Ep 20 - Supporting Teenagers and Young Adults Going Through Grief

Teenagers and young adults might already find life complicated, so adding in loss and grief can be especially challenging. Maintaining relationships is a key starting point to supporting them through this time.   

Featuring Paul McOnie, a counsellor at Cranford Hospice who has experience working with children and adolescents through grief and loss.

Written resources to support this podcast can be found here

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Transcript

Ep 20: Supporting Teenagers and Young Adults Going Through Grief

Kia Ora and welcome to The Ending Life Well Podcast. This podcast series for carers focuses on advice and practical solutions for carers who have been thrown into the deep end looking after a loved family member or friend in their last days, weeks or months of life. 

Our episode today is Supporting Teenagers and Young Adults Going Through Grief

Denise

Hi, I'm Denise van Aalst, a senior palliative care nurse and educator at Otago Community Hospice. Today, I'll be talking with Paul McCone, a counsellor at Cranford hospice. Paul’s had particular experience working with children and adolescents for over 20 years. And this is a passion and interest of his when talking about grief and loss.

Hi, Paul. 

Paul 

Hi Denise, thanks for having me. 

Denise

Paul, when it comes to teenagers, they’re are mixed bag teenagers, aren't they? Because they’re still a child, but they’re yearning to be an adult, and they're in that, betwixt and between. And I'd imagine teenagers would be very, very individual depending on the maturity, perhaps their position in the family, are they the oldest or the youngest? You know, what advice do you have to parents of teenagers when a parent is approaching a terminal diagnosis?

Paul

I think when it comes to helpful advice that I might have for parents, it would be maintain relationship, because quite naturally, they're pulling away from their parents and towards their peers. And so, they’re sort of sharing less with their parents generally, and more with their peers. We have to as parents, fight a little bit harder, and create more opportunities to maintain those connections, and relationships, so that support, discussion, insight into their emotional world actually can happen. Typically, teenagers will be spending lots of time with their peers, or perhaps on their own in their room. And we might think, that's a really normal developmental stage, they're doing really, really well. But actually, what I've learned from counselling teenagers for many years, is that there can often be lots of things going on in that room. There's lots of things going on in the mind of the teenager. In their online world, how they're interpreting all of that information and how that actually generates into, emotions and how all of that affects their mood. Unless we have those connections on a regular basis most parents will just be unaware. And it's just too easy to assume they're okay. Because they're not talking with us and they're just doing what we think is normal teenage stuff. 

Denise

Paul, I remember when my kids were teenagers, one of the things that I did with them was identify another person in their life with them, that they would be comfortable going to, if they felt they couldn't come to me. If for any reason, something was troubling them that they couldn't come to me about, who they might go to. And for me, the reason I did that was that I wanted to know that the person that they might otherwise reach out to was somebody who I would trust. And that it was somebody that they were comfortable going to, and it was kind of an open conversation. It was giving them permission, that if they couldn't come to me, they could go to someone else, and that was okay. But kind of guiding who that might be. Is that something that might be useful in this kind of circumstance as well?

Paul

Oh, absolutely. It's just that the world has changed a little bit in that their go-tos now tend to be, sharing their emotional world online, on social media sites, or to actually just go to their peer group. But the difficulty with that is that they're then getting emotional support from somebody else, that's the same age and the same developmental stage that, you know, hasn't got that life experience. And so they may not be getting the type of support that we would prefer them to be getting. And that may be really helpful, depending on the emotional maturity of their peer, or it may be harmful, in that somebody's talking about what ‘when that happens to me, you know, I've started sort of this self-harming practice, and that tends to help me’ and so they're learning a really maladaptive coping strategy. So, I think, all we can do is create the opportunities, which is what you're talking about, with the most ideal people. And I think that's a really clever thing to do because often, it isn't us that they come to, it will be somebody else. So, all we can do is to enable their support group as much as we possibly can. 

