Suicide Loss & Traumatic Bereavement
Elliot, 37, software engineer
Fictional teaching case
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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.'
Read the full case history and clinical context
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.
Compare how approaches understand this case
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Showing 2 of 7 formulations.
CPT
Elliot's stuck points center on responsibility and control: 'I should have seen the signs,' 'If I had been a better partner, he wouldn't have done it,' 'I failed the person I loved most.' These beliefs maintain the guilt that blocks the grief process. The world is now fundamentally unsafe: if David could die without warning, nothing is predictable.
Identify and challenge stuck points around blame, responsibility, and safety. Socratic questioning: what evidence supports 'I should have known'? What evidence contradicts it? Impact statements about what the loss means. Cognitive processing of themes: safety, trust, power/control, esteem, intimacy, all shattered by suicide loss.
"You wrote 'I should have known.' Let's sit with that. What were the signs? ... And what did you do about the ones you saw? ... So you responded to what you knew at the time. What does that do to 'I should have known'?"
Existential Psychotherapy
David's suicide has shattered Elliot's assumptive world: the belief that the world is predictable, that love protects, that you can know another person. He is confronting death not abstractly but through the most intimate possible encounter: the person he slept beside chose to die. The 'quieter' is worse than the pain because it threatens meaninglessness: if the grief fades, what was the love for?
Don't rush the grief. The question 'what was it all for?' deserves to be taken seriously, not reframed as a cognitive distortion. Explore what David's death has revealed about existence: its fragility, its opacity, the limits of love. Help Elliot find a way to carry the loss that preserves meaning rather than dissolving into nihilism. What does fidelity to David look like going forward?
"You said the quiet is worse. I think I understand: if the pain fades, it might feel like David fades too. Like the grief is the last way you're connected to him. What would it mean to stay connected to David without the pain being the bridge?"
IFS
Elliot's system is frozen. A Manager part went back to work after two weeks and is performing: 'ghost in a chair' is a perfect description of a Manager running on autopilot. A Firefighter part provides numbness to prevent the Exile from surfacing. The Exile holds the scene, the guilt, and the devastation. The system is terrified that if the Exile is allowed to feel, Elliot will shatter.
Approach the Ghost Manager with appreciation: it got Elliot through the worst eight months of his life. The numb Firefighter is protecting something enormous. Slowly, at the system's pace, create space for the Exile. The guilt part needs special attention: 'I should have known' is a Protector trying to retroactively create control over an uncontrollable event.
"The part of you that went back to work two weeks later: that part saved you. But it's exhausted. And underneath it, there's something that hasn't been allowed to feel yet. We don't have to go there today. But I want you to know: when you're ready, I can sit with whatever is there."
Prolonged Grief Disorder Treatment (PGDT/CGT)
Elliot's grief has features of Prolonged Grief Disorder: persistent yearning, identity disruption ('ghost in a chair'), avoidance of reminders (bedroom), difficulty re-engaging with life, and the sense that the loss has not been integrated eight months later. The traumatic nature of the death (suicide, scene discovery) complicates the grief by layering PTSD symptoms onto the bereavement.
Dual process: oscillation between loss-oriented work (telling the story of David's death, confronting avoided reminders) and restoration-oriented work (re-engaging with life, rebuilding identity). Imaginal revisiting of the death story. Situational revisiting: gradually re-entering avoided spaces (the bedroom). Imaginal conversations with David.
"I'd like you to tell me the story of what happened that day. Start from the morning. Take your time. ... I know this is painful. You're not reliving it. You're putting it into words so it becomes something you can carry."
Narrative Therapy
The dominant story of David's death ('I should have known, I failed him, I'm a ghost') is problem-saturated and guilt-organized. The broader cultural narrative around suicide compounds this: silence, stigma, and the implication that survivors are complicit. Elliot's rich, five-year relationship with David has been eclipsed by the final act.
Externalize the guilt narrative: who told Elliot he should have known? What does the Suicide Stigma story say about survivors? Thicken the alternative story: who was David beyond his death? Who was Elliot in that relationship? What did they build together? Re-author: the story of David's life, not just his death. And the story of Elliot as someone who loved well, not someone who failed.
