Helping youth in foster care cope with grief and abandonment

February 2023

Youth who are aging out of the foster care system frequently wrestle with feelings of grief and abandonment. Counselors who have studied the research literature or have treated this population for many years say the losses experienced by youths during the aging-out process can have a lasting impact on these clients.

“There are relationships that foster youth have with individuals in the system that are discontinued upon aging out. This can be a significant loss that needs to be grieved,” says Brian Russ, a licensed mental health counselor and an assistant professor in the Department of Counseling at Xavier University in Cincinnati. “Along with the loss of their childhood, these older adolescents and young adults can also feel a loss of hope for ever being adopted,” he explains.

Amy Watson, a licensed professional counselor supervisor in Dallas who has more than 20 years’ experience counseling children and youths in foster care, says these clients grieve what their lives might have been like if they never entered the system. However, these youths seldom reveal anything about what they have lost or experienced during their time in foster homes, she adds.

“These clients are definitely traumatized and go into fight, flight, freeze and fawn mode when triggered, which helps [to] temporarily protect them from further losses,” Watson says. “In counseling, we work on ways to manage triggers, process negative feelings and increase coping skills so they can get better at opening themselves up in future relationships.”

Providing unconditional positive regard

Russ, who has worked as a home-based clinician, outpatient coordinator and clinical director at Newaygo County Mental Health in White Cloud, Michigan, suggests that clinicians approach grief with this population by using person-centered therapy techniques.

“There are a lot of complex emotions that need to be processed, and a person-centered counselor can help by offering a safe, therapeutic environment that facilitates the core conditions of unconditional positive regard, empathy and genuineness,” he says. “In this environment, the client can process their emotions without feeling judged, which is necessary for the grieving process.”

Russ offers the following guiding thoughts that can help counselors when working with grief from a person-centered approach:

• Detect and reflect. Grief often manifests outside of our awareness; therefore, it is important for counselors to detect the grieving process when it is less explicit. After identifying grief, counselors using the person-centered approach should reflect this to the client to help build awareness and establish an empathic understanding. For example, a counselor could say, “I sense a deep feeling of sadness inside of you. Could this be grief from your loss?”
• Offer a safe space and go at the client’s pace. The counseling environment should be rooted in unconditional positive regard. The client should feel safe to express what they are feeling, and because the grieving process can be unique to each individual, the client should move at their own pace. In session, a counselor could tell the client, “I want you to feel like you can work through this grief in whatever manner you feel would be helpful and at whatever pace you feel comfortable. I want this to be a safe space to do this work.”
• Help clients make meaning and express their feelings. The counselor’s role is to help clients discover their own meaning about what they are grieving. Clients should have the opportunity to express their feelings in their own way. Clients can have a cathartic experience by expressing their feelings in the therapeutic environment. To facilitate this, counselors could say, “I am curious about what this grief means to you. Do you have any thoughts?” or “Have you found ways of expressing your emotions in the past that have been helpful to you? I am wondering if that would be helpful to you in our session.”
• Provide support until the end and don’t be afraid to start the process again. Allowing clients to work toward their own understanding and conclusion regarding their grief is at the heart of the person-centered approach. Clients may want to work toward accepting the loss or saying goodbye. Conversely, they may want to find a way for whatever they have lost to stay with them forever in some form. To help clients work toward their own conclusions, counselors could ask, “How do you feel about where you are at in regard to processing your grief?” or “Is there more work to be done?”

“Our job as counselors is to help the client find this conclusion, and I say ‘conclusion’ with the idea that grief may or may not have an end,” Russ observes. “Some grief lasts forever, and some grief may be cyclical. Either way, we support the client throughout the process.”

Russ says feelings of abandonment often go hand in hand with grief. “There is a loss with both phenomena, but abandonment may connect stronger to feelings of worthlessness,” he says. Allowing clients to “experience unconditional positive regard can help with worthlessness.”

