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Art Therapy as an
Intervention for Bereaved
Adolescents
Valerie Javier
Department of Psychology, Counseling,
and Art Therapy
COUN 7550 Dec. 2024
Dr. Sheila Lorenzo de la Peña
Introduction
Problem to be Investigated
• Research surrounding grief generally focuses on adult grief, not considering
that adolescent grief differs (Alvis et al., 2023)
Purpose Statement
• Design a curriculum utilizing an art therapy and cognitive behavioral
framework to support grieving adolescents
Justification
• Approximately 5.5 million children in the United States will lose a parent or
sibling before the age of 18 (Hillis et al., 2021).
• Numbers increase in times of catastrophe, such as pandemics and war (Burns et
al., 2020).
• Adolescents grieve in ways that is different from adults and children
• Increased likelihood for unsafe coping mechanisms, such as substance use
and self-harm (Andriessen et. al, 2018).
Terms Related to the Study
Adolescence
Art therapy
Bereavement
Grief
Loss
Mourning
Prolonged grief disorder
Literature Review
Adolescence
• Significant development physically, cognitively, emotionally, and socially as a
child transitions to adulthood
• Puberty/hormones
• Piaget’s Theory of Cognitive Development (Formal Operations)
• Erik Erikson’s Stages of Psychosocial Development (Identity vs.
Confusion)
• Social pressures/increased responsibilities
• Increased risk-taking behaviors
Literature Review
Grief
• Associated with physiological distress, separation anxiety, confusion, yearning,
dwelling on the past, and apprehension about the future (American
Psychological Association, 2018)
• In the US, many find discomfort talking about grief (Morley, 2023)
• Mental & physical effects
• crying, lack of energy, irregular sleep, and difficulty with concentration
• emotions coincide with grief, which may include distress, shock, anxiety,
guilt, anger, and a longing for the lost loved one
• Disorientation, loss of sense of self (Morley, 2023)
• A grieving brain enters fight, flight, or freeze mode (Paturel, 2020)
• Grieving time and processes unique to each individual
• Prolonged grief
• Elisabeth Kubler-Ross’s Stages of Grief
Literature Review
Adolescents & Grief
• Individual responses to loss are impacted by the youth’s cognitive development
at the time of loss (Alvis et al., 2023)
• The risk of long-term serious mental health concerns is 2.5 times greater in
adolescents experiencing bereavement compared to non-bereaved adolescents
(Burrell et al., 2022)
• depression, posttraumatic stress, substance use, a decline in academics, and
impairment in developmental tasks (Alvis et al., 2023).
• Prolonged grief disorder higher risk of health issues & suicidality (Falk et
al., 2022).
• maladaptive behaviors, such as using substances to manage (Andriessen et.
al, 2018).
• Suppress emotions, struggle with verbal expression of emotions
• No support in understanding their grief experience a greater intensity and
duration of grief (Palmer et al., 2016).
Literature Review
Developmental Factors
• impacted by the progression of developing skills such as self-regulation,
identity formation, and the ability to cope (Palmer et al., 2016).
• Identity formation/relation to peers
• Movement towards autonomy
• Increased impulsivity
• Abstract thought
• Developmentally appropriate strategies of support:
• normalizing grief responses
• building connections with others
• counseling & creative therapies (Palmer et al., 2016),
• social support
Literature Review
Grief Training in Mental Health Professional Training Programs
• mental health professionals may not be adequately prepared to work with
bereaved clients (Sawyer et al., 2022).
• No CACREP standards
• School counselors
Literature Review
Art Therapy as an Intervention for Grief
• “Art therapy is a mental health profession that enriches the lives of individuals,
families, and communities through active artmaking, creative process, applied
psychological theory, and human experience within a psychotherapeutic
relationship” (AATA, 2017)
• Release of intense emotions related to loss & communicating nonverbal
bereavement experiences (Bat-Or & Garti, 2019)
• Conscious & unconscious elements
• supports meaning making, crisis resolution, and emotional expression (Potash
& Ho, 2014; Weiskittle & Gramling, 2018)
Literature Review
Group Art Therapy
• connections with others can be a rich source of support, establish a sense of
belonging, and increase resiliency (Robb, 2022)
• Decrease loneliness
• Normalizes grief & validates emotions
• Safe space
• the sense of belonging in group from witnessing one another (Moon, 2010)
Cognitive Behavioral Art Therapy (CBAT)
• modify maladaptive thoughts, increase coping skills, and reduce emotional
stress (Rosal, 2018).
