1. Creating the Guidelines for the Treatment of Traumatic Bereavement in Infancy and Early Childhood

2. Underlying Rationale Goal is to communicate a state of mind that relationships are essential to the healthy development of infants and young children However it happens, loss of a caregiver in early childhood is traumatic

3. Intended Audience Clinicians experienced in the treatment of young children Clinicians in training to learn to treat young children

4. Theory Driven Caregivers are essential protectors from threat (psychoanalytic/attachment theory) Understanding of the impact of stress and trauma Early childhood development: relationships central to –Regulation of bodily rhythms –Modulation of emotion –Formation and socialization of relationships –Learning from exploration of environment

5. Approach to Teaching Immerse readers in a way of thinking about caregiver loss and its impact on the very young child Learning is not linear for infants and young children Using vignettes to communicate essential skills

6. Process Gather together our theoretical knowledge and clinical material Create drafts for review by experts in early childhood and trauma Revise Resubmit for review

7. Skills: Assessment The child’s functioning before the death What the child knows about the death Traumatic reminders Nature/quality of child’s relationship with deceased parent Child’s present network of relationships including attachment figures

8. Skills: Assessment Continuity versus disruption of daily routines Family childrearing values and plans to care for the child Cultural and family traditions regarding death and dying Surviving caregiver’s response to the death Family’s strengths and vulnerabilities in caring for the child

9. Skills: Treatment Comfort in viewing clinical material through both a trauma lens and a loss lens Understanding of young child’s “short attention span” for grief Creating a safe frame for treatment –Identifying surrogate primary caregiver –Preserving reassuring reminders of the lost parent –Helping caregiver maintain predictable routines

10. Skills: Treatment Helping young children understand the idea of death as a permanent loss: a process that extends over time Calming fears –Will it happen to me? –Will it happen to my other parent? –Did I cause it? Helping tell the child the “why” and “how” of a parent’s death

11. Concrete Techniques Using play to put feelings into words Using stories Using body-based interventions Creating a memory book Rituals to maintain the child’s connection to the lost parent Using books

12. Skills: Managing Clinician Stress Empathizing with both the child and the surrogate caregiver Experiencing intense feelings of grief and horror without becoming overwhelmed or shut down Examining countertransference responses to avoid acting them out