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Grief and Loss Case Study

Yekaterina Ambrose

Herzing University

Counseling and Psychotherapy, NU672-7A

Dr. Elicia Sutton

April 2, 2023
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Grief and Loss Case Study

This paper considers the case of patient P.F. She has been informing others about how

she feels depressed, and how she is often tearful over the death of her husband that she had been

married to for 43 years. She also feels anger towards her granddaughter whom she blames for her

husband’s passing, as he died from a COVID infection that is believed to have passed on to them

from the granddaughter. She does have good days, and she is able to complete her activities of

daily living. She still enjoys activities such as crafting. She has lost weight, and her children have

been taking her out to eat. She does not want to take any medication.

Is Depression Diagnosis Warranted per DSM-V Guidelines?

The patient in question has asked whether or not she is depressed, although it is always

trickier to consider such cases when there are other circumstances to consider. In looking at the

DSM guidelines, she should not be considered to have a major depressive episode. For starters,

her condition is attributable to another reason which is bereavement, while at the same time, her

symptoms are not impairing occupational or social functioning, both of which would be signs of

major depression (APA, 2022). Another major indication of depression would be having 5 or

more diagnostic signs out of 9 listed by DVM-V. In looking at these signs, she does not have the

majority of them. She is not having suicidal thoughts, she does not appear to have diminished

ability to think, she doesn’t feel worthless or state guilt, she does not report fatigue, she does not

report insomnia, and she is still taking pleasure in activities such as her crafting (APA, 2022).

She does show worrisome signs. She is sometimes tearful, she has lost weight, and, she

has anger towards her granddaughter. This patient still clearly needs treatment, but her condition

is not that of major depression.

Stages of Grief and is Patient’s Grief Abnormal?

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Different models have varying numbers of stages, but they tend to be similar in nature.

This nurse is particular familiar with 5 stages of grief model that is also known as the Kübler-

Ross model (Lawrenz & Holland, 2022. The five stages of grief are denial, anger, bargaining,

depression, and finally acceptance (Lawrenz & Holland, 2022). It is important to note that grief

is not just about the loss of a loved one, but could involve other types of loss, such as the ending

of a relationship, the loss of a job, or receiving a diagnosis of being terminally ill. Obviously, the

reactions one might have during these phases will be somewhat dependent upon the nature of the

grief.

In this case the patient is suffering from the death of a loved one. The denial phase would

simply not really be believing that the person is dead. In the anger phases there tends to be anger

towards those that might have any tenable (or untenable) culpability. This patient is

demonstrating her anger towards her granddaughter, although in other cases she might

demonstrate anger towards herself for letting the granddaughter get near her husband, or towards

her husband for not being careful enough. (i.e. blaming him for not taking better care to be

healthy such as using masks, or getting vaccinated, or losing weight, or whatever the case could

potentially be, etc.)

The third stage of anger is bargaining (Lawrenz & Holland, 2022). In cases like this a

patient might think that if only she hadn’t let the granddaughter meet with her husband then all

could have been well. The fourth stage is depression (Lawrenz & Holland, 2022). In this case,

the patient can be difficult to define, and can be very overwhelming (Lawrenz & Holland, 2022).

The final stage would be that of acceptance, which in the case such as this might be thankfulness

and acknowledgement of all of the years, they she was able to have with her husband (Lawrenz

& Holland, 2022).

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This patient is exhibiting normal behavior. She is going through the expected stages of

grief. She is suffering from the loss of her loved one, with normal reactions that one would

expect. She does not have prolonged grief. Prolonged grief would be grief that lasts for more

than a year (APA, 2022). Setting such a defined timeline for prolonged grief (1 year of adults

and 6 months for children) is controversial in some circles, with some practitioners concerned

that such timelines could make patients feel as if they were abnormal while at the same time

encouraging practitioners to prescribe antidepressants (Styx & Cilli, 2022).

Bereavement is a natural part of living (Okun & Nowinkski, 2012), this patient’s husband

died just 2 months ago. She clearly has a social support network, as demonstrated by her children

taking her out to lunch, she is still enjoying activities such as crafting, and she is able to perform

her activities of daily living. It is expected that a person in bereavement feel depressed and have

loss of appetite, because that is part of the normal process (Okun & Nowinkski, 2012). It is good

that this patient has a support network, as that makes it less likely for grief to turn in to medical

depression (Okun & Nowinkski, 2012). Medication would neither be recommended nor

warranted for this patient, which is in line with the patient’s preferences.

Choice of Therapy for Patient

In this case, this nurse would recommend Interpersonal Psychotherapy (IPT). IPT is

considered to be a first line treatment against depression, and has been shown to be beneficial for

many other conditions (Xu et al., 2020). It is effective at resolving the interaction of

interpersonal events and the mood of the patient to their benefit, which particular success being

the improvement of depressed moods (Xu et al., 2020). In this case, IPT is also effective at
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reducing anxiety (Schimelpfening & Goldman, 2021), which can also plague patients after the

loss of a loved one.

In this case, doing some IPT with the entire family may be of benefit. In the IPT therapy

there would be a focus on the positive aspects of their life; in hopes of more quickly leading the

patient to the acceptance phase of the stages of grief. The patient needs to understand that grief is

just part of the natural life cycle.

In this particular case, this nurse would also recommend a visit with a nutritionist. It is

important that she not lose too much weight. Loss of appetite is common in grief, but in her case

there may also be changes of habits. For example, she may be used to finishing her husband’s

meals, and since he is no longer there she may not be eating as much. Regardless of the reason, it

would be good for the patient to change her diet so as to stop her weight reduction.

Conclusion

This case shows a typical situation of a patient that is still mourning the loss of her

husband. The five stages of grief have been discussed, which show that she is going through the

normal grieving process, with no abnormal grief at this point in time. The patient can be treated

using IPT, and it is also recommended that she see a nutritionist.

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References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental

disorders (5th ed.). American Psychiatric Association Publishing

Lawrenz, L. & Holland, K. (2022). The stages of grief: What do you need to know?. HealthLine.

https://www.healthline.com/health/stages-of-grief

Okun, B. & Nowinski, J. (2012). Can grief morph into depression? Harvard Health Publishing.

https://www.health.harvard.edu/blog/can-grief-morph-into-depression-201203214511

Schimelpfening, N. & Goldman, R. (2021). What is interpersonal therapy?. VeryWellMind.

https://www.verywellmind.com/interpersonal-therapy-1067404

Styx, L. & Cilli, K. (2022). Prolonged grief disorder: Understanding the latest DSM-5 updates.

VeryWellMind. https://www.verywellmind.com/breaking-down-the-latest-dsm-5-update-

5223956

Xu, H., & Koszycki, D. (2020). Interpersonal Psychotherapy for Late-life Depression and its

Potential Application in China. Neuropsychiatric Disease and Treatment, 16.

https://doi.org/10.2147/NDT.S248027