Pastoral Care Case Study: Death of a Child

Dealing with tragedy as a pastor

A Pastoral Care case study is a method where a professor provides students with a hypothetical situation and ask them to reason out how they would resolve the issues facing the congregation. As such, they are worth sharing and investigating with other’s in the industry.

This case study was given to me last year for P504 at Fuller seminary, and as the professor told me he planed to use it as an exemplar to the class I figure the case is out of circulation and it won’t cause any academic hiccups to share it.

The Case-Study Situation:

Jim and Sarah were young parents of three active children, ages 5, 3 & 1, and members of The Church on the Corner. Jim loved to take his oldest daughter on bike rides, and would pull her in a cart behind him. On his way home one evening, near dusk, they stopped at a traffic light. A teenage driver approached them from the rear. She was not wearing her glasses and did not see them stopped at the light. Her car impacted the cart and bike, fatally injuring the daughter and causing serious brain injury to Jim.

The immediate fall-out

Sarah was overwhelmed by the death of her daughter, the injury to her husband, the challenge of planning a funeral for her daughter, and the trauma that came with this accident. Jim was able to attend the funeral a few days later, but the brain injury severely limited his awareness of and participation in the service, and the ability to grieve with and comfort his wife in the weeks and months to come.

In the months that followed, the women’s ministry of their church arranged for meals to be brought, the children to be cared for, and the housework to be covered so Sarah could attend to Jim’s medical needs and rehabilitation work. As the situation developed in the following months, Sarah became increasingly dependent upon the provision of meals and housework, and began to expect that such help would continue far into the future, even though she had no more room in her refrigerator or freezer for the food.

The long-term effects

Some of her deficiencies as a housekeeper began to come to light and the women’s ministry of the church began to believe that Sarah was taking advantage of their generosity. This resulted in some tensions within the Women’s Ministry with regard to the continued willingness of church members to provide Sarah with meals and household help.

Their belief was that enough time had passed and Jim had experienced sufficient healing that Sarah could begin to assume more of the household responsibilities. An effort was made to graciously and kindly address these concerns with Sarah and but her response was to resist the change, and pursue continued help from whatever supportive individuals she could find.

Gradually, previous problems in their marriage surfaced that aggravated by Jim’s change in personality due to his brain injury. The basic situation was well known in the congregation, but the more problematic issues were known by a smaller group of staff and members. Sarah was resistant to efforts that encouraged her to seek counseling to cope with and better understand her husband and how to adjust to the changes in him.

Case Study Response: “The Tragedy that Enveloped a Congregation”

Pastoral Care consists of both a pragmatic and a spiritual component. Being wise as serpents and gentle as doves (Matt. 10: 16), the pastor must avail themselves of scriptural resources as well as their capacity for critical thinking. The case study, “The Tragedy that Enveloped a Congregation”, revolves around the tragic loss of Jim and Sarah’s oldest daughter, Jim’s brain injury, and the responses and controversies that arise in the congregation and family because of this incident. Regarding wisdom, there are pragmatic steps available for leadership to affect the situation positively. Spiritually, there are opportunities to for the pastor to inject Gospel truths into the personal lives of Jim and Sarah. their family, the congregation, and even the strangers that the congregation has encountered through the accident.

While tragic losses if over-contemplated lead to stale theodicies,1 trust that God controls these situations and redeems them towards his ends enables the Church to trust God and preach the Good News to the wounded.

My immediate response to the case study

There is a large volume of necessary pragmatic adjustments apparent in the case study, “The Tragedy that Enveloped the Congregation.” These are best addressed by practical steps, addressing the incomplete interactions of the congregation, and the pastoral leadership injecting Christian teaching into these moments. The family itself faces further challenges that while greatly aided by these steps are moments requiring careful appraisal of the situation.

Setting a practical groundwork

My initial response to the case study, a natural tendency to focus only on the major presenting problem, the death of a child, is dictating all responses. Jim needs much better care, the third parties need to be addressed, and Sarah’s care needs to be re-evaluated. Addressing these heretofore ignored issues is perhaps a primary concern because it would free leadership to preach into the situation, and would itself make the church’s reaction far more in line with Christian ideals.

