Shrinking the space between people
Abstract and Keywords
Having a good face-to-face and person-to-person connection will always be hailed as the cornerstone of child bereavement work. Although bereavement services have developed and grown rapidly over the past fifteen years, there are still a number of places where bereavement services are available in every locality. Thanks to the arrival of the telephone, e-mail services, and the Internet, there is now a new twist to the concept of early intervention in trauma support and bereavement. This chapter discusses the creative use of technology that can help shrink the space between the practitioner and the bereaved person.
The cornerstone of child bereavement work will always lie in the face to face and person to person connection that is made between practitioner and child or young person. Even though bereavement services for children and their families have grown rapidly in the last fifteen years, we are a long way from the desired situation of every bereaved family having a truly local, open access service on their doorstep. And even if we do one day achieve that, there will always be families for whom individual or group work is not possible or appropriate.
However, almost everyone has access to a telephone, an increasing number of people have access to email and the internet, and many people use text messaging. Creative use of this technology can shrink the space between the practitioner and the bereaved person.
Telephone and email support offer a new twist on the concept of early intervention in bereavement and trauma support. At the end of the line, at a click of a mouse, there can be a highly skilled and experienced practitioner who can make a timely, significant, and lasting difference to bereaved families.
Face to face work
Firstly and briefly for comparison, some characteristics of face to face work with bereaved people include:
♦ usually an appointment system, often with a considerable waiting list
♦ within time-restrained hours (e.g. 9 to 5)
♦ either at the family home, the office of the organization or some other ‘clinical’ space
♦ only available in certain parts of the country
♦ family members become known to the organization
♦ temptation to ‘put on a brave face’
At the End of the Line …
Support over the telephone can have the following characteristics:-
Advantages—for the Person Making Contact
♦ feeling in control of the communication; the call can be ended at any time with no embarrassment or apology and the caller can even ring off before speaking
♦ immediacy—calls can be made when there is a need—subject to the helpline's opening hours—without an appointment
♦ ease of contact—the caller doesn't have to tidy the living room or get dressed
♦ emotion—for those uncomfortable with expressing emotion, it may be easier to talk without being face to face
♦ one-way—the caller is the focus of the call.
Disadvantages—for Person Making Contact
♦ no visual clues on the response coming from the other person—shock, sympathy, etc.
♦ some people find it harder to communicate and harder to decide whether to trust without seeing the other person.
Advantages—for the Person Answering
♦ able to focus on what is being said (and not said) without visual distractions
♦ can be easier to ask the more difficult questions or explore the more painful areas
♦ nature of the contact (spontaneity and intimacy) leads to a more quickly established rapport
♦ the answerer can make notes, look out of the window, or sip a cup of tea without appearing impolite or uninterested.
Disadvantages—for the Person Answering
♦ no visual clues that can guide response—is the caller silently struggling ?
♦ accents can be harder to decipher over the phone.
(p. 109 ) An intimate disclosure
Some people think that it must feel impersonal talking to a helpline; in practice, most callers find a special intimacy in talking over the phone to someone who makes the time to listen and is felt to care. A caller once described it as ‘whispering your pain into someone's ear’.
The quality of the intervention—over the phone as much as in a face-to-face encounter—is determined by the way in which the answerer is able to create for the caller a place that feels safe to share.
The caller has overcome the first barrier to seeking support and guidance by picking up the phone and dialling the number. In a phone communication, tone is what matters most. The right tone transcends accent, class, gender and can make someone stay to talk who was poised to ring off.
If the voice at the end of the line sounds warm without seeming cloying, unhurried without seeming un-bothered, accepting without seeming uncaring, and concerned without seeming intrusive, the caller is more likely to trust it with deep feelings. If the voice is also able to convey a kindly, informed competence and a trustworthy reliability, the relationship between caller and called stands a chance. Most of all, does this voice ‘stand alongside’ the caller in their pain and confusion and sound as if it will support their choices and actions?
