Case Study on Grief and Mourning

Biographical Information

N. is a 48 years old single mother of 3 daughters who is currently working as a service crew at Mac Donald as part time near the Family Care Centre. She belongs to Philippine Chinese Family. She had a school grade of GCE O level. She has 2 siblings which include one elder brother and one elder sister. She lost her one daughter named Kathy, who was pursuing Polytechnic and passed away last year when she was just 17 years old. Her other three daughters include Isabella, who is 18 years old and working as a Besrita, Janice, who is 18 years old and studying in the final year in Institution of Technical Education, and Louise, who is 16 years old and studying in secondary 4. Isabella and Janice are twins. She is a free thinker who have good command in English and look very unkempt and messy. She has a very low self-esteem and get stressed up easily. She has been abused by her husband being a battered wife for more than 13 years. Her husband was a lighting technician of 52 years of age. After the death of her daughter Kathy, she left her husband and now is a single mother of three daughters currently staying at Family Care Centre. She is working in Mac Donald for providing a good support to her daughters financially, socially and emotionally. She has grief over the loss of Kathy and is aware of her current psychological problems and difficulties in married life. However, she has full faith and believes in professional and psychological intervention that can provide her and her daughters a prosperous life ahead.

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Psychologists have referred the state of loss or grief due to the death of a loved one as Bereavement. And the process of adaptation of loss of a loved one is termed as Mourning by the Psychologists. Bereavement includes the processes of internal psychological state, experiences of grief, adaptation of family members, changes in external circumstances and changes in the living arrangements.

Referral Information and Presenting Problems

Referral Source

The person to whom N. consulted was a psychologist referred by the social worker of Family Care Centre. Psychologist was a neurologist named L. when N. referred her he initially identified the symptoms of grief and intervened accordingly in order to help N. to overcome the death of her daughter.

Reason for Referral

After the death of her daughter Kathy, she left her husband and now is a single mother of three daughters currently staying at Family Care Centre. Though she was living with her three daughters but still she was physically, mentally and emotionally distressed. The specific behaviors or symptoms identified by N. included exhaustion and fatigue, difficulty in sleeping, frequent sweating, difficulty in breathing and dizziness or nausea. She also experienced confusion in daily life basis, difficulty in memorizing, comprehension, judgment and concentration. She felt dissociated and feeling of detachment hovered her. When she refereed neurologist L. he himself identified some specific behaviors or symptoms of bereavement. Neurologist found that she is suffering from vision impairment or temporary hearing loss, tremors in muscle, rapid respiration and increased blood pressure or heart rate. Neurologist L. tabulated the identified symptoms with fundamental sequences of phases of bereavement. This time course of bereavement exactly fit in the case of N. which involved initial numbness or intrusion, distress due to intense yearning or pining and finally loneliness with the emergence of disorganization. So, N. due to loss of Kathy was undergoing somatic distress, emotional distress, delayed physical responses, change in behavior and change in psychological state.

Expectations

N. had grief over the loss of Kathy and was aware of her current psychological problems and difficulties in married life. However, she had full faith and believed in professional and psychological intervention that can provide her and her daughters a prosperous life ahead. Neurologist L. being a professional psychologist had faced many such cases of bereavement before and was ready to treat N. with bereavement interventions that included pharmacotherapies, brief group psychotherapy, interpersonal therapy and some other therapies to help N. overcome the death of Kathy and work efficiently so that she and her daughter can live a prosperous life ahead. So the expectations of both client N. and psychologist L. is that the effective treatment and advices will be provided to control or decrease the ill effects of the changes in N.’s behavior because of the loss of her daughter Kathy.

Background Information

N. was born in a Philippine Chinese family. She had a school grade of GCE O level. She was a free thinker who had good command in English and looked very unkempt and messy. She had 2 siblings which include one elder brother and one elder sister. She is 48 years old now who have always been a very low self-esteem person who easily gets stressed up. She got married to a lighting technician who is 52 years old now and undergone severe domestic violence in her married life. She gave birth to four daughters out of which three include Isabella, who is 18 years old and working as a Besrita, Janice, who is 18 years old and studying in the final year in Institution of Technical Education, and Louise, who is 16 years old and studying in secondary 4. Isabella and Janice are twins. She lost her one daughter named Kathy, who was pursuing Polytechnic and passed away last year when she was just 17 years old. She has undergone many depressing and discriminated situations in her life but nothing in past depressed her like the death of one of her four daughters’ death did. She has been abused by her husband being a battered wife for more than 13 years but never felt so depressed because she had her kids which mattered a lot to her. But after the death of one of her daughters Kathy, she left her husband and now is a single mother of three daughters currently staying at Family Care Centre. She do not have many friends and social networks. She is currently working as a service crew at Mac Donald as part time near the Family Care Centre for providing a good support to her daughters financially, socially and emotionally. Though she was living with her three daughters but still she was physically, mentally and emotionally depressed. The specific behaviors or symptoms identified by N. included exhaustion and fatigue, difficulty in sleeping, frequent sweating, difficulty in breathing and dizziness or nausea. She also experienced confusion in daily life basis, difficulty in memorizing, comprehension, judgment and concentration. She felt dissociated and feeling of detachment hovered her. After getting aware of her current psychological problems and difficulties in married life she developed full faith and believed in professional and psychological intervention that can provide her and her daughters a prosperous life ahead. So she referred a psychologist N. who was a social worker in Family Care Centre and expected to receive effective treatment and advices to control or decrease the ill effects of the changes in her behavior because of the loss of her daughter Kathy. She had never consulted any doctor or any another person for the psychological treatment.

Assessment Instruments or Procedures

The assessment instruments and procedures used by Neurologist L. were adequate as he explicated the grief of N. from her perspective by means of quantitative and qualitative analysis. Qualitative analysis involved the sessions of framed semi structured interview that were conducted weekly and analyzed by L. using grounded theories. Then the results or outcomes of these interviews were compared with the results produced by the quantitative analysis which involved the use of two quantitative inventories for symptom recognition. These two inventories were SCL-90-R which was a psychological distress scale, while the other was GEI which was a 135 item grief experience inventory.