Talking to Kids about Death and Dying

Parents’ inclination is always to protect their children from the painful aspects of life.  Unfortunately, death and illness touch many young lives, whether through the loss of a pet, a family member or friend’s death, or a terminal illness.  I am often asked for advice regarding whether or not these tragedies should be discussed with children or minimized.  While individual circumstances must always be considered when making this determination, my answer is almost always that it is best to have a meaningful conversation with the child. 

First, an open discussion with a child may prevent them from seeking answers from others who may not be as familiar with the situation or your child or who may be less qualified to provide your child with assistance.  Second, if the line of communication has not been opened on a subject and the child nonetheless becomes aware of a situation (and they are often aware of much more than a parent realizes), it can cause the child to experience growing anxiety or worry.  Think about your own experience.  How often has an imagined unknown seemed much worse than the actual reality?  It is a natural reaction for many people to imagine the worst in the absence of information to the contrary.  It is the same for children but often worse due to their unhindered imaginations. 

The appropriate method for discussing death and dying with a child is very complex and, of course, depends on the age of the child and other factors.  For young children, I often recommend the reading of story books that allow them to process what they are experiencing and often lead to questions.  This can facilitate their taking of the lead in the discussion, thus increasing the likelihood that they receive the information and answers they seek.  My favorites are What’s Heaven by Maria Shriver or, for people with different religious beliefs, The Fall of Freddie the Leaf by Leo Buscaglia PhD.  Sometimes young children also benefit from acting out death through play in order to make sense of this new experience.  This is completely normal and often very effective. 

With older children you may be able to just have a frank discussion about your experience and thoughts.  It is ok for your children to see you suffering when someone is lost.  You are their best model for how to handle grief and sadness. When in doubt, look for outside resources to assist you and your children.  There are many useful resources out there, but remember that creating a loving environment for your children to discuss their feelings in is never the wrong answer.

Letting Go of Regret

So many people seem to struggle with regrets about their lives.  On any given week in my office I will encounter someone struggling with a decision they have made for their life that they know was wrong for them, yet they made it anyway.  Regret about the decisions we “should” have made are at the foundation of our guilt and shame.  While I do not believe that it is possible to live a life completely devoid of regrets, it is possible to live one without the debilitating guilt and shame associated with those regrets. 

Throughout my years of practice I have come to realize that while it is easy for people to say (with all good intentions) that you will never do something (i.e., drugs, an affair, etc.) that they will regret, the reality is typically much more complicated.  People do not just wake up one day and decide to make destructive decisions that ruin their lives.  Those decisions usually result from the culmination of complicated situations and many minute decisions that lead them to a place where they thought they would never be.  If it was just a matter of making amends for poor decision making, I do not believe that so many people would harbor guilt and shame.  Instead, the hurt and shame often derives from the realization that the poor decision has caused pain to others in your life for whom you care.  It becomes difficult to reconcile the good person you believe that you are with the person who hurt others in a way of which you never imagined you were capable.  The truth is that good people sometimes make bad decisions when they lose perspective and we have all been there in some way, and to some degree, in our lifetimes.  Whether it is a matter of something we said that we wish we could take back or developing a problem with addiction, we all have regrets.

The question becomes: how do we move past these feelings of shame and guilt caused by our actions?  My answer is forgiveness.  Moving past shame and guilt comes from forgiving yourself.  You must acknowledge your own humanity and forgive yourself for being fallible.  I have been providing therapy long enough to know that regret is a loop that will continue to play over and over in your mind until you let it go.  So change the way that you talk to yourself about it.  Acknowledge your mistakes and take responsibility for them.  Make amends.  Learn from them and move forward.  You cannot change the past, all you can do is honor those that you have hurt by not repeating the same mistake.  When you do finally get to a better spot in your life, accept that we are made up of the sum of all of our experiences.  Therefore, every negative experience in which you’ve been involved has contributed to the good person you are today.  Whether an experience teaches you an important life lesson or provides you a new perspective on yourself or relationships, it changes you in some way.  Own it, but don’t let it control the sum of who you are.  Be patient with yourself as it may take weeks or months of forgiving yourself regularly when it comes up before positive effects are noticed.  Repeated refocusing of your energy toward the future is the best way to move past it and shed the guilt and shame that you are experiencing.  Ultimately, life will throw difficulties in your path and you will be more adept at traversing them without guilt and regret holding you back.  Use these experiences to make you a better person and you can turn that regretful decision into a tool for personal growth.

Self-Care Without the Guilt

Our daily lives are busy and, for most people, busy is an understatement.  We are constantly juggling the competing demands in our life.  I regularly treat patients who come to me struggling to find a work-life balance.  They are overwhelmed and many are guilt-ridden.  They express feelings that due to all these competing demands on their time, they do nothing truly well.  When I ask them about the things in their lives that are most important, I am not surprised to hear that these are the same things to which they dedicate the least amount of their time and energy. 

My initial suggestion typically involves making more time for these things of primary importance in order to emotionally recharge.  This suggestion is often met with a bevy of commitments or obstacles in their lives that make it impossible or inconvenient for them to carve out more time for recharging.  Yet they continue to have guilt that they miss their children’s soccer games or are too tired to spend much time with their significant other.  They put off developing the hobby that they love or spending time with friends.  So I ask them to make a list of the things that prevent them in a week from being present where they would really like to be.  Then I hit them with a hard truth: the things that prevent them from taking that break to have fun time will always be there, even when they are dead and gone.  There will always be laundry, house cleaning, and work.  So maybe everything doesn’t have to get done.  This is why we prioritize our lives and if we make recharging ourselves a priority, we will feel better, sleep better, think better, and will be significantly more efficient when we set out to do the things that are necessary evils.