Answering the call
After the caller has decided to trust this voice, the task of relationship is not over. It has to be continually remade throughout the call. This requires a very active form of listening; the answerer must sit up and listen, not sit back. The quality of the listening elicits what the caller wants to say. A helpline answerer has highly privileged access to the caller's thoughts and feelings and has to use this access with great care and consideration.
All good helpline answerers use similar equipment and tools. For example:
♦ the use of open-ended questions
♦ reflecting back what the caller has said
♦ asking what they had thought of doing or saying
♦ the creative use of ‘mmm?’
♦ ‘don't just do something, sit there’
♦ the therapeutic use of silence.
A call from a family member is also a call from someone who is experiencing their own bereavement. The child may have lost a parent, a sibling, a grandparent. The caller will have lost a partner, an ex-partner, a child, a parent.
‘When his Grandfather died, my son said solemnly “I'm a bereaved child” and I thought “so am I”’.
A key element of how a child or young person will respond to the death of someone important is the response of the parent or key carer. Any intervention needs to have a concern for the person in the parental role. Support for them will help secure a better outcome for their family.
The answerer should therefore acknowledge the caller's position before beginning to focus gently on the child. At this point in a helpline call with a bereaved family, the practitioner is conducting a brief assessment of what this death of this person, means to this child, at this time, living in this family and in this community.
The next question the answerer needs to ask him/herself is ‘what help/support/guidance is this family asking me for?’. The subsequent question is ‘what do I think this family needs ?’ It can be quite a temptation to put these two questions the other way around, but it is important to respect and honour the caller's autonomy and start from where they are.
This may now be the time to offer some information, for example, about children's differing developmental understanding of death, about common reactions and responses, about the thoughts and feelings of grief.
After the sharing of information, comes the time for advice or guidance. The intention is to offer any guidance tentatively, always being aware that bereaved people attract well-meaning but infuriating advice as a honey pot attracts bees. The helpline answerer will avoid saying ‘if I were you …’ or ‘what you need to do now is ….’ Instead they will try: ‘What have you thought of doing …?’ ‘You may want to consider ….’ ‘I wonder if you'd thought of ….’ ‘What would happen if you ….’ ‘How do you think your child would react if you ….’
The answerer must always keep in mind that this family is operating and needs to operate within their own family context—past, present and future.
The next stage of the helpline call can then be the offering of practical ideas. These are powerful, creative tools and resources to help the family at this time and may include activities and ideas for ways to remember someone who has died.
(p. 111 ) Other resources can be suggested; books or other printed materials, useful websites, child bereavement services in the caller's locality, or if appropriate the time to explore how the service may be able to offer one-to-one or group support.
The approaching end of the call gives the answerer a chance to summarize, to reflect back, to remind of any key points or actions, and a chance to check that the caller has said all they want to.
It is also the time to encourage the caller to call again, if this is appropriate; to acknowledge their grief and sense of loss; to pay tribute to their care and concern for the children amidst their own grief, and to convey the telephonic equivalent of a warm hand clasp.
After the call
At the end of the call, the answerer needs to reflect on what has been shared and learned, take any necessary actions, follow agreed practices on recording the call and, importantly, seek any support they need for themselves.
Some calls demand every ounce of the answerer's attention, skill, knowledge, and heartstrings. It is essential that the organization has a support mechanism in place for the ‘coming down’ phase, if required. Debriefing involves the answerer describing the call, any actions to be taken, their own responses, and how they felt they were able to support the caller.
It must not be assumed that a helpline can meet every caller's needs. There will be times when things go less smoothly. All organizations that provide helpline support have to establish policies and procedures that will address challenging issues, and need to provide training and support for helpline answerers.
In offering bereavement support over the phone, it is good to consider what the outcome of a call may be for the caller. A reasonable outcome might be that the concerned adult feels better able, after the call, to support the bereaved child. This, in turn, would mean that the bereaved child or young person is better able to journey through their grief.
