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Not Just a Doll: An Intervention for Elementary School-Aged Children Affected by Grief


Not Just a Doll: An Intervention for Elementary School-Aged Children Affected by Grief

Onofrio, Erica Nicole (2018) Not Just a Doll: An Intervention for Elementary School-Aged Children Affected by Grief. [Graduate Projects (Non-thesis)] (Unpublished)

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Everyone experiences grief at some point in their life; sometimes it is an unconscious sentiment that could be brought to the surface via art-making, allowing for self-expression of these emotions. Childhood grief may be of particular difficulty for a child to experience and understand. The difficulty can be amplified when the loss is that of a caregiver who they rely on and are strongly attached to. Children may be faced with the lack of self-expressive language or life experience to engage with the emotions that are connected to their grief. An art therapy intervention for school-aged children affected by grief following the loss of a primary caretaker is proposed which integrates attachment theory, Winnicott’s concept of transitional objects, and grief and bereavement research. The intervention uses doll making in a group setting to serve as a positive reminder of the departed attachment figure that can provide a way to honor the relationship.

Divisions:Concordia University > Faculty of Fine Arts > Creative Arts Therapies
Item Type:Graduate Projects (Non-thesis)
Authors:Onofrio, Erica Nicole
Institution:Concordia University
Degree Name:M.A.
Program:Creative Arts Therapies (Art Therapy Option)
Date:11 July 2018
Keywords:Keywords: grief therapy, loss, children, doll making, transitional objects, play therapy, coping strategies, Winnicott Theory, resiliency, attachment theory, group therapy, trauma, rituals, solution focused treatment, prolonged grief, art therapy
ID Code:984036
Deposited On:13 Jul 2018 16:57
Last Modified:13 Jul 2018 16:57


Abram, J. (1996). Transitional phenomena. The language of Winnicott (pp. 311-327). Northvale,
NJ: Jason Aronson.

Art with Heart. (2016). Art therapy for grief: The why and how from Art with Heart. Art with
Heart. Retrieved from

Astramovich, R. L., Lyons, C., & Hamilton, N. J. (2015). Play therapy for children with
intellectual disabilities. Journal of Child and Adolescent Counseling, 1(1), 27-36. doi:10.1080/23727810.2015.1015904

Axline, V. A. (2013). Play therapy – The inner dynamics of childhood [NetLibrary version].
Retrieved from https://books.google.ca/books?id=iYJ8CgAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

Baughman, S. & Kiser, L. (2007). Programs for teens and children. In J. E. Rogers (Ed.), The art
of grief: The use of expressive arts in a grief support group (pp. 227-238). New York, NY: Routledge.

Beaumont, S. L. (2013). Art therapy for complicated grief: A focus on meaning-making
approaches. Canadian Art Therapy Association Journal, 26(2), 1-7. doi:10.1080/08322473.2013.11415582

Beckmann, R. (2000). Children who grieve: A manual for conducting support groups. Holmes
Beach, FL: Learning Publications, Inc.

Berk, L. E. (2014). Part V middle childhood: Six to eleven years. In Pearson (Ed.), Exploring
lifespan development (3rd ed., pp. 226-285). Boston: MA: Pearson Education Inc.

Bettelheim, B. (1987, March). The importance of play. The Atlantic. Retrieved from

Blakemore, J. E. O. & Centers, R. E. (2005). Characteristics of boys’ and girls’ toys. Sex Roles,
53(9/10), 619-633. doi:10.1007/s11199-005-7729-0

Bowlby, J. (1982). Attachment and loss: Retrospect and prospect. American Journal Of
Orthopsychiatry, 52(4), 664-678. doi:10.1111/j.1939-0025.1982.tb01456.x

Bowlby, J. (1988). A secure base: clinical applications of attachment theory [NetLibrary
version]. Retrieved from https://books.google.ca/books?hl=en&lr=&id= yA9nX8W2ddIC&oi=fnd&pg=PP2&dq=bowlby+attachment&ots=1isItW9F2n&sig=OBOySzoNMsUQ9uhSi8sWzaInPFM#v=onepage&q=bowlby%20attachment&f=false

Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth.
Developmental psychology, 28(5), 759-775.

