Apr 30, 2020 in Literature

The Wrong One Died

Introduction

The process of bereavement is a complex phenomenon which takes place in every family. However, not every family is capable of handling grief without professional help. In the majority of cases, one of the parents suffers the most, which may result in divorce or destruction of family relations with relatives. The following discussion is the reflection of a personal reaction to the case written by Irvin Yalom, which shows the complexity of grief. It also outlines the effectiveness of concepts used by the psychotherapist during sessions with the patient compared to the models utilized by other professionals.

Reaction to the Writing

The story titled “The Wrong One Died” written by Irvin Yalom is one of the most touching, impressive, unpredictable, and interesting pieces from the point of view of social work. On the one hand, it is typical to work with patients suffering from grief. On the other hand, the story showed the most untypical situation which happened to Penny, a 38-year-old woman who lost her daughter. The evaluation of the Penny’s story showed that her child’s death became a significant trigger for depression, which started long time before the birth of her daughter. The fact that her daughter, Chrissie, suffered from cancer, was the main cause of Penny’s depression, which deepened due to the fear that her only hope for a better life will die from the incurable disease.

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First, reading of the story aroused different feelings and emotions regarding Penny and her grief. Apparently, the problem was deeper than it seemed at first glance. However, it was difficult to imagine that Penny had to suffer from so many life obstacles. In fact, the story evoked a strong feeling of compassion and sympathy to the woman who had to lose her child. It was also natural to expect her to suffer from grief for a long time. Nevertheless, the story became more complicated when Penny revealed that she had been suffering from grief for four years. At this point, it was evident that the patient needed urgent help in order to prevent her from losing mind and common sense.

Dr. Yalom’s interest in Penny was natural from the point of social work and psychotherapy. Every session revealed new details and information, which influenced Dr. Yalom’s decision to prolong the number of meetings in order to evaluate the levels of grief and depression. Penny’s case is unique and complex because it was necessary to let the patient share all worries and doubts in order to involve her in the process of self-recovery. It was amazing to observe changes in Penny’s thinking from one session to another. Therefore, Dr. Yalom’s approach to communication with the patient was appropriate and efficient as it helped Penny to feel better and start thinking about her family instead of herself. In general, the work with Penny requires a closer consideration in order to track progress in sessions and evaluate appropriateness of the methods and techniques used by Dr. Yalom in therapy.

The Work with Penny

The uniqueness of the situation with Penny is evident from the first lines of the story. In fact, Dr. Yalom’s choice of the number of therapy sessions with the patient was justified from their first meeting. The goal of the therapy was to help the patient accept her pain, grief, and obstacles on the way to relief. During the first therapeutic session, Penny mentioned that all she needed was to get help in starting to tell her story, and then she would take care of the rest. In this way, Dr. Yalom guided Penny through her own life from one session to another. While grief had been progressing for too long, it was necessary to encourage Penny to find the reasons of her desperate life choices in her past. The approach used by Irvin Yalom focused on the idea that the one must find the way to live with the living rather than focus on grief for the dead. Penny’s problem lied in her loss of hopes she had for her daughter Chrissie. Her dreams, her actions, her inability to think about other family members indicated that grief became only a shadow of inner conflicts and depression which Penny had for many years. In addition, therapeutic sessions identified the patient’s fears and their influence on her inability to progress from grieving to normal routine.

The first sessions with Penny showed that she had a strong character, which was formed due to the challenges and obstacles she had to overcome since her childhood. Hence, Dr. Yalom started asking direct questions, which surprised Penny, made her feel uncomfortable and evoked memories of past events that were full of pain, sorrow, and shame. One of the patient’s problems was the loss of time for fulfillment of her dreams and goals. Once Penny gave birth to her daughter, she thought that her gifted and talented daughter would be lucky enough to live the way her mother had dreamed. This idea became the focus of the therapy since new sessions reassured Dr. Yalom in the fact that Penny suffered from inability to fulfill her self-actualization needs, which were darkened by grief at the loss of her only daughter. The main approaches used to guide Penny in her grief were coercing, arguing, badgering, and imploring. All these methods put Penny in the most uncomfortable situations. However, the main benefit of the therapy is that a patient receives a chance to progress to a realistic view on his/her personal life and family issues, which have already transformed from grief to serious family issues. As a result, acceptance of death and realization of the need to take care of her sons helped Penny to relieve the pain of loss.

