When Your Client Gets Ready to Die on You

Personal Perspective: The death of a client is a soul-searching moment for therapists.

Reviewed by Monica Vilhauer Ph.D.

Key points

• Staying human in the face of death is the greatest gift clinicians can give their clients.
• You’re doing a service to your client by sharing your reactions.
• The therapist’s role here is to be less formal, to step beyond our comfort zones.

At some point or another, all clinicians deal with death. Our clients may have unresolved issues around their own deaths or someone else’s; a person close to them may be dying or threatened with death; we lose colleagues and must work through what that means for our professional lives.

And, more often than we’d like, our clients themselves die.

Dealing with a client’s death affects our personal, private lives as well as our professional ones. So what do we do with the grief we’re feeling? Do we bring it into the office, or keep it hidden?

One of my clients is approaching death. He was healthy up until his diagnosis, so he is in the position of having two years in which to plan how he wants his life and death to unfold. To my surprise, he recently asked me how I was dealing with his imminent passing, a question that was both touching and confusing. I was torn about how honest I wanted to be in responding—I could have given him a canned answer, after all—but then decided there was nothing but self-disclosure that would work.

So I shared some of the joys and frustrations I’ve experienced over the years working with this client. I talked about the real emotional experience of being his therapist when he was well, and the transition I’d had to make after his diagnosis with a neurodegenerative disease. It was an interesting and profound experience, sharing this kind of intimacy with a client.

Forged by fire

Being close to death and the process of dying isn’t new to me. I came of age as a therapist in Boston during the AIDS epidemic, where, as a gay man myself, I was front and center, thrust into situations—groups, workshops, individual work—where death was always in the room with me. You either come to like the work, or you don’t last. Fortunately, I did the former. AIDS taught me to embrace death as a topic and a process, and to make it part of my own formation as a therapist.

So I’ve never been afraid of approaching the topic of death with my clients. What was new was my client having curiosity about my reaction—to his death.

Emotional impact on the therapist

I've been blown away by some of the conversations I’ve shared with this client. Everyone responds to a diagnosis such as this one differently, but I've felt that this client provides an amazing model for coping. He spoke with lawyers and he spoke with his partner. He decided what he would do with his property and his money, and he ensured the well-being of his partner's financial future. Then he planned his funeral and wrote his own eulogy. He contacted the place where he wanted his service, including the caterer that would supply the meal after the service. It was all quite moving.

After he asked me about what I was feeling, I realized the experience isn’t just about him dying, it’s also my loss. I recalled that since he’d shared his prognosis with me, I found myself sad and tearing up on several occasions, but I’d been careful to keep it from him… and now what he was needing and craving from me was an honest response, and that I gave him. I spoke about the joys and frustrations of working with him for many years, and what we've done together, and what my own challenges have been in working with him. And then I spoke about the truth and the pain and the loss that I myself will experience as well.

And that’s not inconsiderable. This is someone I’ve worked with for a long time—for years, he has been a regular part of my life.

I shared with him that I will be available and solid. No matter what he wants, I'm there for him. But at the same time, this is very painful for me. What we agreed upon is to have many of these conversations for as long as he's here, to continue to explore what kind of life and what kind of death he needs, and to go into a deeper place of hypnosis or guided meditation to deal with the truth about life, to deal with the physical pain and to quell some of his symptoms, to make meaning of all the things that are coming up, and to allow this to be a process where the ending of his life is something that is beautiful rather than just painful. And we agreed that I, too, would continue to share my feelings with him.

I've always known this, but he has reminded me that it's such a privilege for clinicians to be part of a client's final dealing with things and with their final conversations with loved ones. it's a privilege to help clients review their lives and tie up loose ends.

Takeaways

There are a lot of clear takeaways from this situation. Obviously my own goal is to continue to have open and honest conversations with my client about his illness, death, and the impact it has on others—including myself. I’ll continue with my treatment plan, which includes using hypnosis and guided meditation to help him deal with the physical and emotional aspects of his illness and impending death, and do what I can to help him ensure that his ending of life is a beautiful process and not merely a painful one.

But beyond that, I want other clinicians to ask themselves the difficult questions that I’ve been asking myself. Is it okay for us to be human with our clients? How real and honest do we want to be as we watch them navigate fear and pain? Do we instill hope, or are we simply here to witness tragedy?

We’ve been taught to be formal and a little removed, and this experience has caused me to rework some of that. When a client is getting ready to die, I’m not sure that is really the best and proper stance. Instead, when a client is grappling with death, we need to be ready to be part of that journey with them.