• Construction of self
• Tolerate ambiguity
Methodology
Target Audience
• Adolescents (ages 12-18) in out of home placement
• Hogan Inventory of Bereavement – Short Form (Children & Adolescents)
Curricular Structure
• CBAT
• Closed group, 6-8 participants
• 10 weeks
• Master’s level art therapist
Curricular Outline
• Weekly 90-minute sessions
• Warm up, main intervention, mindfulness-based wrap-up
• Goals:
• process intense emotions associated with grief, memorialize the deceased,
meaning making, explore self-concept, sense of belonging and community
Curriculum
Week
Intervention
Goals
1
Introduction
Introduction of group; Establishing group norms
2
Emotional Color Wheel
Identification of emotions experienced related to grief;
Fostering a sense of belonging within the group
3-4
Masquerade Ball
Identification of emotions experienced related to grief;
Exploring self-concept
5-7
Story Book
Reflecting on events surrounding the loss; Reflecting on past,
present, and future with the deceased; explore self-concept
8
Changes Collage
Reflect on changes that have occurred since the loss; to identify
coping skills; Reframe perspectives on change
9
Memory Box
To honor the deceased by memorializing them; To contain
experienced grief
10
Affirmation Bracelets
Wrap up; Reflect on time in group; Closure
Post Cards
Goals
• Reflect on grief journey thus far; Encourage self-expression towards loved one
Suggested art materials
• Blank postcards plus additional materials will vary week to week depending on
main intervention
Masquerade Ball
Goals
• Identifying emotions surrounding grief
• Exploring self-concept & increase self-esteem
Suggested Art Materials
• Paper mache masks
• Acrylic paint, brushes, water, palettes
• Craft accessories such as feathers, rhinestones, scrap paper, and glue
Changes Collage
Goals
• To reflect on changes that have occurred since the loss
• To identify emotions regarding changes
• To reframe perspectives on change
• To identify coping skills
Materials
• Magazines/newspaper
• Scrap book paper
• Glue
• Scissors
• 11x14 cardstock
Discussion
Limitations
• Cultural differences
• Out of home placement
• Personal struggles with grief
Suggestions for Future Research
• Grief across the lifespan
• Length of time before intervention/prevent prolonged grief?
References
Alvis, L., Zhang, N., Sandler, I. N., & Kaplow, J. B. (2023). Developmental Manifestations of Grief in Children and
Adolescents: Caregivers as Key Grief Facilitators. Journal of Child & Adolescent Trauma, 16(2), 447–457.
https://doi.org/10.1007/s40653-021-00435-0
American Art Therapy Association. (2017, June). About art therapy. American Art Therapy Association.
https://www.arttherapy.org/upload/2017_DefinitionofProfession.pdf
American Psychological Association. (2018). Grief. American Psychological Association. https://www.apa.org/topics/grief
Andriessen, K., Mowll, J., Lobb, E., Draper, B., Dudley, M., & Mitchell, P. B. (2018). “Don’t bother about me.” The grief and
mental health of bereaved adolescents. Death Studies, 42(10), 607–615. https://doi.org/10.1080/07481187.2017.1415393
Bat-Orr, M., & Garti, D. (2019). Art therapist’s perceptions of the role of the art medium in the treatment of bereaved clients in
art therapy. Death Studies, 43(3), 193–203. https://doi.org/10.1080/07481187.2018.1445138
Burrell, L. V., Mehlum, L., & Qin, P. (2022). Parental death by external causes during childhood and risk of psychiatric
disorders in bereaved offspring. Child & Adolescent Mental
Falk, M.W., Alvariza, A., Kreicbergs, U., & Sveen, J. (2022). End-of-Life-Related Factors Associated with Posttraumatic
Stress and Prolonged Grief in Parentally Bereaved Adolescents. Omega, 86(1), 174–186.