(p. 112 ) Calls from children and young people
While having written mainly about receiving calls from adults, it is important to consider briefly calls from young people. Particular training is necessary when preparing to receive calls from children. While, in theory, there may be little or no difference between supporting children or adults who are grieving; in reality, a phone answerer may find themselves becoming involved and affected more quickly and more deeply when talking by phone to a child who is grieving. The use of skills practice (‘role play’) is very valuable in preparing to answer calls from bereaved young people; better by far to make mistakes on each other.
Discussions about the types of calls that challenge established policies and procedures are important. For example, what if a young caller talks about their drug use or suicide attempts ? What if they tell of a bereaved sibling being physically abused ? What if they have disclosed risk while deliberately withholding their name or address but have mentioned the name of their school ?
When supporting children over the phone, it is important to be realistic and honest with ourselves as well as with them about the limits of what can be done.
Having said which, the phone offers a tremendous opportunity to engage young people who may feel more confident at speaking—at least initially—to someone they can't see. It also offers a good opportunity to give support at a distance over a longer period by regular, maybe quite short, contacts between the bereaved young person and the practitioner who is working with them.
The Winston's Wish Family Line (08452 030405)
The question of how to reach more families with an early intervention is what prompted Winston's Wish (a community-based child bereavement organization) to launch the national UK helpline for anyone caring for a bereaved child. By the end of the first eight years (2001–2008), over 25,000 people had contacted the service by phone. These people (70% family members, 30% professionals) in turn, were concerned about around 50,000 bereaved children and young people.
Each call is answered by an experienced and skilled practitioner. That is, the calls are answered by the same person who will also get down on the floor to draw with a six- year old, the same person who will co-ordinate residential (p. 113 ) groups, the same person who can go alongside an angry adolescent, or despairing parent or guardian. The combination of both a theoretical and experiential basis adds quality to the intervention.
At the Click of A Mouse ……
For organizations and groups seeking to support bereaved children, young people, and their families, the provision of support through email has to be at least considered since it will be the contact method of choice of much of their target audience.
Advantages—for the Person Making Contact
♦ control—over content and over ending contact
♦ immediacy and speed
♦ accessibility—emails can be sent and replies accessed from anywhere with an internet connection. Email is increasingly used by those with speech and/or hearing difficulties
♦ one way—when a response is wanted but not a conversation
♦ cost advantage
♦ normality—most young people and an increasing percentage of the population use email as the communication medium of choice
♦ written word—it can be easier emotionally and less embarrassing to write rather than to say, there is also the opportunity to review a response before sending it.
Disadvantages—for Person Making Contact
♦ no clues on the response coming from the other person
♦ have to wait for response when the emotional need may be urgent
♦ some people find it harder to put thoughts and feelings into written words.
Advantages—for the Person Answering
♦ all content of the communication is available from the outset
♦ feelings and thoughts—‘you get deeper quicker’
♦ quality—the response can be improved by checking over each word—and, if required, checking response with someone else before sending
♦ no struggling with quiet voices, regional accents etc.
(p. 114 ) ♦ less judgmental—response not clouded by judgments made on clues in the caller's voice
♦ not distracted by surrounding noise that can affect phone calls
♦ the response can come from anywhere and anytime with a net connection
♦ responses to several emails can be prioritized, rather than taking the next call that comes
♦ the enquirer's email address is known so follow-up can be sensitively offered, if no reply received.
♦ lack of clues to guide responses, lack of cultural reference points, lack of nuance can make it harder to grasp what is being said
♦ harder to assess the urgency of the need
♦ the delay between contact and response cuts the potential for a spontaneous reaction
♦ harder to convey warmth and empathy through the written word
♦ it isn't possible to ‘use’ silence
♦ harder to pull the conversation round if there is a mistake/misinterpretation and having a written record of response may lead to over-caution.
To e or not to e
Responding to email needs to be seen as an integral part of the service being provided—not an ‘add-on’. There are important considerations for a service that intends to communicate with bereaved people by email.
Who will be emailing?
