones, it is necessary to assess their level of trauma, level of development,and understanding of the death and grief process. The developmental levelcan be determined during the intake. Determining the child’s knowledge ofthe grief process can be accomplished by asking open-ended questions intherapy and also by incorporating bibliotherapy, using age-appropriatestories to assist in the client’s awareness of the topic (Lowenstein, 1995).According to Briggs and Pehrsson (2008), manifestations of grief mayinclude 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 responsesmay 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 throughscrapbooking. The first is that the process allows for additional insight intothe feelings about the death of the loved one. Second, as children intention-ally engage in the creative process by selecting photos and expressing theirthoughts, conversation is stimulated to assist them in understanding thegrief process. Another benefit gained through this interactive process is thecreation of a bridge of conversation with family members who were alsoaffected by the trauma. This assists in creating a stronger, more cohesivesystem of support. If the child chooses to share his or her scrapbook withother members of the family, this allows for open lines of communicationto assist the family in understanding how the death has impacted them indi-vidually and collectively. Finally, the utilization of art assists in providing amode of tactile and visual expression for children in areas where they maybe limited in verbal and cognitive functioning (Grebin & Vogel, 2007).

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This allows a method of expression that children may be otherwise unableto access due to their developmental level. Because it is important to assessthe developmental level of the child when determining appropriate inter-ventions, scrapbooking should only be used when it meets the direct needsof the child. Scrapbooking may be used in any stage of the grieving processas an intervention to help the child explore his or her feelings.

Suggested Process for Using Scrapbooking with Grieving Children

There are a variety of activities that may be chosen to aid the child inovercoming the grief and loss that is being felt. The first step requires thecounselor to select scrapbook activities that are tailored to the child’s needs(Lowenstein, 1995). After it has been determined that scrapbooking is aviable treatment option, the next step would be to introduce the process tothe client. To engage the child in the process, it would be important toexplain the purpose of the intervention. This assists children in understandingthat scrapbooking is an effort for them to express feelings in a safe way.

Next, a description of what is necessary to complete the scrapbook maybe important. In order to do this, the counselor must be aware of whom theprimary figure of loss is and explain to the child that he or she should bringin artifacts that serve as reminders. In addition, the counselor shouldexplain to the caretaker to be cautious about the items the child is allowedto bring in. This is so that the child is aware that expensive or rare itemsmay need to be substituted. A picture or drawing of the item may sufficein this situation. Scrapbooking can be used as a therapeutic interventionwith individual children or with groups, as well as in family formats.

Some of the items the child may choose to bring include photographsor other important mementoes of the individual. This places the focus on thedeceased individual and also allows an opportunity to work with survivingfamily members. In preparation for the next session, the counselor shouldhave the materials needed for the scrapbooking process. (See Appendixfor a list of materials and an outline of suggested procedures.)

In the next phase of the scrapbooking intervention, the counselor talkswith the child about the items for the scrapbook. The child may showobjects one by one to the counselor and describe them. The counselor canprompt by asking the child, Why is this item important to you? Who isthis 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. Itis important here to be aware of the child’s reaction to telling about each

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item or photograph. It is important for the counselor to consider the skillsof empathy and understanding when discussing these sensitive subjects.Journals, diaries, or corresponding items may be incorporated. These mayinclude photos, poetry, song lyrics, or letters. They also may participate inenactments of “last conversations” with their deceased loved one, or do awriting assignment such as an essay on their father’s best qualities or theirfavorite stories of their mother (Crenshaw, 2005). This will also allowfurther exploration of the scrapbooking item and the importance that itrepresents.

Once the child has shared each item, the next phase consists of con-structing a timeline. The timeline provides a structure for the items andsets a parameter. With this in mind, based on the timeline, the childselects the event that he or she would like to memorialize within thescrapbook. To fully engage the child at his or her physical level, utilize asmall table or work on the floor to spread out all the items for the stagingphase.

The staging component provides an opening for the child to create andshare the story about the loved one who has died. This process provideslimitless opportunities for imagination or creativity as the child mayselect themes, items, or materials that help in the recollection of the lovedone. An example may be a preprinted themed page with toy boats, whichmay 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, orplay. Additional accessories, mementoes, use of color, or decorativebackgrounds may be used to further expand on the theme.

This is the most significant part of the process: when children are giventhe opportunity to share their stories. The counselor prompts the child byasking questions such as, What story does this page tell? or What do youremember about that day? Children may not instantly respond, and timemay be required for them to disclose feelings in any manner. Providingoptions for children’s communication in this phase is very important. Asa mode of intervention, this process can be very rewarding for childrenand their surviving loved ones.

The scrapbook may be continuously utilized throughout the duration oftherapy with the child. It provides an outlet for expression that can beexpanded as the child wishes, and it may expand to other topics of con-cern for the child. This intervention may be particularly helpful duringthe termination phase of counseling, because the child is able to retain thescrapbook for future use. An option at this stage of the process may be touse the scrapbook as part of the review process during termination. The

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scrapbook is also a tangible reminder of the therapy process and what hasbeen learned throughout the experience.

