Helping Your Child Endure a Loss
By Ken Doka, Ph. D.
A number of years ago a psychologist, Robert Kastenbaum, authored an
article for Saturday Review entitled, “The Kingdom Where Nobody Dies.”
Dr. Kastenbaum’s point was that we, as adults, often like to envision
childhood as that kingdom where nobody dies. We want to protect children
from harsh realities such as death. We avoid discussing death with
children, use euphemisms such as “sleeping” or “passed away” to describe
death and do everything we can to minimize a child’s contact with death
Yet, much as we would wish otherwise, our efforts fail as children constantly face loss and death. Grandparents, and even parents and siblings, die. Friends may face accidents or illnesses. Children, in fact, have a wide range of relationships—teachers, coaches, clergy, neighbors, relatives and parents of friends are all part of their worlds. It is unrealistic to expect that in this web of relations, death will not intrude. Many may have pets—animals they deeply treasure who may one day die. Most children have a significant encounter with death prior to adolescence.
Death intrudes in other ways, too. More than ever, children are exposed to death and loss through television, newspapers, radio and the Internet. Movies and video games, no matter how much we monitor them, frequently expose children to images, often gory, of dying and death. Even children’s books, nursery rhymes, songs and jokes may have themes of death and loss. Think, for example, of “Harry Potter,” ”The Lion King,” “Bambi” or “Charlotte’s Web.”
We cannot protect children from death and loss. We can, though, help children deal with death.
Here we try to describe ways that children and adolescents understand death and experience grief. And, we offer sound suggestions for assisting children and teenagers as they cope with dying, death, loss and grief.
This article is intended for all who are there for grieving children and adolescents—especially their parents and teachers. For even more difficult than dealing with death, especially for a child, is dealing with death alone.
A child’s view of death
From birth, children are constantly growing. This development is not
only physical but also mental, emotional, social and spiritual. As
children grow, their ability to understand death and handle grief
changes as well.
Death is a very difficult concept for children to master. Years ago, we used to try to find an age when children could be expected to fully know what death was. We now recognize that children are all different, not only in their abilities, but in their experiences. A better question simply is: What is a child struggling with as that child grapples with the concept of death?
- The universality of death—understanding that all living things will someday die.
- The irreversible quality of death—unlike being away and coming home, being sick and becoming well, death is final and irreversible.
- We no longer function after death—the deceased will not be watching television, sleeping, sending gifts, etc.
In short, we need to carefully listen to the questions that young children ask to understand what they are struggling with and what might cause fear and concern. However, it is important for us to remember two things. Even though young children may find it difficult to understand death, they are trying to make sense of their world. Although children may not fully understand death, even the youngest children react to the separation that death inevitably brings.
Mental and emotional development
Children are not just developing mentally; they are growing in other ways too. Children, as they age, develop emotionally. Young children have a short feeling span. This means that they sustain strong emotions for only a short period of time. Their times of sadness are like summer thunderstorms—short but intense. It is not unusual for young children to cry bitterly in hearing of a death only to be happily playing moments later. Their periods of sadness come and go.
Children also develop socially. Young children are egocentric—viewing relationships from their own perspectives. Their reactions may come across as heartless or selfish. But, as children grow, they develop more empathy—understanding the many ways that deaths affect all those around them.
Finally children develop spiritually. Children are spiritual pioneers—trying to understand and make sense of their beliefs and their world. When a young child holds a dead bird and asks, “Why?”, the child is asking a profoundly spiritual question. Unlike adults, they are explorers since they have not yet fully developed beliefs that offer an answer.
This development continues through adolescence. Adolescents, too,
struggle with the concept of death. We often speak of the three “I’s” of
adolescence—intimacy, identity and independence. As adolescents age
they grapple with intimacy moving through close friendships, first
crushes and romantic involvements. Adolescents wrestle with
identity—trying to find who they are, what they believe, where they fit.
And adolescents seek to be more independent, to do things on their own.
Death emerges as the ultimate threat—ending intimacy, obliterating
independence and challenging newfound independence.
Adolescence is also a time when young people face significant separations. They part with childhood friends, give up their toys and experience their first break-ups. When adolescents do experience death—especially the death of a friend or peer, it is likely to be both sudden and violent—the result of an accident or suicide. It is little wonder that the theme of death plays out so prominently in adolescent music, video games, books and movies.
