According to research by the Social Security Administration, it was estimated that approximately 4 percent of adolescents below the age of 18 years had experienced the death of a parent ( Edgar-Bailey & Kress,2010). The leading cause of death among adults being chronic diseases, homicide, suicide, and other illnesses. The unanticipated and often the traumatic nature of the events leading to the parental death often impacts the child in various ways. The child is sometimes unable to process the loss of the parent as well as handle the typical grief process. As such, the Diagnostic and Statistical Manual of Mental Disorders (DSM) V- code recognizes deprivation as an essential focus in clinical counseling in the event of the loss of a loved one, as some people experience severe traumatic grief symptoms. Although not often, some of these symptoms may affect an individual's functioning to the extent of being diagnosed with major depressive disorders (MDD). This paper through a case study of an adolescent who lost her loved mother presents the use of specific assessments and interventions that can be helpful in intervening loss and grief.
Description of Field Placement Setting and Client Presenting Issues
My field placement is within The York Early College Academy (YECA), which is a New York Early College Public School ( Hair, et.al., 2015) . Through the partnership with The City University of New York’s Early College Initiative and York College, the students within the program are provided with a rigorous academic program from 6th to 12th grade. My task as a social work intern is to provide specific educational counseling to the at risks students and provide one-on-one for the students to complete their FAFSA and college applications.
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David is one of my clients in the 11 th grader at YECA. He is the only male sibling, older brother to two younger sisters. David's mother died recently from an unknown illness. The father was now left with the responsibility of taking care of them. However, he is an extremely principled man who believes in religion and following specific rules. To him, things should be done according to his ways and not any other way. They go to church and also doing prayers with the three children at home. The father recently has started interfering with David’s studies, as he wants him to stop taking college credits and to go back to the YECA high school and continue taking high school credits instead of college credits at York College. Academic pressure coupled with the loss of his mother has left David anxious and depressed. This has also started affecting his academic performance. He is no longer interested in school activities including learning. The lack of support from his father in this time of bereavement has led to my client David develop separation distress, sadness, diminished developmental energy, and despair.
Biopsychosocial Assessment of David
Date of birth: 9/24/2002
Date of evaluation: 10/25/2018
Age at the time of assessment: 16 years old, one month
Reason for Referral
The client David was referred to the YECA College Counselor, a particular educator specialist that provides specific educational counseling to at risks students and provide one-on-one for the students to complete their college application and guide them through their college process. David is being forced by his father to stop taking college class credits at YECA through York College and go back to the high school and attend high school level classes. David is very stressed about the whole issue, and he is not sure how he will convince his father. Besides the academic pressure from his father, David lost his beloved mother. The unanticipated loss has significantly affected him leading to depression, sadness, anxiety and diminished development energy to the extent of losing interest in his academic studies. The lack of empathy and support from his immediate family in this time of bereavement has further complicated issues. David is always overly fearful and exhibits some symptoms of depression.
Family Description
The father heads the family after the ultimate demise of the mother. The family now comprise of three children and the family. The mother until she met her death has no history of underlying complications or illnesses. The father is a strict principled man who overemphasizes the importance of following his religious doctrines. The family has to attend church services and even hold family prayers at home. Apart from them, he is very strong, aggressive and has masculine pride. He must have his ways and considers his decision more superior and must be followed to the latter. The family lives in a three bedroomed house.
Family Composition
Father Damien, age 52, employed (the former engineer)
Mother Danielle, age 45, deceased.
Child Client David, age 16, eleventh-grade taking college credits.
Sister Dena, age 14, ninth grade.
Sister Dana, age 13, eighth grade.
The Nature of the Client’s and Family’s Problems
The father is exerting a lot of pressure on David to go back to high school in New York and stop taking college credits. David, on the other hand, wants to stay at YECA and get college credits. He enjoys his time at college and is putting a lot of effort to attain the best grades. David has also not come into terms with the death of his mother, and he is still grieving. The separation distress that ensues upon the loss of his relationship with his mother had caused distress and depression leading to a decrease in his academic performance. Lack of specific intervention to cope with the loss such as a supportive family has increased his level of distress, cognitive impairment and instability to operate reasonably.
From the problems exhibited by the family, David needs help on how to cope with the loss. This includes interventions that focus on grief as well as trauma to reduce depressive symptoms. The responses will also focus on stress management skills and cognitive processing. The father also needs some interventions in making meaning out of the loss of his wife as well as how to maintain a positive relationship with his family.
