122 Grief and Loss Across the Lifespan
Again, adolescents need support to mourn not only the relationship but the
hopes and dreams they had built while thinking about futures with the part-
ner. These secondary losses must be identified and acknowledged as valid
sources of grief.Loss of Health
Typically, teens who are ill struggle with the demands of differentiation
and developmental maturation at a time when their health requires them to
depend more on adults. Farrell and Hutter (1980) found several themes in their
research with dying teens: changed perceptions of self-attributable to altered
appearance, lack of control over life, frustration about dependence on adults,
isolation from peers, being a source of worry for parents, physical pain and
limitations, and uncertainty about the future. Notably, they did not find teens
to be preoccupied with death. They recommend helping ill teens continue to
focus on the day to day. They encourage self-care and engagement with peers
(to the extent possible) since this allows teens to continue to feel “normal” and
to continue developmental tasks to the extent they can. At least one scholar
suggests that adolescents should not make independent decisions about life
and death, recommending a shared model of decision making with parents
and medical providers because adolescents’ decision-making capacity has not
fully matured (Markowitz, 2007).
Sometimes ill health reflects chronic conditions that adolescents must
learn to manage as they move from pediatric to adult care providers, a transi-
tion that involves taking on more responsibility for their own health (Reed-
Knight, Blount, & Gilleland, 2014). For social workers who are helping with
this transition, assessing the teen’s executive function, self-efficacy, and dis-
ease knowledge and how these interact with social factors such as family con-
flict and degree of parental monitoring will help identify areas for intervention
(Reed-Knight et al., 2014). Also, losing care providers who have cared for one
through childhood, in many cases truly keeping the teen alive, can be painful.
This loss may be unrecognized and disenfranchised, yet operates to sensitize
(or “depress”) teens in ways they may not recognize.Interventions With Tweens and Teens
When it comes to exploring adolescents’ experience of loss, research and
practice wisdom encourage gentle, specific questions asked by trusted
adults. To a vague question about “how things are going,” a teen likely will
reply that things are “fine.” Rowling (2002) suggests the following questions:
“How did you react? (Not, What did you feel?); How do you experience your
grief?; What did the loss mean to you?; What strategies do you use to cope
that are helpful?; What kind of advice is helpful?; With whom do you share
your loss?” (p. 289). These provide a gentle, implicit demand for an answer
while also providing specific guidance about what to talk about, something
most teens appreciate.
That said, peer interaction is the most valued activity during adoles-
cence, so interventions aimed at groups of teens seem to meet their devel-
opmental needs most fully, even if it is often hard to get them to try a group