Making Meaning After the Death of a Child Client | PAIGE S. SPANGLER, BFA, MS, LCPC, NCC

4 | PLAYTHERAPY | September 2020 | www.a4pt.org

PlayTherapyMag_Sept2020_r10.indd 4 8/6/20 12:35 PM CLINICAL EDITOR’S COMMENTS: The author’s remembrance and mourning process takes shape through visualization and response art.

ohn (pseudonym) was an eight-year old boy who often brought his favorite cherished items zipped in a bag to his play JVJGTCR[UGUUKQPU*GKPXKVGFOGKPVQJKUYQTNFD[UJQYKPIOGVJGQDLGEVU UGUUKQPU + YCU TGOKPFGF VJCV ūVJTQWIJ RNC[ VJGTCR[ VJG VJGTCRKUV KU that mattered to him. His vitality came through in his delight for small allowed the opportunity to enter into the child’s experience as it is played things he loved. I awaited our sessions on Tuesday afternoons until I QWVŬ $TCVVQPGVCNR 4GXKGYKPIO[PQVGUCNNQYGFOGVQ heard the news that he had died unexpectedly. When a member of his TGGZRGTKGPEGVJGLQ[VJCV,QJPRNC[GFQWVKPQWTYQTM HCOKN[ECNNGFVJGQHƒEGVQKPHQTOOGQH,QJPŨUFGCVJ+YCUVQQUJQEMGF to hold the weight of this new reality. This was an experience I was not prepared to manage. Unfortunately, a counselor’s does not The death of a client is a typically address or include clients’ deaths or coping with one of the most RCKPHWNGXGPVUEQWPUGNQTUECPGZRGTKGPEG 5EQƒGNF  unique experience which can provoke feelings of isolation. 6JGFGCVJQHCENKGPVKUCWPKSWGGZRGTKGPEGYJKEJECPRTQXQMGHGGNKPIU of isolation. In studies on non-traditional relationships, Doka (2002) KFGPVKƒGF VJCV UQEKCN PQTOU ECP ETGCVG UVTKEV GZRGEVCVKQPU QH JQY C 6GCTUƒNNGFO[G[GUYJKNGTGCFKPIO[NCUVUGUUKQPPQVGKVVTKIIGTGFXKXKF person grieves and can leave some people out of the grieving process memories of our last moments together. He had invented a game in our CNVQIGVJGT&QMC  FGƒPGFVJKUEQPEGRVCUūFKUGPHTCPEJKUGFITKGHŬ NCUVUGUUKQPVJCVKPXQNXGFCNQVQHNCWIJVGT+VYCUCUGUUKQPƒNNGFYKVJ in which the relationship between the bereaved person and the deceased the child’s magical presence and his welcoming invitation to play. I was is not acknowledged, the loss itself is not recognized, and/or the griever relieved to recall that in my last moments with him, I had been welcomed is excluded. Counselors who lose clients may feel all three of these KPVQJKURNC[+FKFPQVTWUJVJGUGUUKQP+YCURTGUGPVKPO[VTCEMKPICPF components of disenfranchised grief. HCEKNKVCVKXGTGURQPUGUVQJKURNC[PQVFKUVTCEVGFQTƒZCVGFQPCPCIGPFC as play therapists may experience when they are burdened by symptoms I certainly felt that this grief experience was like no other loss because QHDWTPQWVQTEQORCUUKQPHCVKIWGVJGOUGNXGU 6WTPGT 6JGEJKNF +GZGTEKUGFECWVKQPYKVJYJCV+UJCTGF RTQVGEVKPIEQPƒFGPVKCNKV[ CPF led and we played. I did not participate in typically shared grief rituals, such as his funeral and memorial service. At that time, I resided in a smaller town and had Coping with Grief Through Visualization concerns about seeing clients at those services. I was concerned about As I constructed the best ways to cope with grief, I considered the ƒGNFKPISWGUVKQPUCDQWVJQY+MPGY,QJPCPFCDQWVO[QYPXWNPGTCDKNKV[ VGEJPKSWGU + WUG KP O[ ENKPKECN YQTM + QHVGP IWKFG ENKGPVU VQ ETGCVG C and emotionality in attending these rituals. As a therapist, I am viewed ECNORNCEGXKUWCNK\CVKQPCUCEQRKPICPFITQWPFKPIUMKNN6JKUVGEJPKSWG CUCECTGVCMGTD[EQOOWPKV[OGODGTUCPF+HGNVKVEQWNFDGFKHƒEWNVHQT can be a fruitful foundation for all-aged clients. To manage the sadness other clients if they observed me grieving. that followed my client’s death, I started designing an imagined place to help with grief. It was hard to know how to do this: Did I want an escape Revisiting Our Last Session VQUGVVNGO[NQQRKPIVJQWIJVUVQƒPFCTGRTKGXGHTQOUCFPGUU!1T FKF As the realness of my client’s death started to sink in, I found myself I need a place to acknowledge the connection to my beloved client? I obsessing about our last session. What had I said in my last moments was impacted by the separation of this important attachment, and I was with him? Part of grief work involves revisiting memories and searching for decreased discomfort and increased understanding. TGEQPUVTWEVKPIOGCPKPIQHEQPPGEVKQPCPFOQWTPKPI %QTPGNN #U counselors, we might grumble over the chore of writing contact notes, 'ZKUVGPVKCNKUOŨUHQWPFGT8KMVQT(TCPMN  DGNKGXGFVJCVCVVJGEQTG but this provided descriptions that I relished as I read over our last few QHVJGJWOCPGZRGTKGPEGKUVJGTGCNK\CVKQPQHCƒPKVGNKHGCPFCPWNVKOCVG