Cabrera, N., Tamis-LeMonda, C. S., Bradley, R. H., Hofferth, S. and Lamb, M. E. (2000),
Fatherhood in the twenty-first century. Child Development, 71(1), 127–136.

Caldera, Y. M., Huston, A. C., & O'Brien, M. (1989). Social Interactions and Play Patterns of
Parents and Toddlers with Feminine, Masculine, and Neutral Toys. Child Development, 60(1), 70. doi:10.1111/1467-8624.ep7250687

Carney, K. L. (2003). Barklay and Eve: The Role of Activity Books for Bereaved Children.
Omega: Journal Of Death & Dying, 48(4), 307-319. doi:10.2190/5D4K-LWHX-3H17-7TDB

Catts, O., Zurr, I., & Ben-Ary, G. (1996). Tissue culture & art(ificial) wombs. 252-254.
Retrieved from

Christ, G. H. (2010). Children bereaved by the death of a parent. In C. A. Corr & D. E. Balk
(Ed.), Children’s encounters with death, bereavement, and coping (pp. 169-190). New York, NY: Springer Publishing Company.

Colman, A. (2015). attachment theory. In A Dictionary of Psychology. : Oxford University
Press. Retrieved 4 Jun. 2018, from http://0-www.oxfordreference.com.mercury.concordia.ca/view/10.1093/acref/9780199657681.001.0001/acref-9780199657681-e-713

Colman, A. (2015). grief reaction. In A Dictionary of Psychology Oxford University Press.
Retrieved 27 Feb. 2018, from http://0-www.oxfordreference.com.mercury.concordia.ca/view/10.1093/acref/9780199657681.001.0001/acref-9780199657681-e-3615

Corr, C. A. (2010). Children, development, and encounters with death, bereavement, and coping.
In C. A. Corr & D. E. Balk (Ed.), Children’s encounters with death, bereavement, and coping (pp. 3-18). New York, NY: Springer Publishing Company.

Councill, T. (2003). Medical art therapy with children. In Malchiodi, C. A. (Ed.), Handbook of
art therapy (pp. 207-219). New York: Guilford Press.

Cramer, P. (2008). Seven pillars of defense mechanism theory. Social And Personality
Psychology Compass, 2(5), 1963-1981. doi:10.1111/j.1751-9004.2008.00135.x

Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods
approaches (4th ed.). Thousand Oaks, CA: SAGE Publications.

Doka, K. J. (2012). Therapeutic ritual. In R. A. Neimeyer (Ed.), Techniques of grief therapy:
Creative practices for counseling the bereaved (pp. 341-343). New York, NY: Routledge.

Frydenberg, E., Deans, J., & O'Brien, K. (2012). Developing everyday coping skills in the early
years: Proactive strategies for supporting social and emotional development. Retrieved from https://0-ebookcentral-proquest-com.mercury.concordia.ca/lib/concordia-ebooks/detail.action?docID=866341

Feen-Calligan, H., McIntyre, B., & Sands-Goldstein, M. (2009). Art Therapy Applications of
Dolls in Grief Recovery, Identity, and Community Service. Art Therapy: Journal Of The American Art Therapy Association, 26(4), 167-173. doi:10.1080/07421656.2009.10129615

Fitton, V. A. (2012). Attachment theory: history, research, and practice. Psychoanalytic Social
Work, 19(1-2), 121-143. doi: 10.1080/15228878.2012.666491

Fraser, M. W., & Galinsky, M. J. (2010). Steps in intervention research: Designing and
developing social programs. Research on social work practice, 20(5), 459-466. doi: 10.1177/1049731509358424

Gaynard, L., Goldberger, J., & Laidley, L. N. (1991). The use of stuffed, body outline dolls with
hospitalized children and adolescents. Children’s Health Care, 20(4), 216-224.

Gillies, J., & Neimeyer, R. (2006). Loss, grief, and the search for significance: Toward a model
of meaning reconstruction in bereavement. Journal Of Constructivist Psychology, 19(1), 31-65. doi:10.1080/10720530500311182

Glazer, H. R. (2015). Expressive therapies with grieving children. In S.L. Brooke and D.A.
Miraglia (Eds.), Using the Creative Therapies to Cope with Grief and Loss (pp. 95-112). Springfield, Illinois: Charles C Thomas.

