I thought it was my job to protect my parents. They would cry when I cried, therefore I tried not to cry in front of them, then I broke out in hives from the stress. Doctors told me not to do that anymore.

- Sister of a murder victim

influence of family coping mechanisms

The issues of strength and weakness are key concepts in all intervention strategies for co-victims. Other issues that families commonly struggle with have been noted:

- Death and conversations about death are taboo;

- Someone must be to blame;

- Things must go on as before; and

- All must function with openness and a sharing of feelings (Haran, 1988).

implications for caregivers

It is important that all members of a family should be given support and assistance as one entity, even the most reluctant. This may not always be possible, but every effort should be made to include as many members as possible.

Systemic treatment through one or more members can be also effective. Some of the goals of systemic therapy include:

- Reinforce existing strengths in family;

- Empower and promote family social support; and

- Help establish new patterns, rules, expectations, and skills.

Family therapy is ideal for working through traumatic grief, yet many service providers continue to view the individual client without consideration of the family dynamics. I would hope that there would be greater interest and utilization of the systemic model in dealing with co-victims in the future.

unique family issues

Part of the family has died along with the victim. This missing piece can never be restored. As such, treatment models need to be adapted to address this issue. In order to provide appropriate interventions, caregivers will need to understand several distinct familial subsystems within the context of the unique victim to co-victim relationship of each:

- Parents;

- Spouses;

- Children;

- Siblings;

- Significant others; and

- Extended family.

The role that the murdered loved one played in the family will have various impacts on the family.

parents

There have been numerous studies on parents who have lost a child, which find that many parents never heal. They believe that they have failed in a major parental role - that of protector, even if their child was an adult:

- Demographically largest group of co-victims by relationship;

- Death of a child rated as most stressful life event;

- The issues and emotions revolve around the loss of the relationship not the age of the child; and

- There is no word in the English language to define a parent whose child has died.

the parental dyad

One of the greatest problems experienced in parental bereavement is that although parents are viewed as representing a dyad, they are two distinct individuals. These disparities can be especially profound when it comes to gender differences in grieving.

One member may show her distress more visibly than the other. One may sacrifice and put on hold his needs in the service of the other. Misunderstandings may occur with accusations regarding their depth of love, putting wedges instead of bridges between the couple in its attempt to cope.

Responders are cautioned against referring the most visibly distressed family member for individual treatment in place of a more appropriate recommendation for couples or family treatment to minimize the widening of wedges between them.

Grief work must occur almost entirely after a violent death, as differentiated from a natural, anticipated death. In a violent death, the grief work occurs almost entirely after the death, rather than being anticipatory as in the death of a child from an illness.

There are unique tasks that are required of the parents of a murdered child, such as interaction with the hospital, medical examiner's office, criminal justice system, and the media.

Depending on the circumstances, this process can take several years or more to complete. It may also consume a lot of energy, often leaving the parents little strength to focus on what is normally thought of as grief work.

single parents

Depending on the specific personal situation - unmarried, divorced, separated, or widowed - single parents will face a number of circumstances that can further complicate their grief and trauma.

The burden may become heavier as they may have to deal with the various systems alone. They may be estranged from the other parent, be thwarted by the inclusion of the other parent, or unite as a "new" team.

Efforts to include the other parent should encourage the working with one another in the face of this overwhelming ordeal.

It is a strong marriage, a different marriage. We have been through a great deal and the murders played a very big part. I wish I could say we are cohesive, sharing, aware. I think we have dealt with it each in our own way.
- mother of two murder victims.

gender differences in grieving

The bereaved mother is often the more verbal partner in articulating her anger, her reactions to the murder, and any second injuries.

Mothers are more likely to show their emotions and to do so without attempting to contain their feelings; they may cry, scream, keen, and wail.

The often strong reaction to her emotional displays and the attempts of others to intervene may impart the impression to the bereaved mother that there is something wrong with her or that she is "going crazy".

It is important to reassure the bereaved mother that she is not "sick" and that others have had similar reactions. Well-meaning family and friends often encourage the bereaved mother to go to a doctor in the misguided idea that there must be a "pill" that can be prescribed to anesthetize the pain.

