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Acknowledging the impact of a client's death

January 1, 2009
by Dinny McClintock, LCSW-R, CASAC
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A counselor calls for more support of professionals as they deal with loss

At this time in my life, many of my memories have faded, but the “flashbulb” moments remain. I remember where I was at age 12 when JFK was shot, and where I was several months later when The Beatles first came to America. I know where I was when I heard about Dr. King, Bobby Kennedy, the Challenger, and Princess Diana. And so it is that I remember, with the clarity that accompanies many traumatic memories, exactly where I was when I heard that my client “Mike” was dead.

Although this article is partly about Mike and what he and his death meant to me, it is mostly about the relationships some of us choose to form with our clients. We are taught to have boundaries and ethics. We are taught to be professional. We learn about transference, counter-transference, and self-disclosure. It is rare, however, that we are taught how to make those boundaries permeable—to let an emotional exchange cut both ways without any ethical breach—and, when there is a loss such as the death of a client, how to grieve and how to support one another without judgment.

Mike was in his 30s when I first met him at the outpatient agency where I worked as an addiction counselor. He was very nervous at his intake. He was a professional man who said the only way he would come to treatment was if we would not record his last name anywhere. At first I saw this as the normal paranoia of a “coke head,” but in time I realized that he was simply trying to protect himself as his career was taking off and his name was becoming known.

Dinny mcclintock

Dinny McClintock

Mike had been snorting cocaine with increased regularity and decided he was at a crossroads. He did not want to use his health insurance because of the paper trail, and therefore he had decided to visit the outpatient agency where I worked because it operated on a sliding fee scale. He refused to participate in groups (and in those days he could refuse), but said he would attend individual sessions as often as we recommended.

Amazingly to me, Mike stayed clean and stayed in treatment. After about a year, he decided to take a prestigious job about 50 miles away. I assumed that he would choose to terminate treatment at that time, so I readied a list of agencies closer to where he would be living. Mike, however, had other ideas. “I'm not leaving,” he said. “We're staying on schedule.” I pressed him about the commute. “This is working,” he replied. “I'm staying.” For the next six months he continued to come. He did miss an appointment here and there, sometimes canceling, sometimes forgetting, but when he'd forget he'd call within a few days and reschedule.

So when he missed his appointment on a January day in the mid-'80s, I didn't think much of it. Two days later I received a call. The woman's voice on the other end of the line was unfamiliar. “Are you Dinny McClintock?” she asked. “I'm Mike Smith's mother. I knew he was seeing someone and I found your card in his wallet. Dinny, Mike died suddenly yesterday. We don't know what happened—he told his girlfriend he didn't feel well and later he collapsed and died.”

I could feel my heart pounding and the blood draining from my face. Mike's mother continued, “His brother and I would like you to come to his services if you want to. Do you want the information?” I said, “Of course,” and started fumbling for a pen and paper. I took down the information, we said goodbye, and I proceeded to sit there for a few minutes and then went to speak with the co-worker to whom I was closest at the time.

A few days later I attended the services. I took a friend, another social worker, who is the perfect person for such occasions. She is, if there is such a thing, an “empath.” She will pick up on the feeling in the room and reflect it back. Good, I thought; I'm not crying alone. Later on in the car ride home, still sniffing, we were also laughing as she said, “And I didn't even know him! But he seemed to be so loved.”

Mike's death affected me deeply. It was sudden, tragic, and senseless. It was one of those horrible things that just happen. Although it was in the realm of work, it was also a personal loss. We had worked together for more than 18 months and it was meaningful work. Usually at the end of the type of counseling relationship I had with Mike, there would be a formal termination session. This time there would be none. Looking for closure, I wrote his discharge summary soon after his death, hoping that summarizing our work together would be soothing. It was but small comfort.

Colleagues' reactions

One of the greatest effects of Mike's death for a long time was the way others reacted to it. When word of his death spread, some of my colleagues expressed sympathy and concern but most said nothing. Another day, another closed case. When I said I was going to the funeral, questions were raised as to whether my attendance there was appropriate. “Are you kidding me?” I thought. I wasn't exactly planning to wear a name badge or disclose how I knew him. But I was going, and this wasn't negotiable.

I was surprised at the reaction, or rather the lack of reaction, that I got from many of my co-workers. I came to realize that they had not had this experience in their careers yet, but I also knew that they didn't form the same type of therapeutic alliance that I did. It was around this time that I started to think I needed to find a job in a more nurturing environment, and although it took a while to find this, I eventually did.