Introduction
Juanita Perez is an 84-year old Filipino woman who lives in Los Angeles, California, and who has recently lost her husband of 60 years. She came to the agency, seeking help on how she can deal with the grief and loss, as she has been having a difficult time coping with it. In the sixty years that they were married, they have never been apart.
Juanita is a practicing Catholic whose primary language is Filipino and manages to speak a little English. She and her husband came to the United Striates as a result of the petition for immigration filed by her daughter who works as a nurse at one of the local hospitals and who is married to an American and has 2 children. Juanita and her husband have been living in the United States for 5 years when her husband passed away from heart failure two weeks prior. She is covered by Medicare Part A, which her daughter purchased for her.
She and her husband lived with their daughter upon migrating to the United States. She spends most of her time at the community park with her husband. They spend most afternoons there. She is also fond of knitting sweaters for her grandchildren and occasionally playing bingo at the nearby mall. She is quite healthy and strong for an 84-year old, with her main health issues being diabetes and arthritis.
Recommendations and Interventions
Before deciding on the appropriate intervention for Juanita, it is recommended that she first undergo a diagnosis to determine the type of grief she’s experiencing and what its effects are on her. According to Zisook and Shear (2009), the psychiatrist should be able to determine the symptoms being exhibited by the patient in order to be able to classify it as uncomplicated (i.e. normal) or complicated grief. In the uncomplicated grief process, the individual feels a mixture of pain, along with the positive feelings of happiness, peace, joy, and relief, which are felt after the loss of a significant person (Zisook & Shear, 2009). Evidence shows that this form of grief does not require professional intervention or formal treatment (Zisook & Shear, 2009). Most people who undergo this form of grief usually reach an acceptable level of adjustment to living without their loved one. However, if they really feel the need for support, then they should seek information and support, which validates that their response towards the loss is normal. Such support may be obtained from support groups and other community resources.
On the other hand, complicated grief is a syndrome that is said to occur in about ten percent of bereaved people. They fail to make the transition from acute to integrated grief, resulting in prolonged acute grief. Symptoms include traumatic distress (pronounced avoidance of reminders of the loss; intrusive and distressing thoughts related to the death; anger and bitterness; and a sense of disbelief regarding the death) and separation distress (preoccupation with thoughts of the loved one; intense longing and yearning for them; and recurrent painful emotions). In this case, more sophisticated treatment methods may be recommended as per the psychiatrist’s recommendation. However, some of the therapies that have been found to be effective in helping people deal with complicated grief include cognitive-behavioral grief therapy and complicated grief therapy. Cognitive-behavioral grief therapy is based on the CBT- REBT (Cognitive Behavioral Therapy-Rational Emotive Behavior Therapy) perspective, which makes a distinction between the unhealthy and healthy consequences of one’s belief system in response to the loss (Malkinson, 2010). Within this conceptual framework, the grief process is a healthy form of emoting and thinking that helps the grieving person organize their “disrupted belief system into a form of healthy acceptance” (Malkinson, 2010, p. 295). On the other hand, complicated grief therapy (CGT) is based on the attachment theory, which in turn stems from cognitive-behavioral therapy and interpersonal therapy (Wetherell, 2012). The treatment involves techniques that share similarities with prolonged exposure (repeatedly relating the story about the death in vivo exposure activities) and also focuses on personal relationships and goals (Wetherell, 2012).
Resource Attainment Plan
Three community resources would be recommended for Juanita in order to help her cope with her grief. These include the OUR HOUSE Grief Support Center (n.d.); the Bereavement Support Group by Rita Mccrerey (n.d.); and the Stephen Ministry St. Monica Catholic Community (“Bereavement Resources in Los Angeles County,” n.d.).
OUR HOUSE
OUR HOUSE is a non-sectarian, non-profit grief support center, which aims to provide the community with resources, education, and grief support services (OUR HOUSE Grief Support Center, n.d.). They offer age- and relationship-specific support groups, which create a warm environment of comfort and safety for the bereaved. They are located at 21860 Burbank Blvd. Ste195 Woodland Hills, CA 91367 and can be reached at the number (310) 473-1511 (OUR HOUSE Grief Support Center, n.d.).
Rita Mccrerey’s Bereavement Support Group
This is a six-week support group for people who have lost a loved one to death. They provide a confidential and safe environment for the bereaved. The group explores the practical, spiritual, social, and psychological aspects of the loss and help the members develop coping skills. The professionals in this group provide counseling, psychotherapy, and therapy that are sensitive to Filipino cultural issues. They also have Filipino counselors and psychologists,. The group is located at 5575 Lake Park Way Suite 114 La Mesa, California 91942 and can be reached at (619) 822-1115 (McCrery, n.d.).
Stephen Ministry St. Monica Catholic Community
This community provides peer support group that lasts for ten weeks where members pray and reflect together and share their experiences with each other (Gerety, 2015). They are located at 25 California Avenue Santa Monica, CA 90403. For elderly seniors, the contact is Shiela at (310) 394-9871 (Gerety, 2015).