This can lead to a plethora of secondary problems including the inability of the co-victim to experience her grief and to actively participate in the funeral and other rituals, which can have their own healing effect.

grieving fathers

Men are so strongly indoctrinated with the need to be non-emotive in pain that they often feel greater pressure from within themselves, than they do pressure from other people. It is not surprising that many fathers express some resentment for this burden.

The father is expected to be "strong" and to cope with many of the details that arise after the death. When parents are unable to cope and to carry on their traditional roles, society tends to be less forgiving of the father, which may help explain why men appear to return to their normal day-to-day activities more quickly than women.

This, of course, varies within and between different races, ethnicities, and socio-economic classes.

The expectation that fathers must be strong may deny them the opportunity to be comforted by others and to express grief. In the aftermath of a child's homicide, the father may perceive inquiries of, "How's your wife/girlfriend doing?"as a denial of his pain and grief, hindering his desire to discuss his feelings.

spousal grief

Isolating nature of grief creates unique issues for widow / widower. Caregivers need to fully understand the isolating nature of widowhood and the unique stresses surrounding the violent death of a spouse. The recently widowed must learn new tasks and skills, regardless of the cause of death.

"For most of us, our relationship with our mate is .. .a central part of our self and our being in the world. As a result, one of the major roles your spouse had was as someone who affirmed your identity" (Rando 1988).

If a marital relationship is troubled at the time of a murder, there may be residual feelings of guilt and anger.

guilt or anger

A spouse may be angry that responsibilities, which were formerly shared, are now greatly increased because the spouse is now alone as a result of the murder. If the co- victim blames the murdered spouse for behaving in a way the co-victim feels may have contributed to the murder, the anger is exacerbated.

This blame can be extended to behavior as innocuous as working late. The anger associated with blame often covers up other emotions that may be too difficult to deal with at that time in the grief process.

children

Frequently children are forgotten, ignored or not included during the overwhelming experience of the announcement of the murder. This is often well intended, but there is convincing evidence that children's exposure to violence puts them at risk for later violence, health problems, and overall life adjustments.

Children must be included in the solution for helping them deal with the impact of murder in their lives. There is inadequate research on the impact of homicide on children and how birth order and their relationship with the murder victim impacts them.

Children need to know the truth about death. Adults should try to give children as much age-appropriate, factual information as possible. Younger children do not need to know all the gruesome details of murder, but they do need to understand the finality of death. Issues regarding death should be death with concretely.

Small children may engage in "traumatic play." This creative enactment is not inappropriate; in fact, such play can provide an opportunity for further discussion with children about the murder.

On the other hand, older children and teens may not want to initiate conversations about the murder and may need to be drawn out. Utilizing other techniques such as inviting them to write or draw what happened can be helpful.

The grief of child co-victims may be delayed until later on in life. A child's ability to utilize fantasy will help him cope with what has happened, but may also but together connections that debilitate him.

Attention to the needs and assessments that show the potential for maladjustment is needed to help families with support systems for children.

grieving patterns of children

Children mourn differently than adults and a child's grief can be easily aborted and replaced by a variety of defensive operations which can postpone indefinitely the process of mourning.

The grief of children extends across developmental stages. Current needs or events will interrupt grieving. Children communicate their grief differently than adults.

indirect + direct issues

INDIRECT: CO-VICTIMS WHO DID NOT WITNESS THE HOMICIDE

The extent to which violence reaches our children can be seen in a study of inner-city elementary and high schools, where over 70% of the students reported having witnessed the robbing, stabbing, shooting, or killing of another person (Bell, 1991a, p. 2).

Today, with the increase in the homicide rate of young African American men in the inner city, African American children in the inner cities are most likely to have had a sibling murdered, with the murder of a parent being the second most murdered relative.

It is not unusual for children in the inner city to have had more than one family member murdered.

DIRECT: CO-VICTIMS WHO WITNESSED THE HOMICIDE

Children who witness violence directly may be particularly traumatized. They frequently exhibit posttraumatic stress symptoms and other extreme reactions. Such stress may actively interfere with a child's ability to reminisce or otherwise reduce the emotional resources available to them throughout the grieving process.

The extent of stress largely depends on the type and amount of support available to these children, and the ways in which the family interacts as a result of the murder.

Traumatized children are typically haunted by intrusive images of the violence, recurring traumatic dreams, and a preoccupation with revenge fantasies. They may withdraw socially, act emotionally constricted, lose interest in their normal activities, and perform poorly in school.

