Adjustment from Bereavement Using Grief Counselling with Cognitive Behavioural Therapy - Essay Example

? Adjustment from Bereavement using Grief Counselling with Cognitive Behavioural Therapy and Narrative Therapy Target Behaviour: Bereavement CLIENT DETAILS Diagnosis: Bereavement Client Age: 10 years old Client Sex: Female Number of Sessions: 14 Treatment Approach: Narrative Therapy and Cognitive Behavioural Therapy Treatment Mode: Weekly One-Hour Sessions Referral Information The client, a 10-year-old female student, was referred by her mother after the latter noticed a change in her daughter’??s behaviour after the sudden death of the child’????? grandmother The client has become unhappy, down and tearful. Total Session with Client The client attended 14 grief counselling sessions and 2 follow up sessions and after which have shown to be normally coping with the death of her grandmother. Client Presentation The client is neatly dressed in her school uniform when she comes for counselling. She comes on time for each session and never missed an appointment. She was able to sustain her attention, maintained eye contact and displayed a cooperative attitude towards the counsellor. The client described her low mood and sadness due to the passing away of her grandmother. She has difficulty expressing her emotions but claims to be ‘feeling very very sad and missing her grandmother”. She was orientated to time and date and setting. Her speech was clear. No perceptual deficits were noticed . The form and content of her thoughts were assessed as appropriate. No immediate risk was noticed. She appeared to be intelligent. Problem Situation The client has difficulty expressing her deep emotions and feelings about the passing away of grandmother. She have told several times that she is “feeling very very sad” and badly misses her grandmother. She narrated that she has lost her interest in doing things that she previously enjoys such as hanging out with friends after school, and participating in ballet and art classes. The client also stated to becoming easily frustrated and angry and would rather stay at her room alone and cry. Relevant Client History Development and Family history The client is an only child. From her infancy ,she has always been left under the care of her grandmother, as both of her parents are both working on full time basis. Her grandmother lives with them in their family home. Interpersonal Relationship The client is reportedly to be much closer to her grandmother than to her own parents.She used to hang out with friend’? after school to do homework and together and play afterwards. But after, the death of her grandmother the client reported that she has been keeping herself in her room and refuses to talk even to her parents and friends. Psychiatric History The client reported no previous psychiatric history. Discussion of Evidence Based Theories Grief also known as bereavement. It is a profound sadness following a major loss of a loved one (Kaplan and Sadock,1996). According to John Colby it has 4 stages 1. Numbness or Protest – clients are characterized by distress, fear and anger. It could last from moments to months. 2. Yearning and searching for the lost figure – clients are pre occupied with thoughts of the lost person and are usually angry, restless and crying. This may last for several months. 3. Disorganization and despair – client are restless, withdrawn, irritable and repeatedly reliving memories with the deceased. 4. Reorganization – clients start to establish new patterns of goals, grief had recede and is replaced with cherished memories with the loss person. (Kaplan and Sadock,1996). The theories most suitable for this client were Cognitive Bahavioral Therapy (CBT) and Narrative Therapy (NT). The Studies shows that CBT is an effective goal oriented psychotherapy and successful in treating behavioural problems, as it teaches techniques to correct unhealthy thinking patterns and attitudes resulting to painful memories. Narrative therapy on the other hand, provides space for clients to retell their stories. NT believes that everyone has a story to tell, but it is the individual who shapes one’? story and not the story which defines a person. Therefore NT provides clients to retell their stories the way they want to make it happen. Formal Diagnosis A detailed client history, a mental status examination and the result on the Children’s Depression Scale (Decilise:5) were the basis for the following Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR) diagnosis: Axis I V62.82 Bereavement Axis II V71.09 No diagnosis Axis III None Axis IV Extreme Problems with primary support group Axis V 60(highest level beginning the counselling Psychometric Assesssment The client scored Decile:5 on Children’? Depression Scale which indicated that she is not experiencing depression. Rationale for diagnosis: Axis I V62.82 - Bereavement The client claimed to be “feeling very sad” and narrated she has lost interest in participating to activities she previously enjoys such as studying and playing with friends after school, attending ballet lessons and participating in art class. She displays anger and frustration over the first few sessions in the counselling. In DSM –IV- TR , grieving over loss of a loved one and feelings of sadness are