Understanding how children and adolescents view death is the first step in helping them deal with loss and grief. It is their view of death that will shape the experience of grief.
The child's and adolescent’s experience of grief
Children and adolescents experience grief similar to and yet different from the ways adults grieve. Like adults, children and adolescents experience grief in many ways—physically, emotionally, cognitively, behaviorally and spiritually.
The physical experience
Children often may experience grief in very physical
ways—stomachaches, headaches and other complaints of pain and illness.
While such physical manifestations of grief are common to all who
grieve, they are often especially common to children. Sometimes children
have a hard time expressing their grief, so it “converts” or comes out
as physical complaints. My head hurts. I don’t feel well. In addition,
many times children may interpret the physical manifestations of
emotions as physical discomfort. The anxious feeling in the pit of the
stomach when the child is afraid is explained as a stomachache. Most
importantly, physical complaints tell adults that the child needs care—a
hug, attention or a time to rest in the support of a trusted adult.
It is helpful then to monitor the child’s health as he or she deals with loss. The physical complaints of the child may offer insight and provide opportunities to show the child valued support. And although grief can be often manifested in physical reactions, it is important to always take these complaints seriously. If the child’s complaints are persistent, a physician—who understands that the child has experienced a loss—should examine the child. Remember in stressful times, such as during a loss, our ability to resist illness is lessened.
The emotional experience
Children, again like adults, experience a full range of emotions.
Depending on their age, children may not be able to name the emotions
they are experiencing and may even be frightened by their intensity.
Sadness, loneliness and yearning for the person who died are common expressions of grief. Children may also feel angry at the loss—striking out at others in their rage and frustration. They may experience guilt—wondering if the death is a punishment for something they said or thought or feeling bad about the ways they behaved or the things they might have said to the person who died. Children may even feel jealous or envious of others who did not experience such a loss.
Like adults, children’s feelings can be complicated. They may have mixed or ambivalent feelings about the loss—even experiencing a sense of relief at the death. This can happen for a number of reasons. For example, for some children the illness of others may affect their own lives—it could mean a more absent, care-giving parent. For others the experience of sickness or the behavior or relationship with the person who died may not be positive, such as living with an ill relative, exposing a child to formerly uncharacteristic outbursts.
The cognitive experience
Grief also affects our cognitive processes—the ways we think. Children may find it difficult to concentrate. They may be preoccupied by the death and easily distracted. They may find it hard to focus on schoolwork, and grades may suffer as a result. In some ways the cognitive effects of grief—difficulties in concentration, easily distracted—can mimic learning disabilities.
The spiritual experience
Children may have spiritual questions as well. They may wonder why the death occurred. Children may question why the person they loved died—their parents and themselves now suffer with their sadness and grief. Children may struggle in understanding their spiritual beliefs. They may even be angry or fearful of God. Children also may dream about the person who died and struggle to make sense of such experiences.
The behavioral experience
Grief affects behavior as well—often in very different ways. Some children may avoid reminders of the deceased person while others want to speak about them, look at photographs and even hear music they associate with the person. It is common for children to cry or become withdrawn. Other children may deal with their grief by constant activity. Others may become cross and ill tempered. A child may express their grief in many different ways.
- Play—young children may use play as a way to make sense of the loss. They may play at being in a hospital, dying or even at funerals.
- Regressive behaviors—that is, they revert to earlier behaviors that were seemingly outgrown.
- Nightmares or waking frequently during the night.
- Acting out—their behavior in the house or in school may deteriorate.
- Lack of concentration and focus, leading to more accidents.
- Changes of interest—activities that once were of interest now no longer engage the child.
The grief roller coaster
Like adults, children often experience grief as a roller coaster—full of ups and downs, times when they are doing better, and times when they are not doing so well. Often, like a roller coaster, it is not the very start of the ride that is the worst. In the period right after the loss, we are often in shock. In addition, there may be much activity following the death—funerals and events that need to be attended. Moreover in this period, we receive much support—everyone seems so concerned.
It is often later that the loss begins to be fully experienced. Others are not as present. We now have to live with the absence of a person who once meant so much. Holidays, birthdays and other special days, such as the anniversary of the death, may be days when grief seems to surge. Celebratory days such as graduations, confirmations, communions and Bar or Bat Mitzvahs may have a bittersweet quality now that a person so loved is missing.