"Right now the story of David ends with one day. But that's not the story of David; that's the story of his death. Tell me the story of David. Tell me something he did that made you laugh so hard you couldn't breathe."
Somatic Experiencing
Finding David's body was an overwhelming experience that froze Elliot's nervous system. The intrusive images are incomplete sensory processing. The inability to enter the bedroom is somatic avoidance: his body learned that space is death. The alternation between numbness and overwhelm is not oscillation inside the window of tolerance but the swing between hyper- and hypo-arousal outside it, thrown from one end to the other with nothing discharging.
Very gradual titrated approach to the somatic experience of the discovery. Where does the body hold it? What happens in the body when he thinks about the bedroom? Slow pendulation between activation and resource. Don't rush toward the memory: let the body lead. Eventually, support completion of the defensive responses that froze (the impulse to help, to call, to run).
"When you think about walking toward that bedroom door (don't actually walk there, just imagine it), what happens in your body right now? ... Stay with that. You don't have to go further. Just notice what your body is doing."
EMDR
The scene of finding David is a discrete traumatic memory stored with intense sensory detail: visual, olfactory, tactile. Elliot's nervous system is stuck in that moment. The intrusive images, the inability to enter the bedroom, and the avoidance are classic PTSD symptoms. The negative cognition 'I should have known' is locked to the memory and maintaining guilt.
Stabilization and resource development first: Elliot's support system has contracted and he needs internal resources. Target the discovery scene: image, negative cognition ('I should have known / I failed him'), emotions, body sensation. Process toward adaptive resolution ('I couldn't have known / I loved him and that was enough'). Later targets: last conversation, any moments of dismissed warning signs, the bedroom itself.
"The image of what you found: your brain keeps replaying it because it hasn't been able to process it. It's stuck. We can work with that memory directly, not to erase it, but to take the charge out of it so it becomes something you carry rather than something that carries you."
Where Approaches Genuinely Disagree
Stuck points like 'I should have seen the signs' maintain both trauma and grief. Cognitive processing is needed.
This is grief first. The primary task is mourning: accepting reality, processing pain, adjusting.
Philosophical Lenses
These are not treatment plans. They are ways of seeing — philosophical perspectives that illuminate aspects of this case that clinical modalities may not address directly.
Buber distinguishes between I-Thou (the direct, unmediated encounter between whole beings) and I-It, the objectifying relation in which the other becomes a thing to be used, analyzed, or explained. Elliot's grief moves between both. The intrusive images, the inability to enter the bedroom, the raw presence of David's absence: these are the aftershocks of a genuine I-Thou that has been severed. But the guilt ('I should have seen it') is already I-It: turning David into an object of analysis, a problem that could have been solved if only Elliot had been more attentive. The guilt converts the unbearable mystery of a Thou who chose death into a causal sequence that can be mastered. Buber would say Elliot's task is not to 'process' the loss but to find a way to hold David as Thou: as someone who remains irreducibly himself, whose final act cannot be fully explained or owned by Elliot's guilt.
David's suicide confronts Elliot with what Camus called the only serious philosophical question: whether life is worth living. Not as an abstraction but as a lived reality: someone Elliot loved answered 'no.' This makes the question unavoidable for Elliot, not because he is suicidal but because the person who knew him best chose death, and this challenges every meaning-structure Elliot has. Camus would not try to answer the question for Elliot. He would insist that the question must be lived through: that the confrontation with absurdity, with the possibility that life has no inherent meaning, is the only honest starting point. Recovery is not the restoration of meaning but the decision to live without guaranteed meaning.
Sources & Method
This is a composite fictional case — no real client is depicted. Formulations represent how each modality would typically conceptualize and approach a case with this presentation, based on published clinical literature and training materials. Each formulation draws on the modality's own theoretical framework, key texts, and clinical principles as documented on its modality page. Full source citations for every modality are available on the Sources page.