https://doi.org/10.1177/0030222820963768
References
Hillis, S.D., Blenkinsop, A., Villaveces, A., Annor, F.B., Liburd, L., Massetti, G.M., Unwin, H.J.T., COVID-19-associated
orphanhood and caregiver death in the United States. Pediatrics. 2021. 10.1542/peds.2021-053760. 34814177
Moon, B. L. (2010). Art‐based group therapy: Theory and practice. Charles C. Thomas.
Morley, K. E. (2023). Everybody dies, so why don’t we talk about it: Helping a grieving library colleague. Journal of Access
Services, 20(1/2), 1–14.https://doi.org/10.1080/15367967.2023.2186791
Palmer, M., Saviet, M., & Tourish, J. (2016). Understanding and Supporting Grieving Adolescents and Young Adults.
Pediatric Nursing, 42(6), 275–281.
Paturel, A. (2020). The Mourning Mind. Discover, 41(6), 70–73.
Potash, J. S., & Ho, R. T. H. (2014). Expressive therapies for bereavement: The state of the arts. In Grief and the expressive
arts: Practices for creating meaning. (pp. 28–32). Routledge/Taylor & Francis Group.
Robb, M. A. (2022). Group art therapy: practice and research. Routledge.
Rosal, M. L. (2018). Cognitive-behavioral art therapy: From behaviorism to the third wave. Routledge.
Sawyer, J. S., Wilner, L. L., & Ertl, M. M. (2022). Grief and bereavement beliefs among U. S. mental health professionals and
the general public. Death Studies, 46(10), 2346–2353. https://doi.org/10.1080/07481187.2021.1944399
Weiskittle, R. E., & Gramling, S. E. (2018). The therapeutic effectiveness of using visual art modalities with the bereaved: a
systematic review. Psychology Research & Behavior Management, 11, 9–24. https://doi.org/10.2147/PRBM.S131993
Intervention for Bereaved
Adolescents
Valerie Javier
Department of Psychology, Counseling,
and Art Therapy
COUN 7550 Dec. 2024
Dr. Sheila Lorenzo de la Peña
Introduction
Problem to be Investigated
• Research surrounding grief generally focuses on adult grief, not considering
that adolescent grief differs (Alvis et al., 2023)
Purpose Statement
• Design a curriculum utilizing an art therapy and cognitive behavioral
framework to support grieving adolescents
Justification
• Approximately 5.5 million children in the United States will lose a parent or
sibling before the age of 18 (Hillis et al., 2021).
• Numbers increase in times of catastrophe, such as pandemics and war (Burns et
al., 2020).
• Adolescents grieve in ways that is different from adults and children
• Increased likelihood for unsafe coping mechanisms, such as substance use
and self-harm (Andriessen et. al, 2018).
Terms Related to the Study
Adolescence
Art therapy
Bereavement
Grief
Loss
Mourning
Prolonged grief disorder
Literature Review
Adolescence
• Significant development physically, cognitively, emotionally, and socially as a
child transitions to adulthood
• Puberty/hormones
• Piaget’s Theory of Cognitive Development (Formal Operations)
• Erik Erikson’s Stages of Psychosocial Development (Identity vs.
Confusion)
• Social pressures/increased responsibilities
• Increased risk-taking behaviors
Literature Review
Grief
• Associated with physiological distress, separation anxiety, confusion, yearning,
dwelling on the past, and apprehension about the future (American
Psychological Association, 2018)
• In the US, many find discomfort talking about grief (Morley, 2023)
• Mental & physical effects
• crying, lack of energy, irregular sleep, and difficulty with concentration
• emotions coincide with grief, which may include distress, shock, anxiety,
guilt, anger, and a longing for the lost loved one
• Disorientation, loss of sense of self (Morley, 2023)
• A grieving brain enters fight, flight, or freeze mode (Paturel, 2020)
• Grieving time and processes unique to each individual
• Prolonged grief
• Elisabeth Kubler-Ross’s Stages of Grief
Literature Review
Adolescents & Grief
• Individual responses to loss are impacted by the youth’s cognitive development
at the time of loss (Alvis et al., 2023)
• The risk of long-term serious mental health concerns is 2.5 times greater in
adolescents experiencing bereavement compared to non-bereaved adolescents
(Burrell et al., 2022)
• depression, posttraumatic stress, substance use, a decline in academics, and
impairment in developmental tasks (Alvis et al., 2023).