While using a systematic or biblical application as the first approach may seem more spiritual, Ray Anderson places pastoral crises care along a three-pronged strategy that informs the following practical suggestions. For Anderson, the pastor’s main roles are to extend God’s grace and transfer spiritual power by background intervention with his primary end-goal being the creation of “a healing community”.2 To that end, the focus on eliminating barriers so that grace may work is far more pertinent than attempting to create situations in which we infuse grace, a tempting but futile notion given grace’s unmerited nature.

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Healing Jim

For example, Jim has been left in the care of his wife; the depth of his head trauma, had the death not occurred, would be its own source of mourning and grief. The issues arising in the marriage, the sense of responsibility regarding his daughter’s death under his care, and the emasculation and sense of burden resulting from his inability to provide are emotions that would tax healthy individuals. Jim is not healthy, so the use of the term “personality shift” strikes me as a misnomer. He is too damaged mentally to even be, in my consideration, a “damaged person.”

Steps that would promote Jim’s independence and re-socialization are necessary. While his brain trauma issues are being dealt with medically, the community of believers needs to help facilitate his healing spiritually and in fellowship. Practical steps to minister to Jim might consist of involving him in a men’s ministry, giving him other men to talk to not just his wife who is also traumatized. Maybe having someone other than Sarah transport him to his rehab would lift his sense of always burdening her. Even secondary issues, such as the dirty house, present opportunities for the men from the church to help Jim address it. This would make him contribute to the marriage, not justify complaints that “Sarah needs to do it and be less lazy,” and it would get the men in the church, that have been so far unmentioned, involved. Jim needs to be rebuilt as a person to be a “broken person” that can heal.

Sarah is the focus, but still ignored.

The case study focuses intently on Sarah who still seems to be likewise neglected. There is a difference between being in someone’s life and dropping off a casserole. The fridge full of food and a clean house is an indictment that many are willing to stop by the front door, yet not enter that household to give Sarah a real confidant. In a professional context, therapist Jeffery Guteman states, It is also difficult to accomplish true change unless the counselor is listening to what the client wants, not what other people think the client needs.”3 A personal touch that really listens to Sarah’s perspectives is the professional recommendation.

Get outside help when you have to

The situation also involves tertiary parties that need to be included in the mourning process. First are the two surviving children. Though young they have a capacity for grief. Child psychology is complex, so this is something which may require the pastoral leadership to enlist an expert to help them in the process of assisting the children.

While discussing the situation with such an expert, the pastoral leadership and the parents may also have a chance to bring up another hurting child and family. The teenage girl who hit the child needs to be given Christian witness by the hurt parties, even if she herself is a member of another Christian community. Outreach should be made to her entire family, and assistance made available to help with any legal issues and hardships that arise from her responsibility. This is a pragmatic way to model Christian forgiveness, and to show the family that the Gospel has a real radical effect in people’s lives (Luke 6:32, etc.).4

Don’t forget your wider duties

The family’s faith community is also grieving. The step of making outreach to the teenage driver is the kind of activity that builds healthy Christian communities. The community does not seem to be well managed in its crisis response; however, positive reinforcement of the care given so far is pertinent. This would address some of the building resentments against Sarah’s dependence. Also, the “positive” gift of a sponsored spiritual retreat or a day at a mini-golf course would provide mental breaks and allow the pastoral leadership to move in and feel out the congregation’s own state of grief. One senses that the resentments against Sarah may stem from the fact that the congregation has neglected its own grieving process or individual concerns that feel neglected by an outpouring of care towards someone else.

One final piece of simple groundwork consists of the pastoral staff not neglecting themselves. They are a part of the congregation and adequate self-care has become an area of increasing contemporary concern for even the secular therapist.5 Grief is a difficult subject that not all people have experienced. Even experienced pastors may find a situation like the death of a child to be new territory. Martin Copenhaver in the book, The Odd and Wondrous Calling, relates that the death of his father, himself a pastor, was a moment of pastoral conflict.6 The pastoral staff in this case may have its own difficulties, and no pragmatic steps will have lasting effect in the hands of a pastor that does not take adequate time to ensure their own healing process is completed and that they are not just hiding in their work.

