Kübler-Ross Model Of Grief Case Study

Sam is struggling with the loss of not only his brother, but also his entire family. Currently the death of his brother is what is affecting him at the moment, because that was the last remaining blood family member that he had. He states that he lost his mother in a house fire when he was an infant; he lost his father in a hunting accident when he was in his early 20s, and his brother Dean passed defending Sam from an attacker. This was all learned while completing his psychosocial analysis. After the death of his mother, Sam’s father began leaving he and his brother home alone often and not returning for weeks on end. Dean, who is only nine years older than Sam, was forced to care for him. When Sam was accepted to SUNY Oneonta, he isolated himself from his father, but did everything in his power to remain in contact with Dean.
He is staying with his close friend Bobby Singer. He currently does not have a job; he says he makes money doing different odd jobs offered to him. Most of his money is currently being spent on beer and other alcohol. According to the Kübler-Ross (1969): model of grief Sam would fall
into the depression stage. He realizes that what has happened to Dean is out of his control and that there is nothing he can do to bring him back. He has not yet reached the acceptance stage, because he realizes that he cannot do anything to bring Dean back to life, but he is also still suffering emotionally with the loss of his brother.
3. Service Agreement/Contract
a. Describe the processes used for arriving at a service agreement and diagnosis Sam and I met to discuss that the first two weeks of our meetings would be focused on creating a service plan and establishing his goals. I asked Sam to keep a journal and write down throughout the week; dates and times of when he felt the need to start drinking, and why he felt that way. I told him we would go over his journal at our next meeting and use it as a way of identifying his different triggers. This worked better than expected we were able to narrow his drinking times down to nights when he felt he had nothing to do, so he would occupy his time thinking about Dean and his other dead family members. We decided together that he should join a gym that is open 24 hours, because before losing Dean, Sam enjoyed working out.
We also addressed what my role is and what our relationship to one another would entail.
I explained to him the components of a working relationship and how it would benefit him. Throughout this meeting also explained him that our time together would end once it was clear that my help was no longer needed. We both wrote out a formal agreement with one another that clearly stated the expectations each of us had for the counseling process. This was the contract that we both stuck to throughout the entire counseling process. I informed Sam the first step we would need to take was to get him enrolled in AA (Alcoholics Anonymous) in order to help him interact with people who are also struggling with alcohol abuse. (Velten, 1996). It will help him to stay sober and allow him to find somewhere that will occupy some of the time he would have normally spent
drinking. Throughout the first ten meetings with Sam, I noticed a pattern of Sam talking about emptiness and hopelessness. Sam has said on more than one occasion that he wishes it were he that had died and not Dean. I will use the criteria within the DSM-5 to diagnose Sam and the feelings he is expressing. Sam wanted to be able to return to what he thought was a normal life. He wanted to feel comfortable enough to have his own home, and did not want to have to consider himself homeless any longer. Sam also wanted to not have to be dependent on the alcohol in order to get through his grieving process. I wanted for Sam to be in a better place mentally and not to suffer from his survivor’s guilt any longer. I wanted him to understand that what happened to not only Dean, but the rest of his family was out of his own control. Sam stated he would know when his goals were met and his issues were resolved when he was able to make it an entire week without needing alcohol to drown the thoughts of his brother’s loss.
b. Using the DSM-5 nomenclature, assign the client a diagnosis Sam and I had been working together for over two weeks when Sam began to daily voice that he felt empty and hopeless. Sam states that: “I don’t really want to get out of bed most days, or do anything other than drink.” He was experiencing a lack of interest in anything that did not involve getting intoxicated. He states: “When Bobby and I watch the game together, I get bored or easily distracted”. He said that he used to love watching sports on the television, so now that he finds no interest in them it makes him more upset. Throughout his entire grieving process, Sam blamed himself for Dean’s death and suffered from survivor's guilt, because he felt it should have been him to be killed. He could not get the idea of death off of his mind and even experienced thoughts of harming himself, so he would not have to live without his brother. Sam throughout many of our meetings said: “it should have been me, not Dean”. Sam also said that he was unable to get more than a few hours a sleep a night if he did not drink until he passed out. According to the DSM-5, I would diagnose Sam Winchester with Major Depressive Disorder, because he meets five out of the criteria. (American Psychiatric Association, 2013).
c. Identify as least three specific objectives developed in the service agreements Throughout the services agreement Sam expressed that he wanted to overcome his drinking and be able to control it. Sam wanted to not have to be dependent on the alcohol in order to get through his grieving process. He also wanted to be able to return to his normal life before the loss of his brother Dean. He wanted to feel comfortable enough to have his own home, and did not want to have to consider himself homeless any longer. Sam would like to work towards overcoming his survivor's guilt, so that he can be in a better place mentally. Sam stated he would know when his goals were met and his issues were resolved when he was able to make it an entire week without needing alcohol to drown the thoughts of his brother’s loss.
d. How will you determine whether the goals are being met? I will be constantly reviewing the service plan that Sam and I had agreed on. I will be making sure that Sam’s goals are being met. Each month I will also review the service plan with Sam and see how he is feeling about his progress. And if he feels it is appropriate to have a goal deemed as completed, or if he feels it will need to continue to be worked on.