COU 680 Week 5 Case Study: Ilana Ilana is a 37-year-old Korean-American female. She presented to therapy four weeks after the sudden loss of her husband, Eli, and youngest child, Kai, who were killed by a drunk driver on their way home from Korean school. Ilana’s daughter, Claire, was also in the car at the time of the accident but survived. Ilana reports that she moves back and forth between periods of shock, denial, and anger and finds herself “zoning out” many times a day, as if she is watching herself in slow motion. She struggles with feelings of hopelessness and rage and simultaneously feels the needs to cut off her emotions to protect and care for her eight-year-old daughter. She worries she is losing control and does not know how she will continue to manage life without her husband and child.

History Ilana and Eli were married for 12 years. They met at the local hospital where they were both employed as nurses. In addition to their passion for nursing, Eli and Ilana bonded over their shared Korean heritage. Eli was biracial with an Irish mother and Korean father, and Ilana’s family had immigrated to the United States from Korea when she was two years old. Although both adopted “American lifestyles,” they both felt a strong cultural connection to their Korean heritage and agreed to raise their children with an awareness of their Korean roots. After a several years of marriage, Ilana and Eli had Claire, who was later followed by their son, Kai. Ilana reported that both she and Eli had been very close to their children and saw their relationship as one of partners and co-parents. While they preferred to do things together as a family, one of the other of them would take responsibility for the kids’ activities when the other was on call for work. On the day of the accident Ilana had been on call, so Eli took Claire and Kai to the Korean-language school they attended on Saturday mornings. She had been in the process of preparing lunch when she received a call from the local hospital where Eli still worked. She was told a drunk driver had run a red light and smashed head-on into the driver’s side of Eli’s car, killing him and Kai instantly. Claire had been taken to the hospital with a broken leg and some small lacerations. In the month since the accident Ilana has not been working and has largely been supported by her parents and sister who live in her same town. They held a Christian funeral for Kai and Eli three days after the accident, but Ilana claims she has been “unable to do anything” since. She said she often drifts in and out of functioning and will become angry and full of rage completely out of the blue. She notes that she is hypervigilant and jumpy, and she has become increasingly protective of Claire, who is struggling with her own nightmares and distressing memories of the accident. She states that she has “no idea who [she is] anymore” and does not know how to continue to parent in the aftermath of this loss.

Developmental Considerations Ilana had no physical or cognitive delays in childhood. She immigrated to the United States when she was two years old, and although her family spoke only Korean, she quickly learned English when she started public education. She maintained average grades throughout school. Ilana was an outgoing child and made friends easily. She noted no concerns related to psychosocial development.

Relational Considerations As a child, Ilana was close to both parents and is especially fond of her younger sister, who was born when Ilana was 10-years old. As a child, Ilana was an outgoing and precocious child who often greeted

others with a laugh and a smile. As she grew older, she maintained her outgoing demeanor despite the more reserved nature of her Korean-born parents. While there were some inherent conflicts with her parents about her “American” lifestyle, Ilana felt supported by her parents and remains close to them today. She also remains close to her younger sister, who moved in with Ilana and Eli when she graduated from college. Ilana reports strong relationships with coworkers and other parents from her kids’ school, many of whom have been bringing food and supporting Claire when Ilana felt unable to do so.

Multicultural Considerations Ilana’s Korean heritage is of great importance to her. Both of her parents continue to speak predominantly Korean, so she felt this was an especially important part of raising her own children, and why she and Eli elected to send their children to Korean-language school. While Ilana was raised in the Buddhist tradition, she elected to convert to Eli’s protestant Christian religion before she and Eli married. This was initially a point of contention between Ilana and her parents, but over time they came to accept Ilana’s decision. In the weeks since Eli and Kai passed away, Ilana notes that she has struggled with acceptance of what happened and an inability to deal with the unknown of afterlife. She notes that her parents’ belief in samsara seem to have brought comfort and peace to them, but she does not feel the same. She reports that she does not know whether to believe in the heaven of her Christian religion or the reincarnation of her Buddhist upbringing.

Diagnosis Diagnostically, Ilana presents with symptoms consistent with acute stress disorder with a combination of negative mood, dissociative symptoms, and arousal symptoms (American Psychiatric Association, 2013).

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).