Case Study: Special Types of Loss, Imagine that you are discussing this case with Stanley Friedman, the psychologist who will be working with Governor Nixon. Dr. Friedman has asked you for your thoughts on the case. Consider the following as you prepare your response:
•Assess how the governor is coping.
•What issues might be unique to the governor's situation?
•What counseling interventions might help?
Case Study: Coping with Suicide
Expository Text: Grief is normal and natural, but to those who have experienced a significant loss , grief can upend their life, personality, beliefs about the world, and even their sense of reality. There is no standard time limit to the bereavement process and there is no right or wrong way to go through it. Some people get angry, some people become completely numb, and some people find their grief becoming complicated and seemingly intractable.
After a suicide the feelings associated with all grief are often more extreme, especially guilt, depression and anger. Click on each character for a brief description then click Let's Begin to hear the counseling session.
Governor Thomas Nixon: Thomas Nixon is a former communications professor at Brown Trout Bay Lutheran Collage. First elected to the city's school board, Nixon worked his way up the political ranks and has served three terms as Governor. Divorced and remarried, Nixon's personal life has been complicated by his daughter's struggle with bipolar disorder. Almost two years ago, Governor Nixon's daughter, Stacy, took her own life.
Dr. Stanley Friedman: Dr. Stanley Friedman is a board-certified psychologist at RCMC and an Assistant Clinical Professor of Psychology at Beck Medical School. He has over 10 years experience working with patients diagnosed with bipolar disorder, schizophrenia, and borderline personality disorder in residential, outpatient, and inpatient levels of care. He does not specialize in grief therapy or grief counseling.
Listen to the scenario, which represents a glimpse into an initial counseling session. As you listen, consider what advice or thoughts you could offer the counselor on how to help this client. You may replay the scenario if you wish.
Stanley, thanks for making time to see me.
Of course, Tom... even if you weren't the governor or an old friend, I think I could manage to find time for you. What did you want to talk about?
Believe it or not, Stacy. (pause) I know it's been over a year since ... since it happened, but I feel like I'm not getting over her death. I can't believe I'm still struggling with this. I kept telling myself ... "Just get through the funeral. Just get through the holidays. Just get through her birthday..." and then I had the campaign and re- election...
But I'm still struggling. It's like I got through all those events, and I still haven't made any progress. I know I probably won't ever really get over it, but ... well, I just think I should be dealing with it better than I am.
How are you dealing with it?
Well ... I am either consumed with it or completely ignoring it. Some days, she's all I think about. I find myself wondering what she was thinking, what she was feeling when it happened. Wondering what I could have done that might have made a difference. I keep thinking that I should have worked harder to get her hospitalized again. But she seemed to be doing alright. Not great, that's for sure, but she seemed to be .... not so up and down.
Tell me a little more about what you're feeling. You said you're either consumed or ignoring it?
Right. If I throw myself into work, I can keep myself from thinking about Stacy. I can go three or four days like that, but then... it sneaks up on me and I'll walk past one of her paintings in the house and it's like I've been sucker punched. That's actually what prompted me to make this appointment.
I was getting ready for a function ... a white tie fundraiser, very important people and I needed to be on top of my game ... and as I was heading down to the car, I caught sight of a little watercolor she'd done. A beautiful little painting she'd given me for Father's Day one year. The next thing I knew, I was sitting on the stairs sobbing my heart out. I didn't think I'd ever stop. I was half an hour late for the dinner, which wasn't a huge problem, but ... I can't go on like this.
While everyone experiences grief uniquely, what you're describing is not surprising. Losing a child is difficult enough, but losing a child to suicide can be devastating.
Devastating. That's exactly the word for how I feel. Is it normal to feel like a robot? Sometimes I feel as though I'm still in shock. There's this feeling of impending doom... like the worst is yet to come and that the reality of all this hasn't really hit me yet.
Normal is a tricky word, but the short answer is yes. What you're describing is not unusual with complicated grief. Suicide is world changing to the people it touches. People don't really have defenses for the feelings we experience when a loved one, particularly a child, takes her own life. It truly is a shock and during periods of shock, people experience the world differently. Things seem unreal. Confusion, disbelief and numbness are common. It's very common for people to feel physical symptoms as well. You've clearly lost weight - I am guessing that you're having trouble eating?
I haven't had any appetite. Right after it happened, I couldn't keep things down. I dropped over 20 pounds. That's getting a little better, but I don't really care about food. I just know I need to eat, so I go through the motions.
Tom, I think you were right to come in and talk with me about this, but I'm not really the best person to help you work through this. Unresolved grief, which is very common when you lose a child like you lost Stacy, can create a situation where the painful emotions are so persistent and so intrusive to your day to day life that you have trouble moving on with your own life. I am not saying that's what is going on with you, but I think working with someone who specializes in bereavement would be beneficial.
Alright, do you have any suggestions?
The grief of losing a child to suicide can be even more difficult to process when the parent faces the stigma associated with mental illness and suicide. Consider all the factors Governor Nixon is facing as you think about how Dr. Friedman can best help the governor.
Subject Matter Expert:Ed Muldrow, Ph.D., Diplomate in Clinical Social WorkInteractive Design:Brent BerheimInstructional Design:Felicity PearsonProject Manager:Amanda Holman Licensed under a Creative Commons Attribution 3.0 License.
Hi, and thanks for choosing me as your Brain Mass Expert. First, losing a child to Suicide is tragic and can lead to the parent also having thoughts of suicide and that being consistent with a diagnosis of Major Depressive Disorder. Just a few things here- When we think about how the Governor is coping, he is not coping at all because the fact that he continues to feel helpless at not being able to stop his daughter, know all the signs, be there, perseverates about it all the time, not eating, neurovegetative symptms are impacted, this means that if these symptoms, which we can quantify have been going on for at minimum two weeks, then, we can conclude based on the DSM IV-TR, these would qualify for a diagnosis of Major Depressive Disorder, Single Episode, Severe, (if there have been no previous episodes)
There are also other issues here, which are impacting his coping, which first the fact is that we want to protect his privacy. Also, is the fact that ...
The solution examines special types of loss. How counseling interventions help in the situation are discussed.