Rehab Kids

Anticipatory Grief:
Help Clients Face Impending Loss
and Uncertain Futures
Erica H. Sirrine, Ph.D., LCSW, FT

WELCOME!
Connecting Knowledge With Need is our mission. Thank you for joining us today!
We’d love to hear where you are and what you’re learning. Share your photos by tagging us
and using #PESISeminar and/or #LearningWithPESI. You’ll receive a special offer each time!
And be sure to follow us for FREE tips, tools, and techniques.

@PESIinc
linkedin.com/company/pesi www.youtube.com/c/PESIInc
@PESIRehabEdu

@PESIinc
www.pinterest.com/pesiinc
@PESIRehab

www.pesi.com/blog | www.pesirehab.com/blog | www.pesihealthcare.com/blog | https://kids.pesi.com/blog

 Anticipatory Grief:
Help Clients Face Impending Loss
and Uncertain Futures
Erica H. Sirrine, Ph.D., LCSW, FT

Rehab Kids

ZNM057990
4/21
Copyright © 2021

PESI, Inc.
PO Box 1000
3839 White Ave.
Eau Claire, Wisconsin 54702

Printed in the United States

PESI, Inc. strives to obtain knowledgeable authors and faculty for its publications and
seminars. The clinical recommendations contained herein are the result of extensive
author research and review. Obviously, any recommendations for client care must be
held up against individual circumstances at hand. To the best of our knowledge any
recommendations included by the author reflect currently accepted practice. However,
these recommendations cannot be considered universal and complete. The authors
and publisher repudiate any responsibility for unfavorable effects that result from
information, recommendations, undetected omissions or errors. Professionals using
this publication should research other original sources of authority as well.

All members of the PESI, Inc. CME Planning Committee have provided disclosure of
financial relationships with commercial interests prior to planning content of this
activity. None of the committee members had relationships to report

PESI, Inc. offers continuing education programs and products under the
brand names PESI HealthCare, PESI Rehab, PESI Kids, PESI Publishing and
Psychotherapy Networker. For questions or to place an order, please visit: www.
pesi.com or call our customer service department at: (800) 844-8260.

14pp

4/21

Rehab Kids
 Materials Provided By

Erica H. Sirrine, Ph.D., LCSW, FT, is a licensed clinical social

worker, qualified clinical supervisor and the dean of the School
of Social Work at Southeastern University. She has over 17 years
of experience in the field of death, dying and bereavement and
has been awarded the distinction of Fellow in Thanatology by
the Association for Death Education and Counseling. She has
conducted and published research on the continuing bonds
maintained by survivors following a death, and she recently
authored and published Sammy’s Story, an anticipatory grief
counseling book for young children experiencing the serious
illness of a loved one.

Dr. Sirrine has extensive expertise providing individual and

group therapy to bereaved children, adolescents, adults and
families. She has implemented numerous interventions and
programs aimed at improving the emotional health of clients
experiencing loss. Dr. Sirrine presents seminars on bereavement
and loss throughout the United States and is known for her
interactive and engaging workshops. She has been distinguished
as “Professor of the Year” and the National Association of Social
Workers Heartland, Florida Unit’s “Social Worker of the Year.”

Speaker Disclosure:
Financial: Erica Sirrine receives compensation as an Associate Professor at Southeastern
University. She receives a speaking honorarium from PESI, Inc.
Non-financial: Erica Sirrine is a member of the National Association of Social Workers, The
Association of Baccalaureate Program Directors, the National Alliance for Grieving Children, and
the Florida Association of Deans and Directors. She does not receive compensation.
Materials that are included in this course may include interventions and modalities that are beyond the
authorized practice of mental health professionals. As a licensed professional, you are responsible for
reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of
practice in accordance with and in compliance with your professions standards.
 Grief Summit 2021:
Anticipatory Grief- Helping Clients Cope
in the Face of Impending Loss and
Uncertain Futures
Dr. Erica Sirrine, Ph.D., LCSW, FT
www.hopeandgrief.com

APA Disclosure

Materials that are included in this course may include interventions and modalities that are beyond the
authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing
the scope of practice, including activities that are defined in law as beyond the boundaries of practice in
accordance with and in compliance with your professions standards.

1
 Anticipatory Grief

“Stages of Death and Dying”

(DABDA)

2
 Sustained Hope in
Anticipatory Grief

Anticipatory Grief Emotions

3
 Common Anticipatory Grief Reactions
•Regressive Behaviors •Guilt/Regret
•Magical Thinking •Fear/Anxiety
•Disbelief/Confusion •Helplessness
•Difficulty Concentrating/Forgetfulness •Faith/Spirituality Questions
•Change in school work/grades •Isolation/Loneliness
•Sadness/Depression •“Grief Bursts”
•Mood Changes •Physical Symptoms (stomach/headaches,
etc.)
•Anger/Protest
•Sleep Problems/Disturbances
•Acting out/Aggressive behavior
•Lethargy/Fatigue

The Pandemic’s Impact on Grief

•Increased Isolation
•Fewer Opportunities for Face-to-Face Support
•Support System is Now Coping with their Own Losses
•Disguised/Masked Grief
•Loss of Funeral/Memorialization Rituals
•Loss of Control

4
 Continuing Bonds
•Sigmund Freud’s Grief Work Theory

•John Bowlby’s Attachment Theory

•Physical vs. Emotional Attachment

Anticipatory Grief Interventions

Before the Death

•Anticipatory Grief Counseling- Case Example: “Heather”