Denise

I'm sort of thinking teenagers might also, you know, have enough insight that they don't want to burden mum or dad, because they know this is already tough for them, so ‘I don't want to burden them and tell them how terrible I already feel, or I don't want to tell them that I bumped the car’ or something because they feel like mum and dad are already dealing with enough. So, it's, it's knowing that there is somewhere safe for them to go.

Paul

Well, I just think that's a really good point Denise, because that's what I hear in counselling a lot. Because there's this awful news that the parent is very unwell and will die. Everybody is in protection mode. Parents are trying to protect their children and children are trying to protect their parents. And so, none of them sort of talk and open up, they're all coping in their own individual ways, rather than sort of talking as a family and coping as a family and processing as a family. If you are a parent of a teenager, and you're not sure what's happening in their world, share what's happening in your world, in your emotional world, and lead the way. And often with teenagers, it's not sitting down face to face. It's about doing something, driving in a car, and just chatting with them or tuning into what sort of music they like, and then kind of weaving in conversations about what's happening emotionally. But I think what most parents do is that we ask how they're doing, rather than starting with role modelling. So, we should actually start with ‘Hey if it's okay, I just want to share with you how I'm doing emotionally’ and lots of parents go, ‘but isn't that me harming my child? I’m burdening them with my feelings?’ And you would say it was like ‘I'm sharing this because, ideally, I'd want you to share what's going on for you, back. And you actually don't need to do anything to help me or support me, I'm doing that, okay, on my own. But I'm just sharing my emotions with you, and hope that you'll share yours back with me’.

Denise

And that's also role modelling then, isn't it? This isn't about needing to fix anything. This is just about being heard and held, and ‘I don't expect you to fix me, and I know I can't fix you. But I want you to know that I can hear you’. So I was thinking, you know, because often teenagers aren't the greatest communicators. And so actually, what you're suggesting would be a great way of encouraging and allowing them to open up by gently opening up to them.

Paul

And without that pressure of needing to fix, needing to solve some sort of puzzle, or needing to look after. You don't want to burden them with responsibility. You don't have to look after me. This is just part of how families or effective teams work together to support one another. 

Denise

And I liked what you said, I used to find that driving the car was a great opportunity for conversations, because nobody was looking at anybody. 

Paul

That's right, 

Denise

And equally, I used to watch a particular teatime soap opera with my daughter as a teenager, because it was a great opportunity to have a discussion about what was happening on the television without being emotionally involved. And it was a thing that we shared, but it was also that opportunity to kind of discuss some of the difficult topics when they arose without being emotionally invested in it. 

Paul

So that's really clever. I think, like when you're using different mediums like that, like, our music therapists will use music and certain lyrics, to open up conversations. And that's kind of talking in teenagers’ language. Yes. So yeah, and I think that's really, really clever. So sometimes we do need to think a little bit outside the box, don't we? 

Denise

Yeah. And I come back again, that we do need to trust ourselves as parents.

Paul

Yes, absolutely trust, trust yourself, as parents back yourself that even though it might be scary, you'll find a way through those conversations. And it will be okay. And if you feel that, in any part of these conversations, you are concerned that your child may be at risk, then sometimes rather than pushing your child into counselling, or pushing a child to go and see their GP, it might actually be good for you to go to a counsellor, and learn how you can support your child, in different ways to reduce those risks. Just upskilling in that area. Because sometimes that does happen, you know, children, for whatever reason, they may not cope, as well as other children or teenagers do. And for whatever reason, there might be a multitude of other stressful events going on all at the same time. Or this may be their third loss, you know, in a really short period of time, and there's the weight or the trauma load is just too great for them to carry at that moment.

Denise

And that loss isn't necessarily a death either is it? It might be that they didn't get into the sports team, they thought they were going to get into, it might be that a boyfriend or a girlfriend or even just a friend has kind of, you know, turned their back on them at school, or they failed an exam. So especially at that teenage level, as you're saying there can be accumulated losses that mean this is just one more.