Over time the roller coaster ebbs. Generally for most, the pain of the loss lessens, and we are able to function as we once did. We still may have moments, though, special times when our experience of grief surges—perhaps at some milestone or event where we deeply feel the absence of the person who died.
While children follow this same type of pattern in their grief, there may be a few differences. Very young children, for example, are not able to understand death fully. As they age, they may begin to comprehend different dimensions of their loss—moving into more intense moments of grief.
All grief, whether of children or adults, is very individual. Each person grieves in his or her own way. Part of this will be influenced by very individual factors:
- The child’s age, developmental level or previous experience with loss.
- His or her general physical and mental health.
- The child’s relationship with the person who died.
- The nature of the death. Was it sudden or after a long illness? Was the child able to attend the funeral?
- The kind and amount of support received by the child—at home, at school, from friends or in support groups.
- The child's religious, cultural and spiritual beliefs or practices.
Adolescents and grief
Adolescents may have particular difficulties as they grieve. Many adolescents strive to fit in with their peers. For many, a death singles them out, sometimes causing embarrassment. In addition, many adolescents may be reluctant to reach out for support. Trying to be independent, they may avoid family, not wish schoolteachers or counselors to mention the death and avoid discussing the loss with friends. Often they feel isolated in their grief.
Moreover, as adolescents struggle with their identity, they often question their prior beliefs. The spiritual and religious beliefs that supported them in childhood may be less available now.
While most adolescents will experience grief in the same physical, emotional, cognitive, spiritual and behavioral ways as other age groups, some may have more complicating and troubling reactions. Some adolescents may act out their grief in aggressive or even delinquent behaviors. Other adolescents may cope by turning to alcohol or illegal drugs. A few may act out their grief in risky sexual behaviors. Grief may even be a factor in eating disorders.
Seeking support online
One major way that adolescents may seek support is through the Internet. Over 93 percent of teenagers report using the Internet. The Internet can offer information on grief as well as opportunities to memorialize online the person who died. Adolescents may “blog” or write about their grief in their own entries. They may even find support from other adolescents online.
Yet, the Internet carries certain dangers as well. The information offered may not always be accurate. Online support groups may lack professional supervision and even be unsupportive. In fact, participation in Internet support may make the adolescent less prone to seek support from more suitable sources.
There can be other dangers as well. The anonymity of the Internet magnifies the possibility that the comments of others—in support and in blogs—may be hateful, harmful or denigrating. In addition, there is, of course, the danger that predators may seek to contact vulnerable, grieving adolescents.
Parents and other adults such as counselors need to create an ongoing dialog with adolescents about the ways that they are using the Internet. It is always useful to ask adolescents what they have learned about grief from the Internet and the ways they are using the net to find support.
How to Help
The Value of Funerals and Memorials
Before history, there was ritual. Some of the earliest pre-historical ruins bare mute testimony to the careful funeral rituals that accompanied death. There is good reason for that. Research has emphasized how funerals, memorials and other rituals offer powerful therapeutic value as we cope with loss. Funerals confirm the painful reality of the death—moving us beyond the natural desire to deny that truth. These funeral rituals assist us in expressing feelings, exchanging memories and validating the life of the person who died. They bring together family and friends—offering the bereaved the support of others and reminding family, even in the midst of loss, of a caring community that offers sustenance. Spiritually, funerals offer a message of hope—reminding mourners of the ways that faith speaks to their grief.
These are powerful benefits that hold not only for adults but also for children. So it is critical that children should not be discouraged from attending funeral rituals but rather allowed to make choices on the ways that the child wishes to be involved. That right should be given to children once they are old enough to sit through a short service and are able to communicate their wishes and desires.
In order to make meaningful choices, children first need information. If a child has never attended a funeral ritual before, it is important to explain to the child what he or she might experience, see or hear. They should know that some people might be crying because they are sad, while others may even laugh as they share funny memories of the person who died. Younger children may have particular questions about the tangible things that they see such as a casket or flowers. One little girl worried about all the flowers around her grandmother since she was very aware of her grandmother’s allergies. Funeral directors may have books and materials that can help parents and children understand the funeral. They would certainly be willing to show the child the viewing room prior to the visitation and patiently answer any of the child’s questions.
Children also need choices. Funerals are really many events that may take place over a couple of days. There may be a visitation or wake, a funeral service and an interment at the cemetery. Children should have the choice as to whether they wish to attend all or only some of these event—or even if they wish to attend at all. If the child is not present, the choice should be to stay with a friend or family member with whom they feel comfortable.
Support during the funeral
Finally, and in many ways most importantly, children need support. There should be one person at the funeral whose basic role is to support each child. If the parents are intimately involved in the funeral, they are unlikely to be able to provide that constant support. This person should be ready to answer the child’s questions, and if necessary, to provide respite—taking the child for a walk, for example, should the child need to leave the event for a time.
Children should not only have a choice as to whether to attend the ritual—they should have a choice in planning and participating in the rituals if they wish. Consider allowing your child or adolescent to read a poem, select the casket or distribute flowers to mourners for a final goodbye at the cemetery. These opportunities to participate in the planning or the ritual itself enhance the therapeutic value for children. As the Harvard Child Bereavement Study indicated, children who participated in the planning of the funeral felt both important and useful at an otherwise overwhelming time.
Rituals need not end after the funeral. Rituals remain powerful ways to mark the continuing bond that the child feels with the person who died. Simple rituals like visiting the cemetery or lighting a candle on special occasions, such as a birthday or an anniversary of the death offers both children and their parents an opportunity to share memories and to grieve together. These ongoing rituals reinforce the fact that even death cannot break the connection with the deceased.
Keeping communication open
Throughout the period of a loss—whether during the illness, the time of death, the funeral or after the funeral—it is critical to keep communication open. Only by doing so can we truly understand the ways that the child is experiencing grief, allay any fears the child may have and support the child in his or her grief journey.
Keeping communication open means responding to the child’s questions in clear and honest ways. We need to make sure we fully understand the question. The question “Are you going to die Mommy?” may not be a request for reaffirming mortality but rather the child asking for reassurance that he or she will not be abandoned. Two rules can help here. The first rule is to always understand the context of the question. Gee, that is an interesting question, what made you ask that? Such a question helps clarify the child’s concerns or fears. Then always answer in a way that is honest but also keeps the conversation going. A simple yes or no leaves little room for further discussion. A response like "Most people live until they are old, even old enough to see your children or grandchildren—that’s why Mommy always buckles her seat belt and stopped smoking so she could live, I hope, a long life," is both truthful and reassuring.
It is also helpful to be direct. The romantic stories we may weave and the euphemisms that we use might only frighten and confuse the child. Telling a child that someone who is dead is asleep can make a child anxious at bedtime. Saying that Dad was so good that God wanted him in heaven may lead a child to behave in a way that does not lead to such an invitation. It is best to give simple, honest and direct answers appropriate to the child’s developmental level. If you do not have an answer, it is good to simply say so. "I do not know why Grandma had to die. I miss her—what do you miss most about her?" Such a response both answers honestly and keeps the conversation going.
As children cope with their grief, they can learn as we model how we deal with our own grief. Sharing our feelings with the child reassures children that their feelings are normal and natural. "Sometimes I miss your dad so much. I am sad, even angry at times, that he is not here to see how well you did in the game tonight." Such statements can validate the child’s feelings and empower the child to talk about the ways he or she is feeling. We need to let children share when they are ready though. We should never believe that only if the child expresses sadness or other feelings they will surmount grief or try to force the child to respond emotionally.
We can share our faith, too. Our religious and spiritual beliefs help us to deal with crises and loss. The best way to impart those beliefs to a child is to model them—to show the child how these beliefs help us as we deal with loss. "I am crying because I miss Grandma, but I am comforted that she is now in heaven."
While we can share our feelings and our faith, we need not share our anxieties and worries, especially if the child does not ask. It does little good, for example, to share financial worries with a child who may neither be able to understand fully those fears or be able to help. Instead reinforce the message that no matter how tough things may get, we will survive and stay together.
Assist children as they try to understand and acknowledge the loss
Children may struggle with trying both to understand and acknowledge the loss.
It is difficult, even for adults, to really understand and accept that someone we love will no longer be in our lives. This is even more difficult for children since they may struggle, at least in the younger ages, with understanding death. It is even made more difficult when adults in an effort to be a protective shield for the child from the death use words such as passed away or sleeping that may further confuse the child.
Adults can help children in a number of ways. The first is to involve the children in making comfortable choices, throughout the illness. Let children clearly understand that someone is very ill. Visits to the hospital or home of the person may help the child to really understand the seriousness of the illness and may cushion the shock when the person dies. Naturally, the earlier rules governing choice should apply. Children should have information, options and support. Adults should carefully address any questions aroused by such visits.