While it is important to be clear about who the primary ‘audience’ for support is intended to be (so that the service can plan to meet their needs), in practice, whoever it is aimed at, emails will be received from people in other groups (parents, young people, professionals) as well as from the researcher, journalist and the person who has ‘come to the wrong shop’. The following points will concentrate mainly on responding to emails from young people.
Who will respond?
Because email is so much part of our world, it may be thought that there is no need for special training in replying. However, it takes real skill and experience to be able to make an assessment of the email writer's needs and feelings—both the stated and unstated—and to respond supportively. Additional training in using the written word therapeutically is required; while the medium allows (p. 115 ) the possibility of consultation on a response that is not possible with a phone call or face-to-face work.
It might be assumed that email support is best handled by younger people. In practice, older people may be more comfortable and familiar with responding using the written word (emailing is equivalent to writing a letter).
The tone is just as important as in a helpline or face-to-face contact. In responding to a young person, the tone needs to convey an impression of a person who can be supportive of all thoughts and feelings, has helpful information but is not going to lecture, and is fundamentally on your side.
In practice, emails can be answered at a remote location at a convenient time. If answerers are working off-site it is important to have support structures in place.
The usual response time needs to be advertised and adhered to. In practice, writers seem to accept a 24-hour turn-around.
While the medium allows for a long detailed response, in practice there is a balance to be set between providing enough information and support and keeping the reply within a reasonable length. The temptation to demonstrate erudition needs to be tempered by realising how intimidating this can be for the recipient.
Recognizing the language
Email uses a vibrant, direct, and immediate language that is suited to the communication of feelings and thoughts. It is unlikely that an email message from a young person will be correctly spelt or grammatical, but it will be powerful.
In replying to an email from a young person, it is not necessary to use the same language—for example, to deliberately mis-spell a word to seem ‘cool’ and ‘in touch’; but it is necessary to be direct, non-fussy and non-academic.
My dad died nearly a yer ago.And scince then my life feel rubish.and i somtimes just want to die. When will i stop like this?
it is my mum who has died she died of a brain hemeridge it was all sudden. i live with my dad i have no brothers or sisters i am 12 years off age my bday is today
Policies, practices, and procedures
Email response should be in integral part of any service, subject to the same policies, practices and procedures as face-to-face or group work. In addition to those mentioned before, these need to include a policy on data protection, record keeping and storage.
(p. 116 ) Policies may need to be re-considered in the light of email support. Here are some questions:
♦ How can you enact your child protection policy if you do not know the child's location ?
♦ How do you support a suicidal young person when you do not know their location ?
♦ To what extent are you prepared to attempt to trace someone ?
♦ How mindful do you need to be to the possibility of someone else reading your response ?
♦ If you are offering advice that can be printed out and kept, do you need to have indemnity insurance ?
♦ For how long will you keep records ? And will you keep these electronically or on paper ?
♦ How do you ensure continuity if your service starts an email ‘conversation’ with someone?
What makes email support particularly appropriate for young people who have been bereaved ?
Many young people can find it hard to seek support from a stranger face-to-face. Even with those close to them they may struggle to reach a point of easy communication about thoughts and feelings of grief.
It is much easier to tap out a question or a comment while already sitting at the computer doing something else. Sending it off doesn't involve a major commitment to a relationship with the person or organization to which it is sent. The communication takes place at a distance yet it feels like an intimate connection. When a reply comes, there is no pressure to respond in turn. The emailer can feel and act diffidently, crudely, angrily, and no-one gets hurt. It is about the nearest one can get to a safe expression of grief.
The medium has all the advantages outlined above—immediate, convenient, tentative, fleeting—that makes it suit a young person who is unsure about seeking support following bereavement.
Using the web to reach young people
One of the real challenges for a child bereavement service is to engage children, young people, and their parents by finding a variety of communications that (p. 117 ) will work for all ages. For those with access to the Internet, it is now usually the first choice for those seeking to understand more about a subject or seek support.