As Pynoos and Eth (1985) state these children are also at greater risk to perpetrate violence as they grow older (p. 21). Child witnesses of murder will be affected throughout their lives.

intra-family homicide

The murder of a loved one by another family member exacerbates all of the issues that affect co-victims of homicide.

Furthermore, the stresses of an intra-family homicide may totally destroy any semblance of family, at least as it existed before the murder. In addition to the trauma, grief, and bereavement issues, there are many other complex family system and legal issues, such as custody, property matters, and concerns with social security payments.

It is not uncommon for the family to end up in criminal or civil court, or both, locked in an adversarial stance.

Also common in intra-family homicide situations is longstanding issues of distrust among family members.

beyond the immediate family

Although the immediate family of a murder victim may feel the greatest impact from the death, there are others who experience its effect as well: such as extended family members who often rally around the immediate family and give support.

These co-victims may feel the loss as deeply or, under certain circumstances, even more deeply than the identified family of grief. A part of the family of the murder victim includes co-workers and friends, neighbors, fiancee's, and so on.

The victim may have lived far from family members and learned to rely on friends and colleagues as a surrogate family. Or, perhaps, a family estrangement may have led to the strengthening of other non-familial relationships.

Estimates have been attempted that suggest for the 30,000 homicides annually in the United States there are between 120, 000 and 240,000 relatives and other co-victims making homicidal bereavement a major public health problem (Rynearson, 1997).

significant others

The term significant other can be applied to a number of different relationships: fiancés, live-in partners, and gay or lesbian partners, who are all relegated to the position of secondary mourners.

They are left to believe that their pain can be considered only after that of the more immediate family. Blood relatives especially often wrongly assume that their relationship is less meaningful than that of other family members.

Furthermore, these relationships may not have met with the approval of some family members, and exclusionary practices can be wrenching for these co-victims.

Socially forbidden relationships or relationships that are not publicly acknowledged Significant others include those who are engaged in extra-marital affairs or in a gay or lesbian relationship with the murder victim at the time of the death.

According to Fowlkes, "In the socially forbidden relationship of an extra-marital affair, special stigma is attached to the 'other woman [or man]'. Secrecy obscures the ending of such a relationship socially just as it obscured its existence. There is no satisfactory outlet for the expression of loss and grief" (1990, p. 645).

The trauma, the loss, and the grief, are thus complicated which makes the mourning, "perhaps the loneliest and potentially most destructive grief of all (Fowlkes, 1990, p. 644)

disenfranchised grief

These mourners are also co-victims, but their status is often misunderstood or denied. They suffer from what Doka (1988) refers to as "disenfranchised grief," and they may not feel that they have permission to grieve (p. xv).

It is not unusual for someone to remark to such a co-victim, "What are you so upset about?" It makes co-victims feel even worse when they do not receive the necessary acknowledgment and support from others around them.

Caregivers, members of the criminal justice system, and even victim advocates may not think to include or invite this group of co-victims to court proceedings or support groups or to offer them any standing in the case. This is an area for growth.

I always thought that life-endangering oppression happened to people different than me. To heal, I had to acknowledge the world as a place that includes the possibility of getting shot and killed at any moment.
- lesbian lover of murder victim

- from Family Recovery From Terror, Grief and Trauma

recovery over time

Traumatic events usually lead to a variety of internal changes in the family. Such changes include changes in outlook on life and expectations about the future, there may be a development of subtle posttraumatic reactions that continue to influence a person's life, i.e. at anniversaries, or for some years of continued longing and searching for the lost person.

Over time, however, most families, even those who lost a loved one, are able to establish new continuity, and live on with both happy and sad memories. The long and tiresome task of establishing new meanings and verifying old may go on for years.

In the following section, I will focus on some of the challenges for families in dealing with the event, with ensuring that adults and children continue to communicate in ways that benefit them in the long run.

The changes and problems that occur in families do not necessarily lead to dysfunction at work or in school, but continue to influence the family. For many, the loss of a loved one means that some life spheres never will be as before, while others will normalize over time. Some survivors are able to return to normal fairly soon, while others struggle for a long time.