The funeral, too, is an important event that helps reinforce the reality of the loss. Again, children should be given choices about what parts of the ritual they wish to participate in, as well as being supported throughout the event.
In addition, adults should communicate clearly with the child—using terms such as dead, death and dying. Patiently answer any questions the child may have. Realize that as children age, their understanding of death deepens. We can educate children through conversation and resources such as books about experiences and reactions that are common in grief. Over time, they may continue to have questions. Keep the dialogue open. Remember, too, that their play, drawings and writings may offer clues and opportunities to dialogue.
Assist children in processing their feelings
As with adults, death arouses many emotions in children. Some like anger and sadness may be easily visible; others such as guilt may be more hidden. Like adults, children may have to process and express these feelings. This can be difficult for a number of reasons.
Young children may have both a short feeling span—where strong feelings are tolerated for only a short time—and a limited vocabulary that allows them to interpret and express their emotions. Adolescents may be defensive about their feelings—afraid that displays of emotions may show them to be vulnerable. Children also may wish to protect the adults around them from the rawness of their feelings, afraid of what it might set off in others. Children and adolescents may be confused or ashamed of some of the more complex and ambivalent emotions, such as guilt or relief.
Explain to children that feelings are just that—feelings. These emotions are not easily controlled. The feelings we have, even the complex and ambivalent ones, are normal. They need to be shared and accepted.
Certain times of the year may be particularly difficult. Holidays, anniversaries, birthdays, and other occasions may be times when feelings of loneliness and grief become particularly strong. Adults can reassure children that their feelings are natural in such occasions and perhaps even plan a small ritual that acknowledges and focuses the grief and allows for conversation: for instance, leaving a gift under the tree for the deceased family member during the holidays.
Sometimes children may need to be reassured. As children openly express their emotions, adults can help them confront and process fears that are unrealistic. A child, for instance, may be worried they have the same disease or that a bout with the flu may lead to death.
Support groups and counselors can be helpful when adults are struggling so much with their own feelings that they feel they cannot be there for their child. It is also important to remember that children’s emotions are as unique as adults. In many cases children may process their emotions in expressive and active ways and have little need for adult intervention. We should be open to the child’s expression of feelings. We need not force feelings upon or out of the child.
Adjust to a life now changed from the loss
Whenever someone dies, our world changes. In some cases, such as the death of a parent or sibling, the changes may be great—the child may have to move to a new neighborhood. In other cases, the changes may be subtler. Holidays, for example, may no longer be spent at Grandma’s.
These changes can be difficult for children since they have little control over them and perhaps cannot completely understand their necessity. Again dialogue and conversation help. Adults can validate the child’s feelings about changes. It is different and difficult not to go to Grandma’s house for the holidays. Sometimes a simple question such as "what would you wish to change if you had a magic wand?" can create a dialogue with children over the changes they are struggling with and experiencing.
If possible, introduce changes slowly into the life of the child. For example, when dating after the death of a spouse, introduce dating partners carefully and slowly, allowing for carefully cultivated relationships.
When losses involve substantial changes, it is important to bring children and adolescents into the planning process. This helps them have a sense of control over the events that are occurring. Even choices within a decision might lessen the blow of change. For example, if a child has to move, it can help to involve them meaningfully in selecting their next home or apartment.
Continue to remember the person who died
We never stop remembering or loving a person—even when that individual dies. Our connection with that person continues, although now in a different way. Children and adolescents may be frightened that once their grief diminishes they may no longer remember the person they loved. Many times children need opportunities to be reassured that they will always remember that person.
Sometimes these memories can intrude painfully, often coinciding with important life milestones. In such moments, it is important for parents or other adults to reassure children that such feelings are normal and natural. Perhaps the parent even might create a moment within or around the event to specifically remember or honor the person who died.
Sharing stories and remembrances strengthens the reality that the individual remains in our lives. Reminiscing about the person assures that the legacy of their presence will always be preserved. Visiting the memorial, creating photo albums or “memory boxes” allows opportunities to retell stories and reminds children of the continuing bond that is still retained.
Help children make sense of the loss
Children and adolescents will often try to make sense of the loss. Like adults they will often question why the person they loved died, why now or why in that way. This struggle can be particularly intense for children. Younger children may lack the ability to fully understand the death. Even when children understand the how they may struggle with the why. Younger children may still be developing their spirituality while older children and adolescents may question their spiritual beliefs in the face of a difficult and incomprehensible loss.
