LGBTQ Bereavement Assessment and Intervention Plan
This paper examines bereavement assessment and intervention planning for a client named Emily, a lesbian woman grieving the loss of her same-sex partner, Christine. Drawing on recent LGBTQ-specific bereavement research, the paper identifies key assessment questions targeting depression and persistent complex bereavement disorder (PCBD), analyzes the complicating factors unique to Emily's situation — including family rejection, social isolation, and disenfranchised grief — and proposes a three-pronged intervention plan. The recommended interventions include a medical and nutritional referral, individual and group cognitive behavioral therapy (CBT), and a community-based social support program. Each intervention is grounded in peer-reviewed evidence and addresses the short- and long-term needs of a client whose grief is compounded by her sexual orientation and introverted personality.
- Background and Assessment Questions: LGBTQ grief research informs Emily's assessment questions
- Diagnosis and Complicating Factors: PCBD diagnosis complicated by isolation and family rejection
- Referrals and Therapeutic Modalities: Medical, CBT, and social work referrals with evidence
- Three Core Interventions and Conclusion: Nutrition, CBT, and community interventions address Emily's needs
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What makes this paper effective
- Grounds every recommendation in peer-reviewed literature, quoting sources directly to justify each referral and intervention.
- Applies research on LGBTQ-specific grief themes — disenfranchised grief, isolation, family rejection — directly to the individual client's circumstances, demonstrating applied clinical reasoning.
- Structures the intervention plan across three distinct tiers (physical, psychological, social), showing awareness of holistic treatment and prioritization of care.
Key academic technique demonstrated
The paper models evidence-based clinical case formulation: it moves systematically from assessment questions, to diagnosis, to referral, to intervention — with each step supported by a distinct citation. This shows how academic sources translate into practical clinical decisions, a core skill in social work and counseling courses.
Structure breakdown
The paper is organized into four numbered sections corresponding to a structured case-response format: (1) assessment questions with rationale, (2) diagnostic impressions and complicating factors, (3) referral recommendations with evidence, and (4) intervention descriptions and a conclusion. Each section builds on the previous, creating a coherent care pathway from intake to treatment.
Background and Assessment Questions
Bereavement research has focused primarily on heterosexual, married couples, frequently within the later years of life. The latest research has taken a step toward understanding bereavement among members of the LGBTQ community, particularly lesbians (Fenge, 2013). By understanding the main themes related to same-sex bereavement, one can better develop 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 include disconnection from family, internalizing homophobia, seeking a place for sincerity and acceptance, the benefits of friendships displaying cross-sexual orientation, and the intimacy of relationships among women (Ingham, Eccles, Armitage, & Murray, 2016). With this information in mind, the assessment questions 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?" Emily has stated she has problems sleeping and eating. This could be related to depression and would therefore 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 a diagnosis of depression. The remaining questions would focus on complex bereavement.
Persistent complex bereavement disorder (PCBD) is a DSM-5 disorder similar to depression, yet it is characterized by an unrelenting grief that does not improve over time. The symptoms are caused by the loss of a loved one, unlike depression, which can be caused by multiple factors. As Robinaugh, LeBlanc, Vuletich, and McNally (2014) explain, "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" (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?" and "What about Christine's death has affected you most?" These questions are meant to help understand the degree of grief Emily is feeling while also collecting information on her current condition.
Diagnosis and Complicating Factors
It appears that Emily's problems arose after she lost Christine. She exhibits signs of complicated grief, or persistent complex bereavement disorder. She has a preoccupation with thoughts of Christine, especially the circumstances surrounding her death. She feels empty and as though life is meaningless, as evidenced by her decision to stop going to work and eating. This can also be understood as a lack of desire to pursue personal plans and interests. She also displays intense sadness and feels she has no one to talk to about her relationship with Christine.
Emily stated that her parents' religious beliefs prevent them from accepting homosexuality. As a result, Emily feels she must keep the loss of her loved one a secret from her family, fearing they will chastise her for her feelings. She has also not come out to her friends. While she mentioned having some lesbian friends she might turn to for support, her introverted nature may prevent her from reaching out. Adding to this is the decision Christine's family made to end Christine's life, which presents yet another painful dimension to Emily's grief.