While much is known about the factors that influence individual recovery, less is known about the factors that influence family adaptation to trauma and grief over time. Family recovery will be determined by the interplay of factors such as:

- the nature of the disaster and one's exposure to it;

- the family's prior history of trauma and loss;

- the prior and current functioning of the family;

- family coping resources; and

- availability of help and support.

In the following some aspects of family functioning will be given particular attention, and some suggestions to help foster adaptive coping outlined.

family dynamite: internal dynamics

When a traumatic situation strikes a family member or the whole family, the entire family experiences the aftermath.

Traumatic events have the capacity to disturb vital functions within the family such as parenting functions including emotional nurturing, education, and protection. Children may be particularly at risk when trauma occurs in the family, as traumatized parents often reduce physical contact and try to shield their offspring from facts.

Communication, intimacy, expressiveness and role-distribution may be affected, resulting in a reduced capacity to cope with internal and external demands.

Single parents may be at special risk.

Parents and other adults that are aware of their tendency to overlook children in this period can try to balance their absorption with what happened with nurturing their children 's need for more presence and physical comfort.

internal dynamics: fact-sharing

From more than twenty years of experience from working with grief and trauma, I have realized that the first and following days following a traumatic event often are extremely important in how individuals and families can cope and recover over time.

Not only is this related to the traumatic impact of this day, but also to the resulting cognition regarding one's own and other's reactions, and the secondary trauma that family members may experience in their meetings with responding organizations and other members of their family or social network.

These problems are very often related to the provision of facts to the family or to communicating these facts within the family. The immediate handling of information to and within the family can influence communication patterns, cohesion, and the internal dynamics of the family and their long-term recovery.

It cannot be emphasized strong enough how important it is to try to foster a climate where facts and information can float freely within the family, and where difficult facts and issues are dealt with in an open and direct manner.

Parents and other adults are role models for how their offspring with deal with difficult situations later in life. At the same time experience shows us that traumatic events often become the starting point for the formation of family secrets.

Secrets are a minefield in families, especially between parents and children.

After the death of a father one mother held back from her two boys, twelve and sixteen years old, the fact that he had a child with another woman. At the funeral this now pre-adolescent girl turned up, to the surprise of the two boys. In a family session following this, where this and some other secrets were dissolved, the twelve year old said: "Are there more secrets now?"

Family secrets can create walls of silence within the family, walls that are difficult to tear down when solidified over time. When facts about a trauma are hidden from parts of the family system, this can greatly affect the trust and stability in the system over time.

Sometimes it is a partner that keeps back information in relation to a trauma or loss from the other partner with reduced trust or continued suspicion that other facts also are held back as the result. For children it is important that parents continue to speak openly and directly about facts of the disaster that become known over time.

internal dynamics: handling of traumatic reminders

Family members may hold very different views on what to do with the personal belongings of a loved one, on how to deal with anniversaries and rituals, and on how to approach or avoid symbolic places like the scene of the event. An example will illustrate this.

Following the death of a young adult son, his parents gave his fiancé a shirt that he always used to wear. This created strong tension between the parents and their daughter, as she felt that they disregarded her need to keep that shirt when they gave it away.

The sister felt she was higher in the grief hierarchy than the fiancé. Not only did this create a tension within the family, but the sister also started to feel anger towards the fiancé who also was her good friend.

Dispute over personal belongings can take many forms, but are often related to different needs in different family members regarding when to take away, clean or organize all the belongings that are left from the dead loved one.

One family member may be ready to put the belongings away while the other needs them present for a long time. A mother who lost an adult son demanded that the crumbs from his bread should be left on the kitchen table and she commanded her partner to let some of his favorite food be left in the fringe.

Imagine the strain upon her partner, not the father of the boy, when this order still was in effect more than a year after the boy's death.

Be careful to include children in discussions about what to do with personal belongings - they will very often have opinions that should be listened to.

internal dynamics: lack of synchronism in reactions

When working with families it is obvious that while the immediate reactions often are similar, involving shock reactions characterized by unreality etc., reactions over time differ greatly due to differences in personality, previous experience, age and interactions with the wider social network.

If reactions are asynchronous this can cause problems and conflicts in the family, i.e., lack of understanding from parents regarding absence of strong emotional reactions in children, or inability of members to support each other.

These aspects are also tied to different gender reactions in grief and trauma. Women tend to experience more intense emotional reactions that last over a longer time.