Connection of the Story with Concepts and Theories

While reading the story, it became possible to track different stages of the bereavement process which Penny had to go through. The fact that her grief had been lasting for four years since her daughter’s death suggested the idea that Penny could not proceed from one stage of bereavement to another. It is obvious that Penny had a strong attachment to her child based on her maternal instinct and a pure feeling of affection. However, the loss of the daughter meant that Penny had to separate from her child, and she could not accept that. In fact, Penny did not proceed from the stage of shock full of intense grief, which overwhelmed her as soon as Chrissie died. She continued to suffer from the lack of concentration, loneliness, and restlessness. Along with fear, anger, and guilt, the aforementioned symptoms of grief led to intensification of Penny’s feelings related to her loss. As a result, she alienated from her family and did not even notice that the husband left her. John Bowlby’s attachment theory is applicable to the case of Penny. It shows inability of the patient to detach from the lost child. In fact, Dr. Yalom made detachment one of the primary goals of the therapy, which was supposed to help Penny to focus on her life rather than grief.

In addition, the story showed some elements of the dual process model, which helped the patient to shift focus from grief and try to avoid it by concentrating on other aspects of personal life. As long as Penny’s situation was complex enough to incorporate different theories and concepts in the therapy, the dual process model helped to assess Penny’s case and her life in general from another point. From the point of loss orientation, Penny did everything to focus on her daughter, and she brilliantly described her feelings related to loss in details. As for the restoration orientation, it was difficult for Penny to consider other aspects of her life and accept the fact that her focus on loss prevented her from living a normal life. However, Dr. Yalom succeeded to turn Penny’s attention to other issues of her life by asking unexpected questions and making her gasp at the idea that she was losing her sons because of her grief. In this way, it became possible to direct Penny in her recovery process and help her to see the truth about her grief.

Dr. Yalom’s Methods I Agree and Disagree with

The therapeutic approach towards guidance of Penny in the process of the recovery from grief evoked divergent ideas in my mind. A detailed story full of facts about every session clarified a highly professional approach of Dr. Yalom. First, it is necessary to agree that grief related to the loss of a child is a serious psychological problem, which demands adopting a cautious approach to patient’s treatment. Otherwise, lack of attention to the patient and a single mistake can worsen the situation and lead to unpredictable actions from the side of the patient. The first impression about Penny arouse as soon as she entered Dr. Yalom’s office. She was a survivor who had to face many life challenges, which ultimately led her to the office of a psychotherapist. It cannot be denied that Penny needed someone to discuss her grief and past events. On the one hand, Dr. Yalom was right by asking Penny direct questions and making rough conclusions about her condition. On the other hand, the results of this approach could be unpredictable. As long as Penny had been suffering from her grief for a long time, she could have developed unstable neurotic conditions, which would trigger anger, desperation, or even violence. Therefore, Dr. Yalom’s approach to address the patient’s problems is a questionable practice, which can hardly be a panacea in every case of grief.

Another point that is worth of attention is that Dr. Yalom had a supporting role in guiding Penny through her recovery. He admitted that she was the best teacher in the grief process he could have. I support Dr. Yalom and agree with his idea to let the patient think about different periods of life which brought her the intense depression and grief. The unique case of a prolonged bereavement process required a cautious approach to its elimination. As a result, any radical interference in the recovery process would result in different side effects, which could hinder the natural process of treatment. It means that Penny had to realize that her current condition was the result of her past, which became intensified by the loss of her precious daughter.