Greenland, S. K. (Ed.). (2016). Mindful games: sharing mindfulness and meditation with
children, teens, and families. Boulder, CO: Shambhala Publications, Inc.

Goddard, C. (2014, July 15). More than just teddy bears: The significance of transitional objects
in an early childhood classroom. Retrieved from https://www.psychologytoday.com/blog/the-guest-room/201407/more-just-teddy-bears

Gordon, S. A. (2009). “Make it yourself”: home sewing, gender, and culture, 1890-1930
[NetLibrary version]. Retrieved from http://0-hdl.handle.net.mercury.concordia.ca/2027/heb.99021.0001.001

Guerney, L. (2001). Child-centered play therapy. International Journal of Play Therapy, 10(2),

Hanh, T. N. (Ed.). (2012). A handful of quiet: Happiness in four pebbles. Berkeley,
CA: Plum Blossom Books.

Harris, J., & White, V.(2013). learned helplessness. In A Dictionary of Social Work and Social
Care. : Oxford University Press. Retrieved 4 Jan. 2018, from http://0-www.oxfordreference.com.mercury.concordia.ca/view/10.1093/acref/9780199543052.001.0001/acref-9780199543052-e-945

Harvey, S. (2016). Using drama in play therapy. In O’Connor, K. J., Schaefer, C. E., &
Braverman, L. D. (Eds.), Handbook of play therapy (2nd ed., pp. 289-308). Hoboken, NJ: John Wiley & Sons, Inc.

Johnson, J. E., Christie, J. F., & Wardle, F. (2005). Play, development, and early education.
Boston: Pearson Education, Inc.

Johnson, J. L. (2016). Chapter two: The history of play therapy. In O’Connor, K. J., Schaefer, C.
E., & Braverman, L. D. (Eds.), Handbook of play therapy (2nd ed., pp. 17-34). Hoboken, NJ: Wiley & Sons, Inc.

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to
face stress, pain, and illness. New York, NY: Delacorte.

Kline, P. (2012). A critical perspective on defense mechanisms. In Hentschel, U., Smith, G.,
Ehlers, W., & Draguns, J. G. (Eds.), The concept of defense mechanisms in contemporary psychology: Theoretical, research, and clinical perspectives (1st ed., pp. 3-11). New York, NY: Springer-Verlag.

Knell, S. M. (2016). Cognitive-behavioral play therapy. In K. J. O’Connor, C. E. Schaefer, & L.
D. Braverman (Ed.), Handbook of play therapy (2nd ed., pp. 119-134). Hoboken, NJ: John Wiley & Sons, Inc.

Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief
through the five stages. Kingsway, LDN: Simon & Schuster.

Leggett, E. S., & Boswell, J. N. (2017). Directive play therapy. In Directive play therapy:
Theories and techniques (1st ed., pp. 1-15). New York, NY: Springer Publishing Company.

Leick, N. & Davidsen-Nielsen, M. (1991). Healing pain: Attachment, loss, and grief therapy
[NetLibrary version]. Retrieved from https://books.google.ca/books?hl=en&lr=&id=Uy0H9h0pwbkC&oi=fnd&pg=PA1&dq=attachment+informed+grief+therapy&ots=F9LTuAMsrr&sig=Z4BZ1Jf_KnUDZbfwAsiz_kragyI#v=onepage&q=attachment%20informed%20grief%20therapy&f=false

Lieberman, A. F., Compton, N. C., Van Horn, P., & Ghosh Ippen, C. (Ed.). (2003). Losing a
parent to death in the early years. Washington, DC: ZERO TO THREE.

Lister, S., Pushkar, D., & Connolly, K. (2008). Current bereavement theory: Implications for art
therapy practice. The Arts In Psychotherapy, 35, 245-250. doi:10.1016/j.aip.2008.06.006

Litt, C. J. (1986). Theories of transitional object attachment: An overview. International Journal
Of Behavioral Development, 9(3), 383-399. doi:10.1177/016502548600900308

Lyons-Ruth, K. (1991). Rapprochement or Approchement: Mahler’s theory reconsidered from
the vantage point of recent research on early attachment relationships. Psychoanalytic Psychology, 8(1), 1-23.