They also tend to use confrontational coping styles where they want to talk about and share feelings around what happens, while men use more avoidance strategies where they work through the event alone, in a more private manner, often through activities and rituals.

This lack of synchronism can lead to blaming for not reacting enough, for dwelling on the thoughts about the lost one, or for lack of understanding of one's partner's reactions. Based on different reactions, the members of the family can have different expectations for how they perceive that other people should react and what kind of caring and comfort they want from a family member.

When individual members of the family have been traumatized, there may be large differences in the recovery time needed. This is difficult as the different members may be at different stages in the recovery process.

Children grieve differently than adults, although the types of reactions are similar. They are able to distract themselves and be absorbed in other activities, while in the next moment being very aware, even overwhelmed, by the thoughts of what has happened. Children's emotional span is shorter than adults, they usually are not very sad for long periods of time, and may shock adults with their questions and behavior.

Do not put pressure on them to behave or grieve in a certain fashion.

Many children use time before they are able to confront the loss, and may be unwilling to talk about what has happened (this is especially so for boys).

If the child is doing okay in school, does not withdraw from friends, and does not evidence major personality changes, have patience, but use natural opportunities to start a conversation about what has happened.

internal dynamics: sub-level conflict

A trauma shatters the illusion of invulnerability and makes the parents and children very prone to expect the worst. In parents this often leads to a need to control, restrict and limit the child in a way that sometimes preclude them from developing autonomy and independence, or make them prone to develop into more anxious children.

This overprotection can limit the child's development and make them more anxious.

However, anxiety in children can develop as a consequence of misperception and fantasies on their behalf as well. Only by being interested in and asking about their perceptions can adults understand what goes on inside children's heads.

Both following non-death trauma, but especially following bereavement, roles within the family may be transformed. A traumatized parent may be unable to fulfill his or her role obligations, both regarding practical tasks in the family, but also in providing the emotional support that children may need.

While the effects of depression in parents on small children are well researched, less is known about what effects trauma in parents has on children.

Parental trauma may sometimes result in too much pressure on children.

Following the accidental death of her father, a teenage girl, an only child, had to make dinner for her mother every day as the mother became dysfunctional at home, returning exhausted from her workday. In a joint session with her mother, about one and a half months following her father's death, she exploded and accused her mother bitterly of ruining her life.

She complained that she had no time for friends, no time for her school lessons, and she got no comfort from her mother at all. "I feel like your mother."

If possible a constructive discussion on what has happened to the role functions that the deceased took care of, and in what ways other needs of various family members are cared for in the present situation could be talked about in the family, maybe with the assistance of someone with experience in leading such family discussions.

family dynamite: social network problems

Family recovery does not take place in vacuum. How successfully the family can deal with trauma and grief is partly dependent on the interaction with their social network.

Although much of the grief and trauma literature specifies the importance of the social network, there are reports from both the trauma and the grief area that have pointed out some problems that can arise between traumatized family members and their social network.

Too easily we tend to think that most families are met by understanding from their friends and family, a network that will help them talk about the event and provide support and understanding. As a clinician I repeatedly hear how difficult this interaction with the social network can be.

Although there usually is an immediate outpour of concern and an increase of social attention immediately following a trauma or loss, many traumatized family members soon perceive a lack of deeper understanding of their reactions, both regarding type, intensity and duration.

Many describe how, sometimes already after some weeks, there is a pressure to conform to a norm of rapid recovery where members of their social network wants to hear that things are going better and everything is returning to normal.

With a disaster of this magnitude, there will be more acknowledgement of the depth of the tragedy and continued social support. However, an inadequately understood social psychological process is at work, where it seems that many people doesn't want to be reminded of the fact that horrible things can happen to everyone.

Those who have experienced a trauma or a recent loss become a reminder of our own vulnerability.

Therefore people often refrain from making contact over time, or actively avoid traumatized people when they see them, leaving the traumatized person and family in a social vacuum. This vacuum can be reinforced by family member's own perception of not being understood that leads to a withdrawal from the social network on their part.

As traumatic events often lead to a revaluation of values in life, it is not uncommon that a different rate of maturation and growth occurs in the family, compared to their former social network. Often this leads the family to seek the company of other families with a similar experience, i.e., through grief groups or survivor groups, and to a gradual reduction in contact with their previous network members or to a renewal of their network over time.

