Loss of a Loved One

.....bereavement research has focused primarily on heterosexual, married couples, frequently within the later years of life. The latest research has taken a step towards understanding bereavement among members of the LGBTQ community, particularly, lesbians (Fenge, 2013). By understanding main themes in relation to same-sex bereavement, one can better draw a clear plan of assessment to help someone like Emily deal with the grief of losing a loved one.

Some main themes seen in recent research in this area is disconnection from family, internalizing homophobia as well as seeking a place for sincerity and acceptance, benefits of friendships displaying cross-sexual orientation, and intimacy of relationships among women (Ingham, Eccles, Armitage, & Murray, 2016). With this information in mind, the questions asked center on depression, PTSD, available support, and desire to perform daily activities.

The first question would be: "How many times do you shower, eat, and sleep each week?" This is because Emily has stated she has problems sleeping and eating. This could be related to depression and therefore would be a clear indicator of a potential depression diagnosis. The second question would be: "Does your job interest you anymore?" Emily stated she was given a warning due to her poor performance and absences.

If she no longer wishes to work due to her illness, this could support the diagnosis of depression. The other questions would focus on complex bereavement. Complex bereavement or persistent complex bereavement disorder is a DSM-5 disorder similar to depression yet is characterized by an unrelenting grief that will not improve over time. The symptoms are caused by the loss of a loved one unlike depression, that can be caused by multiple factors. ".

symptoms do not reflect an inferred, unobservable category or dimension, but rather are themselves constitutive of the disorder. PCBD constitutes a causal system of mutually reinforcing symptoms that arise following the death of a loved one settling into pathological equilibrium" (Robinaugh, LeBlanc, Vuletich, & McNally, 2014, p. 510).

Questions 3-5 would be: "Have you felt this way only since Christine died?" "What have you done to cope with the loss and has it worked?" "What about Christine's death has you most affected?" These questions are meant to help understand the degree of grief Emily is feeling while also collecting information on Emily's current condition. 2. It seems that the problems arose after Emily lost Christine. She exhibits signs of complicated grief or persistent complex bereavement disorder.

She has a preoccupation with thoughts of Christine, especially the circumstances that surrounded her death. She feels empty like life is meaningless, as seen when she decided to stop going to work or eating. This can also be seen as a lack of desire to pursue personal plans/interests. She also displays intense sadness and feels like she has no one to talk to about her situation with Christine. Emily stated her parent's religious beliefs prevent them from accepting homosexuals.

Therefore, Emily feels she must keep the loss of her loved one a secret from her family for fear they will chastise her for her feelings. She also has not come out of the closet with her friends. While she discussed having some lesbian friends that she may be able to turn to for support, her introverted nature may prevent her from reaching out. Add to that, the decision Christine's family made on behalf of Christine to end her life, and this presents another issue.

Essentially, Emily may feel like she has nowhere to turn to because of her sexuality, her introverted nature, and the pain she feels from the decision Christine's family made to end her life. Therefore, Emily's grief is not the normal grief typically experienced. Her grief becomes complicated grief due to the lack of options she has for support and her personality. 3. The first referral would be to a primary care physician. The information provided on Emily said she has a gaunt appearance from not eating.

While she needs a therapist to talk to and perhaps CBT therapy, the most important referral that should take priority is for a primary care physician so she can get some blood work done. Long periods of not eating can wreak havoc on a person's physical health and can lead to other health complications (Bartrop, Buckley, & Tofler, 2016). Bereavement may present an increased risk of cardiovascular disease. "The death of a loved one has been known to convey an adverse health risk, including increased cardiac events.

While mortality risk appears to be greatest in the initial weeks following bereavement, it remains elevated during the first 6 months" (Bartrop, Buckley, & Tofler, 2016, p. 229). Bartrop, Buckley, & Tofler explain early bereavement can be tied to immune imbalance, prothrombotic and hemodynamic changes, altered sleep, and neuroendocrine activation. Such changes can lead to an increased cardiovascular risk. Couple that with a lack of eating and it can lead to death.

Emily needs to find out if she is deficient in any key nutrients and then may be referred to a nutritionist who can help her get back to a healthy weight with supplements and an eating plan. Earlier mentioned was the possibility of seeing a therapist. Cognitive behavioral therapy has been used successfully for a myriad of mental disorders like PTSD and depression (Bryant et al., 2014). Prolonged grief disorder (PGD) has been treated successfully with CBT along with a focus on exposure therapy.

"Grief-focused cognitive behavior therapy (CBT) has been shown to be effective in treating PGD. Although treatments for PGD have focused on exposure therapy, much debate remains about whether exposure therapy is optimal for PGD" (Bryant et al., 2014, p. 1332). The kind of CBT therapy Emily would receive would include 2-hour group therapy sessions made up of CBT techniques. Emily would also receive individual sessions and exposure therapy to help deal with the memories of Christine's death.

That means Emily would receive a group therapy referral and an individual therapy referral. Group therapy would help immensely with her need to connect with others and gain support for her loss. If she could be placed in a group with members of the LGBTQ community that would make her feel even more connected. The need to not feel alone is an important aspect of Emily's healing process and would be addressed by allowing her time with people that have experienced something similar to her.

Going back to an earlier article, many in the LGBTQ community feel alone. When they lose someone dear to them or experience some other traumatic event related to their sexuality, they feel they have no one to turn to. A 2014 article highlighted some of the unique experiences lesbians endure when they lose a partner, one such theme was loneliness of isolation. "Qualitative analysis identified several themes that ran throughout, including disenfranchised grief, the loneliness of isolation, and the frustration of relentless battles" (Jenkins, Edmundson, Averett, & Yoon, 2014, p. 273).

Emily needs to feel a part of a group or community and needs to do so in order to effectively cope with the loss of Christine. Therefore, if she needs another referral, it would be to a social worker who can provide the necessary options for her to be placed in a program where she can find people similar to her and be able to form the kind of community she needs. 4.

The three main interventions are what the referrals are, which is evidence-based nutrition intervention, cognitive behavioral intervention, and community intervention. The evidence-based nutrition intervention begins with blood work to a clear picture of Emily's current state of health. The next step is having Emily see a nutritionist so she may be prescribed an eating plan and supplements to help her get back on track. This is the highest priority intervention because of the current state of her health.

Emily needs to get back some stability in her life and that can be done with proper nutrition and proper support for nutritional assessment. With this intervention, she will have the energy and mindset to continue with the other interventions. These interventions will help her deal with the emotional and mental aspects of bereavement. Cognitive behavioral therapy is the next intervention and will be done in two ways. The first way is individual.

Emily will see a therapist, discuss her problems and together, the therapist and Emily will be able to address the concerns and struggles Emily faces due to the loss of Christine. Just being able to talk to someone about her problems and being able to address the painful memories through exposure therapy will help Emily deal with Christine's death and the fact that she is dealing with it in isolation because of potential judgment concerning her sexuality.

"Some participants experienced acceptance and acknowledgement from the community, and institutions, recognizing their loss and treating them with respect enacted through talking openly and supportively about their relationship" (Bristowe, Marshall, & Harding, 2016, p. p. 741). The CBT intervention will also have a group therapy component where Emily will be placed with people that have experienced a similar situation. This will allow to her to connect with others and perhaps deal with Christine's family's decision to end Christine's life.

It can be a very difficult time for someone so isolated to deal with such pain and anguish. However, when that person sees other people go through the same thing, this may help greatly in overcoming some of the grief. Support is essential to any kind of treatment plan and that is why the final intervention will be used. The final intervention is a community-based intervention. Through the help of a social worker, Emily will be able to find a program that has participants from.