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Children and chronic sorrow: reconceptualizing the emotional impact of parental rejection and its treatment.

The concept of chronic sorrow offers afresh perspective for understanding the negative emotional impact of parental rejection on children. Additionally, it provides a clinical alternative to coercion for breaking through children's emotional defenses against further rejection in caregiving relationships.

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It was Christmas day, and Nancy, a 14-year-old only child who lived with her mother, was thrilled at the prospect of seeing her father again for the first time in almost a year. He had promised to take her for a "Christmas lunch" and then to see The Nutcracker, which was being performed by a local drama group. In the 3 years since her mother and father divorced, her father had relocated, and although he lived within an hour from Nancy and her mother, his contact with Nancy had steadily dwindled to an occasional call every 6 months or so, despite promises to contact her more often. Aware of her alcoholic ex-husband's lack of dependability in the past, Nancy's mother had tried to prepare Nancy for possible disappointment on this occasion, but Nancy's enthusiasm was not to be dampened, since her father had previously canceled a visit planned on her birthday and had made a "solemn promise" that he would spend Christmas day with her. When the time of his scheduled arrival came and passed, Nancy called her father to see why he was running late. Her father answered the telephone, and she could tell that he had been drinking and could hear other people talking and laughing in the background. He told Nancy that he was planning to call her because he had had car trouble and wouldn't be able to make it. He added that she would really like the Christmas present he had for her, and that he would reschedule another outing for them very soon. Slamming the phone down on the table, Nancy threw herself on the sofa and turned on the TV. Realizing what had happened, her mother asked Nancy if she wanted to talk about it, and Nancy angrily replied, "He did it again--I hate him!" Trying to hold back her tears, she asked, "Am I really that bad to be with?" To the reassurance from her mother that she had done nothing wrong, Nancy only replied, "Just promise you won't ever leave me!"

Nancy's response suggests more than just disappointment in her father; it shows signs that she has come to feel rejected by him. (Note. The client's name and some details have been altered to protect client privacy.) According to Hardy (2002), "The most egregious form of rejection that anyone can ever experience is parental rejection." When children feel that their parents do not love them, they may come to believe that they are unlovable and undeserving of respect and dignity as worthwhile individuals (Rohner, Khaleque, & Cournoyer, 2005). It has been well documented that children run a heightened risk for developing psychological, social, and emotional problems when they believe they have been rejected by one or both of their natural parents.

Psychologically, this belief (or reality) can lead children to evaluate themselves and their futures negatively, making them vulnerable for internalizing behaviors such as depression or psychosomatic illness and for externalizing behaviors such as hyperactivity and aggression (Magro & Weiss, 2006). Their negative self-evaluation stems from an as-yet undeveloped ability to differentiate their view of themselves from their negative view of rejecting parents whom they essentially see as part of themselves (Hamilton, 1989). Being limited developmentally to see beyond their own role in the parent-child relationship, rejected children can only assume that they were somehow unworthy of their parents' acceptance and responsible for the rejection. Intense shame and guilt are the characteristic by-products of this false assumption (H. E. Thomas, 1999).

Ainsworth (in Ainsworth, Blehar, Waters, & Wall, 1978) described the damage done to children socially as a result of several patterns of rejecting parental involvement. She proposed that children who experience intermittent rejection (the first pattern) will become anxious and ambivalent about the security and certainty of all relationships, resisting and even sabotaging others' efforts to relate to them to avoid the anticipated pain of ultimately being let down. Children who experience a parental relationship that is consistently rejecting (the second pattern) may become dismissive and avoidant of all relationships, entering them only superficially and as necessary to meet their own needs. Children who experience parental rejection in the form of abuse (the third pattern) may become erratic and disorganized in responding to subsequent relationships, having been placed in the paradoxical position of fearing harm in a relationship on which they were also dependent for safety and security. Ainsworth suggested that children's problematic responses to early patterns of rejecting parental involvement form the working models for their engagement in all subsequent relationships.

Rejected children are also more vulnerable to excessive emotional responses, especially intense anger and grief (Akse, Hale, Engels, Raaijmakers, & Meeus, 2004). Anger is a characteristic response to social rejection generally, because it denies and insults powerful and innate human efforts

to belong (Baumeister, Brewer, Tice, & Twenge, 2007). In parental rejection, children's anger also appears to originate with the loss of the rejecting parent(s) as a source of direction and support. The loss of parental instruction and direction in day-to-day tasks increases the children's risk of frequent and repeated failure. Simultaneously, the loss of parental nurturance and support inhibits the development of children's ability to self-soothe and contain negative emotions in the face of failure (Gallop, 2002; Winnicott, 1971). Thus, lacking the skills and confidence they need to succeed as well as the self-control they need to handle failure, rejected children are understandably prone to encounter frustration and failure more frequently and to respond to them with anger that is less restrained (McAdams, Foster, Dotson-Blake, & Brendel, 2009).