Coping Capacities of Client and Family: Assessing Strengths, Obstacles. Risk, and Protective Factors
Each of the family is dealing with the loss of the mother differently from each other. We lack in-depth information about how they are coping with stress, but from their various encounters at home and school, we can learn something. David and the sisters suffer from inhibited grief, a type of grief that involves inhibition of the ordinary behaviors associated with grief. They do not exhibit the grief directly, but other issues such as academic pressure push them to develop other complications such as depression. The risk with this kind of mourning is that the bereaved may develop maladaptive behavior without being aware as a result of repressing the feelings. Despite the loss of his mother, David is still a brilliant and great student. He is in the eleventh grade taking college credits. His exemplary performance will enable him to graduate to the college of his choice. His coping mechanisms, therefore, lies in his ability to continue with his studies uninterrupted.
David’s father is suffering from distorted grieving. This type of grief manifests itself through unusual changes in behavior and self-destructive actions. David's father has been hostile to David to the extent of forcing him to go back and retake high school grades. He is not empathetic that the children have not yet coped with the loss of their mother. This coping strategy is quite risky as he may engage in self-destructive behaviors such as violence and addiction. Thus, the possibility of depression will need to consider when evaluating David's father. His coping mechanisms are complicated to determine as he already has a history of aggression and masculine ego.
Other Persons or Systems Involved in Client’s and Family’s Situation.
Some people will be involved with this family among them being: the staff at YECA. College Counselor and parent coordinator. The staff at YECA will help in assisting David to get back on his track in academic performance. The college counselor will help him in his bereavement journey as well as any help that he will be needing. The father's church will be providing the family with the spiritual assistance that they will need as well as how to cope with the loss of their beloved one.
Available or Needed Resources
The family most pressing need is how to cope with the demise of their mother. The different counseling agencies will play a critical role in addressing the ambivalent feelings, redefining the relationships between the father and the children and making meaning out of the loss. Grief focused interventions by the college counselor as well as other counselors will play a critical role in decreasing psychological problems experienced by the family. Besides, through the appropriate responses, the father will learn how to control his aggressive tendencies and emotions. The college advisor will help David in his academics particularly on how to improve his performance.
Clients and Family Motivation to Work on Their Problems.
David's motivation is in his academics and the ability to perform. After going through counseling, David will be able to continue with his studies without a lot of obstacles. Similarly, lack of pressure from his David will play a critical role in improving his situation. David's as a single parent having lost his wife is also going through a lot of challenges, as he is the only sole provider of the family. While counseling him, it is essential to acknowledge the excellent work he is doing. This will most probably encourage him to continue working hard and fill the gap the mother left.
Client’s Current Stage of Brain Development
The brain is the most complex organ of the body involving millions of neuron and connections. Throughout infancy, adolescence, and adulthood the neurons and cells continuously develop creating more complexities. These complexities are organized into groups to carry out specific functions. When an individual undergoes a traumatic experience such as the loss of a loved one like David’s mother and too much pressure, the brain releases a hormone and neurotransmitters that enable the person to adapt to the external stressor and modulate internal stress.
Currently, the cortisol part of the brain has provided David with the necessary energy to concentrate on his studies and at the same time suppressing stressful situations. This has enabled him to cope with the death of his mother with so much ease. However, the constant pressure from his father to change schools is likely to improve the functioning of his brain. According to Hair, et.al. (2015), the quality of caregiving determines how an individual brain develops and function. Thus, due to constant pressure, David's brain is likely producing too much cortisol and corticotrophin-releasing hormone. This subsequently puts systems whose principal responsibility is to control stress on hold, resulting in prolonged periods of stress that affect development ( Hair et.al., 2015) . This is what has been happening to David leading to decreased participation in school activities and depression.
Two Theories Related to the Client Case
Attachment Theory
John Bowlby developed the attachment theory several decades to explain loss and grief over a long period. Under his theory, Bowlby came with four distinguishing characteristics of attachment among them: proximity maintenance, safe haven, secure base and separation distress ( Boerner, et.al., 2015). According to him, when a child is born, they become attached to their caregivers promoting their survivals as they are dependent on them on almost everything ( Boerner et, al., 2015). In childhood or adulthood when their primary caregiver is taken away through death or any other means, the child is likely to suffer from psychological and physical distress. Having had a close relationship with the mother, David experiences separation anxiety as he tries to come up with the death of his mother. The preoccupation with the death and increased yearning is some of the factors that are likely to cause depression and stress.