Traumatized people can find conversing with their old friends shallow, as they sense that they are concerned with the trivialities of life instead of more "real" issues. Social network problems can also lead to blaming between the family and their social network.

The traumatized family members can blame their network for lack of understanding, for not making enough contact, for forgetting them, or for not helping enough. The social network can find the family demanding; blame them for being to preoccupied or for nurturing the loss or trauma, or for being to sensitive and moody.

Sometimes this can have a dramatic impact on close relationships.

This is a phenomenon that adolescents often experience as well. They can find their friends and their friends activities less interesting before and may gradually withdraw from what they find are "empty" activities.

As adults we may have to explain to them why they experience this, i.e., that the disaster has triggered a maturational "spurt" and that they should keep up their social contacts even though they for a time find them more "shallow".

intervention to promote family recovery

Immediately after a trauma, the family continues to be in a situation where everything they experience is experienced with more intensity than normal. This means that the caring climate around them has the potential to be felt as very caring and helpful, or distant, cold and unhelpful.

This makes it extremely important that the family is met by a good system for immediate help.

Because of the heightened sensitivity to all aspects of their environment, a high emphasis must be placed on establishing a caring climate. Parents and siblings can years after an event return to this situation, either with a positive focus: "The doctor had tears in his eyes. Can you imagine that he cared so much for us that he cried?", or with strong, negative intrusive memories: "I will never forget how we were left waiting and waiting with no information at all."

psycho-educational intervention

It is very important to receive information about normal psychological reactions that may be experienced by family members over time. Almost every family return to the value of the information they received about various reactions (thoughts, feelings, behavior) that are common after a trauma.

Being mentally prepared for what is to be expected helps identify, sort out and accept reactions as part of a normal reaction, and helps in understanding what happens within themselves and in their relationship.

Parents should make sure that children and adolescents get the same information. Many adolescents can be frightened by the intensity of the emotions they experience, and may fear they are turning crazy, others are amazed that their friends and teachers so soon forget what they have been through.

handling traumatic reminders

Finding acceptable ways of handling traumatic reminders within the family is very important. How are the family members able to deal with the reminders, i.e. viewing the television coverage of the disaster and the investigation? In what way are they able to modulate the strong affect triggered by the reminders?

Talking about the reminders, identifying what triggers reactions, and learning ways to gradually approach difficult reminders are crucial for regulating emotions, and can determine how this is done for the rest of a person's life.

Handling reminders often involve returning to places, meeting persons, or confronting activities that involve the presence of emotional pain resulting in avoidance.

After family trauma, we have found that a confrontational approach to such situations benefits family members, adults or children alike. Family members or individuals should be properly prepared for entering the situation, be accompanied by others, and have control over the tempo of approach, and be followed up afterwards.

Besides helping the family members with both their emotional and cognitive work-through of the traumatic event helpers must focus on the sensory impressions and intrusive recollections that result from the disaster. Unfortunately, many families receive inadequate help in working through their traumatic moments in a second by second, detailed fashion.

There is a need for professional competence in this area, as it is not enough simply to tell one's story. If that is done, both important thoughts and sensory impressions are often left out. Without proper help in this regard, there is an increased chance of sensory impressions turning into long-term traumatic recollections.

Lately, I have added what I find to be an important aspect to the follow-up information I give to families within the two first weeks following a sudden, traumatic event.

The family members who have been exposed to strong sensory impressions are given advice on what they can do to take control of the intrusive memories. I tell them to imagine that they see the image (or film) on a television-screen. They are then instructed to imagine that they have a remote control in their hand, and to turn the image off.

Alternatively, they are asked to see the haunting image in front of them, and then to move it further and further away from them, until it finally reaches the wall, or to change the image from color into black and white, etc.

Such simple methods have been reported as very helpful for those who struggle with memories they have no control over.

There is a variety of such "control methods" that can help family members take control over intrusive images.

family dynamics intervention

Early on in the intervention, preferably within the first two weeks of the event, but not in the first shock phase, partners must receive information concerning usual gender differences. This may prevent undue blaming between the partners, lessen potential conflicts, and increase their sense of control. The information should be verbal and written.

The following themes should be discussed to secure more understanding between partners and within the family: