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Key points
- Therapists need to give themselves the space to grieve the death of a client.
- Therapists genuinely care for their clients—often more than clients know.
- It can be hard to find the appropriate ways to grieve a loss in an uneven or asymmetrical relationship.
People spend a lot of time and money on therapy, and they often feel close to their therapists in all the obvious ways—support, affirmation, growth, change. Many clients assume that the relationship is one-way, that they’re really no more than just the 12 PM slot on the therapist’s schedule.
I am here to tell you how far that is from the truth.
After 40 years of practice, I’ve heard and absorbed just about everything imaginable, but this past year has been different. Two of my clients died, and not only did their deaths affect me profoundly, but they brought the whole therapeutic relationship into question. How does a therapist grieve a client’s death?
I felt grief with each of these losses deeply inside my body, which made me notice it all the more. I usually associate that depth of grief with family members or close friends. And yet I was feeling it here.
The first person ended his life after significant struggles with depression and anxiety. I had been present with him in therapy, rooting for him, providing additional resources, doing hypnosis to help relieve pain and restore a sense of calmness and agency—but his struggle didn’t improve as much as he needed.
One Monday, I was seeing someone via video link. He had to step away from the camera for a few moments, and I took advantage of the lull to check my email. I was shocked to learn that another client had, only hours prior, ended his own life. I zipped up all my thoughts and feelings to get through the rest of the current session—and it wasn’t easy. I got through that video session somehow and then sat alone and in shock. The feelings didn’t wear off as the week progressed.
I shared the situation with just a few folks, calling a couple of clinicians who regularly guide me and talking to my husband and a friend who would understand the nuances of a therapy relationship. But the pain was still there, and I still felt alone inside it. My world hadn’t changed, nothing was different, but I was profoundly sad, traumatized by the notion of him ending his life, and yearning for a way to connect with him despite the fact that he was no longer alive.
Normally, in tragic circumstances like this, people come together and grieve jointly, They make phone calls, gather at homes with food, offer each other some solace. It was extraordinary to be living my daily life exactly the same as I had before when something so profound had just happened. I had no role to play in the public grief for this man’s life. I was neither friend nor family.
An Early Death and My Therapeutic Journey
It was actually my first painful experience of death that led me to become a therapist, one who assists individuals and families through the process of dying. I came of age professionally during the AIDS epidemic, and as a gay man, I felt compelled to reach out to others in my community, helping other gay men and their families move through the stages of letting go.
I think I was prepared for this important work partially through my own first experience of grief. I was 11 years old and the daughter of family friends had died unexpectedly of an aneurysm. I was profoundly shocked and disturbed by her death—we had been friends, had played together—but my parents’ response was to try and shield me from the reality of grief. They left me alone at home when they went to visit the family, their idea of keeping me safe.
Fortunately, I had the sense to do something about it and insisted I needed to be included. My father picked me up and brought me to the friends’ home, and I felt instant relief to be among a group of people who were feeling the same shock and heaviness that I felt. The Jewish tradition of sitting shiva for five days after a death was exactly what I needed: I was no less sad, but I was no longer alone. And I understood intrinsically how important it is to have witnesses to our lives, our joys, and our sorrows. It set me on the professional path I’ve pursued now for four decades.
No wonder I ended up working with AIDS patients and their communities.
The Therapist’s Role
Recently I found myself uncharacteristically worried about a client who no-showed. People no-show all the time, and generally, they figure things out and contact me—usually mortified that they hadn’t canceled in the normal way. But this time felt different. After his no-show, I emailed him and then, when he didn’t respond, I followed up with a text message. This was someone whose responses to texts were immediate, and my sense of disquiet increased.
Finally, I called the police to request a wellness check, and as I waited for them to get back to me, I felt exactly as I did with family members in emergency surgery following catastrophic medical events, knowing they might not come out, or come out with significantly altered lives. Then the call came: my client was found in his home, expired.
I was obviously shocked and saddened, with mixed feelings of love and grief and pain. But a bigger question loomed: What was my role here? Should I get on with my life, spend the weekend as though nothing had happened? Or get involved—help the police contact his family and close community so they could know about his death without delay?
It meant straddling the lines of confidentiality, but I did—carefully—what I knew my client would have wanted me to do, and what his family needed me to do. They were grateful. I was relieved.
Over the next couple of days, I kept reliving conversations, playing through the scenario of his passing in my mind, feeling that heaviness in my body that I’ve felt during other catastrophic events before, and acknowledging that my being a therapist offered no shield or boundaries to the feelings of pain and loss that occur with a sudden death. And as I am outside the community of my clients' “loved ones,” I have no place in their collective grief. I need, again, to handle mine alone.
Advice for Therapists
In a community, you share stories and pain, but for therapists, it’s a solitary process. Unconsciously we end up in the privacy of our own grief trying to convince ourselves it’s useless because there’s no one around us. We may want to grieve with the families of our lost clients—but we can’t. Finding a way to deal with the tragedy is an immense and heartbreaking challenge.
My advice to other therapists: Take your time. Give yourself space to think about and reflect on what your client has meant to you over the time you’ve worked with them. And—this part is more controversial—allow yourself to love them. We often think that loving our clients is an indication of a lack of boundaries, but the truth is that we do love them.
It may be helpful to do a meditation, or write a letter to the client about work you’ve done together. Allow yourself to own the power of the role you’ve played in your client’s life, and appreciate that perhaps you were one of the most important persons in their network—if not, sometimes, the most important.
Honor your relationship, pay homage to the privilege of the role you’ve assumed with them, but also experience fully the sadness and pain inherent in that role. Call on your colleagues’ support: they will understand the trauma of feeling alone with this kind of pain. I cared more about this client than I ever realized. He may have been my 10:30 appointment, but when he died, it hit me profoundly that he was much more than a “client in a slot.” I had invested hope, energy, and a tremendous amount of caring for his having a better life for himself.
Most of All, Advice for You, the Client
If you think you’re “just” your therapist’s 12 PM appointment, know that isn’t true. As I hope you’ve seen through my experience, your therapist cares deeply about you, your progress, your well-being, even your happiness.
It’s not an equal relationship, and that comes with a cost. For us, as I’ve pointed out, it means having a certain intimacy with people without being acknowledged or shared as someone important in their lives. For you, as you know, you come to a therapist to benefit from skills and perspective you yourself don’t have—and you pay them for their time and expertise.
But for all of those confining factors, know that this relationship—however uneven—is still a real, vibrant, meaningful relationship for me as much as it is for you. I take your hopes and dreams and challenges to heart. I think about them, and you, even when you’re not in the room with me. I care, probably far beyond however you may perceive my involvement with you to be.
You will never be merely the noon appointment on my calendar. So… talk to me.
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