Treating Complicated Grief in a Teenager With Autism: When the Client’s Limitations Prevent Engagement in Therapy

Abstract

Treating grief in adolescents is only further complicated by a diagnosis of autism spectrum disorder (ASD). When the loss is traumatic, treatment becomes even more difficult, because mourning can be interrupted by the stigmatizing events of the loss, which leads to feelings of helplessness in the survivor. The case of 15-year-old Manda demonstrates a client with ASD whose traumatic grief symptoms do not respond to traditional approaches to treatment. Despite using therapeutic interventions targeted to clients with ASD and grief, 5 months of work based on complicated grief treatment (CGT) with Manda and her father has not led to any improvements in her suicidality and grief. In this treatment, her slow processing speed and cognitive rigidity seemed to prevent CGT interventions' effectiveness. Additional months using the neuropsychological therapeutic intervention of social medicine, education, exercise, diet, and sleep (SEEDS) by Arden (2015) has resulted in limited progress by helping Manda to develop some global skills in the areas that neuropsychology indicates support general mental health. After months of intensive work, Manda still seems unable to articulate or connect her feelings of loss to her sadness. Based on a literature review of developmental grief processes, Manda would be expected to be showing more understanding of what her loss means to her life moving forward and an ability to articulate the feelings attached to that loss. Until she is able to verbalize her feelings of traumatic loss, therapy will continue to be unable to significantly address her grief and integrate those feelings.