ABSTRACT
Clinical vignette: Carmen Ruiz was a 32-year-old single Puerto Rican woman and 3rd of 11 siblings when her 50-year-old mother, Gloria, died of breast cancer, leaving Carmen in charge of three younger siblings: Mario, age 24 and a heroin addict, and two halfsiblings, Roberto, age 16, and Luisa, age 11. Carmen became her mother’s coparent at age 8, when her hard-drinking father died in an accident near home in rural Puerto Rico, and her mother was pregnant with Mario. Gloria Ruiz relocated her family to Boston where, remaining single, she had the two younger children. While older siblings married and had families, Carmen learned little English, her world revolving around her mother and care of their household. With Gloria’s diagnosis of stage IV breast cancer, Carmen became her mother’s primary caretaker through swift progression of devastating illness reducing her beautiful, sociable mother to agonized skin and bones. At her mother’s request, Carmen became the younger children’s primary parent, struggling to establish parental authority but thwarted by their rebellion and rejection. Seeking parenting help at our Child Guidance Center, she was referred to a new Family Bereavement Center where I worked. Respecting her request, initial interventions used behavioral parenting counseling techniques to help Carmen set effective age-appropriate limits with her half-siblings. As these relationships improved, Carmen requested help with her own overwhelming grief and family conflicts concerning bereavement. Carmen disclosed her continuing close yet troubled relationship with her mother’s spirit, who visited her nightly in dreams and scolded her for not taking proper care of the children. The younger siblings were frightened by Carmen’s invocation of their mother’s deceased spirit and refusal to change anything in their mother’s bedroom. Her older siblings thought Carmen’s grief exceeded acceptable cultural and spiritual traditions.