Grief is an anticipated response to the experience of serious loss (Harvey, 2007). Bowlby (1980) defined two patterns of problematic grief specific to children's "irretrievable loss of secure proximity to parents" (p. 138). First is an unresolved pattern, often extending years after the experienced loss and characterized by an intrusive preoccupation with grief and consequent difficulty in maintaining normal functioning. Second is an inhibited pattern characterized by a conspicuous suppression of the normal grief process. Research on these patterns is limited; however, both the unresolved and inhibited patterns of grief are suspected to be problematic, leading to long-term adjustment problems for children who have lost a secure relationship to parental figures (Cassidy & Shaver, 2002).

CURRENT INTERVENTIONS

The negative psychological, social, and emotional consequences of parental rejection have prompted the development of various psychotherapeutic protocols intended for work with rejected children. These interventions have centered primarily on the treatment of attachment disorders, including reactive attachment disorder (RAD), a formal clinical diagnosis describing those children who, as a result of trauma in early caregiving relationships, have come to initiate and respond to social interactions pathologically across a wide range of relationships (O'Connor & Zeanah, 2003). Interventions to address the psychological and social consequences of attachment disorders have applied a combination of psychoeducation and psychotherapy to revise negative, internalized representations of self and others that children with traumatic early relationships often carry into new relationships with caregivers and, ultimately, as caregivers themselves (Cornell & Hamrin, 2008). These interventions have also attempted to identify inaccurate relational cues sent by both children and their caregivers that reflect these negative representations and that serve to confirm and maintain their negative self-other views.

For example, children with histories of failed adult relationships can be expected to test the security of all relationships (Dozier, 2003). Although they may desperately seek adult connection, they will attempt to push away new offers of adult relationship through unresponsive and undesirable behaviors. Their testing behaviors are an attempt to avoid further rejection by driving off those would-be caregivers whose commitment to them is conditional on certain behavior standards. To avoid further rejection themselves, insecure caregivers may respond to these attempts by withdrawing their offers and thereby seeming to fulfill the children's expectations about the insecurity of relationships and the unworthiness of pledges of unconditional commitment (Dozier, 2003).

By assisting caregivers in identifying (through psychoeducation) and resolving (through psychotherapy) their own relational insecurities, counselors assume that caregivers will more appropriately be able to interpret and respond to the often confusing signals of insecurely attached children. In this therapeutic milieu, children can, in turn, begin to experience and develop new representations of relationships as accepting and stable and of themselves as acceptable. Although empirical outcome research is limited, there is currently broad support in the professional literature for the benefits of this combined psychoeducational-psychotherapeutic approach to the psychological and social damage of parental rejection (Cornell & Hamrin, 2008). The literature is far less supportive regarding best practice in the treatment of its emotional impact.

Whereas anger and grief are anticipated emotional responses to parental rejection, clinical attention has been given primarily to the anger component, as shown by emphasis in RAD diagnosis on the presence of aggressive, cruel, and destructive externalizing behaviors (Kay Hall & Geher, 2003). Interventions have targeted an internalized rage that is presumed to be harbored by rejected children toward their rejecting parent(s) and externalized through the children's negative behavioral responses. Accordingly, these interventions have stressed a need for children to reexperience and work through their rage before they can successfully enter into new caregiving relationships. A variety of corrective attachment therapies such as holding therapy, rebirthing, and rage reduction have been developed and applied to induce rage in insecurely attached children (Speltz, 2002). In the most notable of these methods, the therapist (or caregiver under therapist supervision) takes involuntary control of the child through physical restraint (holding) to induce resistance and, ultimately, rage. The child's unsuccessful attempts to escape the holding lead to eventual capitulation to the caregiver, who then takes advantage of the moment by soothing and assisting the child in containing the induced rage. This is assumed to allow the child to build new trust in the caregiver as a source of safety and security. Although proponents have claimed that coercive methods are necessary to force and resolve overwhelming, internalized emotion in rejected children, a substantial number of critics suggest that such methods do more harm than good by re-creating the previous harmful experience of those children in which parental nurturance and love were made contingent upon their submission to authority (Mercer, Sarner, & Rosa, 2003).

