This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.

Psychotherapy Casebook


Dean Schuyler, MD

Published: September 21, 2017


Vertical divider


Through this column, we hope that practitioners in general medical settings will gain a more complete knowledge of the many patients who are likely to benefit from brief psychotherapeutic interventions. A close working relationship between primary care and psychiatry can serve to enhance patient outcome.

Dr Schuyler is a psychiatrist and a member of the palliative care team at the Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina

Prim Care Companion CNS Disord 2017;19(5):17f02204

Published online: September 21, 2017.

Corresponding author: Dean Schuyler, MD, Geriatrics/Extended Care, Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC 29401 (

Funding/support: None.

Potential conflicts of interest: None.

There are caretakers who devote a significant part of their lives to taking care of a spouse at the end of life. Some are young and will live for a great many years after losing a spouse. Some are older and will also live for quite a few years on their own. The track record of a spouse who loses a lifelong partner is not a good one—many die in the year that follows a spouse’s death.

It becomes incumbent on the survivor to establish a new identity once relieved of the responsibility of taking care of a dying spouse. This is easier said than done. It is tempting to return to ways of spending time that have worked in the past, but for many, this is no longer possible.

Helping a formerly married partner adjust to the changes that life brings is a worthwhile endeavor. Assigning a therapist to a former caretaker makes abundant sense. I spoke with a woman who made caring for her dying husband her number one priority. Once he had passed on, there was a new agenda for me and for her: figuring out how to spend the rest of her life.


Mrs A is a 50-year-old woman married for 30 years to her husband who recently died of a medical illness. They had 2 children who were now grown and married. Mrs A lived to "please others." The only person she had provided care for was her husband. However, this task had taken up most of her free time.

Born in the Midwest of the United States, she was the oldest child of 2 in her family. Her father was a lawyer, and her mother taught school. Mrs A graduated from high school and met and married her husband soon thereafter. They had many happy years together. She had played and watched sports as a young girl and had developed a talent for knitting and sewing.

Since her husband’s death, she has received requests for help from a wide circle of friends. She has tried to be available to anyone who has a need for help. One concern in treating Mrs A is the need for her to develop some alternatives to life as a caretaker. Her husband was ill for a period of 5 years, and she took care of him while continuing her office job. She rarely missed a day of work despite having a rather structured existence at home.

Her children are concerned with her reaction to the changes in her life. They have warned her not to continue caretaking activity now that her primary responsibility has ended.

We spoke about some of the reactions she has received from friends who have asked her for help. She spoke about "being seen as selfish" when she felt she had to turn them down. She spent some time initially alone in the house. It went rather well. I made clear to her that she would now be responsible for her own life. I spoke in some detail about the new life stage she was about to begin.

I stressed the importance of her finding something meaningful to occupy her time. I committed myself to working with her to determine an identity separate from that of her husband. She is very likely to have many years to live and lots of space to occupy. We made a next appointment to continue exploring her options.

Related Articles

Volume: 19

Quick Links:


Buy this Article as a PDF