Strength-Based Perspective
A strength-based perspective is an approach that is used to emphasize the importance of individuals techniques, knowledge and procedures as essential keys to change ( Hammond & Zimmerman,2012) . This perspective reminds individuals that they hold the key to their transformation and meaningful change process. David believes that his coping abilities lie in his strengths. He uses his ability to perform well in school to cope with the loss of his mother. He finds comfort and happiness while in school as compared to being elsewhere. While counseling David, this perspective should be used in fostering hope and optimism.
Discussion of Risk and Protective Factors Related to Your Client Presenting Issue(S)
Bereavement, the experience of losing a loved one to death, is one of the most painful experiences in life. It has several physicals, psychological and social ramifications when the necessary interventions are not put into place (Bylund-Grenklo et al., 2017). David as one of my clients is likely to have the following risk factors as a result of inhibited grief. One, separation from one of his primary caregivers as a result of death is expected to cause him to suffer from separation anxiety. Though not sure of the kind of relationship they had with his mother, David is scheduled to have conflicted feeling related to his loss. He expresses the painful emotions by studying and performing well in school.
David’s father pressure in his academic is likely to put him in social isolation. Occasionally, when adolescents do not experience much support especially from their close relatives, they are possible to isolate themselves as they look for creative interventions to help themselves (Bylund-Grenklo et al., 2017). This isolation is likely to push David into depression. Moreover, the pressure from his father is expected to have a negative impact on his academics. In the assessment, David is now no longer interested in his studies, and the grades have been dropping significantly.
As observed, David copes with the loss of his loved mother by performing well and studying in school. This protective technique can be widened to help David cope well with the grief. For instance, David can be encouraged to widen his scope in writing for instance poems or creative arts. The poems and arts can play an essential role in providing an outlet through which he let out his intense emotions. This technique can also help in bringing out the positive image of the mother, thus countering the traumatic imagery associated with death (Stroebe, Schut, & van den Bout, 2013).
According to Lord and Gramling (2014), religion is one of the primary ways through which people make sense of the world. David comes from a deeply religious family who can act as a source of solace and comfort. The various religious activities that they attend together with his family may help in creating the meaning of a loved one’s life and death. Believing that they will be reconnected with the mother at some point in life may help in feeling reconnected with the person, thus easing the pain (Kilgo, 2010).
In conclusion, the paper has addressed the various risk factors that face families especially adolescents when they lose their beloved ones. These factors include social isolation, depression, anxiety, and poor academic performance. It has also focused on creative ways through which counselors can help clients undergoing grieving deal with traumatic experiences and continue with their normal activities. These creative ways include strength-based approaches as well as protective factors that surround the client.
References
Boerner, K., Stroebe, M., Schut, H., & Wortman, C. B. (2015). Theories of grief and bereavement. Encyclopedia of geropsychology , 1-10.
Bylund-Grenklo, T., Fürst, C. J., Nyberg, T., Steineck, G., & Kreicbergs, U. (2016). Unresolved grief and its consequences. A nationwide follow-up of teenage loss of a parent to cancer 6–9 years earlier. Supportive Care in Cancer , 24 (7), 3095-3103.
Edgar-Bailey, M., & Kress, V. E. (2010). Resolving child and adolescent traumatic grief: Creative techniques and interventions. Journal of Creativity in Mental Health , 5 (2), 158-176.
Hair, N. L., Hanson, J. L., Wolfe, B. L., & Pollak, S. D. (2015). Association of child poverty, brain development, and academic achievement. JAMA Pediatrics , 169 (9), 822-829.
Hammond, W., & Zimmerman, R. (2012). A strengths-based perspective. A report on resiliency initiatives .
Kilgo, J. (2010). Exploring themes of resiliency in children after the death of a parent. Childhood Education , 86 (5), 347-348.
Lord, B. D., & Gramling, S. E. (2014). Patterns of religious coping among bereaved college students. Journal of religion and health , 53 (1), 157-177.
Stroebe, M., Schut, H., & van den Bout, J. (2013). Prospective risk factors for complicated grief: a review of the empirical literature LAURIE A. BURKE AND RoBE RT A. NEIMEYER. In Complicated Grief (pp. 163-179). Routledge.
