Prolonged grief disorder
Three years after loss of adult child; pervasive yearning, avoidance of reminders, identity disruption.
Presenting concern
Three years post-loss of adult son to overdose. Persistent intense yearning, intrusive imagery, avoidance of his belongings and his friends, identity crisis ('I don't know who I am without being his mother'). ICG-19 score: 38.
History
Previously well-functioning. No prior psychiatric treatment. Withdrew from work and most relationships post-loss. Husband grieving differently, marital distance grown.
- Three years duration (prolonged)
- Identity disruption
- Social withdrawal
- Type of loss (overdose) — added shame, guilt, stigma
- Stable prior functioning
- Husband present (if distant)
- Self-presenting
- Spiritual practice available as resource
Conceptualization across modalities
Grief becomes complicated when avoidance and rumination prevent integration. Imaginal revisiting of the death scene, situational revisiting of avoided places, and goals work for the future-self all support integration.
- Imaginal revisiting of the death
- Situational revisiting of avoided places
- Memories work (positive memories too)
- Future-self goal-setting
Loss has shattered the assumptive world and identity structure. Reconstructing meaning — narrative and existential — is part of integration.
- Narrative work on the loss
- Continuing bonds (with him, not despite him)
- Values and meaning reconstruction
- Identity beyond 'mother of'
Treatment plan
Engage (1–3)
Psychoeducation on complicated grief, formulation, hope.
Active CGT (4–14)
Imaginal and situational revisiting, memories work.
Meaning (15–20)
Continuing bonds, future-self, identity.
ICG dropped to 18 by session 16. Returned to part-time work at month 5. Marriage warming as both grieved more openly.