Malchiodi, C. A. (1998). Trauma. In Understanding children’s drawings (pp. 132-160). New
York: The Guilford Press.

Malchiodi, C. A. (2005). Expressive therapies: History, theory, and practice. In Malchiodi, C. A.
(Eds.), Expressive therapies (pp. 1-15). New York, NY: The Guilford Press.

Malchiodi, C. A. (2015). Calm, connection, and confidence: Using art therapy to enhance
resilience in traumatized children. In Play therapy interventions to enhance resilience (pp. 126-145). New York: The Guilford Press.

Mahler, M. (1967). On Human Symbiosis and the Vicissitudes of Individuation. Journal Of The
American Psychoanalytic Association, 15(4), 740-763. doi:10.1177/000306516701500401

McMahon, L. (1992). The development of play. In The handbook of play therapy (pp. 1-26).
New York: Tavistock/Routledge.

Moon, B. L. (2006). Safety, rituals, and risk. In Art-based Group Therapy: Theory and Practice
(pp. 49-68). Springfield, Ill., U.S.A.: Charles C Thomas.

National Ethics Advisory Committee. (2012). Ethical guidelines for intervention studies.
Wellington: Ministry of Health. Retrieved from www.neac.health.govt.nz

Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of
reconstruction. Death Studies, 24(6), 541-558.

Newton, T. L., & Ohrt, J. T. (2018). Infusing Mindfulness-Based Interventions in Support
Groups for Grieving College Students. Journal For Specialists In Group Work, 43(2), 166-183. doi:10.1080/01933922.2018.1431347

Orlans, M. & Levy, T. M. (2014) Roots of attachment. In Attachment, trauma, and healing:
Understanding and treating attachment disorder in children, families and adults (2nd ed., pp. 42-74). London, ENG: Jessica Kingsley Publisers.

Pearlman, M. Y., Schwalbe, K. D., & Cloitre, M. (2010) Grief in childhood: Fundamentals of
treatment in clinical practice. Washington, DC: American Psychological Association.

Prigerson, H. G., Vanderwerker, L. C., & Maciejewski, P. K. (2008). A case for inclusion of
prolonged grief disorder in DSM-V. In M. S. Stroebe, R. O. Hansson, H. Schut, & W. Stroebe (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (pp. 165–186). Washington, DC: American Psychological Association.

Rechtschaffen, D. (2016). Part III: Mindfulness lessons for students: Classroom activities,
practices, and techniques. In The mindful education workbook: Lessons for teaching mindfulness to students (pp. 89-97). New York: W. W. Norton & Company, Inc.

Rogers, J. E. (2007). The art of grief: The use of expressive arts in a grief support group
[NetLibrary version]. Retrieved from https://books.google.ca/books?id=HTWUAgAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

Rosmalen, L., Veer, R., & Horst, F. (2015). Ainsworth’s strange situation procedure: the origin
of an instrument. Journal Of The History Of The Behavioral Sciences, 51(3), 261-284. doi:10.1002/jhbs.21729

Rozum, A. L. (2012). Art therapy with children in grief and loss groups. In C. A. Malchiodi, C.
A. Malchiodi (Eds.), Handbook of art therapy (2nd ed., pp. 422-432). New York, NY, US: Guilford Press.

Sarkadi, A., Kristiansson, R., Oberklaid, F., & Brember, S. (2007). Father’s involvement and
children’s developmental outcomes: a systematic revi of longitudinal studies. Acta Paediatrica, 97, 153-158. doi:10.1111/j.1651-2227.2007.00572.x

Sas, C., Whittaker, S., & Zimmerman, J. (2016). Design for Rituals of Letting Go: An
Embodiment Perspective on Disposal Practices Informed by Grief Therapy. ACM Transactions On Computer-Human Interaction (TOCHI), 23(4), 1-37. doi:10.1145/2926714

Schneider, L. (n.d.). 10 things grieving children want you to know. Our House. Retrieved from

Schore, J. R., & Schore, A. N. (2008). Modern attachment theory: The central role of affect
regulation in development and treatment. Clinical Social Work Journal, 36(1), 9-20. doi:10.1007/s10615-007-0111-7

Schuurman, D. (n.d.). Developmental grief responses. The Dougy Center. Retrieved from

Schuurman, D. (2015). Never the same: Coming to terms with the death of a parent [NetLibrary
version]. Retrieved from https://books.google.ca/books?id=HgoRBwAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

Seymour, J. W. (2016). An introduction to the field of play therapy. In O’Connor, K. J.,

Schaefer, C. E., & Braverman, L. D. (Eds.), Handbook of play therapy (2nd ed., pp. 3-16). Hoboken, NJ: Wiley & Sons, Inc.

