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Play and healing: therapeutic recreation's role in coping with grief.

Camp can be an ideal setting to help children cope with the death of a loved one. Since 1991, Camp ReLeaf, a weekend camp hosted by Triangle Hospice of Durham, North Carolina, has been helping children develop positive coping skills for dealing with the recent death of a family member. Camp ReLeaf offers all the fun of a traditional residential camp, while creating a safe place for youth to express and deal with their grief. Over the years, therapeutic recreation has become one of the cornerstones of this camp's program.

The Role of Therapeutic Recreation

By using education and recreational activities, therapeutic recreation helps people with illnesses, disabilities, and other conditions enhance their health, independence, and well-being. Hospice coordinators recognize the benefit of therapeutic recreation components to the camp schedule. One certified therapeutic recreation specialist (CTRS) and several college students facilitate sessions for all age groups. Many campers share their feelings for the first time while participating in these therapeutic recreation sessions.

Teaching Coping Skills

When campers arrive at Camp ReLeaf, they are divided into three groups based upon grade (K-2, 3-5, 6-8). Siblings and cousins are placed in different groups, if possible, to allow campers more security in expression of feelings and to reduce behavior issues and unhealthy competition.

The older group attends sessions in problem solving/trust building, journaling as a coping strategy, and "Cool Tools for Coping," an interactive discussion focusing on coping skills development. Other sessions include making a collage of life, making T-shirts and hats, and playing games using open-ended questions to facilitate discussion of feelings, interests, and memories of their deceased loved ones.

Sessions in the two younger groups' schedule include: "Cool Tools for Coping," a humor workshop lead by a professional clown, and an anger management workshop to teach them to safely express and cope with their anger through physical activity. Campers also attend therapeutic recreation sessions, where they take part in activities, such as collage of life and hand puppets, which are facilitated by a CTRS.

Collage of life

In this activity, campers search through magazines and catalogs to find pictures of their favorite activities, as well as those that make them feel good. They then make a collage of these items on paper. Once the collages are finished, the certified therapeutic recreation specialist leads campers in a discussion. Because children often feel afraid or guilty if they laugh and have fun, discussing what makes them feel good can be difficult. The CTRS helps campers understand how these special activities can actually be powerful coping mechanisms.

Hand puppets

Campers make hand puppets out of socks, decorating them to reflect their individual personalities and preferences. A wide variety of materials, such as buttons, pom poms, ribbons, doll eyes, glitter and sequins, yarn, and a hot glue gun, are available to help campers make puppets that are special to each of them. Staff members explain to campers how their puppets can help them when times get tough: the puppets can listen when no one else is available, they can give companionship when the child is lonely, they can help tell an adult something that is difficult to say out loud, and they can be used to have fun.

Making a Memory Board

Each child at camp makes a memory board using photos and other items brought from home that remind the child of their deceased loved one. Not all campers bring photographs, so they are encouraged to make a board that is representative of the person who died by writing words to express their feelings, listing the interests of the person, or describing a happy memories of that person. In addition, pictures cut from magazines and catalogs, stickers, glitter, fabric material and notions, and items found on nature walks often complete the boards.

The making of the memory boards provides an excellent opportunity for camp staff (and parents when campers return home) to talk bout the person who died. Making memory boards can be emotionally powerful and emotionally draining for both campers and staff. Each child takes the memory board home to remember the loved one, to remember camp and what was learned, and to help with cope when times get tough.

Balloon Release Ceremony

After campers complete their memory boards, they are given a piece of rice paper on which to write messages to their loved one who died. Staff members help write, as well as help with the emotions that this task often evokes. The rice paper message is then attached to a helium balloon. (The rice paper and special balloons are both biodegradable).

The entire camp then gathers on the field for the balloon release ceremony. The camp director talks about the concept of "ritual" and explains how rituals can help people deal with loss. She states that the balloon stands for the person who died and that it carries a personal message from the camper. She further explains that the balloon is not the person, but by this ritual, an event was created to help the camper deal with grief and loss.