Exploration of Client’s Strengths
Some of Juanita’s strengths are that she is fairly strong physically and in fairly good health, given that her diabetes and her arthritis do not debilitate her, meaning that she can still join activities that require minimal physical exertion. She also lives with and is supported by her daughter, which means that she receives some level of support at home and that she has her basic needs met. She also speaks and understands a little English, which means that she can at least communicate with other people outside her culture. As well, her strong faith in God can be considered a strength as it makes her believe that her husband is in a better place. It also becomes her source of spiritual and emotional strength.
Exploration of Potential Barriers
Some of the potential barriers include Juanita’s physical weakness. Due to her age and her health condition, she might not be able to regularly go to support group meetings. There may also be issues with her transportation going to the support groups, particularly if there are times when her daughter cannot take her. As well, even if Juanita speaks and understands some English, she may still have difficulties understanding the language if the speaker talks very fast or uses complex vocabulary due to her lack of English proficiency. Moreover, it might be difficult for her to understand the concept and purpose of a support group. She might also feel uncomfortable sharing her thoughts, feelings, and stories with strangers, especially with those from outside her culture. Lastly, since she depends on her daughter financially and does not have sufficient health coverage, she may not have enough financial resources to avail of the services and support she needs.
Impacts of Culture or Religion on Recommendations Made
The recommendations made would benefit Juanita in different ways. Allowing her to first undergo diagnosis will enable the determination of whether Juanita has complicated or uncomplicated grief. In turn, this will lead to the determination of the appropriate treatment for her. However, a possible effect this may have on Juanita is that she may feel uncomfortable going to a mental healthcare professional, as mental illness is associated with a social stigma in the Philippines (“Mental Health and Mental Illness in the Philippines,”). Being seen by a mental healthcare professional is misconceived as having mental illness.
Referring her to OUR HOUSE will allow her to gain access to professionals who can help her in the diagnosis of her grief as they have been providing such service for a long time. They would also have a large network of healthcare and social workers to whom they can refer Juanita if needed. However, some challenges may be that the agency will not have Filipino counselors, which may pose challenges in terms of communication.
Upon diagnosis, Juanita’s membership in Rita McCrery’s Bereavement Group will allow her to interact with Filipino counselors with whom she may be better able to relate to and with whom she may be more comfortable. This will also allow her to better express her thoughts and feelings, as she will be able to communicate with these professionals in her own language.
Finally, joining the bereavement support group at the Stephen Ministry St. Monica Catholic Community would allow Juanita to get solace from her faith and from people who share her faith.
Conclusion
Juanita Perez is an 84-year old Filipino immigrant who has been living in Los Angeles for five years when her husband, also an immigrant, passed away. She lives with her daughter and her daughter’s family. She is financially supported by her daughter, and she is covered by Medicare, as purchased by her daughter for her.
Juanita is experiencing a difficulty in coping with her grief, that’s why she sought help from professionals. In this regard, it is recommended that Juanita’s grief be diagnosed first so that it can be classified as either uncomplicated or complicated grief. If she is suffering from uncomplicated grief, then she will be referred to community resources and support groups such as OUR HOUSE, Rita Mccrerey’s Bereavement Group, and the Stephen Ministry St. Monica Catholic Community. On the other hand, if she is found to be suffering from complicated grief, then it would be recommended that she undergo either cognitive-behavioral grief therapy or complicated grief therapy These recommendations were made in consideration of Juanita’s cultural and religious background.
References
Bereavement Resources in Los Angeles County. (n.d.). Retrieved from
http://losangeles.networkofcare.org/content/client/25/BEREAVEMENT-DIRECTORY-
2013.pdf
Gerety, C. (2015). Bereavement. Retrieved from http://stmonica.net/ministries/pastoral-
care/bereavement
Malkinson, R. (2010). Cognitive-behavioral grief therapy: The ABC model of rational-
emotion behavior therapy. Psychological Topics, 19(2), 289-305.
Mental health and mental illness in the Philippines. (2016). Retrieved from https://mentalhealth-
ph.wikispaces.com/2.%09The+Problem+of+Mental+Health+in+the+Philippines
Mccrerey, R. (n.d.). Bereavement support group. Retrieved from
https://groups.psychologytoday.com/rms/prof_detail.php?profid=134202&sid=14550787
12.6675_13420&state=CA&spec=354&gid=34647&tr=ResultsName
Our House Grief Support Center. (n.d.). Agency - OUR HOUSE grief support center. Retrieved
Wetherell, J. L. (2012). Complicated grief therapy as a new treatment approach. Dialogues in
Clinical Neuroscience, 14(2), 159-166.
Zisook, S. & Shear, K. (2009). Grief and bereavement: what psychiatrists need to know. World
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