Paul

And to adults the loss of a friend or a boyfriend or girlfriend, or, you know, failing at an exam; for us as adults, we've learned that's not the be all and end all. But for them at their age, that can be really, really huge and bring some really intense emotions with it. So, when you put that on top of what's going on in the family, then where are the stable areas in their life? You know, they're all sort of unstable at that time.

Denise

Paul, the other behaviour that sometimes we see in teenagers is what appears to be them being very selfish or very self-centred, that they don't seem to want to be involved with their family, they might be going off and engaging in some other destructive behaviours, or just being absent from the home. And it's all about them, when you know, it shouldn't be, it should be about the fact that dad's not well, but actually, that also is normal isn’t it?

Paul

And it's incredibly important to keep a lot of those normalities going. So, if we're in that space, where either myself or my partner is terminally ill and will pass away, and I'm not seeing my teenage child because they're more away with their friends and hanging out outside of the home, that might be really hurtful. And I may interpret that as well, they obviously don't care. But actually, that's normal teenage stuff. And it's incredibly important that that's what they continue to do, because that's their coping. If they were to be at home more, where there's lots of emotion in the house, where they're having to interpret and process all of that emotion more constantly, they’d actually be more at risk.

Denise

That could really overwhelm them, couldn't it?

Paul

That's right. So having a balance is really important. So rather than seeing it as uncaring, it's like, “oh great. This is her, or his coping, this is their way of coping, and I'm pleased that they're doing that. That's what I want as a parent.” 

Denise

What if Paul, though, what if your concerns are that they are really, perhaps taking this to the extreme as we know teenagers can do. And I know that my husband's time is becoming very limited, and they’re simply not home. My 16-year-old is just not in the house, they’re always out with friends. And I feel deep down, they're going to regret this later. Because they aren't spending the time, and in a few short weeks, they won't be able to spend that time with their dad. I don't want them to have those regrets later. But I don't want to be trying to lay down the law now. What are some of the ways you could negotiate that?

Paul

Yeah, I mean, that's a really good question. If you're seeing any behaviour to an extreme sort of, or excessive level like that, where perhaps they're not at home, hardly ever, then I would see any behaviour at that sort of level as a red flag, really. It's a sign that they're not able to cope with what's going on, it's that fight or flight. It's too big, it's too much. So I've got to remove myself from the situation. So that's a sign that it's at an overwhelming level for them. So for any parent that sees sort of excessive behaviour like that or, extreme behaviour, that's a sign that they probably need to do more investigation, assessment of what's going on for them. It's then again, about how you go about doing that, isn't it? Which is why I think, trying to maintain relationship with your teenager, as difficult as it is, and as much as they need to pull away, we still need to have that regular connection so that we have opportunities to open up discussions about how they're doing, ‘How can I help you?’  Otherwise, we just lose all opportunity and influence. And that's a scary thing. 

Denise 

Yeah, and would this perhaps be an instance where it might be, is there another, and I'm thinking sometimes it needs to almost be in between generation. So, it might be an older sibling, or, you know, a younger uncle or aunt or somebody that they are connected with, might be able to help bridge that gap. 

Paul

Again, if you are a parent that's in tune with your child, and most parents are, you would know, who in their world, who do they listen to? Who do they respect? Who would they likely open up? Who would likely get through to them? You'd probably be able to pull out a couple of people I imagine from, whether it's their support group, or your family, or the community around you. Because often we're not the right person. You know, it's about choosing who the messenger is, so that the message can get through. So I think that's really wise thinking. 

