Content warning: may be triggering for those who have experienced grief, or are uncomfortable discussing mortality.

A Very Sad Day

When you’re sitting, waiting for a video session to start, and a client does not show up, most therapists don’t worry too much. Missed appointments, from time to time, are a thing in this line of work and the typical process is to try to reach out to the client in a different way: email, phone or text, to follow up.

In my professional experience, 80 percent of the time clients have forgotten, 10 percent of the time clients are overwhelmed by the idea of seeking counselling and are avoiding it and less than 10 percent of the time, it’s a weather event or other circumstances. But when I later learned that the client I was waiting for had died since our last appointment, I was truly and deeply shocked.

And I might never had known that they had passed away, if I hadn’t Googled their name—a rare practice I employ only when I have concerns about a client’s safety.

As I implied, above, after waiting half an hour on the open video call (excessive, perhaps) I decided to pack up and have my lunch a little early. At that point I wasn’t concerned. But as I sat drinking my tea, I had a nagging feeling of something not being ok, which I couldn’t pinpoint. I returned back to my desk a few minutes later and as I typed my client’s name, Google automatically populated the word “obituary.” Astounded, I clicked on the link, saw my client’s picture and saw that the date of birth lined up exactly with my records. There was no doubt.

Absorbing

I then sat, taking it all in. And the wheels in my mind were moving very slowly. Did. Not. Compute. My client was younger than me and healthy, as far as I knew.

Fortunately there was time before my next session to try to gather myself. This looked like:

Identifying Feelings

• Shock and disbelief
• Confusion
• Surrealism
• Sadness
• Worry
• In awe of their impact in the world
• Longing for their smile and gentle presence
• Gratitude for the opportunity to have worked with them

Thoughts

My thoughts were random and not necessary logical. I was trying to make sense of something that made no sense.

• “I can’t believe that I had left a message on a person’s voicemail who had passed away. Their message said that they would return my call as soon as they could.”
• “What happened? Why did they die?”
• “This makes no sense. We were celebrating some key life events.”
• “Was there anything said in previous conversations that made me concerned for their safety?” (No).
• “How is this possible?”
• “Their family must be gutted. I can’t imagine their grief.”
• “What about their therapy goals that we were in the middle of working on?” A strange thought now, I suppose.
• “Had they ordered that book that we were talking about?”
• “I can’t believe I will never see their smile again.”

Actions

After my sessions of the day had ended, I then switched to behaviour:

• Combing through my notes, looking for “evidence” of clinical concern (none).
• Reading and re-reading my notes to bring their presence back to my mind and heart.
• Contacting another registered social worker to discuss and process my sadness and shock.

And as the days passed, I:

• Brought up the loss of my client, my feelings about it and reviewed my work with them in clinical supervision, in order to receive support, guidance and to do an accountability check.
• I wrote about the loss, which led to this article.

Conclusions

While the loss that I described was recent, and sudden, I am old enough to say that there have been several clients that have died over the course of my career, including many that I will never know about, as our counselling had previously concluded.

I’ve come to a few thoughts on client loss, which may or may not resonate for other therapists or counselling clients.

Clients Matter

Many times over the years I have internally grimaced if a client implies that the therapist-client relationship “doesn’t count” because there is an exchange of money for counselling services. From my perspective, this couldn’t be further from the truth! Yes, clients pay me to make use of my counselling training and experience, however, only those that care deeply about others, should enter this profession!

Therapists Are Attached To Their Clients

I will never identify as an emotionally remote, detached therapist. I am not shy to say that I love my clients. Everyone I have met over my career is unique and has enriched my life so substantially. And no, my profession is not primarily about me and my growth, but this is a secondary effect that comes from the privilege of counselling amazing human beings.

I Will Likely Never Know What Happened

Registered social workers are expected to maintain confidentiality—even after death—a principle enshrined in the social work Code of Ethics/Standards of Practice. Also, in thinking about my client, who was a very private person, I did not feel comfortable disclosing the existence of a counselling relationship, or me as their counsellor, to next of kin. I agonized a lot about this because of my concurrent desire to honour their family’s pain and express my condolences to them.

Grief Is Unique

Grief is not experienced for therapists in universally the same way. What I feel may be similar to what other therapists who have a lost a client have experienced, or it may be completely different. There is no playbook on this and I can’t speak for others’ experience.

There is Not One Right Way to Grieve

Related to the above, the concept of “stages of grief” has been long dispelled in the research as being a universal phenomenon, although it remains a popular concept in society. Counsellors are not any different and there are many valid ways to experience grief.

Grief is Natural

This applies to therapists’ grief too. I continue to feel genuine sadness and lingering shock because of the person that this client was, and their contributions to the world. And I’m so very sad that I will not have the opportunity to see them again.

Therapists’ Grief Can Go Underground

Because of the importance of protecting confidentiality, therapists often cannot show up at funerals, phone family members or share information that their client had disclosed to them in trust. There are times when a therapist may be able to offer the family support, particularly if they were doing family counselling or a family member was introduced to the therapist in the course of the client’s counselling, because in such scenarios, the client had given previous consent to bring their family in. The waters can get a bit murky, so consultation with a clinical supervisor is recommended. Time with a supervisor can also help to reduce feelings of isolation about the grief experience.

Client Loss Can Be Unexpected

The counselling professions do not do a good job of preparing therapists for client death—at least in the private practice world. When I worked in public mental health, this conversation usually converged around suicide or the toxic drug crisis. But, before I judge my profession too harshly, perhaps there is no way of truly preparing for the loss of a client.

Gratitude, Gratitude, Gratitude

I am honoured to have had the opportunity to have worked with this client, who was well known for their compassionate, caring nature. The fragility of life has reminded me to affirm my gratitude for each and every one of my clients, past and present. If there was ever a point to pause and reflect on the deep privilege that is inherent in this profession, it is now. 🙏