Essentially, Emily may feel she has nowhere to turn because of her sexuality, her introverted nature, and the pain she carries from the circumstances of Christine's death. Her grief is therefore not the typical grief most people experience. It becomes complicated grief due to the limited support options available to her and her personality.
Referrals and Therapeutic Modalities
The first referral would be to a primary care physician. Emily has a gaunt appearance from not eating regularly. While she needs a therapist and perhaps CBT, the most urgent referral is to a primary care physician so she can have blood work completed. Extended periods of inadequate nutrition can severely damage a person's physical health and lead to serious health complications (Bartrop, Buckley, & Tofler, 2016).
Bereavement may present an increased risk of cardiovascular disease. As Bartrop, Buckley, and Tofler (2016) note, "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" (p. 229). They further explain that early bereavement can be tied to immune imbalance, prothrombotic and hemodynamic changes, altered sleep, and neuroendocrine activation — all of which can increase cardiovascular risk. Combined with a lack of adequate nutrition, these factors can become life-threatening. Emily needs to determine whether she is deficient in any key nutrients and may then be referred to a nutritionist who can help her return to a healthy weight through supplementation and an eating plan.
Cognitive behavioral therapy (CBT) has been used successfully for a range of mental disorders, including PTSD and depression (Bryant et al., 2014). Prolonged grief disorder (PGD) has been treated successfully with CBT combined with a focus on exposure therapy. As Bryant et al. (2014) note, "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" (p. 1332). The CBT Emily would receive would include two-hour group therapy sessions incorporating CBT techniques. She would also receive individual sessions and exposure therapy to help her address memories surrounding Christine's death. This means Emily would receive both a group therapy referral and an individual therapy referral.
Group therapy would be especially beneficial in addressing her need to connect with others and receive support for her loss. If she could be placed in a group with members of the LGBTQ community, she would likely feel even more understood and connected. Combating the sense of isolation is a critical aspect of Emily's healing process, and group therapy would provide her time with people who have experienced something similar.
A 2014 study highlighted some of the unique experiences lesbians face when losing a partner, including the theme of loneliness through isolation. As Jenkins, Edmundson, Averett, and Yoon (2014) found, "Qualitative analysis identified several themes that ran throughout, including disenfranchised grief, the loneliness of isolation, and the frustration of relentless battles" (p. 273). Emily needs to feel part of a group or community in order to cope effectively with the loss of Christine. If she requires an additional referral, it would be to a social worker who can connect her with programs where she can meet people with similar experiences and build the kind of community she needs.
References
Bartrop, R., Buckley, T., & Tofler, G. H. (2016). Bereavement and the risk of cardiovascular disease. Handbook of Psychocardiology, 229–246. doi:10.1007/978-981-287-206-7_18
Bristowe, K., Marshall, S., & Harding, R. (2016). The bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner: A systematic review, thematic synthesis and modelling of the literature. Palliative Medicine, 30(8), 730–744. doi:10.1177/0269216316634601
Bryant, R. A., Kenny, L., Joscelyne, A., Rawson, N., Maccallum, F., Cahill, C., . . . Nickerson, A. (2014). Treating prolonged grief disorder. JAMA Psychiatry, 71(12), 1332. doi:10.1001/jamapsychiatry.2014.1600
Fenge, L. (2013). Developing understanding of same-sex partner bereavement for older lesbian and gay people: Implications for social work practice. Journal of Gerontological Social Work, 57(2–4), 288–304. doi:10.1080/01634372.2013.825360
Ingham, C. F., Eccles, F. J., Armitage, J. R., & Murray, C. D. (2016). Same-sex partner bereavement in older women: An interpretative phenomenological analysis. Aging & Mental Health, 1–9. doi:10.1080/13607863.2016.1181712
Jenkins, C. L., Edmundson, A., Averett, P., & Yoon, I. (2014). Older lesbians and bereavement: Experiencing the loss of a partner. Journal of Gerontological Social Work, 57(2–4), 273–287. doi:10.1080/01634372.2013.850583
Robinaugh, D. J., LeBlanc, N. J., Vuletich, H. A., & McNally, R. J. (2014). Network analysis of persistent complex bereavement disorder in conjugally bereaved adults. Journal of Abnormal Psychology, 123(3), 510–522. doi:10.1037/abn0
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