In addition, he or she is almost certain to feel responsible, and guilty about the loss he or she has experienced." (nd) Behavioral manifestations of the inability to cope with feelings of grief include "angry outbursts, irritability, sleeping and eating disorders, and persistent questioning about the details of death." (Fiorini and Mullen, 2007) Frequent expression of grief in childhood and adolescence include "fear of personal fallibility, psychosomatic ailments, and difficulties with schoolwork, nightmares or sleep disorders, changes in eating patterns, temporary regressions and shock." (Fiorini and Mullen, 2007) Fiorini and Mullen note that four tasks were outlines by Fox (1985) in assisting children with understanding their grief, commemorating the loss and with moving on with their life. It is stated that interventions that have been successful in children who are dealing with grief include those of "play therapy, narrative therapy and art therapy." (Fiorini and Mullen, 2007) The work of Nabors (2004) et al. entitled: 'A Pilot Study of the Impact of a Grief Camp for Children' relates a study in which states findings that "children reported that art activities helped them to express feelings about their grief and release feelings of sadness and worry related to the death. Parents and children felt that the camp was a positive experience and that the children benefited from being in groups with peers who had also lost family members." (2004)

The work of Busch and Kimble (2001) entitled: 'Grieving Children: Are We Meeting the Challenge' published in the Journal of Pediatric Nursing states that "an effective way to help children develop strategies to cope with loss is though a bereavement support groups. The use of art therapy, recreation, psychodrama, puppets, workbooks, discussions, writings and other supportive activities are all structured into sessions that help children express grief openly and receive support from others who are grieving." (2001) the primary purpose of the group is "not to achieve resolution of grief, but rather to give the students the skills and support to continue to work toward resolution of their grief." (Busch and Kimble, 2001)

The work of Graham and Sontag (2001) entitled: 'Art as an Evaluative Tool: A Pilot Study' published in Art Therapy: Journal of the American Art Therapy Association relates a study that examined the effectiveness of an art therapy support group for children who were grieving. The assessment utilized artwork for making qualitative measure of the perspective of the experiences in this group of children. Results of the study state that evaluation of perceptions of the children's grief "was conducted retrospectively at a 'reunion' of the group one year after completion of a 10-session treatment program." (Graham and Sontag, 2001) it is stated that three themes emerged in this study as follows:

1) the vulnerability of grieving children;

2) the importance of maintaining memories; and 3) the contribution of the group to the process of grieving. (Graham and Sontag, 2001)

Findings are stated to indicate "that art can be an effective tool to evaluate children's grief groups." (Graham and Sontag, 2001) the work of Ellenbecker and King (1990) entitled: 'The Effects of Gender and College Major on Mood State Changes Induced through Artistic Expression' published in the American Journal of Art Therapy states that "a basic tenet of art therapy is that the process of creating art is associated with positive mood change."

The work of Nicole Resnick (2005) entitled: 'It's All Right to Cry: How to Help Kids Cope with Death, Dying and Grief' relates a story in which a child is asked why he believed his grandfather had died and the little boy confided that "he felt he was responsible" as he had "accidentally stepped on his grandpa's oxygen tube the same night the terminal man passed away." (Resnick, 2005) Resnick expressed that had this child not had the chance to voice this belief "he may have harbored this misguided guilt for years." (2005) the tendency, according to Resnick is to not speak about grief...

Resnick specifically states: "For many young children, art therapy is a highly effective approach to managing the grieving process." (Resnick, 2005) Resnick relates that a bereavement counselor and art therapist at HospiceCare, Molly Tomony "...says the philosophy of this growing field is that we all have an inherent capacity to create, when it is difficult to articulate feelings verbally, there are other ways to express feelings and struggles." (2005) in fact, many things are revealed through children's artwork. Resnick share the story of Tomony who states "...she once taught a little boy who drew a picture of the battle being waged between the good healthy cells -- drawn in red -- and the bad cancerous cells -- drawn in black -- inside his father's body. Very perceptive, Tomony thought, but she also noticed many black cells drawn along the bottom of the paper, outside of his father's body. When asked what they meant, the child said that they represented the cancer cells that came off of his dad's feet as he walked. That is why, the child explained, he always wore shoes at home -- to avoid catching cancer from the cells on the floor." (Resnick, 2005)
CONCLUSION

Findings in this study indicate that art therapy is a very effective method is assisting grieving children in coping with the loss of a loved one. Children often harbor erroneous beliefs and misconceptions about the reason the loved one has died and furthermore, often harbor misplaced self-guilt concerning the death of their loved one. Art therapy is highly effective in assisting children in the expression of their grief and furthermore, is highly effective in assisting children in moving on with their life avoiding depression and self-guilt associated with the death of their loved one.

RECOMMENDATIONS

Recommendations that have arise during the course of this study for future research include a recommendation that more research be applied to understanding how children process the death of a loved one and the various forms of guilt that children attach to self related to the death of a loved one. Furthermore, future research should focus on understanding precisely how children represent grief and death and how this conceptualization of death is portrayed in their artwork and specifically as related to death by disease and how this relates to the child's feelings of safety and security following the death of a loved one by diseases such as cancer.

Bibliography

Art Therapy (2008) National Standard - the Authority on Integrated Medicine. Online available at http://www.naturalstandard.com/index-abstract.asp?create-abstract=/monographs/alternativemodalities/patient-arttherapy.asp

Malachiodi, Cathy a. (2003) Using Creative Activities as Intervention for Grieving Children. Trauma and Loss: Research and Interventions Vol. 3 No. 1, 2003. The National Institute of Trauma and Loss in Children. Online available at http://www.tlcinstitute.org/creative.html

Fiorini, Jody J. And Mullen, Jodi a. (2007) Understanding Grief and Loss in Children - Article Seven.

Nabors, Laura, et al. (2004) a Pilot Study of the Impact of a Grief Camp for Children. Cambridge Journals Palliative and Support Care 2004 Vol. 2-19 Jul 2005. Online available at http://journals.cambridge.org/action/displayAbstract;jsessionid=8DE0B69D35D46519FE4401EA5F569E1C.tomcat1?fromPage=online&aid=315560

Busch, Teri; and Kimble, Cathy S. (2001) Grieving Children: Are We Meeting the Challenge? Pediatric Nursing July 2001. Online available at http://findarticles.com/p/articles/mi_m0FSZ/is_4_27/ai_n18612273/pg_1?tag=artBody;col1

Resnick, Nicole (2005) it's All Right to Cry: How to Help Kids Cope with Death, Dying and Grief. Madison Magazine. September 2005. Online available at http://madisonmagazine.com.stage.embtv.com/article.php?section_id=918&xstate=view_story&story_id=207474

Art Therapy with Children Experiencing Grief