Grief Models

The methods and techniques applied by Irvin Yalom were effective in the case of Penny’s grief. However, it is possible to consider other models of treatment in order to see new approaches to helping patient handle stress, depression, and grief. It does not mean that Dr. Yalom’s approach was wrong or ineffective. It implies that other professionals could generate a different model of treating patients with similar problems based on their perceptions and beliefs. For example, it is possible to start with the model generated by William Worden. As long as the scholar believed that a person should proceed from passive ways of overcoming grief, he would focus on active methods helping to focus on the future rather than past. According to the Worden’s model, family is one of the main means of bringing the person to reality in order to look into the future together. Based on the case, Worden would start engaging the patient’s family in the recovery process approximately at the third or fourth session after learning enough about the patient’s grief. He would suggest having both open and closed family conversations, which would facilitate every family member to reveal their feeling and help them to accept the loss. In Penny’s case, it would be a mandatory activity to help the patient to accept the loss since other family members might have already learnt how to live with the loss. This activity would also lead Penny to another task, namely sharing emotions with other family members. Finally, Worden would suggest making reorganizations in the family, including changing roles and even the position of pieces of furniture in the house. It would help to clear the mind and set new goals of the family’s performance. In general, all actions would have a single goal – to help the patient accept the death and learn how to continue living a normal way.

Therese Rando, by contrast, would utilize an approach similar to Irvin Yalom’s methods. She would use the stage of confrontation to analyze Penny’s pain which prevented her from accepting the death of her child. According to Rando’s model, Penny needed such confrontation with the realization of her intense sadness and guilt in order to move to the stage of accommodation, which would help her to re-enter the reality with her sons. However, Rando would help Penny learn to accept her pain, and then Penny herself would become responsible for her transition in the real world.

Key Ideas

The writing belonging to Irvin Yalom proved that the bereavement process is a complex phenomenon which requires much attention from the therapist in order to help the patient handle the pain. The evaluation of the story showed that careful attention to the patient’s needs, challenges, and obstacles of the past is appropriate in the selection of the treatment methods. It is possible to outline several key findings that relating to the sessions of Dr. Yalom with Penny.

First, it is important to adhere to the patient’s character and situation to make the process of treatment natural. The patient should not be forced to follow the requirements of the therapy in a stressful way. The point lies in building sessions on trust and understanding, which will facilitate revealing important facts about the life of the patient. In the discussed case, the patient believed that she would tell the story, and Dr. Yalom would tell the best way to progress to routine activity. However, Penny the reasons of her stress and endless depression herself by sharing the problems she had to face throughout her life. Dr. Yalom’s role was to support, understand, and make justified conclusions. Secondly, the story showed that grief is a multilayer problem, which may result from a set of past events. Consequently, it is necessary to analyze all periods of patient’s life in order to find the roots of depression, which may be a consequence of not only grief but also other life obstacles. Thirdly, it is important to help the patient feel that reaction to loss is human and natural. Dr. Yalom made everything to relate to Penny’s case and reassure her that she did not behave inhumanly or cruelly. Fourthly, the story showed that grief is a state of mind rather than a process which requires a detailed consideration in order to find the reasons for grief. Penny became an exemplar patient, who showed that evaluation of grief step by step is effective as long as it contributes to building a treatment therapy based on triggers of grief. Finally, patient’s fears are valuable in making a therapy effective. In Penny case, the patient’s grief became an embodiment of her fear of death, which she faced in her dreams. It means that fears, aspirations, characteristic traits, and personal interests represent a significant portion of factors which influence the development of the therapy.

Conclusion

The evaluation of the story accompanied by a detailed comparison of the situation to the well-known models of grief showed the effectiveness of the approach used by Dr. Yalom. Regardless of personal doubts regarding the therapy, the sessions were effective enough to help the patient handle stress and focus on the reality instead of loss. The main idea of the evaluation is that it is necessary to consider every aspect of the patient’s personality in order to develop the most effective treatment approach, which will guide the patient back to the routine activity with new goals and aspirations.

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