When grief has been targeted for intervention in parental rejection, approaches have relied largely on traditional grief work practices; that is, they have viewed grief as a normal reaction to the identified, finite loss of a parent's involvement, with recovery involving a child's movement from the loss through progressive stages of healing (Kubler-Ross & Kessler, 2007). Through combined efforts to lessen children's affectional bonds to rejecting parents (e.g., "saying good-bye" exercises; Speltz, 2002, p. 7) and to help them build their trust in new bonds, current approaches have sought to help children move on from their loss, and it is here that a major shortcoming is cited. For most rejected children, the loss of engagement from living parents is not a singular event but instead is reexperienced regularly through continued disappointments, broken promises, and dashed hopes that the rejecting parental behaviors have changed. Their resolution of grief from one loss experience is soon mitigated by new grief over the next loss, making traditional notions of recovery from grief impossible and, thus, rendering traditional intervention methods ineffective.

Concerns about the ethics and efficacy of existing approaches have resulted in calls for alternative conceptual models for understanding and treating the emotional trauma of parental rejection on children (Cornell & Hamrin, 2008; Mercer et al., 2003; Speltz, 2002). Accordingly, we introduce a promising alternative in the remainder of this article. It has been suggested that individuals who experience perpetually recurring losses may not be subject to traditional emotional responses but rather to a distinct type of emotional suffering that requires specialized considerations for counseling intervention (Roos, 2002). Whereas children's experience of perpetual loss in parental rejection is unquestionable, this distinct form of suffering has not previously been considered in efforts to understand and assist them. It is known as chronic sorrow.

CHRONIC SORROW

Chronic sorrow refers to a unique response to loss that occurs when loss is not final but continues to be present in the life of the individual (Roos, 2002). The term was first introduced by Olshansky (1962) to describe the distress of young parents following the birth of a chronically disabled child. For these parents, there was no finite period of mourning the loss of a healthy child; rather, they suffered renewed loss at each developmental milestone their child failed to achieve. Their grief was unique in that it was sustained by a cycle of ongoing loss and, thus, did not abate over time but instead became a recurrent and often increasing presence in their lives. In recent years, chronic sorrow has been identified in broader populations of individuals living with escalating physiological losses, such as Alzheimer's disease (Mayer, 2001) and multiple sclerosis (Liedstrom, Isaakson, & Ahlstrom, 2008). Although the professional literature is limited regarding the manifestation of chronic sorrow in these populations, extrapolation from current treatment and diagnostic literature suggests that chronic sorrow includes elements of grief, depression, and anxiety, but with some notable differences (Roos, 2002; Rossheim & McAdams, 2010).

Grief typically occurs around the experience of a loss and abates as the griever processes and accommodates to that loss. Grief reactions may recur periodically, but they tend to diminish with time, as the living object of the grief is gone (Rosenthal, Williams, & Naughton, 2006). In some cases, the grief process becomes "complicated" (Shear, Frank, Houck, & Reynolds, 2005, p. 2601), in that the griever is unable to accept or resolve the loss, and the intrusive symptoms of grief endure for a prolonged period. In chronic sorrow, grief may likewise be enduring, but rather than resulting from the griever's inability to resolve a finite loss, it is triggered by an ongoing pattern of new and recurring losses that are often of increasing severity.

Anxiety associated with chronic sorrow manifests itself in many of the symptoms of anxiety disorder, including constant worry, lack of focus, and anger (Mayer, 2001). However, it also bears an important distinction from that diagnosis. According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000), generalized anxiety disorder involves pervasive, disabling anxieties that "frequently occur without precipitants" (p. 475). Whereas the disabling anxiety of those experiencing chronic sorrow is characteristically pervasive, it is not characteristically without precipitants. Conversely, chronic sorrow is almost always triggered and maintained by some actual crisis or the realization of impending and, often, advancing loss (Roos, 2002).

The diagnosis of chronic depression defines the presence of affective (guilt, sadness, apathy, etc.) and behavioral (withdrawal, impaired function, etc.) symptoms that are debilitating and pervasive and not attributable to bereavement (American Psychiatric Association, 2000). The exclusion of bereavement as a diagnostic criterion for depression presumes that the clinical symptoms of depression are normal for a bereaved individual who has suffered significant personal loss and that, over time, those symptoms will subside to nonclinical levels on their own as the individual adjusts to the loss. Unlike chronic depression, chronic sorrow typically involves a normal bereavement response to real personal losses for children (e.g., guidance, nurturance, security). However, because the loss in chronic sorrow is perpetual rather than finite, its depressive symptoms tend to be pervasive and degenerative much like those experienced by people who are chronically depressed (Jacobs, 2004).

