Case practice · Counselling
co-03 · AdvancedGrace: two cups in the morning
The case (fictional)
Grace is 67, a retired primary school headteacher who was born in Jamaica and came to Birmingham at the age of nine. Her husband Winston died suddenly of a stroke fourteen months ago, after forty years of marriage. Her daughter urged her to come to a bereavement counselling service.
Grace still sets out two cups in the morning and talks to Winston's photograph, which she says comforts her. Friends from church visit often. But she also describes an intense, daily longing for him, says she "cannot accept he is gone", feels that "part of me died with him", and finds life meaningless. She avoids the road past the hospital, has not touched his wardrobe and has stopped going to the choir they sang in together.
She sleeps poorly, eats little and has lost four kilograms. She feels guilty that she did not notice he looked unwell that morning. She has type 2 diabetes and admits she has been "careless" with her tablets.
Towards the end of the session she says quietly, "I just want to be with him." Her daughter says her mother "has not been herself since the funeral".
Identify differential diagnoses and what you would assess next
Set out the possibilities you would consider for Grace (from expected grief to diagnosable conditions), with your reasons, and say what you would assess next.