My Story About Loss of a Client to Suicide

I am a clinical social worker, who has been involved in mental health-related work for 35 years, and been a therapist for nearly 25 years. I am not a stranger to suicide. I have known many suicides, including friends, acquaintances, colleagues, friends of the family, and past and current clients.

Most recently, I experienced a client suicide this past Christmas eve. I had seen him a few times, and he was also being seen by several other providers. He was involved in a therapy group, individual therapy, psychiatric care, and he was slated to start a skills-building CBT group for managing anxiety and depression.

My initial reaction was great surprise. The client clearly appeared invested in treatment, was engaging, and appeared to be future-oriented. I have worked with many people over the years who would clearly not surprise me if they suicided - This client was different. Clearly I felt that I had missed something...And I ruminated for days about what I might have done wrong, or what those of us working with him had missed. I felt sadness, guilt, frustration, and a little anger. I did a great deal of second-guessing.

What was most helpful was that those of us involved, as well as other clinicians that I work with, immediately were able to talk about it. Many clinicians came to me to share support, and to listen. A Suicide Prevention Coordinator, who works with us as a team member, spoke with each of us, shared about the case, and offered resources related to this kind of loss. Most clinicians that I know have experienced this before, so all of us were coming from a place of having been there – It wasn't a totally new experience that jarred my foundations. I knew that it could happen, and it was a real risk. There was a great deal of support from others, as well as my own past experience and intellectual understanding of suicide, that helped normalize it for me. I was also able to meet with a family member of the deceased, to offer support - Ironically, yet not surprisingly, meeting with her was also helpful to me, in that she was able to share additional information about the client, including the contents of his suicide note. Clearly there was a larger picture, and we only had pieces of the larger picture, and were unable to "connect the dots" as a result. It was also instructive in a number of other ways, including my sitting with, and experiencing of the impact of a suicide on a family member or close other, and observing that process, along with my own parallel processing of the experience.

I think what felt the least helpful was others trying to reassure me; rather, listening has been the most helpful. In a previous situation, in which someone that I had had contact with suicided, the supervisor came to me promptly to reassure me that everything in the client record was in good order, and that there was no indication of wrong-doing, mistake or liability on my part. That felt quite antiseptic and matter-of-fact, and did not address the emotional impact of the loss at all. In fact, I felt very angry that the client's death was relegated to "no evident liability for us as an agency."

I was impacted similarly to other losses in my life - A reminder that life is tenuous, finite, and sad & sweet. A reminder of the pain that many experience, that leads them to take their own lives. A reminder that we can do everything "right," and still miss the risk. A reminder that we are fallible, and that our profession is still limited  in terms of predicting suicide risk. Also, a reminder that no matter what I do, I can't keep everyone alive. I think professionally this is true too – I have to recognize that there are limits to what we can do to protect others. I also believe that collateral contacts can provide us with additional valuable information about a client, and a fuller picture of the context of a client's life. Unfortunately, this is often not possible, due to a lack of access, and also due to the time constraints on those of us working in mental health settings. Mental health providers are expected to serve more-and-more clients, handle sicker-and-sicker clients, with fewer resources. It's certainly a prescription for more failures, and more suicides in the future.

I feel that the response of fellow clinicians was outstanding and very helpful to me. Many of us were able to talk about this particular suicide, as well as to further process past losses, and to anticipate future incidents, in a more healthy fashion. As a result of these encounters with co-workers, I feel that I am moving beyond this loss. It's still sad, but I'm no longer ruminating, no longer looking for possible mistakes or lapses on my part, but am integrating it further into my life, my experiences of life & death, and the larger human drama.

This loss again makes the prospect of suicide among the clients I work with more real, more possible, and more on the "radar screen." I am finding that I am just plain more aware, and less likely to take it for granted that if a client is working on his issues, seems motivated, that he/she is therefore less likely to be at risk. Even people who appear to have everything going their way are at potential risk, in ways that I may never see clearly, so I can't take anything for granted.

When I was a young clinician, and a client suicided, an older clinician came to me and quoted the line, "There are only two kinds of therapists: those who have had a client suicide, and those who will." Since then, I have heard this quote repeated many times. While it is perhaps not literally true, it will apply to most clinicians, especially if a career is lengthy. We are professionals who deal with other human beings when they are in need, when they are wounded, when they are perhaps the most vulnerable. Human beings often do not share the extent of their pain, and frequently do not open their inner life to others, even to caring professionals. Suicide is a risk to those of us in the trenches working with sick and sad and lonely and depressed people. We cannot live without that risk. We can’t avoid it, but we can learn from it. And living with it as a possibility for those we work with, is perhaps no different for us than how our awareness of our own finitude and future death may enliven and enrich us. Living and working under the shadow of suicide may ultimately be a gift, if we are able to open it.

I have been interested in death and dying issues, and also with loss and grief, for many years. I suspect that this particular loss, as well as other life experiences, will better prepare me to support fellow clinicians, and the family and friends of suicides, in the future.  I may actually commit, at some point, to joining and becoming involved with one of the organizations that address suicide.

William E Clymer, LCSW
San Francisco VA Medical Center