categorized as Bereavement . Axis V- Global Assessment Functioning (GAF) Commencement GAF 60: - (Moderate difficulty in social and school functioning resulting from bereavement) Loss of interest in attending art class and ballet sessions, which she used to enjoy Does not want to hang out with friends Conclusion GAF 80 : (No more than slight impairment in social and school functioning) Differential Diagnosis Major Depressive Episode (MDE) has been ruled out, though the client displayed 2 of its criteria, (1) depressed mood and or irritable most of the day. (2) markedly diminished interest or pleasure in activities (DSM IV-TR) DSM IV-TR specifies that for a client to be diagnosed with MDE, the client should possessed 5or more of the criteria listed in the DSM IV-TR. (DSM IV TR-Guidebook, 2004)) . Moreover, the client did not display characteristics that are not synonymous to normal grief reaction such as guilt feelings, thinking of being better to be dead together with her grandmother, feeling of worthlessness, psychomotor retardation and hallucinations.(DSM IV-TR) Treatment Objective Grief Counselling was used to encourage the client to speak freely of her current feelings in relation to the death of her grandmother. Goals of intervention were as follows: To identify and express feelings related to the loss (for example sadness) (CBT) To explore different ways to deal with the loss (Narrative therapy) To explore her own personal way of saying goodbye to her grandmother.(CBT) Resume interest in daily activities at home and school (contingency reinforcement method Treatment Plan 1 .Identify and express feelings related to the loss (CBT) Let the client freely express her current feelings (frustration,sadness,anger) over the death of her grandmother. Assist the client in recognizing and identifying her feeling as normal reaction over loss of a loved one 2.To explore different ways to deal with the loss (NT) Let the client share her fondest memories with her grandmother and help her realized that these are cherished memories she can keep forever in her heart. Creating lasting bond with the deceased. 3.To explore her own personal way of saying goodbye to her grandmother.(CBT) Let the client create and recreate a story where she is able to say goodbye to her grandmother 4. Resume interest in daily activities at home and school (contingency reinforcement method) Participate in art class Invite friends at home Hang out with friends at school. Create “new memories” with parents Application of Appropriate Interventions 1.Identify and express feelings related to the loss Generally, children have difficulty identifying their feelings and much more expressing those emotions out loud .Grief Counselling was conducted through conversations with genuine listening, and letting the client to express freely what she felt without pre-empting what she would like to express. The client was encouraged to show her sadness, anger and frustration. Expressing and identifying these emotions are an important part of accepting the reality of loss and equally important in order to enter into the process of healing .(Philips,2009) 2. Exploring different ways to deal with the loss The client was asked to share her fondest memories with her grandmother and brought photographs of her grandmother with her. 3 .To explore her own personal way of saying goodbye to her grandmother The client was asked to share the things she did with her grandmother days before her grandmother died and on the day she died. She was also asked to wrote a letter for her grandmother in her diary, expressing her final goodbye to her and a promise that she will be her ever cheerful and intelligent granddaughter. 4.Resume interest in daily activities at home and school . The ultimate reflection that the client is already coping up with the loss of her grandmother, is when she start to resume doing her regular activities at home and in school. In consultation with some of the client’? teacher, the counselor was informed that the client is managing to go around with her friends in the school and have been recently attended ballet lessons again. Parents shared that the client looks forward to their weekend family bonding and is open to talk about her unforgettable memories with her grandmother. Summary of Outcomes and Evaluation of Treatment The intervention given assisted the client to reach the treatment goals. NT and CBT interventions provided space for the client to express and identify her emotions over the sudden passing away of her grandmother. NT has greatly helped the client to recognize that her sadness and frustrations were normal reactions and that simply voicing out or expressing her emotions out loud are forms of releasing the grief. After the completion of counselling ,the client has moved to the stage of reorganization, which is an indication that she is already coping up with the loss of her grandmother and is currently establishing new routine in her life without the guidance and assistance of her grandmother. References: 1. First M., Frances A.,Pincus H (2004) DSM IV-TR Guidebook. American Psychiatric Pub. 2. Kaplan Harold, Sadock B. (1996) Pocket Handbook on Clinical Psychiatry. Williams and Wilkins 3. Philips T.,Losing Someone You Love Dealing with Death and Dying. Enslow Publisher Inc. Read More