Grief Therapy Assessment and Intervention Plan for Bereavement

Clinical Assessment of Bereavement

Grief therapy is typically applied in cases such as Kong's, following the loss of a loved one. The procedures outlined below form the foundation of a comprehensive clinical assessment.

The Semi-Structured Clinical Interview

The informal assessment of individuals facing the effects of losing a loved one — such as in Kong's case — is the semi-structured clinical interview. This approach allows the therapist to classify clients according to the symptoms they exhibit and to record changes in symptom profiles over time. The following information should be collected from a client:

• Biographical data
• The mental illness history of the family
• The client's medical history
• Any past visits or interactions with a psychiatrist
• The client's social history
• Varying aspects of specific information related to the loss of a loved one

There is a need to focus the interview on the primary and secondary characteristics surrounding the death. Additional questions should address:

• Symptoms linked to bereavement, such as intense yearning for contact with the deceased, self-blame, anger, and avoidance of anything that is reminiscent of the deceased
• A pre-morbid personality profile
• Features related to depression, substance abuse, aggression, or anxiety

The clinician should ask pointed questions directed at revealing details related to post-traumatic stress symptoms, including the frequency, nature, duration, intensity, and brief descriptions of those symptoms (Shear et al., 2012).

Examination of the State of Mind

A person's state of mind is professionally assessed during an interview using the Mental State Examination. The method applies a common language and format to capture information that patients who have experienced loss manifest during the interview. The main objective is to identify symptoms so that the most appropriate intervention can be sought while any risks are taken into consideration.

The aspects that must be considered when conducting a loss assessment include behavior, appearance, speech, content of thought, cognition, perception, mood, affect, and insight (Marks, Jun, & Song, 2007).

Important Questions to Ask While Screening for Bereavement

Elderly individuals who manifest severe symptoms of bereavement as a result of losing 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 the effects of bereavement and grief despite his cultural values. He feels that he will face many challenges following the death of his loved one, and believes that life has no meaning anymore. He may even be contemplating death as a means of reuniting with the deceased. Suicidal ideation is an important subject to explore with grieving individuals. Direct questions that avoid ambiguity are important in this regard, such as:

• Do you sometimes think of killing yourself, especially when things are bad?
• Have you ever thought about how you might kill yourself?
• Can you access [mention opportunity or means]?
• Have you ever tried to kill yourself?
• Do you drink, smoke, or use other intoxicating substances?

Other risk factors such as social isolation and substance abuse should also be taken into consideration. Additional critical questions include:

• Can you tell me more about the death?
• Tell me what happened that day.
• What are the most notable developments since that day?
• How have your relationships with friends and family unfolded since then?

Such questions explore the dimensions of bereavement and grief. They offer the bereaved person a chance to speak about their loss and shed light on the circumstances and nature of the death. Factors such as denial will begin to surface, and feelings of anger and guilt are likely to emerge if they are present. The typical emotional responses associated with bereavement will manifest, and congruence between affect and content, alongside the client's history, will serve as a reliable indicator of conflicted emotions and ambivalence.

The signs of bereavement and grief may also indicate where the client currently stands in the bereavement process. Furthermore, these questions provide an opportunity to explore social interaction patterns following the death. It is important to consider terms of inclusion to help assess the client's acceptance of the permanent loss (Grief Counselling Through Questioning, 2013).

Exploring Dreams

People in grief commonly experience significant dreams. It is a helpful clinical intervention to invite clients to talk about their dreams. While there is no need to attempt interpretation, the therapist should gently guide the client in discussing them when the client expresses a desire to do so.

Formal Assessment Tools

Information that may be overlooked during the semi-structured interview can be gathered through the formal assessment process. Several assessment approaches can be applied to individuals who have experienced loss.

The Geriatric Depression Scale

This tool can be applied in Kong's case to establish the possibility of developing depressive complications as a result of the loss of his son. It is a useful instrument for screening adults of advanced age.

Cognitive Impairment Assessment

It is common and developmentally normal for elderly individuals to experience memory impairment. These may be typical symptoms of aging, including cognitive function decline and dementia. Memory loss has also been noted as a common occurrence resulting from grief. Therapists must differentiate such symptoms from early-stage dementia. Dementia and depression are known to co-occur frequently, and late-onset depression is recognized as a common cause of dementia. Therefore, there is a need to assess for cognitive impairment in older clients who exhibit signs consistent with dementia.

Psychophysiological Assessment

Increasing attention is being given to psychophysiological techniques as a complement to clinical interviews and psychometric tools used to assess traumatized individuals. Heart rate is one common psychophysiological index; others include muscle tension, skin conductance, peripheral temperature, and blood pressure. This approach guards against response bias and can detect elements that may be difficult to identify by other means. A substantial body of research on post-traumatic stress has demonstrated multiple psychophysiological responses to trauma cues. There is broad agreement that such responses can be used to distinguish individuals experiencing post-traumatic stress from those who are not (Bryant & Harvey, 2000).

Provisional Diagnosis

The client is undergoing a period of intense emotional stress as a result of exposure to a traumatic stressor — namely, the suicide of his son. This experience is beyond the range of what his cultural background has prepared him for. Kong is devastated by his son's death and further distressed by his belief that his son considered him a disappointment. Kong blames himself for having confronted his son about drug abuse and believes that things would have been different had he taken a different approach. He is consumed by guilt, frequently cries, and exhibits signs of confusion and disbelief.

Given these symptoms and this history, a bereavement diagnosis referencing the DSM-5 (APA, 2013) is applicable. This diagnostic framework is used when the therapist is focused on normal reactions to the loss of a loved one. Grieving individuals commonly exhibit the following symptoms:

• Depressive episodes such as persistent sadness, sleeplessness, crying spells, and poor appetite
• Preoccupation with the deceased
• Intense and persistent yearning for the company of the deceased
• Inability to make sense of the loss
• Misinterpretation of certain aspects of the loss
• Avoidance of anything that is reminiscent of the loss
• Inability to find meaning in life following the death
• Extended grief lasting beyond one year

Nevertheless, a full assessment of the case depends on detailed examination of the client.