As stated previously, chronic sorrow has been conceptualized primarily as a condition that affects adults who have faced repeated losses with each progression of their own or a loved one's disability. It is surprising that it has not been applied to the case of children who similarly experience recurring loss and sorrow each day that living parents are voluntarily absent from their lives. The tenets of chronic sorrow seem to provide more accurate and comprehensive understanding of the emotional impact of parental rejection on children. Additionally, they offer a conceptual and clinical alternative to coercion for breaking through children's emotional defenses against further rejection in new relationships.

ADDRESSING CHRONIC SORROW WITH CHILDREN

In the case example, Nancy had experienced the significant loss of her father's daily involvement in her life 3 years earlier when her mother and father had divorced and established different households. At that point, according to traditional grief response models, Nancy's "grief work" would begin with her progression through initial emotions of anger and despair to a desirable point at which she could simultaneously acknowledge and accept the loss of her father's immediate availability without defensively isolating him as a source of affection and positive confirmation (Cassidy & Shaver, 2002). Ideally, her overwhelming feelings of loss and grief would give way to renewed confidence in her father's efforts and desire to be present in her life despite his physical absence from the household.

Regrettably, this adjustment was not possible for Nancy. Confidence in her father's affection and acceptance following the divorce was progressively eroded by his ensuing pattern of broken promises to spend time with her and his increasingly lengthy absences from contact with her of any kind. In the midst of recovery from her initial loss, Nancy began to suffer new, advancing losses and renewed grief as a result of her father's rejecting behavioral cues. Over time, it seems that she had become victim to the effects of chronic sorrow, its component elements all made evident when, following her father's cancellation of the Christmas visit, her visible grief was accompanied by anger ("I hate him!"), depressive doubts about her self-worth ("Am I really that bad to be with?"), and an anxious plea for reassurance that her mother would not also reject her ("Just promise you won't ever leave me!").

Because the tenets of chronic sorrow have not before been applied to understanding and addressing the needs of rejected children, counselors may be ill prepared to assist children such as Nancy with their unique experience of chronic sorrow, translating that unfamiliarity into reliance on standard treatments for its component elements of grief, depression, and anxiety (Rossheim & McAdams, 2010). Counselors are cautioned against equating chronic sorrow with any one of its component elements independently. The distinct but interactive features of grief, depression, and anxiety associated with chronic sorrow suggest a unique condition calling for both traditional and specialized counseling approaches (Roos, 2002).

ADDRESSING GRIEF

As grief is a normal response to loss, the goal of counseling is not to eliminate grief but rather to help grieving individuals put their losses and consequent suffering into perspective (Peteet, 2001). Toward that goal, supportive, person-centered counseling interventions are almost always prescribed to help grieving individuals acknowledge and bear the pain of their loss (Boelen, de Keijser, van den Hout, & van den Hout, 2007). Cognitive interventions are likewise recommended to correct for distorting tendencies (Boelen et al., 2007), such as the tendency among children to believe that they are somehow deserving of their parents' rejection. Together, these interventions are aimed at helping children to redefine the initially overwhelming scope and impact of a loss into more manageable proportions that will allow the loss to move from a foreground to background position of influence on their day-to-day lives. However, in the case of chronic sorrow for rejected children, bringing closure to the daily awareness of loss may be difficult, if not impossible to achieve, since their experience of loss is not finite and is returned to the foreground, often with increased severity, each subsequent time that a rejecting parent breaks a promise of involvement or is conspicuously absent at significant life events (e.g., holiday, birthday).

According to Peteet (2001), providing companionship is preferable to achieving closure as a therapeutic goal in grief counseling when the source of grief is without boundaries. Bringing closure to the perpetual loss of rejected children would require either a reestablishment of active parental involvement in their lives or an abandonment by the children of all hope and desire for such involvement, and neither of these outcomes is within the counselor's (or the children's) control. Children experiencing parental rejection may have greater need for trusted companionship in dealing with their grief than for ultimate resolution of the ongoing loss that is at its source (Peteet, 2001). Jeffreys (2005) more specifically defined a counselor's role in addressing the grief of chronic sorrow as one of offering "exquisite witness" (p. 127) to a griever's ongoing struggle. In that role, a counselor recognizes the unique impact of perpetual loss, accepts his or her own limitations in affecting a finite resolution, and is comfortable with a counseling process that involves understanding and support rather than control. Success in the role requires that counselors be comfortable with uncertain direction, structure, and outcome in the counseling process and tolerant of setbacks in a child's progress as new losses inevitably occur. It also requires their movement beyond only the pathological dimensions of grief toward helping grieving children to recognize and identify with the triumphs as well as the tragedies in their lives (Brown & Augusta-Scott, 2007).