Processing past emotions

Clinicians who work with youth who are aging out of the foster care system can help them to peel away the emotional defenses they have developed to protect themselves from hurtful people and situations. Watson says clinicians can use a cognitive behavioral approach to reframe clients’ thoughts by asking open-ended, empathic questions to start the process. For example, counselors might say:

• Tell me about your losses and how you have coped with them.
• What would you tell a young person entering foster care about losing siblings and family?
• How has loss helped you to develop as a person?

“My clients have a hard time sharing about grief and sadness because they don’t feel safe and have a hard time being vulnerable,” Watson notes. “Once they build trust, they open up more and know I am safe for them. When youth[s] move around a lot, they lack consistency in relationships. Relationships are where youth[s] heal.”

Helping clients work through feelings of abandonment also better prepares them to form positive relationships in their present and future.

“Every person has a right to happy and healthy relationships with boundaries,” says Watson, a board member at WAY Alliance, a North Texas nonprofit dedicated to helping foster care youth transition to independence by providing mentors. “We live in a social world. … If youth do not work through abandonment, they will not have the skills or confidence to be open to relationships and roles throughout life.”

Watson used a trauma-focused cognitive behavioral approach when working with a 17-year-old young woman in foster care whose breakup with a boyfriend triggered feelings of abandonment from her past. The client had been in foster care for about three years, but child protective services had been involved in her life since early childhood when she was removed from her home of origin. She was then placed with an aunt until she was sexually abused by a relative while she was in her aunt’s care.

When Watson began working with the client, she was living in a group home that provided transitional living services. The client, who had also been sex trafficked, had feelings of low self-esteem and was desperate for the approval of men, which Watson describes as a consequence of her trauma. “The past relationship with her boyfriend was age appropriate (unlike her past encounters with men) and had the boundaries of a normal consensual relationship. The client was especially disappointed because she finally had the experience of dating like the average teenager and felt it was safe,” Watson recalls. In session, the client expressed negative statements such as “I’ll never have another boyfriend”; “I trusted him. I loved him. I thought he was different”; and “People don’t want me.” To help the client process her feelings of abandonment, Watson asked the young woman several self-reflective questions:

• “How does the end of this relationship impact your self-image?”
• “Can you see this breakup as part of normal dating rather than the belief that everyone is compatible?”
• “How do you feel about the breakup now that some time has passed?”
• “What would you tell someone going through a similar dating experience?”
• “How does it feel to realize that your family was not there for you and did not protect you?”
• “What has helped you cope with being on your own?”

With Watson’s help, the client began to view the breakup as an experience for personal growth rather than one of ruin and rejection.

“We discussed how she could take this time to focus on herself” and move forward, Watson says. The client noted in session that she wanted to grieve only for a week and then “be over it.”

Watson helped the client focus on her schoolwork, which she had been neglecting, and look for a job. They also discussed how she could put her energy into building other relationships — by talking to a staff person she was close to at the group home, for example.

Eventually, the client’s statements began to reflect a new sense of personal power, Watson says. She was now saying, “I know I need to be strong,” “I realize I need to get over this,” “I can’t let it stop me” and “I can’t let it keep me down.”

In a later session, the client “was also able to connect how abusive her trafficker was when she once thought he loved her and protected her and could now see she was a victim,” Watson says.

“This is a big step in healing,” she notes. “That’s all trauma processing. … The goal was for [the client] to find a way to build herself back up.”

Working on self-worth is vital for these youths whether they are recovering from grief, abandonment, or both. “Counselors can help youth with this by assisting them to discover their strengths and giving them opportunities to build self-esteem and self-worth by doing new things, taking risks and gaining confidence,” Watson says.

////

Learn more on this topic in the feature article "Counseling youth aging out of foster care" in the February issue of Counseling Today and in the online exclusive "Is Medicaid properly serving youth in foster care?"

Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

The views expressed in Counseling Today are those of the authors and contributors and may not reflect the official policies or positions of the editors or the American Counseling Association.