A counselor from each cabin calls out the name of each child's loved one and the child's special name for that person, such as "MeMaw" or "Daddy." As the balloons drift up and away, Collin Raye's song, "Love Remains," is played. Campers and staff spend time talking, hugging, consoling, or in silence and wander off in pairs or small groups.

We Are Better People

At the end of this time of reflection, the three cabin groups meet in separate locations around camp. A counselor gives each camper a small cloth bag containing three stones and a poem. Two of the stones are smooth, polished, and beautiful. The other rock is rough and plain. The poem says, "Each of us has bright and shiny pieces in our lives, as well as places in our hearts that will always be rough and painful; and because of this, we are better people."

For children who are experiencing grief, the availability of understanding staff who are willing to listen, peers in a similar situation, and coping activities provide a valuable step toward healing. Therapeutic recreation can play a large role in this process.

About Camp ReLeaf

Camp Setting

Like most bereavement camps, Camp ReLeaf is held on the grounds of an existing established camp. Many of the children coming to the camp are from more urban areas and have never been to camp before. The excitement over the natural setting is very much a part of the positive atmosphere of Camp ReLeaf.

The Referral Process

Approximately thirty-five campers attend Camp ReLeaf each year. Campers are referred by local hospice programs, schools, counseling centers, local hospitals, and other human service agencies. The deceased loved one of the campers was not required to have been involved with the sponsoring hospice. Each camper pays a nominal registration fee. However, scholarships are available if the cost is a hardship to the family.

Camp Staff

Approximately fifty staff members participate in Camp ReLeaf each year. Many of the staff members are trained professionals and volunteers from Triangle Hospice. The remainder are volunteers from the community, including teachers, social workers, and students. All staff members are given training in how to support bereaved children and how children grieve in general. Staff members are assigned to a specific cabin group or a specialty area, such as therapeutic recreation. Those assigned to a specific cabin group are given background information on each of the campers in the cabin.

What Is Grief?

Grief is the extreme emotional pain felt following a loss. For a child, the death of a loved one is one of the most traumatic experiences. Each child grieves differently, depending upon the age and developmental stage of the child. However, all children feel the loss of a loved one at some level.

* For an infant, the loss of a family member is not comprehended. However, behavioral changes often occur as the baby responds to parental grief. General distress and despair will often be seen.

* For children ages two to five, confusion, bad dreams, and agitation are often seen during times of bereavement. Regression is also common, with children exhibiting behaviors such as tantrums, bed wetting, and thumb sucking that have not been present for months or years. Repeated questioning about the deceased family member reveals that some amount of understanding has occurred, although misunderstandings about what death is may be common.

* A child who is five to eight years old wants to understand death in a concrete way. Denial, anger, and intense sorrow are frequently expressed. Children at this age may also ask repeated questions about death and will have deeper comprehension.

* Children ages eight to twelve have a better understanding of the finality of death. Often morbid curiosity and peer conformity are key components of the grief process.

* Adolescents grieve similar to adults, but have fewer coping mechanisms.

Suggestions for Working with Grieving Children

* Encourage questions and give honest answers.

* Expect regressive behavior.

* Let the child talk; be prepared for repetition of the details.

* Accept their grief and anger toward God and people.

* Establish trust.

* Realize that no one can give grieving children what they wants most: the return of the loved one.

* Encourage bereaved children to be patient with themselves.

* Use the words "death" and "died." Don't use euphemisms such as, "went asleep," "went away," or "lost." Children may take it literally, which can cause additional fears.

* Don't be afraid to mention the deceased.

* Don't expect the bereaved person to be the same as before.

* Don't tell grieving children that they should feel better.

* Don't try to take their defenses away.

Beth Sorensen, MSRA, TRS/CTRS, CCM, is project coordinator and instructor in the Department of Recreation and Leisure Studies at the University of North Carolina at Chapel Hill.

Kathryn (Kat) King, MSRA, works as an inclusion specialist at Community Partnerships in Raleigh, North Carolina.
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Title Annotation:Camp ReLeaf; includes related article on grief
Author:King, Kathryn
Publication:Camping Magazine
Date:Mar 1, 1999
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