Focus on the Family

The above steps will introduce many new resources into the situation: councilors to address the grief of the children, the men of the congregation to assist Jim, and broad pastoral care to avoid dealing with the tragedy as if in a vacuum. They also will re-direct the care mechanisms already in place such as the women’s ministry and set-up groundwork to work against the growing resentment among current caregivers. And, God willing they might even reach out in grace to the family of the teenage driver.

Still, the family faces threats that need to be addressed more directly. As a man, I sense Jim would most likely suffer from a sense of emasculation having lost his child under his care, his loss of mental faculty, and his ability to be a provider. Mentioned in the case study is friction in the marriage, and as gender roles feature in a marriage, there could be a sense that Sarah is reacting negatively to Jim’s weakness and further emasculating him. This is a dangerous trend.

Rehabilitation instead of “Rescue”

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Direct intervention is unlikely to be very effective as it would feed into the notion Jim is enfeebled. The pragmatic step of including a men’s ministry mentioned above is a partial solution that requires little buy in. If men help with housework they break the gender stereotype; moreover, Jim taking on a traditionally female role might leave Sarah with an impression that he is taking care of her again. Other indirect options include the pastor or other men attending a support group for brain trauma with Jim at the hospital, or even have a doctor in to tell the involved parties about that kind of trauma. Creative thinking is required.

I think though, that more needs to be done under the heading of making “Jim able to provide again”. Even third parties have started to pressure Sarah to become self-sufficient. The financial stress of this situation must be very real itself, adding this third-party pressure against her husband’s sociological male role is simply salt in the wound. Interventions may include help with resume writing, finding odd-jobs, and even extra rehabilitation work if only to give the impression that Jim is “trying hard” in a machismo style.

A spiritual danger of resentment is there in Jim’s case but less apparent than in Sarah’s. As Christians, we also must forgive. And I think that for Jim to forgive himself, a guided outreach between him and the girl could allow such to take place. At the very least, this experience may help him realize that he too is forgiven and aid in his recovery without the hindrance of self-condemnation.7

What other issues arise…

In Sarah’s case, her biggest dangers are the threat of resentment towards Jim coupled with resentment is fear especially about losing another child and buying into the notion that she can manage the situation all on her own. The first is not clear; however, having witnessed the death of a child effect a relationship before when my childhood friend tragically passed and on other occasions as well, this is a common occurrence. This most likely shows in little things, like Sarah refusing to let Jim watch the children alone and her acting like a helicopter parent around him. Gentle approaches are to take short times when the family is around the church to break Sarah away from her children and leave them with Jim. More direct methods after initial counseling is to directly ask her. If she harbors resentments towards Jim, the marriage will not survive.

If Sarah or Jim is unable to ask or Sarah senses the growing resentment the pastor might have to help find someone willing to help and how to help she might tell a pastor, a counselor, or a doctor. The American ideal is that people will be self-sufficient and tough it out.8 There is always a danger that Americans will consider they have been open and confided in others when they have not, or to simply bottle things in. In fact, very external things like dropping off casseroles can become mental substitutions for actual in-depth care. Sarah, with her reaction to the complaints of the women’s ministry might resist being open, especially if she has not really connected with any close friends in the congregation or the congregation is a larger “mega-church” type that is dominated by lower-level types of acquaintances.

If a direct approach to addressing these threats is unsuccessful, there are secondary paths to try and organically facilitate these kinds of developments. Instead of dropping of meals, the family can be invited over to socialize with others. This means a break in focus for the family, new topics, and simply sounds much healthier than being shut in and having food dropped off at the door. Christians gather around a meal, and the pastoral staff can facilitate such initial meetings as required.

Slow process

My experience with death is rather extensive for a North American. My experience with needy families and parishioners sleeping on our floor is sadly still too unique. What I have learned from both, however, is that healing processes do not work on set timetables. The most realistic and worrying issue of a case study like “Tragedy” is that the pressure for Sarah and Jim “to hurry up and get better” is the most theologically troubling and potentially damaging at the same time.

