Found his partner David dead by suicide in their apartment eight months ago. Still sleeping on the couch — cannot enter the bedroom. Intrusive images of the scene. Alternates between numbness and overwhelming guilt ('I should have known'). Went back to work after two weeks, performs adequately but describes himself as 'a ghost in a chair.' Friends have stopped asking how he's doing. Says: 'Everyone says it gets better. It doesn't get better. It just gets quieter, and that's worse.'
History
No prior mental health history. Relationship with David was five years, stable, loving. David had depression but was in treatment — Elliot believed it was managed. No warning signs Elliot recognized. One previous loss (grandmother, natural causes). Elliot's family is supportive but geographically distant. Gay man, out since college, strong pre-loss social network that has contracted since David's death. No substance use beyond occasional increased drinking in the first months, now moderated.
Clinical note: Elliot's presentation is consistent with Prolonged Grief Disorder (PGD), newly added to the DSM-5-TR and ICD-11, with comorbid PTSD features from the scene discovery. Suicide bereavement has a clinically distinct profile: survivors experience elevated guilt, shame, stigma, and 'why' rumination at rates significantly higher than other bereaved populations (Jordan, 2001; Sveen & Walby, 2008). Elliot's 'I should have known' is nearly universal among suicide survivors and is both a stuck point (CPT framing) and a Protector's attempt to retroactively create control (IFS framing). Complicated Grief Treatment (Shear et al., 2005) has the strongest evidence for PGD (d = 0.58 vs. interpersonal therapy), using dual-process oscillation between loss and restoration. EMDR is appropriate for the traumatic imagery specifically. The contracted social network is clinically significant — suicide loss often triggers social withdrawal because friends don't know what to say, and the survivor reads the silence as abandonment. Elliot may benefit from a suicide loss support group (American Foundation for Suicide Prevention facilitates these) as adjunct to individual therapy. The bedroom avoidance will need graduated exposure eventually, but premature push risks retraumatization.
Where Approaches Genuinely Disagree
Process the trauma or support the grief?
CPT
Stuck points like 'I should have seen the signs' maintain both trauma and grief. Cognitive processing is needed.
vs.
Worden's Task Model of Mourning
This is grief first. The primary task is mourning — accepting reality, processing pain, adjusting.