A Case of Bereavement-Related Withdrawal Shayna, a woman in her mid-20s, presented for counseling…

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
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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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