The illusion that comes from finding and outlining well thought-out and concrete steps that pastors can take, is that these all will have immediate effect, can be implemented immediately, and will produce quick returns. We must not surrender free grace at the altar of even well-being. Care in these situations is far more a long-term prospect, and these steps need to be implemented in a way that fosters among the congregation both the spirit and ability to provide care on longer terms than just a year. Grace will move on God’s good time. For those who remain unconvinced, it should at least be apparent that intense cycles of care like in person cleaning and cooking cannot be maintained for the long term and in this case, are already failing.

Long-term community options need to be explored and set in place. Perhaps a grief group, hosting AA, or just a bible study group of grieving parishioners will aid the congregation to develop its general “caretaker skills.” The impetus is to involve the broader community. Even a car safety class for neighborhood would bring in more people to develop the “Healing Community” of Anderson’s method.

Why we can’t detach evangelism from real life

In all this, the main goal “Preach the Gospel” needs to be inserted into this situation, and this situation will flow into our daily “Preaching the Gospel.” 9 Even things that seem selfish, such as a memorial project for the child, can be directed with an outward intent to benefits others. This could be a powerful testimony to the Gospel working in the community. Jim can even be brought in to organize such a project or another mission project both to give him something to do, and to witness to outside observers the differentiation of Christian and non-Christian grief.

That difference is grounded in the hope of a resurrected Christ. It is the source of comfort that “the man of many sorrows” was tempted as we are, cried over Lazarus’ grave, yet still enjoys laughing amid a people he loves. The human reaction to death is to see it as something final, and a defeat of all God, parents, and friends intend for a life. The reality though, is that in caring for Jim and Sarah’s family new life can be breathed into the congregation. If pastoral work is willing to be implicit in applying biblical principles, and with much prayer works on fostering room for grace to grow, instead of a loss of life this tragic accident can burst forth into a source of life much like an old cross at Calvary. And it shall be a life eternal, which to this day that girl, that family, that congregation, that pastor, and we all share in the person of Christ.


Works Consulted:

Anderson, Ray. The Shape of Practical Theology. Pasadena: Fuller Seminary, 1999

Daniel, Lillian and Martin Copenhaver. This Odd and Wondrous Calling. Grand Rapids: Eerdmans, 2009. ebook.

Herman, Judith. Trauma and Recovery, New York: Basic Books, 1992.

Hick, John. Evil and the God of Love. San Francisco: Harper, 1977.

Lampman, Lisa. God and the Victim. Grand Rapids: Eerdeman, 1999.

Lea, Larry and Judy Doyle, Mending Broken Nets and Broken Fishermen. Rockwell: Church on the Rock, 1985.

Mayers, Laurie. “Connecting with Clients,” ct.cousiling.org, last accessed 12/5/2016 http://ct.counseling.org/2014/08/connecting-with-clients/

Footnotes:

Seamands, David. Healing for Damaged Emotions. Colorado Springs: Chariot Victor, 1977.

1John Hick, Evil and the God of Love, (San Francisco: Harper, 1977). pg. 338-341.

2Ray Anderson, The Shape of Practical Theology, (Pasadena: Fuller Seminary, 1999). Pg. 181.

3Laurie Mayers, “Connecting with Clients,” ct.cousiling.org, last accessed 12/5/2016 http://ct.counseling.org/2014/08/connecting-with-clients/

4Lisa Lampman. God and the Victim, (Grand Rapids: Eerdeman, 1999). Cf. Pg. 190-200.

5Judith Herman, Trauma and Recovery, (New York: Basic Books, 1992). Pg. 151-154.

6Lillian Daniel and Martin Copenhaver, This Odd and Wondrous Calling (Grand Rapids: Eerdmans, 2009) ebook. (Kindle loc. 2626)

7Lisa Lampman. God and the Victim. pg. 210

8David Seamands, Healing for Damaged Emotions, (Colorado Springs: Chariot Victor, 1977). pg. 79-88.

9Larry Lea and Judy Doyle, Mending Broken Nets and Broken Fishermen, (Rockwell: Church on the Rock, 1985). Ch 6.

Post Author

Paul is the founder of Religible.com and a life long Christian with a childhood interest in systematic theology. He holds an M.Div. from Fuller Theological seminary and hopes to use his education to better his fellow man. He also operates an automotive blog, has worked at Google, and has diverse life interest.

reformedmonk – who has written posts on Religible.


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