Alex and Charlie's Story

This is a case study about two young brothers, Alex and Charlie, who received therapy from Gaddum after their sibling Johny passed away.

Please note, this story contains references to death and thoughts of suicide. Names have been changed for anonymity.

Johny had been under the care of the Complex Care Nursing (CCN) team as he had Leukaemia and Down’s syndrome; he was 4 years old when he died. Johny’s parents asked the CCN team for support for their other two children, Alex (age 10) and Charlie (age 7). The CCN team referred them both to Gaddum at the beginning of March 2024.

Alex and Charlie’s mum, Claire, said that both would benefit from having a space to explore their feelings, as well as their relationship with each other, as they often didn’t get along. Although the CCN team believed that both parents would benefit from therapeutic support, the parents were not ready at that time.

Liam, a Gaddum therapist, communicated with Claire and her sons’ teachers. Together they arranged for weekly therapeutic sessions to take place at the boys’ school. Both Alex and Charlie opened up straight away during therapy, due to Liam’s non-judgemental, empathetic responses.

Alex described having a close relationship with his late brother and expressed feelings of sadness following his death. Liam offered a safe space for Alex to explore this sadness and discuss the family’s plans to remember Johny, including going abroad to scatter some of the ashes.

Liam and the boys explored family conversations about different urns and ashes pendants. They spoke about revisiting places their brother used to like and how that would bring comfort and connection. The family also held memorial football matches. Alex recently got an ashes pendant and showed Liam stating, “he is with me all the time now.”

Liam focussed on Alex’s anxiety and sadness at night, and normalised thoughts about his late brother and what they would be doing together. They also looked at strategies for Alex to calm and relax himself if he felt these thoughts were becoming overwhelming. They made a self-care jar, decorated with ribbons, feathers and glow-in-the-dark sand.

Liam and the boys spoke about spiritual beliefs, and Liam gave Alex the opportunity to explore his belief in heaven and how Johny was now being looked after by his late grandad.

Alex became ready to move to a point of acceptance that he is able to build his life around his grief; his grief will always be there, yet he can move forward with his life.

When working with Charlie, it became apparent that his continuing bond with Johny provided him great comfort. The therapist again offered a non-judgmental, empathic space for him to talk about the family trips abroad to scatter ashes in different countries and what this meant to him. Charlie felt his brother was still with him on holiday, and he would have different places to return to in future and visit his brother. He said that when they scattered some ashes in the ocean, this means, “he will be everywhere, all over the world”.

Charlie said that he can feel sad at times, and sometimes angry. Liam normalised and validated these feelings, and together they explored how it can be difficult and confusing when feelings come and go and overlap. They soon started to explore Charlie’s anger and how he usually takes it out on his Alex.

It became apparent that Charlie’s muscles tense up when he becomes angry, and then his behavioral response is to raise his voice and shout at his brother. Liam helped Charlie explore calmer ways of responding – they then roleplayed these scenarios, and Charlie could see how much calmer he felt.

When reviewing sessions, Liam and Claire believed Charlie’s anger was getting better as he was putting into practice calmer ways of responding. However, they decided to continue Charlie’s sessions into the summer holidays at a community venue as there was still some work to do.

Although Alex initially seemed to be coping well with his grief and was working towards a final session, he then expressed thoughts of killing himself to be with his late brother again. The therapist worked closely with Alex, Claire and the school, and it was decided to extend his sessions into the summer holidays too.

In June 2024, Claire and her husband, Joel, said they were looking for in-person therapeutic support for themselves. They had found a service and joined a waiting list. Liam said that he could offer support immediately, so he now works with the whole family.