On the use of a Modified Kubler-Ross Model of Grief to Treat Bereavement in Schizophrenia

Models and therapeutic approaches to bereavement have focused on patients without mental illness, with limited studies done on patients with psychiatric disorders, specifically schizophrenia. A question arises as to how the models of bereavement may be modified in schizophrenia and what are the possible adjustments in bereavement counseling for those with schizophrenia. We describe the case of a 50-year-old African American male with a history of schizophrenia. He was admitted to the psychiatric inpatient service after he was found living at home with the decomposing body of his dead mother for several days. Positive and Negative Syndrome Scale (PANSS) score was 32 on the positive scale and 39 on the negative scale at the beginning of his hospital course. A modified model of bereavement was formulated in light of his acute psychotic symptoms, based on Kubler-Ross and Cognitive theory, which consisted of 20 sessions implemented over four weeks. Initial sessions were supportive and focused on establishing rapport, psychoeducation about the concept of dying, and losing support systems. Later sessions focused on the exploration of cognitive beliefs and targeting cognitive distortions. By the end of the fourth week, the patient did not seem to exhibit delusions and more readily accepted the finality of his mother's death. PANSS score was 8 on the positive scale and 19 on the negative scale by the end of his hospital course. We utilized modified Kubler-Ross and bereavement counseling models in this patient with a resolution of the psychotic denial phase of his loss. Further studies need to be done on the possible utility of our modified model and modified therapeutic approach for bereavement in patients with schizophrenia.