It is not surprising that as people adapt to the idea of putting themselves higher on the priority list, guilt rears its ugly head.  This is where self-talk comes into the equation.  Guilt is a by-product of your expectations for yourself.  People who feel guilty have a constant inner monologue telling them what they “should” be doing.  I tell people to listen to this inner monologue.  Really listen and maybe even write some of it down.  Then you can go back as a rational calm person later and realize the undue pressure to which you subject yourself.  Life is hard enough at times without you beating yourself up.  So as soon as you hear the word “should” enter your inner dialogue it is time to put on the brakes.  Who determined you “should” be doing something?  Challenge these thoughts internally.  You are likely to find that there are a lot of things that you have been telling yourself to do that really aren’t necessary.  Start replacing that internal monologue with the words “nobody is perfect and I will do my best”.  That is all that is fair to expect from yourself. 

Taking care of yourself and recharging allows you to be a better worker, a better friend, a better parent, a better lover, frankly a better all-around person.  It makes you happier and more productive.  It makes your thoughts clearer and makes you more efficient.  So do the work to re-prioritize and change your inner dialogue.  Life is way too short to keep being your own worst enemy.

Simple Meditations for Erasing Worry

It seems now that meditation has become a commonplace skill.  Many patients express familiarity with some form of meditation.  When I was first starting out, this was not the case.  I will never forget being introduced to Dr. Brian Weiss’s guided imagery meditations.  I was planning my wedding at the time and my stress level was particularly high.  I listened to his guided imagery right before bed and was astounded by how much it helped!  I slept better and was calmer all day long.  As I continued my practice, I was introduced to Dr. John Kabat-Zinn and became a huge fan of his guided meditations as well.  Now there are even applications for your smart phone, such as Headspace, that help you work your way through meditation.  I often recommend all of this resources to patients in my practice.

The biggest dilemma that is posed by meditation as a treatment is time.  In our fast paced lives time is a commodity that people do not take lightly and meditation works best when performed regularly.  While a lot of these meditation prompts offer shorter meditations, they also require people to have the time to complete them when they are near the source of the guided imagery.  So I spend time teaching my patients small meditations that they can do in a few minutes at any time during their day.  This practice call allow them to function more efficiently in a current task by temporarily freeing them from the weight of a particular anxiety until a later time when that anxiety can be appropriately addressed. 

One of my favorites for worry and anxiety I call “Wiping the Slate Clean”.  I ask patients to spend time visualizing a dry erase board (or a chalk board depending on their age).  Then I ask them to imagine their concerns written or drawn on the board.  I ask them to fill their board with the dilemmas that are stuck in their heads.  By this point they are feeling the stress of ruminating on their worries.  Then I ask them to erase them one by one.  The act of erasing those problems causes a wonderful reduction in anxiety so once we have gone through it together in session they are highly motivated to practice on their own.

While this works extremely well for individuals prone to anxiety, we all have worries that can use a little erasing.  I encourage everyone to use this meditation regularly.  If you have read any of my discussions in the past you know that I think this would be great at bed time to help improve sleep quality, but I also like the idea of people using it with their morning coffee to start their day off right.  Really, there isn’t a bad time of the day to reduce your stress level a little bit and now you can do it in a matter of minutes.

Worry Boxes

In my practice I have come across a rise in anxious patients.  I can speculate on the changes in our world that seem to be causing this rise in anxiety and, unfortunately, none of them seem to be going away any time soon.  Since anxiety seems to be a pervasive problem that is here to stay, I have been working with my patients to develop tool boxes of techniques that are helpful in managing both symptoms of anxiety and their underlying causes.  For patients who have anxiety-related sleep difficulties, one tool that I find especially helpful is the Worry Box.

Most patients who have anxiety struggle to fall and/or stay asleep.  This break in the sleep cycle causes sleep deprivation, which has multiple emotional and physical detrimental effects.  Often the reason for a patient’s inability to have sound sleep is their sensation that they are laying in bed running through worries and concerns or to do lists when they should be settling down and falling asleep.  While the eventual goal is to teach patients how to mentally “wipe the slate” so that they can rest peacefully, the worry box is the intermediate step that can help develop this positive life habit. 

The technique is fairly simple.  I ask patients to find a box with a lid.  For some it can be as simple as a shoe box with a slit cut in the top.  For others it has to have more symbolic meaning than that.  For one patient, it had to be a solid wood box with a hinged lid because that “felt solid enough” to hold in the worries.  Just pick the box that’s right for you.  Right before bed, as you are running through the litany of worries or overwhelming lists, write them each down on an individual piece of paper and put the paper in the box.  As you put them into the box use self-talk to tell yourself that you are “putting that worry away for tomorrow”.  In essence, you are symbolically wiping your mind of these concerns knowing that they will be there for you to pick up in the morning should you choose to do so. 

While this is not likely to work the first time you try it, this is something that, with practice, you can do successfully to really improve your sleep.  There is also a modification I often use that works with kids that worry.  In their case, I use a worry doll or stuffed animal.  They get to talk to this worry buddy every night and let their worry buddy handle the weight of their fears and anxieties while the child sleeps soundly.  At the end of months of practice, the worry box can be retired and this can become a mental exercise where you can visualize your worries floating into the box in your head and getting shut up tight for the night.  This is a wonderful metaphoric way to teach yourself how to compartmentalize your worry so your body and mind can get what it truly needs: a good night’s rest!

For other helpful tips for dealing with anxiety you may want to read some of the articles posted here www.betterhelp.com/advice/anxiety