• Prolonged grief disorder higher risk of health issues & suicidality (Falk et
al., 2022).
• maladaptive behaviors, such as using substances to manage (Andriessen et.
al, 2018).
• Suppress emotions, struggle with verbal expression of emotions
• No support in understanding their grief experience a greater intensity and
duration of grief (Palmer et al., 2016).
Literature Review
Developmental Factors
• impacted by the progression of developing skills such as self-regulation,
identity formation, and the ability to cope (Palmer et al., 2016).
• Identity formation/relation to peers
• Movement towards autonomy
• Increased impulsivity
• Abstract thought
• Developmentally appropriate strategies of support:
• normalizing grief responses
• building connections with others
• counseling & creative therapies (Palmer et al., 2016),
• social support
Literature Review
Grief Training in Mental Health Professional Training Programs
• mental health professionals may not be adequately prepared to work with
bereaved clients (Sawyer et al., 2022).
• No CACREP standards
• School counselors
Literature Review
Art Therapy as an Intervention for Grief
• “Art therapy is a mental health profession that enriches the lives of individuals,
families, and communities through active artmaking, creative process, applied
psychological theory, and human experience within a psychotherapeutic
relationship” (AATA, 2017)
• Release of intense emotions related to loss & communicating nonverbal
bereavement experiences (Bat-Or & Garti, 2019)
• Conscious & unconscious elements
• supports meaning making, crisis resolution, and emotional expression (Potash
& Ho, 2014; Weiskittle & Gramling, 2018)
Literature Review
Group Art Therapy
• connections with others can be a rich source of support, establish a sense of
belonging, and increase resiliency (Robb, 2022)
• Decrease loneliness
• Normalizes grief & validates emotions
• Safe space
• the sense of belonging in group from witnessing one another (Moon, 2010)
Cognitive Behavioral Art Therapy (CBAT)
• modify maladaptive thoughts, increase coping skills, and reduce emotional
stress (Rosal, 2018).
• Construction of self
• Tolerate ambiguity
Methodology
Target Audience
• Adolescents (ages 12-18) in out of home placement
• Hogan Inventory of Bereavement – Short Form (Children & Adolescents)
Curricular Structure
• CBAT
• Closed group, 6-8 participants
• 10 weeks
• Master’s level art therapist
Curricular Outline
• Weekly 90-minute sessions
• Warm up, main intervention, mindfulness-based wrap-up
• Goals:
• process intense emotions associated with grief, memorialize the deceased,
meaning making, explore self-concept, sense of belonging and community
Curriculum
Week
Intervention
Goals
1
Introduction
Introduction of group; Establishing group norms
2
Emotional Color Wheel
Identification of emotions experienced related to grief;
Fostering a sense of belonging within the group
3-4
Masquerade Ball
Identification of emotions experienced related to grief;
Exploring self-concept
5-7
Story Book
Reflecting on events surrounding the loss; Reflecting on past,
present, and future with the deceased; explore self-concept
8
Changes Collage
Reflect on changes that have occurred since the loss; to identify
coping skills; Reframe perspectives on change
9
Memory Box
To honor the deceased by memorializing them; To contain
experienced grief
10
Affirmation Bracelets
Wrap up; Reflect on time in group; Closure
Post Cards
Goals
• Reflect on grief journey thus far; Encourage self-expression towards loved one
Suggested art materials
• Blank postcards plus additional materials will vary week to week depending on
main intervention
Masquerade Ball
Goals
• Identifying emotions surrounding grief
• Exploring self-concept & increase self-esteem
Suggested Art Materials
• Paper mache masks
• Acrylic paint, brushes, water, palettes
• Craft accessories such as feathers, rhinestones, scrap paper, and glue
Changes Collage
Goals
• To reflect on changes that have occurred since the loss
• To identify emotions regarding changes
• To reframe perspectives on change
• To identify coping skills
Materials
• Magazines/newspaper
• Scrap book paper
• Glue
• Scissors
• 11x14 cardstock
Discussion
Limitations
• Cultural differences
• Out of home placement
• Personal struggles with grief
Suggestions for Future Research
• Grief across the lifespan
• Length of time before intervention/prevent prolonged grief?