www.a4pt.org | September 2020 | PLAYTHERAPY | 5

PlayTherapyMag_Sept2020_r10.indd 5 8/6/20 12:35 PM FTKXGHQTETGCVKPIOGCPKPIYKVJKPVJCVNKOKVGFVKOGHTCOG(TCPMN   view of grief and views it through a person’s ability to integrate the believed we do not have to be bound to our environments and although GZRGTKGPEGKPVQVJGKTNKXGUKPVJGKTQYPWPKSWGYC[ )QNFUYQTVJ[  we may experience suffering or harsh circumstances, it does not determine our destiny. We have a choice in how we perceive our Applying the concept of meaning making to a painful loss experience experiences, and in that regard, we can experience painful feelings, can be confounding for a griever. Unpredictable events have the potential QXGTEQOG HCEVQTU CPF FKUEQXGT OGCPKPI (TCPMN   6JKU DGNKGH VQEJCNNGPIGVJGXCNKFKV[QHDGNKGHUVJCVVJGYQTNFKULWUVCPFDGPGXQNGPV in allowing feelings to occur with the knowledge that meaning can be /CEMC[  $NWEM   9KVJ VJG FGCVJ QH C EJKNF QPG SWGUVKQPU VJG unveiled provided a hopeful perspective for me. fairness in the world. For me, I knew there would not be an answer to YJ[ JKU FGCVJ JCRRGPGF DWV RGTJCRU + EQWNF ƒPF OGCPKPI KP JQY Meaning-reconstruction theory, based on existentialist concepts, this relationship, and its loss, impacted me. Bereaved individuals may encourages creating an integrated memory of the deceased that is ƒPF OGCPKPI ūVJTQWIJ C UGCTEJ HQT EQORTGJGPUKQP QT C UGCTEJ HQT ūTGCNKUVKECEEGRVCDNGCPFKPHQTOUQPGŨUHWVWTGNKHGŬ 5WRKCPQGVCN UKIPKƒECPEGŬ /CEMC[$NWEMR +PJGTRQGOū6JG7UGUQH R 8KUWCNK\CVKQPUECPETGCVGOGCPKPIVJTQWIJCFGUETKRVKXG CPF 5QTTQYŬ/CT[1NKXGTYTQVGū5QOGQPG+NQXGFQPEGICXGOGCDQZHWNNQH personally constructed narrative. This approach removes a medicalized darkness. It took me years to understand that this too, was a gift.” In the midst of grief, one cannot see any gift at all, but I held hope in striving towards eventual meaning.

