Intake Information:Sarah was referred to the New Hope Grief Counseling Center by the Austin Police Department's Victim Services.Her voice was a little shaky as she asked more about grief counseling, cost, and times available for meeting. She does shift work at a local hospital and is afraid it may conflict with counseling. Though she said that she is willing to do what is needed, because she has felt a lack of support since her loss. She is seeking individual counseling at your center to support her emotional needs during this time.

Initial Interview:As you arrive to take Sarah to the counseling room, she is startled when you speak to her and says, "Oh, I'm sorry, I was just in my head. That is happening a lot lately." "No problem," you say, "that is very common when grieving.""I hope that today you find a safe place to share some of those thoughts with me. Please follow me."

"Sarah, you shared in your intake that you lost your partner, Carlotta three months ago. Can you tell me more about what happened?"

"Ummmmm, yeah, I guess that is why I am here. It is just so hard talking about this; I don't know where to start. You know, I am a nurse in an ER and I am so used to compartmentalizing so that I can continue working. It is like I can't access it."

You say, "Sarah, this is your time, and you can get to your story in whatever way it feels comfortable.Would you be able to start by telling me how you found out?"

Sarah looks down at her hands in her lap and then starts sharing. "Yeah, you know, that is one thing I keep going back and forth about. I had just arrived home after a long shift and there was a police car in the apartment parking lot near our building. As I walked into the apartment the police asked me if Carletta lived here." When I said ,"yes, but it looks like she isn't home.Which I was thinking was weird, because Carletta was a homebody. She almost always was home when I got home at 8pm."

"I was about to ask them why when they asked if they could come in and asked me to sit down. I knew something was wrong. I sat down and they told me that there had been an accident.Carletta was driving home from work around 5:45pm and the car in front of her blew a tire. The car spun around and pinned Carletta's car to a construction wall. They said that she had a brain bleed and was not at my hospital, but one in South Austin.They then asked if she had any family. "

Sarah was stating the story rather remotely until she got to that last line. She then looked down and ran her hands through her hair. When she looked up, she had tears in her eyes and began talking again.

"I told them that I was her family. We have been together for the last six years. We met in Puerto Rico when she was doing a charity animal clinic. Carletta loved animals and worked with Emancipet who travelled to Puerto Rico to provide free spay/neuter services for the community. She was such a loving soul. Sarah and I dated long distance for the first year then she moved to Puerto Rico for four years. We just moved to Austin last year."

"Oh, sorry, you know what the police officer said to me when I said I was her family"? He said, "No, her real family." "What the hell? He didn't even ask if we were married". Sarah started wringing her hands at this point. "I wish we were. We had talked about it, but she only wanted to do it if her mom and dad would attend. She thought they would learn to accept us once we got back here to Austin.That just didn't happen."

"Anyway, the police asked again, if she had family and I told them that I could call her mom, but I wanted to go to the hospital." They said that she wasn't conscious and that if I didn't have medical Power of Attorney that they needed to find her family." She stopped wringing her hands and looked at me devastated.

"That is the worst part. Once I called her mom, my world fell apart. Her mom told me not to go to the hospital. Of course, I didn't listen, but she was there when I arrived. They live closer to the hospital than we did."Sarah started crying and said that she was not allowed into the hospital room. Her Dad literally blocked the door and they said they would call security. "I just saw Carletta from outside of the hospital room and then she died that night."

"They didn't allow me to attend the funeral. Damn it!I still can't believe that they did that to me....and to Carletta. We were in love with each other for six years and lived together for five of them.Don't they know she would want me to have been there?" "God, I wish we had drawn up Power of Attorney documents at least until we got married. But, I mean, I am 33 and she was 29. We didn't think about us having to do that so young. As a nurse, I should have known.Though, I just didn't fathom that her parents would be so cruel. I mean, they tolerated me at holidays, but always introduced me as Carletta's friend or roommate.That is why we had stopped flying in from Puerto Rico. Though, Carletta was really trying to reconnect with them since we moved back."

"Sarah, it sounds like you and Carletta shared a lot of love and that she was hoping that her parents could join in your happiness. It is such an added burden to have faced judgement and disconnection from her family. I notice that we only have a few minutes left, but this is a good start. Do you think in the next few minutes you could tell me a little more about your support system since losing Carletta?

"Oh, it kind of sucks.My family in Puerto Rico has been very supportive, but it just isn't the same being so far away from them. They loved Carletta and understand the pain I am experiencing. My Dad wanted to beat up his dad after he heard about what happening n the hospital." Sarah, got a little smile on her face as she said this last part. "Here in Austin, I haven't made a lot of friends, because of my crazy work schedule.I have one nursing friend, but it is hard for us to get together, because we often work opposite shifts.She has been really understanding when we can talk. However, most of the other people I know are friends of Carletta's that she has known for many years. I don't feel like I can go to them because they are sad too. One of them said, 'Well, I have known Carletta since we were five.' Like that means she is allowed to grieve more than me. Ugh, well, I mean some of them are nice and I liked them, but we just were not yet that close."

"Sarah, I want to thank you for coming in today and opening up about Carletta. I know you have a demanding job and I want to take that into consideration when scheduling your next appointment. If you are open to it, I would like to pick up next week where we left off. Maybe you can tell me more about Carletta and your relationship, while we explore ways for you to find additional support. Does that sound okay to you?"

"Sure, the receptionist told me I can schedule with her for the next appointment. Thank you and I will see you next week."

After the session ended, you had a chance to staff this case with your supervisor. They inform you that there might be a "situation" because Carletta's parents have recently joined a support group at your agency. You do not facilitate the support group that Carletta's parents attend. This situation is not an unusual occurrence since your organization is the only grief and loss provider in your area. You agree that further discussion about this situation needs to happen at your next supervision session.

1. Highlight or underline some of the social justice issues that are a part of this case.What will you be thinking about in terms of the way you support this client in session around these issues?

1. What are some things to be worried about in terms of Sarah's ability to cope with this loss? How does the type of loss potentially impact her ability to cope?

2. What are some of Sarah's strengths? How could those strengths be used to assist her with her grief process?

3. There is a tricky ethical issue in terms of Sarah's care at your organization.What initial things would you keep in

4. mind as you navigate this issue?