er new world without forgetting her old one but has not yet developed a new relationship with her losses, she has however adopted new ways of being in her world and is currently forming a new identity as a mother and she is re-investing herself in her role as a new mother again.

As N has not experienced the death of her children an adjustment to recognising the loss by acknowledging and understanding the death must be undertaken, in this instance working with N to understand and acknowledge the events that led up to her children being placed for adoption. I feel that she has reacted to the separation by experiencing the emotional pain of losing her children to adoption, she has to some extent achieved this stage, however, she has not yet identified the secondary losses, for example, she has not lost her identity as a mother as she has other children remaining with her, with further work I will encourage her to recollect the relationship with her sons by remembering them realistically and re-experience the feelings that she had for them, I feel that she has begun to re-adjust and adapt to her new world without her sons without forgetting her old one with them in it, however, due to the adoption she is not able to develop a new relationship with them and finally I feel that she is re-investing herself in her relationship with her new baby.

In relation to Worden’s tasks of grief, while C says that she has accepted the loss of her children, both in death and through adoption, I feel she may not have accepted the reality of the loss. In our sessions we have been working together to help her tell her story, how the baby died and how the children came to be adopted, I have encouraged her to tell me about her children, describing their appearance, their mannerisms and their personality. We have discussed the events that lead up to the children’s adoption, which was evidently difficult for her to recall. She is displaying a lot of shame around her behaviour in this instance and a lot of guilt with regards to her parenting, however, it is clear that she feels remorse around the events that lead to her children’s adoption. She is, however, confident that she made the right decision to terminate her pregnancy, as the baby may not have survived,due to her diagnosis, but she is also questioning if the baby would have survived. Through further reading around the subject of Trisomy 18, it was found that the median survival time for live births with full trisomy 18 was 14 days. Although median survival for these children is 2 weeks or less. (Wu, Springett & Morris, 2013). In relation to the last time the children were seen or contacted, C receives letters occasionally however has not disclosed if she is allowed to send letters, this is a cause of both distress and contentment as she knows they are having a g