What facts surrounding the death of her fiancé made recovery more difficult?

A Case of Bereavement-Related Withdrawal

Shayna, a woman in her mid-20s, presented for counseling several months after the death of her fiancé, Jerod, from a rare viral infection. While hospitalized for the virus, Jerod had a heart attack, lapsed into a coma, and died several days later. He was 25 years old. Shayna was distraught, as was Jerod’s family. The death was completely unexpected—and making sense of it was deferred for months as they awaited autopsy results. It was only after the autopsy that they discovered that a rare and fatal virus had crystallized in Jerod’s organs, and one by one his organs failed. Even then, the cause of death was not fully comprehensible. It did not make sense.

His mother and father were in their 40s; his younger brothers and sisters still lived at home. His death was out of chronological order. Shayna was sad and could not stop searching for answers. She sought out her minister and a psychic, and she even attended new age healing sessions in her efforts to make sense of the tragedy. She had a large support network of college friends and coworkers of her own age. While initially supportive of her grief, many of her friends had never experienced the death of a loved one, and one by one, they stopped asking about her loss and began to focus instead on their latest career moves, graduate school plans, and other day-to-day activities. Shayna stopped returning their calls. She began to isolate herself from friends and family and, other than going to work, did not leave her house. She reported, “No one can understand what I am going through.” She could no longer relate to the trivial matters that made up the drama of her young friends’ lives. “Only someone who has experienced death can appreciate the fragility of life,” Shayna said.

Shayna’s counseling focused on building a bridge back to her life. At first, her days were filled with yearning to have her fiancé back, while at night she dreamed about him but could not communicate with him. Each morning she awoke sad and frustrated. Those first sessions early in counseling were very painful as Shayna recounted the story of her fiancé’s death. Nothing could be done to help except to be present, empathic, and bear witness to her pain. This gave her comfort in the knowledge that someone else was accompanying her on this painful journey. She was not alone.

Counseling included discussion of the unconscious needs reflected in Shayna’s dreams and the importance of establishing rituals to honor her fiancé. Each night she would light a candle and talk to his picture. This gave her comfort and a newfound way to communicate with him. Shayna also talked about the goals she and her fiancé had for the future. She decided to continue on the same path for a while and to move ahead with one of their goals—to get a dog. The puppy proved to be source of solace and support.

Shayna continued to go to work as an accountant, although she had many physical symptoms including anxiety, waking up in the middle of night, loss of interest in food and daily routines, and poor concentration. Cognitive behavioral therapy helped her identify and rate her anxiety. She learned how to do breathing exercises to regulate her breath and ward off panic attacks, and how to conduct a simple body scan meditation at night to help her relax and get back to sleep.

Gradually, Shayna began to confide in two coworkers who checked in with her regularly. The trust and support she found in these two women helped her begin to integrate the trauma into her life and start to reconnect with the community. When she was ready, she participated in a support group, run by a local hospice specifically for young people who were widowed or had lost siblings or significant others. Finally, she found a group of people of her own age who could relate to her, and she began to tell her story in an empathic, supportive environment. “I no longer feel like I’m a freak,” she said. “I looked at the men and women in that room and realized that every person has baggage. Everyone has some trauma or some deep dark secret that they’re living with. I’m not alone.” Within a year, Shayna was ready to continue on the path she had set for herself prior to the death. She applied to graduate schools, was accepted, and the following year moved to New York.

Discussion Questions

1. What symptoms of grief did Shayna exhibit?

2. What facts surrounding the death of her fiancé made recovery more difficult?

3. What other questions would you ask about Shayna’s life to help in your clinical decision making?

4. What type of treatment would you recommend?

5. With a peer as a client in this situation, role-play implementation of the task model of crisis management and intervention presented in Table 1.1.

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