To cope, I developed a visualization of a place where I could visit with the client. With other personal grief visualizations, I have created imagery that allowed me to visit a deceased loved one in their new afterlife. This allowed for calming and making sense of a painful loss. The counseling relationship is different, though, because the client always came to visit while I waited for his arrival. Keeping this in mind, I decided that this visual YQWNFTGSWKTGOGVQYCKV

Visualization description: I wait at the top of a tree, in a treehouse. A treehouse is child-sized, private, sacred in its location in the woods, and magical in how it captures the wonderment of childhood. As I UKVKPVJGVTGGJQWUG+EQWPVūŬCU+JGCTJKO climb up each rung of the ladder. I see his hands at the entry way as he arrives at the top to greet me. *GDTKPIUCUGNGEVKQPQHJKUHCXQTKVGQDLGEVUCPFJKU electric smile. He is so excited to tell me about his new adventures. I sit and listen to him. I soak up the time and I am even more aware of the preciousness of the moment.

From Visualization to Response Art I am a collage artist and longed to make an art piece of this visualization, because making images ECPHCEKNKVCVGOCMKPIOGCPKPI .QVJ4Q\WO  Art also can act as a container, providing relief and sanctuary for the creator. Fish (2012) encouraged therapists to make art in response to their clinical YQTM CU C XGJKENG VQ ūEQPVCKP FKHƒEWNV OCVGTKCN express and examine their experiences, and share