•Provide Death Education and Practical Support

•Linking Objects

•Legacy Journals/Letters/Video

•Video Diaries/Life Review

•Anticipatory Grief Retreats and Hope@Home Groups

•Inheritance of Hope

10

5
 Anticipatory Grief Interventions
After the Death

•Attend Funeral/Memorial Service

•Condolence Calls/Letters/Flowers

•Prepare Children and Adults to Return to School/Work

•Prepare Children to Attend Funeral/Memorial Service

11

Talking to Kids about Terminal Illness

Do’s and Dont’s
•Do:

•Be honest, clear, and direct

•Normalize feelings of anticipatory grief

•Model healthy mourning behaviors and coping skills

•Use concrete terms when discussing illness and death

•Foster an environment encouraging open and honest dialogue about the impending death

•Provide a caring and supportive environment

•Provide opportunities for memorialization/funeral rituals

•Don’t:

•Lie or conceal the reality

•Avoid the subject

•Use platitudes or euphemisms

12

6
 Explaining the Dying Process to Children
•Identify a trustworthy adult to be present

•Be honest and encourage questions

•Prepare children in advance about medical equipment/devices/personnel in the room

•Discuss the body’s process of dying

•Allow continued communication with person who is ill (per developmental age)

•Emphasize that hearing remains until the end

13

Preparing Kids for Funerals and Memorials

•Educate about Funeral Ritual (Who, What, When, Where, Why)
•Discuss Expected Emotions/Grief Reactions of Adults
•Explain Body Disposition/Viewing Expectations
•Prepare Activities for Younger Children- Case Example: “Poster Boards, Pictures, and
Memories”
•Allow Children/Teens to Participate in Planning
•Identify a Supportive Adult
•Never Force a Child to Attend

14

7
 Preparing for Return to School
•Notify Caregivers of Death

•Teachers, guidance counselors, principal, extracurricular activity directors, and coaches

•Educate Caregivers about Death

•Expected and normal grief reactions

•Classroom/schoolwork/homework needs

•Identification of “safe” support person and place

•Prepare fellow students

15

Preparing for Return to School/Work

•Provide Psycho-education for Successful Reintegration

•Management of grief waves and reactions

•Emotional time-outs

•Cognitive/concentration difficulties

•Preparation for questioning by others

•Possible feelings of isolation (feeling ignored)

16

8
 Identifying Sources of Support

17

Activity:
Circle of Support

18

9
19

20

20

10
 Love after Loss: An Illustration

21

22

22

11
 Hope and Healing
Amid Anticipatory Grief
“Truly it is in darkness that one finds the light, so when we are
in sorrow, then this light is nearest of all to us.”
-Meister Eckhart

23

Questions?
[email protected]

24

12
 Grief Summit 2021- References
Erica Sirrine

Anticipatory Grief

References

Coehlo, A., de Brito, M., Teixeira, P. Frade, P., Barros. L., & Barbosa, A. (2020). Family
caregivers' anticipatory grief: A conceptual framework for understanding its multiple
challenges. Qualitative Health Research 30 (5), 693-703.
https://doi.org/10.1177/1049732319873330
Coehlo, A., & Barbosa, A. (2017). Family anticipatory grief: An integrative literature review.
American Journal of Hospice and Palliative Medicine, 34 (8), 774-785. doi:
10.1177/1049909116647960
Ener, L., & Ray, D.C. (2018). Exploring characteristics of children presenting to counseling for
grief and loss. Journal of Child and Family Studies, 27 (3), 860-871. doi: 10.1007/s10826-
017-0939-6
Kübler Ross, E. (1971). What is it like to be dying? American Journal of Nursing, 71 (1), 53-60.
Meager, D.K., & Balk, D.E. (2013). Handbook of Thanatology (2nd ed). New York:
Routledge.

Moon, P.J. (2016). Anticipatory grief: A mere concept? The American Journal of Hospice &
Palliative Care, 33 (5), 417-20. doi: : 10.1177/104990911557426
Patinadan, P.V., Tan-Ho, G., Choo, P.Y., & Yan Ho, A.H. (2020): Resolving anticipatory grief
and enhancing dignity at the end-of life: A systematic review of palliative interventions.
Death Studies, 1-14. doi: 10.1080/07481187.2020.1728426

Rubin, S. S. (1999). The two-track model of bereavement: Overview, retrospect, and

prospect. Death Studies, 23(8), 681-714. doi:10.1080/074811899200731
Rubin, S.S., & Shechory-Stahl, M. (2013). The continuing bonds of bereaved parents: A ten-year
follow-up study with the two-track model of bereavement. OMEGA, 66(4), 365-384. doi:
http://dx.doi.org/10.2190/OM.66.4.f
Shaver, P. R., & Tancredy, C. M. (2001). Emotion, attachment, and bereavement: A conceptual
commentary. In H. Schut (Ed.), Handbook of bereavement research: Consequences, coping,

13
 and care. (pp. 63-88). American Psychological Association. doi:10.1037/10436-003
Sirrine, E. H. (2017). Sammy's Story. Publisher: Author.
Sirrine, E. H., Salloum, A., & Boothroyd, R. (2017). Predictors of continuing bonds among
bereaved adolescents. OMEGA: Journal of Death and Dying, 76 (3), 237-255.
doi.org/10.1177/0030222817727632
Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning healthcare professionals: Bereaved
persons are misguided through the stages of grief. OMEGA: Journal of Death and Dying, 74
(4), 455-473. doi: 10.1177/0030222817691870

14
NOTES
NOTES