Losing a Client to Suicide: The Experience of a New Clinician

When I was just 2 months away from completing a Master's degree in Clinical Psychology, I had the unfortunate experience of losing a client to suicide. It was something that had been discussed, albeit peripherally, in my classes, but it had always felt like something that would happen to other clinicians. It was never something I considered might happen to me. I was young. I was invincible. I was going to be the next Carl Rogers, or Albert Ellis, or Freud, or whoever -- I was going to be the next great therapist. Right? Well, maybe, but I deluded myself into thinking that my clients would never deteriorate, would be dedicated to our work together, and would never betray me or the counseling process by committing suicide. I found out the hard way that I was wrong.

Upon returning from my doctoral interviews in Northeast Ohio, I walked into my clinic eager to get my messages, break out my clients' charts, and get back to work. And then the rains came. No sooner had I walked into the lobby when the receptionist told me "You have two messages, one of your clients cancelled today, and, by the way, one of your clients committed suicide over the weekend." I thought she was kidding, but I was immediately sick to my stomach. "What kind of sick joke is this," I wondered to myself. It was no joke. One of my very troubled clients, who had struggled with chronic suicidality for the better part of his life, had finally done it. His dramatic musings about killing himself had turned to reality, and I was never to see him again.

I'll spare you, the reader, the details about the client, because those are really not important for the purpose of this story. My purpose here is to shed some light on how the experience went after I found out about it. I regret that I can not provide a story that paints a more positive image of what it was like to lose a client to suicide. While mental health workers certainly recognize that a client suicide represents one of the worst possible outcomes, we must also take a moment to acknowledge that given the reality of client suicide, clinicians must utilize the event to the greatest extent possible so that they can learn from it, move on, and allow it to inform future clinical work. When I lost my client to suicide, the growth/educational potential was completely destroyed because I was forced to defend myself, my clinical work, and my case conceptualization. If there was a single facet of the event that I could cite as being the most "helpful," I suppose I would say that it was the personal support that I received from my colleagues in my academic setting. The faculty at both my academic and clinical settings were, for the most part, unsupportive, unavailable, and unwilling to rally behind me.

Now much of the research into the effects of client suicide on the therapist has differentiated between two types of responses, personal and professional. Given this convention, I will briefly address both. On the personal level, I think that I delayed having a truly personal, emotional response to the event for several months. I was near the end of my degree program, terrified that the suicide of a client would delay receipt of my Master's degree, and consumed with the rigors of my academics. That, along with the fact that I was placed in a defensive position by the administrators at the clinic where I was working, served to stifle my own personal reaction.

Professionally, I tried very hard to reflect on the work that I had done with my client. I reviewed my case notes (to the extent that I was permitted access to them), I considered consultations in which I had engaged with other members of the client's treatment team, and I reviewed the literature that had informed my case conceptualization. Ultimately I came to the decision that my own clinical work had been both professional and appropriate, but there is a lingering doubt that will always remain. I frequently wonder if I would ever again counsel a client such as the one I lost.

Now clearly I have painted a rather grim picture of what it was like in the aftermath of my client's suicide, and to be sure it was pretty miserable. There was one bright spot, however, and that was the support I received from my colleagues (the other students in my Masters program). Those who I felt especially close to allowed me a willing ear to talk about the events, the responses, and my own feelings of fear and doubt. Being given a chance to "unload" those feelings made them manageable.

I often wonder what I might have done differently. Certainly it didn't have to go the way it went, and despite the fact that most of the responses to the event were beyond my control (e.g., supervisors, administrators, etc.), there were a few things that I could have done to seek out more support. As I have progressed to a doctoral program, I have discovered that I have a very strong interest in researching different areas of suicide. By throwing myself into that endeavor with both feet, I have discovered a body of literature that comforts me. It lets me know that I am only one of many clinicians who have struggled with the loss of a client. If I had known about the AAS when I was experiencing the loss, I would have joined in a second. The support that is given to survivors of suicide (including clinicians) at AAS is marvelous, and would have been much appreciated, had I known about it at the time. Additionally, in retrospect it seems a rather major mistake on my part to have foregone the chance to engage in my own counseling following the suicide. I should have given myself the opportunity to be a client -- to experience my feelings, to face my doubts, to confront my guilt, to address my anger at the way I was being treated. Instead, I secluded myself under the umbrella of my studies.

I really have no wonderful way to close this story, except to make two requests of the reader. First, if you are a clinical supervisor, please be aware that inexperienced therapists need to feel that they have your unwavering support during your time together. Should you ever supervise a therapist who has lost a client, be aware that the therapist needs to be reassured that we, as a profession, recognize that sometimes suicide happens, and sometimes we can do nothing to prevent it. Do all you can to prevent the assigning of blame and the arousal of defensive positions.

Second, if you are a therapist, either in training or experienced, please remember what the literature consistently suggests -- that approximately one-in-five therapists will lose a client to suicide during the course of a career. Don't believe the myth that says it is a "rare" event. Don't be afraid to seek out the support you need during a time of personal and professional turmoil. Remember that you are not, in fact, alone, and that there are many of us around who will be happy to provide you with the support you need should you have difficulty finding it elsewhere.

Thank you, reader, for taking the time to consider my story.

Jason S. Spiegelman, M.A.