Figure 1: Mixed media collage by Paige S. Spangler 2019

6 | PLAYTHERAPY | September 2020 | www.a4pt.org

PlayTherapyMag_Sept2020_r10.indd 6 8/6/20 12:35 PM VJGKTGZRGTKGPEGUYKVJQVJGTUŬ R +WUGFO[XKUWCNK\CVKQPCUCETGCVKXG References exercise and waited until when I was ready to make a real tactile art piece. $TCVVQP5%4C[&%'FYCTFU0#.CPFTGVJ)  %JKNF centered play (CCPT): Theory, research, and practice. Person- I felt a self-imposed pressure to make art in response to my experience Centered and Experiential , 8  ŤJVVRUFQK of loss, but it was hard to get started. A year after my client’s death, while QTI looking at imagery I had collected and created, I got swept up into the %QTPGNN 9 (   )TKGH OQWTPKPI CPF OGCPKPI +P C RGTUQPCN flow state of collage making. Much of the art piece came together in a voice. Journal, 44    JVVRUFQK RNC[HWNOCPPGT+ECPPQVGZRNCKPO[JCPFULWUVMPGYYJGTGGXGT[VJKPI QTI needed to go (see Figure 1). &QMC - ,   5KNGPV UQTTQY )TKGH CPF VJG NQUU QH UKIPKƒECPV QVJGTU Death Studies, 11   Ť JVVRUFQK Open hearts help us connect QTI Doka, K. J. (2002). Disenfranchised grief: New directions, challenges and more deeply yet leave us strategies for practice. Research Press. vulnerable to the pain of loss. Fish, B. J. (2012). Response art: The art of the art therapist. Journal of the American , 29  JVVRUFQKQTI  6JG KOCIG KU SWKGV [GV UJQYU VJG YKNFPGUU QH O[ RCKP GZRGTKGPEG (TCPMN 8 '   Man’s search for meaning: An introduction to YKVJVJGUVTCPIGDNWGDTCPEJGUITQYKPIKPWPKSWGRCVJYC[U6JGEJKNF . Beacon Press. KUITQWPFGFPGCTVJGDCUGQHVJGNCFFGT6JGTGCTGUJCFQY[ƒIWTGU (TCPMN8 '  The will to meaning: Foundations and applications of descending the tree trunk, which symbolize the counselor’s movement logotherapy. New American Library. through the grief experience. The process of peeling away a part of the )QNFUYQTVJ[ - -   )TKGH CPF NQUU VJGQT[ KP UQEKCN YQTM collage that I wanted to remove revealed a shape that looks like a heart RTCEVKEG#NNEJCPIGUKPXQNXGNQUULWUVCUCNNNQUUGUTGSWKTGEJCPIG YKVJKPQPGQHVJGUJCFQY[ƒIWTGU6JKUGOGTIGPEGQHCJGCTVTGOKPFU Australian Social Work, 58  ŤJVVRUFQKQTIL me of the importance and fear of closeness in counseling: Open hearts Z help us connect more deeply yet leave us vulnerable to the pain of .QVJ4Q\WO#  6JGTCR[YKVJEJKNFTGPKPITKGHCPFNQUUITQWRU loss. It is a radical act to be heart-based like this, but with our known In C. A. Malchiodi (Ed.), Handbook of art therapy PFGFRR impermanence, how can we live any other way?  )WKNHQTF2TGUU Mackay, M. M., & Bluck, S. (2010). Meaning-making in memories: Conclusion and Acceptance A comparison of memories of death-related and low point The creative visualization I developed in my and then drafted life experiences. Death Studies, 34    JVVRUFQK into reality served as a tool to cope with grief, but I also hoped for meaning QTI ETGCVKQP9JGP+ETGCVGFVJGEQNNCIGKVHGNVNKMGCPGPFVQTWOKPCVKQPU 5EQƒGNF64  9JGPENKGPVUFKG7UKPIUVQT[VGNNKPILQWTPCNKPI however, there was another step I had yet to realize. I eventually started to and correspondence in times of loss. Journal of Creativity in Mental share my experience by showing this art piece to close colleagues. I have Health, 1  JVVRUFQKQTI,XPA CNYC[UKFGPVKƒGFCUCPGZKUVGPVKCNKUVDGECWUG+EQPEWTYKVJVJGFGGRGT 5WRKCPQ-2*C[PGU.$2QPF8  6JGVTCPUHQTOCVKQPQH acknowledgement of suffering and our human striving for meaning. the meaning of death in complicated grief group therapy for survivors Bringing my grief-inspired collage art into the light by sharing it with of suicide: A treatment process analysis using the meaning of loss colleagues in trusted conversation, by discussing my grieving process codebook. Death Studies, 41  ŤJVVRUFQKQTI at a state counseling association roundtable, and by publishing it here  has demonstrated that meaning making is dynamic and unending. My 6WTPGT4$  2NC[JGCNUWUVQQБ Play Therapy, 14   meaning comes from memorializing my client, not in a static way, but in a dynamic one. ABOUT THE AUTHOR In our treehouse in the wild blue tree, we can still meet. He is also kept CNKXGKPVJGGZCORNGJGUGVHQTOG*KUYQPFGTOGPVCPFLQ[HQTUOCNN Paige S. Spangler, BFA, MS, LCPC, NCC, implements different expressive and play things and the cherished way he shared his is a model I follow. VGEJPKSWGUVQGPEQWTCIGGOQVKQPCNGZRTGUUKQP His collecting and sharing likely guided the way I made the visualization and regulation in all-aged clients. Paige works EQNNCIGQXGTVJGEQWTUGQHC[GCT+EQNNGEVGFKOCIGT[GXGPVWCNN[ICVJGTGF in private practice and is a PhD student in CPF RKGEGF KV CNN VQIGVJGT CPF PQY + CO ƒPFKPI C YC[ VQ UJCTG VJKU Counselor Education and Supervision at story. My sadness still lingers but transforming my grief into a tangible Northern Illinois University. narrative and a response art collage has allowed me to integrate feelings [email protected] and meaning. Sharing allows me to accept the loss of my client and to appreciate what our time meant together, rendering the time I spend in play therapy sessions with others even more precious.

www.a4pt.org | September 2020 | PLAYTHERAPY | 7

PlayTherapyMag_Sept2020_r10.indd 7 8/6/20 12:35 PM