It's Not Been the Best Day

When a client dies during the course of treatment, the therapist is left with a residue of grief, with no formalized connection to the mourning process, and with many questions about the consequence of therapy itself. The therapist must deal with an intense loss within the strict confines of professional confidentiality. Death-and its finality-brings to the fore the central paradox of the clinical relationship, the therapist's knowing a patient so intimately and yet being totally outside the social structure of that person's life. Three psychotherapy cases will illustrate the complexity of feeling generated in the therapist when a patient/client dies.

From Rubel, Rena. When a Client Dies. Psychoanalytic Social Work, 11, 1-14.

I just found out on a news feed that one of my regular clients, a 35-year-old father of two, was killed when his truck went off a coastal highway and burst into flames.

I probably know more intimate details of his emotional life than anyone else, but because of confidentiality, I can't call and express my sympathies to his family. It's OK - confidentiality is a good thing and it's a good thing for it to extend beyond death. But....what a weird place to be.

If I hadn't seen the news feed, I'd probably wonder why he didn't show up to his appointment tomorrow. I'd call his cell phone and may have found it disconnected.

I might be able to attend the service, but I'll have to sit in the back and not tell anyone who I am. I'm fortunate that G is also a therapist and understands the amount of grief I feel, and the questions that remain - did I do enough? Was I a help in his last years, with neither of us knowing that's what we were working with? Would I have done anything differently?