References
Alvis, L., Zhang, N., Sandler, I. N., & Kaplow, J. B. (2023). Developmental Manifestations of Grief in Children and
Adolescents: Caregivers as Key Grief Facilitators. Journal of Child & Adolescent Trauma, 16(2), 447–457.
https://doi.org/10.1007/s40653-021-00435-0
American Art Therapy Association. (2017, June). About art therapy. American Art Therapy Association.
https://www.arttherapy.org/upload/2017_DefinitionofProfession.pdf
American Psychological Association. (2018). Grief. American Psychological Association. https://www.apa.org/topics/grief
Andriessen, K., Mowll, J., Lobb, E., Draper, B., Dudley, M., & Mitchell, P. B. (2018). “Don’t bother about me.” The grief and
mental health of bereaved adolescents. Death Studies, 42(10), 607–615. https://doi.org/10.1080/07481187.2017.1415393
Bat-Orr, M., & Garti, D. (2019). Art therapist’s perceptions of the role of the art medium in the treatment of bereaved clients in
art therapy. Death Studies, 43(3), 193–203. https://doi.org/10.1080/07481187.2018.1445138
Burrell, L. V., Mehlum, L., & Qin, P. (2022). Parental death by external causes during childhood and risk of psychiatric
disorders in bereaved offspring. Child & Adolescent Mental
Falk, M.W., Alvariza, A., Kreicbergs, U., & Sveen, J. (2022). End-of-Life-Related Factors Associated with Posttraumatic
Stress and Prolonged Grief in Parentally Bereaved Adolescents. Omega, 86(1), 174–186.
https://doi.org/10.1177/0030222820963768
References
Hillis, S.D., Blenkinsop, A., Villaveces, A., Annor, F.B., Liburd, L., Massetti, G.M., Unwin, H.J.T., COVID-19-associated
orphanhood and caregiver death in the United States. Pediatrics. 2021. 10.1542/peds.2021-053760. 34814177
Moon, B. L. (2010). Art‐based group therapy: Theory and practice. Charles C. Thomas.
Morley, K. E. (2023). Everybody dies, so why don’t we talk about it: Helping a grieving library colleague. Journal of Access
Services, 20(1/2), 1–14.https://doi.org/10.1080/15367967.2023.2186791
Palmer, M., Saviet, M., & Tourish, J. (2016). Understanding and Supporting Grieving Adolescents and Young Adults.
Pediatric Nursing, 42(6), 275–281.
Paturel, A. (2020). The Mourning Mind. Discover, 41(6), 70–73.
Potash, J. S., & Ho, R. T. H. (2014). Expressive therapies for bereavement: The state of the arts. In Grief and the expressive
arts: Practices for creating meaning. (pp. 28–32). Routledge/Taylor & Francis Group.
Robb, M. A. (2022). Group art therapy: practice and research. Routledge.
Rosal, M. L. (2018). Cognitive-behavioral art therapy: From behaviorism to the third wave. Routledge.
Sawyer, J. S., Wilner, L. L., & Ertl, M. M. (2022). Grief and bereavement beliefs among U. S. mental health professionals and
the general public. Death Studies, 46(10), 2346–2353. https://doi.org/10.1080/07481187.2021.1944399
Weiskittle, R. E., & Gramling, S. E. (2018). The therapeutic effectiveness of using visual art modalities with the bereaved: a
systematic review. Psychology Research & Behavior Management, 11, 9–24. https://doi.org/10.2147/PRBM.S131993