A website is, nowadays, a necessary requirement for any organization seeking to have a public profile; but it can also become so much more than simply a promotion of the organization's existence. For a child bereavement service, one strong reason to have a website is as a means of engaging bereaved young people. Additionally, information and guidance on supporting bereaved children and young people can be put into the public domain where parents and carers, professionals and, in particular, schools can instantly access and use it.
The young person's perspective
You can imagine a bereaved teenager, sitting at the computer in their room or even at school—feeling very diffident, very suspicious, very reluctant—and steeling themselves to search for information on bereavement. It is quick and easy to click away from a website about bereavement and onto something more enticing.
Therefore the tone of any website (or youth pages with an organization's website) need to convey the qualities of the service, for example, that this service is approachable, trustworthy, and accepting of people's feelings and thoughts. There is, of course, no control that says only young people will access pages aimed at young people; equally it can be assumed that young people will explore throughout the site and need to feel acknowledged and respected wherever they go.
Pages aimed at young people—like all good website content—need to be accessible to those with impaired sight or hearing and to young people with low literacy levels or for whom English is not their first language.
Web-based services, including message boards and other interactive activities, have many potential advantages for bereaved young people providing:
♦ ease of access
♦ accessibility—to all regardless of physical ability, race, culture, gender—and no need to travel
♦ one-to-machine—no obvious contact with another person
♦ freedom of expression
♦ culturally relevant—meeting young people on their own ‘ground’.
(p. 118 ) Logging out
The web has transformed communication between people, but it's not a magic answer in itself. The development of a website does not remove the need to develop and deliver other direct services for bereaved teenagers.
- ‘Actually, I don't like to admit it, but I felt a bit better afterwards’.
- ‘I talked to mum about dad for the first time since he died’.
- ‘I'll have a look tomorrow to see if anyone else feels like me’.
Like most organizations, the Winston's Wish website provides a window to the range of services available and carries a wealth of information for parents, carers and professionals, especially schools, on how to support bereaved children. A large interactive section within the website is specifically aimed at young people.
Through this area of the site, bereaved young people are able to engage in a range of activities around remembering the person who has died and expressing feelings and thoughts of grief; these include a starscape of memories, grafitti wall and podcasts. They can gain access to information about death, dying, and bereavement. Young people can also communicate with us by asking a specific question by email or with one another through often moving and powerful messages on the moderated message boards.
HRU? RUOK? (How are you? Are you ok?)
Another possibility to add to the opportunities to reach bereaved people is the use of text messaging: a technology that has almost universal acceptance amongst young people.
Responding to text messages should be an integral part of the overall package of services offered. In place there need to be training, adapted policies, procedures, quality control, monitoring, etc. The points made above relating to responding to emails are equally relevant here.
Texting has the advantages of email to young people (please see the longer list above). In summary these are:
♦ immediacy and speed
♦ culturally-relevant and normal
♦ low cost.
(p. 119 ) Text messaging can be used to support bereaved young people in the following ways:
♦ a message on an important day—anniversary of the death, birthday of the person who has died etc
♦ a gentle ‘thinking of you’ message when they are going through a rough time
♦ an encouraging reminder of the next appointment or group meeting
♦ a follow-up to an individual session—‘good to see you today’
♦ a continuing conversation with a caller—albeit one conducted in short bursts (software exists to make this possible)
♦ a first point of contact for someone exploring the service. (‘Text INFO to 07979 xxxx’). The response could start a supportive connection for the young person.
It could be said that the provision of emotional support is at its purest between two people—one who needs support and one who cares to give it—irrespective of their ages, genders, nationalities, and even location. This chapter has looked at how technology can be used to provide relevant services to bereaved young people, their families and the professionals who care for them.
For many adults, a helpline call, an email, or the opportunity to read through a web page will be sufficient to enable them to continue to support their bereaved children. For some, the call, mail, or page will point them to fresh ideas, new insights and useful resources. For a few, the technology will act as a gateway to the services available nationally and locally. For young people, emails, texts and websites may be the most bearable way to make the first tentative approach for help and support.
The technology is succeeding in shrinking the space between people. (p. 120 )