Part 2: The Case Evolves

Mary accepted referral and was greatly helped by the treatment of her PTSD, the dreams stopped and she became less “pressured” at home. She obtained great benefit from her continued meetings with the volunteer who was able to give positive reassurance that the powerful feelings that soon emerged were natural. Mary remained excessively anxious about the children despite their rapid response to treatment. In joint meetings with Mary and her mother the volunteer was glad to find that neither of them was heading for depression and was able to express appreciation of their care for the children and each other. The situation was relatively stable and she was able gradually to reduce the frequency and then stop her visits.

Teaching Points

• The powerful feelings that Mary experienced after David’s death were natural expressions of grief and not depression,
• The traumatic circumstances attending the death precipitated PTSD in Mary that required specialist help. Even without a death of this kind, Mary would have been at risk because of:
  • her youth,
  • lifelong insecurity,
  • her two small children and
  • the family history of depression (mother in this case).
• Prompt and effective professional help will ameliorate the worst symptoms. The grief counselor (trained hospice volunteer, in this case) was able to provide the secure base in which Mary and the other members of her family were able to grieve in a healthy way while discovering the potential value of their mutual support for each other.
• The anxiety symptoms in the children were appropriately managed by prompt referral to a child psychologist.
• Quality grief counseling can be provided by volunteers who have been trained to provide such counsel ( in many situations, psychologists and psychiatrists may not be available or even necessary to counsel bereaved subjects).
• Home hospice agencies use trained volunteers and chaplains (both disciplines are members of the core hospice team, as mandated by the Medicare Hospice Benefit) to provide bereavement support.