CASE EXAMPLE

Matthew is an 8-year-old child who came to counseling following therecent death of his father. Prior to counseling, Matthew’s mother notedhe was not doing well in school, was having stomach aches and night-mares, and was withdrawn both at home and in school. Prior to this event,Matthew had never received counseling services. It was determined thatMatthew may benefit from a more creative intervention than traditionalbereavement counseling. Following a discussion with Matthew regardingthe scrapbook process and obtaining his agreement, the process began.First, the counselor asked Matthew his age to establish the beginning forthe timeline. The counselor then asked about Matthew’s earliest memory,which Matthew recounted as the birth of his brother Austin. The counse-lor then asked Matthew to discuss events that followed his brother’s birth.This provided a timeline that was used to identify key events during Mat-thew’s life up until the present (see Figure 1).

FIGURE 1. Sample Organizational Timeline.

2000 2002 2004 2005 2006 2007 2008 Future

Dad drove us to Disney.

Daddy bought me Coda.

I was born.

Timeline

Name: Matthew Today’s Date: 7/07/08

Moved to Maine with Grandma & Papa.

Went to visitwith Grandma & Papa.

Started a new school.

Daddy’s plane crashed.

Baby brother Austin born.

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Following the identification of important events and obtainingapproval from his mother, Matthew brought in memorabilia, whichincluded several photographs, drawings, and stickers. After beingasked by the counselor to separate the items by theme or specificevent, Matthew identified several items that reminded him of the dayhe received his puppy Coda and went to the park with his parents.Matthew and the counselor used these items and his recollections ofthis special day to create a scrapbook page (see Figure 2). Throughthe power of creativity and using art in the sessions, Matthew wasable to recount and memorialize various events (e.g., family vaca-tions, sports events, activities with his brother). Matthew’s symptomsbegan to subside over the course of the year he was seen in individualcounseling that incorporated the use of scrapbooking. During thistime, 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 hisstory with his family as well as connect with new peers in school. Heoften brought in school assignments and mementoes from field tripsto share with his counselor. In having the opportunity to share hisexperiences of adjustment, Matthew was provided a space and givena creative opportunity to grieve his loss as well as share his experi-ences in new events and relationships of importance.

CONCLUSION

Scrapbooking is an intervention that does not have to be limited to thetime the child is seeing a counselor. The scrapbook may continue to beutilized beyond this point because of the ability to incorporate a widearray of different outlets through which the child can express emotionsand thoughts. This can also be helpful for the child due to the cyclicalnature of grief. Scrapbooking provides the child with something concretethat can be taken away from therapy sessions and kept with the child torevisit when going through a difficult time.

It is important that we, as mental health professionals, consider differ-ent methods of working with child clients because of the differencesbetween child and adult clients regarding the grieving process. This inter-vention provides an outlet for children that uses alternative methodsinstead of traditional talk therapy to work through the grief they are expe-riencing related to their loss.

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FIGURE 2. Scrapbook Page Example.

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REFERENCES

Briggs, C. A., & Pehrsson, D. E. (2008). Use of bibliotherapy in the treatment of grief andloss: 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. Journalof Clinical Social Work, 35, 125–134.

Duffey, T. (2005a). Grief, loss, and death. In D. Comstock (Ed.), Critical contexts in humandevelopment (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: Enhancingconnection through creativity. Journal of Creativity in Mental Health, 2, 61–73.

Howard, B., Matinhure, N., McCurdy, S. A., & Johnson, A. (2007). Psychosocial disad-vantage: Preparation, grieving, remembrance and recovery for orphans in easternZimbabwe. African Journal of AIDS Research, 5, 71–83.

Kirwin, K. M., & Hamrin, V. (2005). Decreasing the risk of complicated bereavement andfuture psychiatric disorders in children. Journal of Child and Adolescent PsychiaticNursing, 18, 62–78.

Lowenstein, L. B. (1995). The resolution scrapbook as an aid in the treatment of traumatizedchildren. Child Welfare, 4, 889–904.

McClatchey, R. S., & Vonk, E. M. (2005). An exploratory study of post-traumatic stressdisorder 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 socialwork. 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 dreamdies (pp.135–154). New York: Haworth Press, Inc.

White, T. (2005). Creating keepsakes encyclopedia of scrapbooking. Little Rock, AR:Leisure Arts, Inc.

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Willis, C. A. (2002). The grieving process in children: Strategies for understanding,educating, and reconciling children’s perceptions of death. Early Childhood EducationJournal, 29, 221–226.

Zall, D. S. (1994). The long term effects of childhood bereavement: Impact on roles asmothers. Omega: Journal of Death & Dying, 29, 219–230.

APPENDIX

MATERIALS NEEDED AND SUGGESTED PROCEDURE FOR GRIEF/TRAUMA SCRAPBOOKING

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. Glue or adhesives3. Scissors (available with customized edges)4. Colored pens and/or markers (acid-free, non-bleeding)5. 12″ × 12″ paper trimmer6. Hole puncher7. Page protectors8. 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 bringshealing in that its author is able to revisit the experiences and thefeelings 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.

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• This would provide foundational information regarding therelationship between the child and the lost loved one.

• This would also highlight important dates or things they enjoy thatthey may currently be avoiding as a result of traumatic memories(conflict).

• As emotions and feelings emerge, ideas may be generated for othercreative techniques that could be used (poems, songs, drawings).

4. Allow the child to choose paper colors for background layouts andframing.• This may include paper and artifacts with specific themes (sports,

military, food).• Additional embellishments or mementoes may be added to high-

light 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 toprovide a story of the events captured on paper. Assemble photoswith glue or adhesive.

6. Include journal titles, captions, thoughts, and feelings about experiences.

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scrapbooking as an intervention for grief recovery with children

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