therapy is usually applied in cases such as the one exhibited by Kong, following the loss of a loved one. The procedure is outlined below:
The Semi-Structured Clinical Interview
The informal assessment of individuals faced with the effects of the loss of a loved one such as Kong's case is the semi structured interview. This approach allows the therapist to classify victims according to the symptoms that they exhibit. The approach allows for the recording of changes in profile symptoms demonstrated over time. The information below should be collected from a client.
The mental illness history of the family
Ones medical history
Any past visits or interactions with a psychiatrist
One's social history
Varying aspects of one's specific information should be collected regarding the loss of a loved one
There is need to focus the interview details on the secondary and primary characteristics of the death of the son. More questions touch on:
Symptoms that can be linked to the state of bereavement such as instances of intensively yearning for contact with the diseased, self blame, anger and avoiding anything that reminds them of the diseased
A personality that can only be described as pre-morbid
Features that are related to depression, substance abuse, aggression or anxiety
In other words, there is need for the clinician to ask relevant pointed questions directed at unveiling details to do with the symptoms of post traumatic stress, the frequency of content, its nature, duration, intensity and short descriptions of the signs (Shear et al., 2012)
Examination of the State of Mind
A person's state of mind is professionally assessed during an interview using Mental State Examination. The method applies a common language and format to capture the information that the patients who have gone through loss manifest in the course of the interview. The main objective is to identify the symptoms so as to seek the most appropriate intervention while any risks are taken into consideration.
The aspects that must be considered when conducting a loss assessment include behavior, appearance, speech, content of speech, thought, cognition, perception, mood effect and insight (Marks, Jun, & Song, 2007).
Important questions to ask while screening bereavement
Elderly individuals that manifest severe symptoms of bereavement as a result of the loss of a loved one need to be assessed for symptoms of complex bereavement and grief. These are potential triggers for serious reactions, including possible suicidal tendencies. Kong may still succumb to effects of bereavement and grief despite his cultural values. Kong feels that he will face many challenges in the country following the death of his love one. He thinks that life has no meaning any more. He may even be contemplating death because it will give him an opportunity to reunite with the diseased. Suicidal ideation is an important subject to explore with grieving veterans. Direct questions that avoid ambiguity such as the ones below are important in this respect.
Do you sometimes think of killing yourself especially when things are bad?
Do you ever figure out how you can kill yourself?
Can you access . . . . (Mention opportunity or means)
Is there a time you tried killing yourself?
Do you drink, smoke or use other amphetamines and intoxicating substances?
Put other risk factors, such as being isolated or abusing substances into consideration. Other critical factors to consider include
Can you divulge to me more regarding the death?
Tell me what transpired that day
What are noteworthy developments since that day?
How have matters unfolded between you and friends?
Such questions dig into the matter of bereavement and grief. They offer the bereaved person a chance to talk about their loss. It sheds light on circumstances and nature of the death. Factors such as denial will start to show. It is likely that feelings of anger and guilt will also manifest if they are present. There is likely to be the typical emotional response from a bereaved person manifested. Congruence between effect and content along with the history will be a sure indicator of conflicted emotions and ambivalence.
The signs of bereavement and grief may be pointed out by indicating the progress point in the bereavement process. Furthermore, the questions give you a chance to explore the patterns of interaction at a social level after the death. It is important to take terms of inclusion into consideration to help in the assessment of the client's acceptance of the permanent loss (Grief counselling through questioning, 2013).
People in grief commonly experience dreams. It is a helpful intervention to talk about their dreams. While there is no need to attempt an interpretation of these dreams, a therapist should simply lad the patient in talking about them when the patient has a desire to discuss them.
Tools for Formal Assessment
Information that has been overlooked in the semi structured interview can be accessed through the formal assessment process. There exist several assessment approaches that can be applied to people who have gone through loss.
The Geriatric Depression Scale
This procedure can be applied in Kong's case to establish the possibility of developing depression complications as a result of the loss of his son. It is a useful tool in screening adults of advanced age.
I. Cognitive Impairment Assessment
It is common and normal for elderly people to experience impairment of memory. These may be typical symptoms of normal aging, including cognitive function depreciation and dementia. As a result of being bereaved, memory loss has been noted to be a common occurrence resulting from the accompanying grief. Therapists must also differentiate such a scenario from dementia in its early stages. Dementia and depression are known to commonly exist side by side; and late occurrence of depression is noted to be a common cause of the dementia. Therefore, there is need to assess the possibility of cognitive impairment in an older person experiencing signs of dementia.
More and more attention is being given to psychophysiological techniques to add value to clinical interviews along with the psychometric tools used to assess traumatized people. Heart rate is a common major psychophysiological index. Others include muscle tension, skin conductance and response, peripheral temperature and blood pressure. The approach is a useful guard against response bias. It can also detect elements that may be hard to identify by other means. A lot of studies on post traumatic stress have exhibited multiple psychophysiological processes in resonance to trauma cues. There is a concurrence that such responses can be used to discriminate people experiencing post traumatic stress from those who are not (Bryant & Harvey, 2000).
Current Issues Faced by Kong- Provisional Diagnosis
The client is undergoing a period of emotional stress as a result of being exposed to the traumatic stressor; being the act of suicide by his son. The experience is beyond the normal experience that his culture has exposed him to. Kong is devastated by his son's loss and is further dismayed that he thought that he, Kong, was a disappointment. Kong blames himself for having confronted his son on the issue of drug abuse and thinks that things would have been different if he had used a better approach to handle the matter. Kong is full of guilt and frequently cries about his predicament. He often shows signs of confusion. He is in disbelief.
With the symptoms and such history in mind, a bereavement diagnosis refereeing to the DSMV (APA, 2013) can be appliedon the client. The approach is used when the therapist is focused on normal reactions to the loss of a loved one. Grieving people commonly exhibit the following symptoms.
Depressive episodes such as sad feelings, sleeplessness, crying spells and poor appetite are common.
a. They are preoccupied with the diseased
b. Intense and persistent yearning for the company of the diseased
c. Can't make sense of the loss
d. Misinterpretation of some aspects of the loss
e. Avoiding anything that reminds them of the loss
f. Can't make sense of life after the death of the loved one
g. Extended feeling of grief that runs beyond a year. Nevertheless, the full assessment of the case depends on the detailed examination of the client
Multidisciplinary Referrals for Client
Instances of grief are commonly associated with regret, guilt, anger; among other similar symptoms. While some people can't make meaning of life, others experience a feeling of relief. Grieving individuals can oscillate between different contradicting thoughts as they try to make sense of their loss. A client may be sent to the health providers listed below for management of their condition:
Psychiatrist: for the management of chronic and severe issues. A psychiatrist can review a case and prescribe medication. They can also diagnose a patient and manage other complications that are co-occurring.
Clinical Psychologist: Psychologists have the skills to assist a client to lead a normal functional life in their new surroundings. They employ therapies such as stress inoculation training.