Sprinthall and Collins (1984) suggested that children tend to establish and evaluate their place within the world based on "personal fables" (p. 76) in which they have overdifferentiated their experiences and feelings from those of others and believe that they are the only ones who are capable of experiencing whatever feelings of joy, horror, misery, or confusion they encounter. The fabled stories of children who have experienced parental rejection often include unrealistic and exaggerated themes of personal failure, self-blame, and inadequacy, themes that define not only their life experiences but also their views of themselves. At the same time, these children's accounts of their experiences almost always include implicit acts of extraordinary courage and personal strength that have enabled the children to prevail during periods of extreme hardship. The act of telling a personal story alone can revise its meaning and significance for the storyteller (White & Epston, 1990). Through invited and unpressured storytelling to a counselor who is attentive to triumphs as well as tragedies, children suffering from the ongoing grief of chronic sorrow may come to better understand their accomplishments and balance them against their losses as they evaluate the overall worth and quality of their lives and themselves.

ADDRESSING ANXIETY

Currently, preferred approaches to the treatment of disabling anxiety in children include medication and individual and group psychotherapy. By reducing the intensity of symptoms, antianxiety medications have demonstrated utility in helping highly anxious children to more functionally manage their anxious responses to crises and daily problems (National Institute of Mental Health, 2006). Behavioral therapies have also been used to assist children in anticipating and either avoiding or preparing for recurring crises as well as increasing their abilities to self-soothe when crises invariably occur. Group therapies have been shown to be particularly useful in providing anxious children with affirming opportunities to exchange experiences and coping mechanisms with others who share similar burdens (Bernstein, Layne, Egan, & Tennison, 2005). The demonstrated value of these medical and psychotherapeutic interventions should not be overlooked as part of a comprehensive treatment plan for children suffering from disabling anxiety. However, for children experiencing the anxiety of chronic sorrow, counselors must also be prepared to attend to resolution of the real-life insecurities that are at the source of their anxiety. This almost always requires direct intervention with the parents or surrogate adult caregivers who remain engaged in the children's lives (Cornell & Hamrin, 2008). Facilitating the caregivers' awareness of their own and their children's relational insecurities was described previously as a necessary and salient goal of the counseling process. However, awareness alone may be insufficient to enable caregivers to fulfill rejected children's needs, and counselors must be prepared to offer several other kinds of assistance (Rossheim & McAdams, 2010).

The first form of counselor assistance is crisis preparation and management. As noted previously, the anxiety of chronic sorrow is fueled by a cycle of recurring crises, the progress of recovery from one crisis soon being interrupted by the trauma of a new crisis. Although they may not be able to prevent new crises, counselors can assist caregivers and children in predicting the kinds of crises that are likely to occur and in planning for how they will respond to them. In doing so, they can reduce the ever-present element of surprise that fuels anxiety. When crises inevitably do arise, counselors can help to lessen their length and severity by providing objective insight into problem-solving efforts that otherwise may be confounded by intense emotion.

The second critical area of counselor support is around emotional respite. Over time, relentless testing behavior can exact a damaging emotional toll from those caregivers who may come to feel guilty and responsible for the children's continuing insecurity as well as resentful that their presence in the children's lives appears to be ignored and unappreciated (Cornell & Hamrin, 2008). Counseling can provide both caregivers and children a needed alternative from their day-to-day relationship as the exclusive venue for expressing intense, negative emotions. By detecting and addressing (rather than avoiding) these highly charged emotions in counseling sessions, counselors can help to ensure that the emotional pressure does not become more than the relationship can withstand, thereby enhancing the security of the relationship and reducing an important source of children's anxious insecurity.

A third contribution of counselors to anxiety reduction in chronic sorrow is through linking children and caregivers to community support. The perpetual losses underlying chronic sorrow may require ongoing support that exceeds the feasible scope of a professional counseling relationship. Physical respite child care may be needed to relieve caregivers from the drain of constant testing by insecure children. Community medical and mental health services may be needed if new losses result in crisis levels of anxiety or depression in children. Legal consultation may be necessary to ensure that remaining caregivers have sufficient authority to effectively fulfill their role. Thus, from the outset, a goal of counseling will be to link children and caregivers with appropriate community resources that will continue to support them after the direct support of the counseling relationship has ended. Counselors should be knowledgeable of their community's support services and proactive in initiating their clients' involvement with those that are appropriate to their needs. Caregivers who have the security of a strong community support system will convey that security to children who, in turn, will have less reason to feel anxiously insecure.

