Identifying and Addressing Grief and Loss Issues in a Person With Aphasia: A Single‐Case Study

The Centers for Disease Control and Prevention (2015) identified stroke as a leading cause of long-term disability, with approximately 800,000 people in the United States having a stroke each year. Strokes may cause paralysis; problems understanding and producing language; painful physical symptoms; and myriad emotional issues, including depression and anxiety (Brumfitt & Barton, 2006; Code & Herrmann, 2003). The impairment of communication as a result of a stroke is called aphasia and is characterized by difficulty with formulating and comprehending language (Davis, 2007). Aphasia affects both genders equally, and it is estimated that approximately 1 million people in the United States have aphasia (National Institute of Neurological Disorders and Stroke, 2015). Hilari et al. (2010) reported that 62% to 70% of individuals with aphasia experience depression and profound psychosocial losses. Often, these social and emotional losses are overlooked by health care professionals, friends, and family because the immediate physical symptoms and the need for rehabilitation move to the forefront (Brumfitt & Barton, 2006). Furthermore, because their ability to express themselves is diminished, individuals with aphasia are frequently incapable of asking for help or acknowledging their emotional needs (McGurk, Kneebone, & Pit ten Cate, 2011). Therefore, individuals with aphasia are frequently precluded from receiving the emotional support needed after such profound losses. Such unacknowledged loss and grief has been termed disenfranchised (Doka, 2002) and can lead to intensified and chronic depression (Lenhardt, 1997). Research in aphasia recovery has shown survivors' emotional state to be a crucial factor in their short- and long-term rehabilitation process (Brumfitt & Barton, 2006; Code & Herrmann, 2003; Hilari et al., 2010). Therefore, counselors can play an important role in the rehabilitative process for individuals with aphasia. The purpose of this case study was to help counselors gain a better understanding of grief and loss issues from the perspective of one woman's experiences following a stroke. Because traditional forms of communication, such as speaking and writing, are diminished in individuals with aphasia, it is imperative that counselors use creative methods to provide opportunities for the fullest possible expression of these individuals' internal experiences. Also presented are recommended strategies for working with this population. Method A single-case study is a means of obtaining specific and detailed information from one person's experience to gain a greater awareness of an issue or concern. For this study, we used a qualitative phenomenological case study method. According to van Manen, "the basic purpose of phenomenology is to reduce individual experiences within a phenomenon or an 'object of human experience' to a description of the universal essence, or a 'grasp of the very nature of the thing'" (as cited in Creswell, 2007, p. 58). Case studies are used to understand a problem in depth from a source believed to be able to help others gain insight (Patton, 1990). Because of communication difficulties experienced by individuals with aphasia, we determined a single instrumental case study to be the appropriate method for an intial investigation into the grief and loss associated with aphasia. A case study is also the best design to understand the essence of the experience of the loss of words (Creswell, 2007). We made some modifications (described later) to the method to accommodate the special needs of the participant. In addition, we used an interprofessional research team to better understand every aspect of the participant. The team consisted of two counselor educators who specialize in grief and loss (first and second authors); a speech language pathologist who is also a licensed professional counselor (third author); and a former director of a university-based program that provided rehabilitation, career, and personal counseling for nontraditional and reentry college students as a licensed social worker (fourth author). …