These questions provide opportunities for parents and other supportive adults to share their spiritual stories and beliefs as well as the activities that help them confront the loss. It is acceptable as well to share our own struggle as we seek to find some sense of meaning in the event.
We need not do this alone. In recent years, a number of resources have become available to assist children and adolescents as they cope with loss.
Books can be helpful for a number of reasons. They can reassure children that their experiences of grief are normal. Books can offer children suggestions for coping with the common problems of loss. Most importantly, books can provide reassurance that the painful reactions they are experiencing will subside.
Naturally, it is critical that books be selected for a child based on the child’s appropriate reading level as well as the context of the book—the message we wish to convey. Books should always be evaluated before they are given to the child or adolescent. They are never a substitute for conversation but a conversational aide. Reading together or discussing what was read can offer an opportunity for children to share their experiences and reactions with parents and other supportive adults. Local or school libraries, as well as bookstores or the Internet, are good sources for such literature. Some funeral homes as well might have such books as part of their Grief Resource Library.
There are now many books to help children and adolescents cope with loss and grief. Some books to consider:
- “Lifetimes: A Beautiful Way to Explain Death to Children”
- “When Dinosaurs Die: A Guide to Understanding Death”
- “Mama’s Going to Heaven Soon”
- “Where Is Grandpa?”
Grief groups or grief camps
Children and adolescents may benefit from Grief Support Groups as well. Grief groups like books can normalize the experience of grief, offer suggestions for coping and nurture hope. In addition, grief groups connect children and adolescents who have had the common experience of a significant loss—building supportive networks. This is particularly important for adolescents who now have a network of peers who will not ostracize them but who can share their loss.
Some groups may even offer summer camp programs that are either day or sleep away programs. These provide many of the same benefits although in a more intensive format. Some camp programs may be generally open to the children and adolescents from the community while others may be restricted to those that have participated in groups.
Children’s Grief Centers, schools or local hospices may offer grief support groups or camps. School guidance counselors, hospice bereavement coordinators and funeral directors also may sponsor or refer to local groups and camps.
Some children and adolescents may benefit from individual counseling. This often can be helpful when the loss was very traumatic or the relationship with the person who died was very ambivalent or conflicted. Certainly behaviors following a loss that are self-destructive or destructive of others or when the child seems to have great difficulty in resuming previous patterns of behavior—for example giving up once treasured activities or failing in school—merit evaluation from a trained counselor. Again hospices, funeral directors, the Association of Death Education and Counseling or, for younger children, the Association for Play Therapy, are excellent sources for referrals.
Remember though, the best thing that adults can offer grieving children and adolescents is good parental care. Especially when they are grieving, children and adolescents need the same things that they always need—a consistent, loving, and stable environment. They need to continue to have positive experiences within the family—family celebrations, trips and rituals.
If our grief is overwhelming, there is little we can offer to our children. We need to seek support for ourselves—from friends and family—and if needed from support groups and counselors so we can function effectively. Only then can our children thrive—even as they cope with death, grief and loss.
About the Author
Dr. Kenneth J. Doka is a professor of gerontology at the Graduate School of The College of New Rochelle and senior consultant to the Hospice Foundation of America. A prolific author, Dr. Doka has authored 24 books on the subject of grief, has published over 100 articles and book chapters and is editor of a journal and newsletter.
Dr. Doka was elected president of the Association for Death Education and Counseling in 1993. In 1995 he was elected to the board of directors of the International Work Group on Dying, Death and Bereavement and served as chair from 1997-1999. The Association for Death Education and Counseling presented him with an award for Outstanding Contributions in the Field of Death Education in 1998. In 2000 Scott and White presented him an award for Outstanding Contributions to Thanatology and Hospice. His Alma Mater, Concordia College, presented him with their first Distinguished Alumnus Award. In 2006 Dr. Doka was grandfathered in as a Mental Health Counselor under New York state’s first licensure of counselors.
Dr. Doka has keynoted conferences throughout North America as well as Europe, Asia, Australia and New Zealand. He participates in the annual Hospice Foundation of America Teleconference and has appeared on CNN and Nightline. In addition he has served as a consultant to medical, nursing, funeral service and hospice organizations as well as businesses and educational and social service agencies. Dr. Doka is an ordained Lutheran minister.