Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3)
Mental Status Exam: Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio
Presenting Problem: You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.
Other Contexts: The client has been on antidepressants for 3 weeks and has shown improvement with depressive symptoms. She has benefited from weekly counseling sessions and attends a psychoeducational group designed to help reduce stigma associated with mental disorders, provide information on medication management, and improve healthcare access and utilization. It has been 18 months since her grandmother’s death, and she has expressed a desire to process feelings of grief and loss.  You help the client process the loss of her grandmother by educating her on Elizabeth Kubler-Ross’s stages of grief

Question: You help the client process the loss of her grandmother by educating her on Elizabeth Kubler-Ross’s stages of grief. Which one of the following accurately depicts this theory?
(A): The stages of grief are often cyclical rather than linear.
(B): Individuals in the first stage of grief may lash out and blame others for their loss.
(C): In the last stage of grief, individuals experience disbelief, shock, and sadness.
(D): All cultures experience grief in the same fashion.

Correct Answer: The stages of grief are often cyclical rather than linear.
Explanation: Elizabeth Kubler-Ross’s stages of grief are often cyclical rather than linear. While there are defined stages of grief, all individuals experience grief differently, with most moving back and forth between the stages of denial, anger, bargaining, depression, and acceptance. Cultural differences are found in varying practices, rituals, and beliefs that a person incorporates into cultural expressions of grief. Individuals in the second (ie, anger) stage of grief may lash out and blame others for their loss. In the first (ie, denial) stage of grief, individuals experience disbelief and shock, and in the fourth (ie, depression) stage, individuals experience sadness. Therefore, the correct answer is (C)
Competency: counseling skills and interventions