For me it’s the ‘at risk’ stage, where naturally the developmental stages that they are developing their sense of identity. And so, it's highly experimental. It's at a time in their life, where their hormones are going, so the chemicals in the that the brain is releasing, affects their mood, which affects their behaviour, which affects their thinking. There's work pressures, peer pressures, parental pressures, there's so many variables and factors going on, all at once in this great big mix. And so there are real risks in that for teenagers. And you know, our statistics in New Zealand aren’t great when it comes to self-harm or suicide, with teenagers. So, for me, as a counsellor, that's something I've always been really big on, always assessing. And I find if you’re just upfront with teenagers about that stuff. And say look, I'm just asking, and not shy away from it, they'll actually start talking back and sharing more with you. I think a lot of us shy away from asking, because if we open that can of worms, we might not know how to close it or what to do. But actually, it's really important to, to know that that risk is there, and to not be afraid of having that conversation.

Denise

And I guess, being willing to think this will be uncomfortable, but I can do this. And perhaps a time to reiterate that I am a safe space, you can tell me anything, and I might not like it. But we'll work through it together. 

Paul

Yeah, absolutely. I think that's really wise. And what I often do when I'm counselling teenagers is I'll not normalise it, but I'll kind of say things that will take it away from them, and say, you know, like, “other teenagers that I've counselled, who have had similar things going on for them have talked to me about sometimes it being just too much and, you know, they've had desperate thoughts come into their mind about ‘maybe I should end my life, maybe that's the best answer’. And when they hear that, if it's happening to them, they're relating to it. It's resonating with them. And so, it starts to open up conversations, rather than going ‘Are you suicidal? Are you having suicidal thoughts?’ You know, you're coming at it from a different angle. 

Denise

And so as a parent, I could perhaps be phrasing that that, ‘look, you know, what we're all going through right now is really hard. I know, for some teenagers, this is a time that might cause them to have thoughts around hurting themselves as a way of taking some control. And I hope that if you were having those thoughts that you'd share it with me’. So, because as a parent, I don't perhaps have the experience you have as a counsellor but can still be aware of other teenagers. So, as you say, taking the personal away this isn't ‘are you thinking it’, but putting it out there and reading their reaction to that?

Paul

Yeah, absolutely. 

Denise

So, Paul on the whole though, I mean, we all survived teenage years didn't we? So actually, teenagers are on the whole, pretty resilient. And if they know there's a safe space, if they know there’s someone safe to talk to, they will get through this.

Paul

Yes, absolutely. We have to remember, as parents that our teenagers just haven't appeared, we have instilled in them morals, values, resilience, all of this stuff through their whole life leading them to this point. So, it's a time of trust and faith really, and everything that we've sort of downloaded into them, if you like. I think both children and teenagers surprise their parents with how well they cope. I actually think it's us adults that struggle a little bit more. 

Denise

And so maybe we need to trust them a little bit more. 

Paul

Yeah, trust them, even though we might think at their age, they might not have the knowledge or skill, actually they are very intuitive beings, and they cope in their own way. They find a way through this stuff. And there's just so much evidence, you know, that highlights that. 

Denise

Yeah. And I guess, if you're concerned, then reach out perhaps yourself to a counsellor to get some advice for your next steps. Because we're not in it alone. For those who are involved with a hospice, there's always a team there that you can call on.

Paul

Yes, that’s right. And the great thing where we’re at in this technological age is that there are also so many online supports, there are texting supports for children. There's just a huge array of supports for them.

Denise

Paul, thank you very much for today. This has been really helpful and I'm sure parents of teenagers, you know, just some tips here, some ideas to be to be going on with, but trusting themselves.

Paul

Yes, absolutely. trust themselves, trust their children. Trust the process. You know, it's awful, it's tough, it's really difficult. It's got sometimes quite a lot of pain attached. But there's a way through. It's rare that people get stuck. So, it's more common that grief is natural.

Denise

Thank you for that Paul.

Paul

Thanks, Denise.

Denise

And thank you listeners for joining us today. This podcast was brought to you by Otago Community Hospice, with support from Hospice New Zealand. If you found this discussion helpful, check out our other episodes of Ending Life Well, a podcast series for carers. You can also find more resources for caring for a person who's dying at otagohospice.co.nz/education

If you would like to look at some specific resources around supporting a teenager through periods of difficulty or grief and loss, check out the website skylight.org.nz