ADDRESSING DEPRESSION

Standard treatments for the symptoms of depression in children typically include a combination of medical and psychotherapeutic interventions that should not be discounted in the treatment of chronic sorrow. Appropriately prescribed medications have shown substantial benefits in both reducing depressed mood and relieving impaired cognition and affect that could inhibit a depressed child's objectivity and responsiveness to the counseling process (Badal, 2003). Cognitive therapies have likewise been shown to be beneficial by helping to establish restorative goals and dispel restrictive beliefs, such as a belief by rejected children that they are somehow responsible for the rejection (Asarnow, Jaycox, & Tompson, 2001). Several approaches to cognitive intervention appear to have particular salience for achieving these goals with children whose sense of parental loss is real and frequently renewed.

The first approach involves reframing the rejection, so that the child is provided with alternative reasons for it other than the often prevailing assumption that he or she is unworthy of being loved. Sternberg (1988) and others have described love not as a singular entity but as having both feeling elements (e.g., having high regard for another, valuing another in one's own life, and wanting the best for another) and doing elements (e.g., sharing oneself and one's possessions with another, providing for the welfare of another, and being there for another in time of need; Newman & Newman, 2009). Applying this multifaceted conceptualization of love, counselors can help children begin to understand that being loved is not always a dichotomous experience, as in "I am either loved or not loved." Rather, children can come to see its feeling and doing elements, and that their parents can still feel love for them without being able to provide all of the doing elements. Drawing this possible distinction between parental love and availability can be self-affirming for children who may have come to assume that they were not loved (or worthy of being loved) due to the unavailability of their parent(s). Counselors can also discuss the reasons for the parents' failure to provide the doing elements of a loving relationship, such as substance abuse or mental illness, within the counseling relationship, always emphasizing that responsibility for the failure lies with the parent and not the child. By reframing parental love from a more complex perspective, counselors can help rejected children and their remaining caregivers to capitalize on the feeling and doing components of love that a distant parent is able to provide while minimizing unrealistic expectations of the parent that can lead to further disappointment and negative self-evaluation.

In addition to redefining children's negative views of themselves, counselors can also help them to maximize their associations with positive sources of self-affirmation. Within the counseling session, counselors can apply a strength-based approach that highlights past and present successes in children's lives to give them a tangible anchor of self-affirming experiences and perceived competencies (Smith, 2006). It is hoped these competencies will then be weighed against perceived insufficiencies as children evaluate their overall worth. Integral to this is counselor encouragement of parents and caregivers to also engage in strength-based communication with their children. By modeling and teaching parents to incorporate strength-based communication, counselors help to ensure that its potential benefits will be afforded to children at home as well as in the counseling session. Another beneficial aim of counseling can be to work with parents and caregivers to expand their children's associations with positive adult influences in the community. Establishing a broad network of positive relationships with adult mentors through school, sports, church, and other community activities increases the chances that children burdened with self-doubt will receive frequent and consistent messages of affirmation in their day-to-day activities. Finally, counselors can promote culturally responsive interaction with children that helps them differentiate between environmental barriers and personal deficiencies. Acknowledging the way children have fought through significant social, racial, cultural, or gendered barriers can also result in greater self-efficacy and engagement in treatment (Swartz et al., 2007).

A third area of counseling intervention involves helping children restore a sense of control in their lives. Whereas counselors cannot change the reality of parental rejection for children, they can work collaboratively with remaining parents and caregivers to help rejected children to reestablish a necessary sense of personal control and competence that rejection has eroded (Kaslow, Davis, & Smith, 2009). They can first help caregivers to establish a sufficient structure in the children's living environment based on a clear system of rules and boundaries. Children must know what their freedoms and limits are before they can successfully learn to navigate them independently (Pickering, 2003). Next, counselors can help caregivers ensure that the established living structure affords children maximum, age-appropriate opportunities to learn to make decisions and to solve problems that have an impact on their lives. Whereas rules may appropriately need to be determined by caregivers, there is almost always some latitude for giving children a say in precisely when or in what manner the rules are to be carried out (N. Thomas, 2002). Finally, counselors can facilitate the engagement of children in helping activities. By working with caregivers to engage children in helping others at home and in the community, counselors can give children the opportunity to view themselves as capable of making a contribution to the world rather than as victims to it (Parker, Zuckerman, & Augustyn, 2005).

BEYOND THE FORMAL COUNSELING RELATIONSHIP

As indicated throughout the preceding paragraphs, counseling intervention to address the chronic sorrow of rejected children is, by necessity, a collaborative endeavor that must involve the children's remaining parents and caregivers. Because these children experience recurrent and advancing loss, intervention to address their chronic sorrow is also likely to be an ongoing endeavor that will need to continue well beyond the feasible period of a counselor's direct involvement. To sustain the benefits of counseling beyond the formal counseling relationship, parents and caregivers must be able to assume essential aspects of the counselor's therapeutic function once the formal counseling relationship is terminated. A counselor's primary task is, thus, to facilitate this necessary transfer of responsibility.