Schaefer, C. E., & Braverman, L. D. (Eds.), Handbook of play therapy. (2nd ed., pp. 3-15).
Hoboken, NJ: John Wiley & Sons, Inc.

Stace, S. M. (2014). Therapeutic doll making in art psychotherapy for complex trauma. Art
Therapy: Journal Of The American Art Therapy Association, 31(1), 12-20. doi:10.1080/07421656.2014.873689

Standard, M. E. (1999). The use of puppets in children’s grief groups: An exploratory study.
(Masters dissertation, The Graduate College University of Wisconsin-Stout, 1999).

Statistics Canada. 2017. Father’s day… by the numbers. Version updated June 2017. Ottawa.
https://www.statcan.gc.ca/eng/dai/smr08/2017/smr08_218_2017 (June 14, 2018).

Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement”
Rationale and description. Death Studies, 23(3), 197-224. doi:10.1080/074811899201046

Tabin, J. K. (1992). Transitional objects as objectifiers of the self in toddlers and adolescents.
Bulletin Of The Menninger Clinic, 56(2), 209.

Thompson, M., Tiwari, A., Fu, R., et al. (2012) A framework to facilitate the use of systematic
reviews and meta-analyses in the design of primary research studies: Appendix a, assessing validity of systematic reviews. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK83629/

Todd, B. K., Barry, J. A., & Thommessen, S. O. (2017). Preferences for "gender-typed" toys in
boys and girls aged 9 to 32 months. Infant And Child Development, 26(3), 1-14. doi:10.1002/icd.1986

Topp, J. (2005) The uses of doll making in art therapy with children: Four case studies. (Masters
dissertation, Concordia University, 2005). ProQuest Dissertations & Theses Global.

Trawick-Smith, J., Wolff, J., Koschel, M., & Vallarelli, J. (2015). Effects of Toys on the Play
Quality of Preschool Children: Influence of Gender, Ethnicity, and Socioeconomic Status. Early Childhood Education Journal, 43(4), 249-256. doi:10.1007/s10643-014-0644-7

Wicks, P. G., & Rippin, A. (2010). Art as experience: An inquiry into art and leadership using
dolls and doll-making. Leadership, 6(3), 259-278. doi:10.1177/1742715010368767

Williams, K., & Lent, J. (2008). Scrapbooking as an Intervention for Grief Recovery With
Children. Journal Of Creativity In Mental Health, 3(4), 455-467. doi:10.1080/15401380802547553

Willis, C. A. (2002). The Grieving Process in Children: Strategies for Understanding,
Educating, and Reconciling Children’s Perceptions of Death. Early Childhood Education Journal, 29(4), 221-226.

Winnicott, D. W. (1980). Transitional objects and transitional phenomena. In Playing and reality
(p. 1-25). London: Tavistock.

Winnicott, D. W. (2005). Playing and Reality. New York, NY: Routledge.

Wood, D. D. & Near, R. L. (2010). Using expressive arts when counselling bereaved children. In
C. A. Corr & D. E. Balk (Ed.), Children’s encounters with death, bereavement, and coping (pp. 374-391). New York, NY: Springer Publishing Company.

Worden, J. W. (1996) Chapter two: When a parent dies. In Children and grief: When a parent
dies (pp. 18-34). New York, NY: The Guilford Press.

Worden, J. W. (2009). Grief Counseling and Grief Therapy, Fourth Edition: A Handbook for
the Mental Health Practitioner. New York, NY: Springer Publishing Company.

Yogman, M., & Garfielf, C. F. (2016). Fathers’ roles in the care and development of their
children: The role of pediatricians. Pediatrics, 138(1), e1-e15.
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