First, counselors can help these parents and caregivers come to understand that their role with children experiencing the chronic sorrow of parental rejection is not only one of providing "good parenting" but also one that requires them to assume a remedial role to address the unique psychological, social, and emotional damage of parental rejection, including chronic sorrow. This understanding may be particularly beneficial for caregivers who have successfully parented children in the past but now find their same parenting practices to be frustratingly ineffective with rejected children. Next, counselors can provide parents and caregivers with opportunities to learn and practice the appropriate intervention skills and to identify sources of family and community support that will enable them to persevere in their delivery of those interventions for an indefinite and potentially extended period of time. Above all, counselors can empower remaining parents and caregivers by honoring their selfless and sometimes thankless willingness to bear the brunt of the emotional harm done by the neglect of other adults in the children's lives. Whatever shortcomings parents and caregivers might bring to the task, counselors must remember that the sustained involvement of these individuals in rejected children's lives may offer the best hope the children have of successfully managing the chronic sorrow of perpetual loss.

REFERENCES

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.

Akse, J., Hale, W. M., III, Engels, R. C. M. E., Raaijmakers, Q. A. W., & Meeus, W. H. J. (2004). Personality, perceived parental rejection, and problem behavior in adolescence. Journal of Psychiatry and Psychiatric Epidemiology, 39, 980-988.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Asarnow, J. R., Jaycox, L. H., & Tompson, M. C. (2001). Depression in youth: Psychological interventions. Journal of Clinical Child Psychology, 30, 33-47.

Badal, D. W. (2003). Treating chronic depression: Psychotherapy and medication. Northvale, NJ: Jason Aronson.

Baumeister, R. F., Brewer, L. E., Tice, D. M., & Twenge, J. M. (2007). The need to belong: Understanding the interpersonal and inner effects of social exclusion. Social and Personality Psychology Compass, 1, 506-520.

Bernstein, G. A., Layne, A. E., Egan, E. A., & Tennison, D. M. (2005). School-based interventions for anxious children. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1118-1127.

Boelen, P., de Keijser, J., van den Hout, M., & van den Hout, J. (2007). Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 75, 277-284.

Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. New York, NY: Basic Books.

Brown, C., & Augusta-Scott, T. (2007). Narrative therapy: Making meaning, making lives. Thousand Oaks, CA: Sage.

Cassidy, J., & Shaver, P. R. (Eds.). (2002). Handbook of attachment: Theory, research, and clinical implications. New York, NY: Basic Books.

Cornell, T., & Hamrin, V. (2008). Clinical interventions for children with attachment problems. Journal of Child and Adolescent Psychiatric Nursing, 21, 35-47.

Dozier, M. (2003). Attachment-based treatment for vulnerable children. Attachment & Human Development, 5, 253-257.

Gallop, R. (2002). Failure of the capacity for self-soothing in women who have a history of abuse and self-harm. Journal of the American Psychiatric Nurses Association, 8, 20-26.

Hamilton, G. N. (1989). A critical review of object relations theory. American Journal of Psychiatry, 146, 1552-1560.

Hardy, K. (2002). Parental favoritism. Retrieved from http://abcnews.go.com/sections/2020/ DailyNews/2020_favoritism_020503.html

Harvey, G. (2007). Grieving for dummies. Hoboken, NJ: Wiley.

Jacobs, B. J. (2004). From sadness to pride: Seven common emotional experiences of caregiving. In C. Levine (Ed.), Always on call: When illness turns families into caregivers (pp. 111-125). Nashville, TN: Vanderbilt University Press.

Jeffreys, J. S. (2005). Helping grieving people wizen tears are not enough: A handbook for care providers. New York, NY: Brunner-Routledge.

Kaslow, N. J., Davis, S. P., & Smith, C. O. (2009). Biological and psychosocial interventions for depression in children and adolescents. In I. Gotlib & C. Hammen (Eds.), Handbook of depression (2nd ed., pp. 642-672). New York, NY: Guilford Press.

Kay Hall, S. E., & Geher, G. (2003). Behavioral and personality characteristics of children with reactive attachment disorder. Journal of Psychology: Interdisciplinary and Applied, 137, 145-162.

Kubler-Ross, E., & Kessler, D. (2007). On grief and grieving: Finding the meaning of grief through the five stages of loss. New York, NY: Simon & Schuster.

Liedstrom, E., Isaakson, A.-K., & Ahlstrom, G. (2008). Chronic sorrow in MS patients' next of kin. Journal of Neuroscience Nursing, 40, 304-311.

Magro, M. M., & Weiss, J. R. (2006). Perceived control mediates the relation between parental rejection and youth aggression. Journal of Child Psychology, 34, 863-872.

Mayer, M. (2001). Chronic sorrow in caregiving spouses of patients with Alzheimer's disease. Journal of Aging and Identity, 6, 49-60.

McAdams, C. R., III, Foster, V. A., Dotson-Blake, K., & Brendel, J. M. (2009, February 9). Dysfunctional family structures and aggression in children: A case for systemic, school-based approaches with violent students. Journal of School Counseling, 7. Retrieved from http:// www.jsc.montana.edu/articles/v7n9.pdf

Mercer, J., Sarner, L., & Rosa, L. (2003). Attachment therapy on trial: The torture and death of Candace Newmaker. Westport, CT: Praeger.

National Institute of Mental Health. (2006). Anxiety disorders (DHHS Publication No. ADM 06-3879). Washington, DC: U.S. Government Printing Office.

Newman, B., & Newman, P. (2009). Development through life: A psychosocial approach. Belmont, CA: Wadsworth.

O'Connor, T. G., & Zeanah, C. H. (2003). Attachment disorders: Assessment strategies and treatment approaches. Attachment and Human Development, 5, 223-244.

Olshansky, S. (1962). Chronic sorrow: A response to having a mentally defective child. Social Casework, 43, 191-193.

Parker, S., Zuckerman, B., & Augustyn, M. (Eds.). (2005). Developmental and behavioral pediatrics: A handbook for primary care (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Peteet, J. R. (2001). Patient suffering into perspective: Implications of the patient's worldview. Journal of Psychotherapy Practice and Research, 10, 187-192.

Pickering, J. S. (2003, July 1). Discipline: Developing self-control. Montessori Life, 15, 18-20.

Rohner, R. P., Khaleque, A., & Cournoyer, D. E. (2005). Introduction to parental acceptance--rejection theory: Methods, evidence and implications. In R. P. Rohner & A. Khaleque (Eds.), Handbook for the study of parental acceptance and rejection (4th ed., pp. 1-35). Storrs, CT: Rohner Research.

Roos, S. (2002). Chronic sorrow, a living loss. New York, NY: Routledge Taylor & Francis Group. Rosenthal, T. C., Williams, M. E., & Naughton, B. J. (Eds.). (2006). Office care geriatrics. Philadelphia, PA: Lippincott Williams & Wilkins.

Rossheim, B. N., & McAdams, C. R. (2010). Addressing the chronic sorrow of long-term spousal caregivers: A primer for counselors. Journal of Counseling & Development, 88, 477-482.

Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F. (2005). Treatment of complicated grief: A randomized control trial. Journal of the American Medical Association, 293, 2601-2608.

Smith, E. J. (2006). The strength-based counseling model. The Counseling Psychologist, 34, 13-79.

Speltz, M. L. (2002). Description, history, and critique of corrective attachment therapy. The APSAC Advisor, 14, 4-8.

Sprinthall, N. A., & Collins, W. A. (1984). Adolescent psychology: A developmental view. Reading, MA: Addison-Wesley.

Sternberg, R. (1988). The triangle of love. New York, NY: Basic Books.

Swartz, H., Zuckoff, A., Grote, N., Spielvogle, H., Bledsoe, S., Shear, M., & Frank, E. (2007).

Engaging depressed patients in psychotherapy: Integrating techniques from motivational interviewing and ethnographic interviewing to improve treatment participation. Professional Psychology: Research and Practice, 48, 430-439.

Thomas, H. E. (1999). The shame response to rejection. Sewickley, PA: Abnel.

Thomas, N. (2002). Children, family and the state: Decision making and child participation. Bristol, England: Policy Press.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY: Norton.

Winnicott, D. (1971). Playing and reality. New York, NY: Basic Books.

Charles R. McAdams III and John A. DeweI1, Department of Counselor Education, The College of William and Mary; Angela R. Hohnan, Department of School Administration and Counseling, The University of North Carolina at Pembroke. Correspondence concerning this article should be addressed to Charles R. McAdams III, Department of Counselor Education, School of Education, The College of William and Mary, Jones Hall 3065, 200 Ukrop Way, PO Box 8795, Williamsburg, VA 23187-8795 (e-mail: crmcad@wm.edu).
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Author:McAdams, Charles R., III; Dewell, John A.; Holman, Angela R.
Publication:Journal of Humanistic Counseling
Article Type:Report
Geographic Code:1USA
Date:Mar 22, 2011
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