My colleague sat across from me, teary-eyed, in the conference room where we had met so many times before while she was under my supervision. Now, only a few months into her new life as a fully licensed clinician, she had lost a client to suicide. She was understandably distraught.
The client was high risk from the beginning, but my colleague hadn’t missed anything. She had covered every base she could. She had developed a thorough safety contract with the client that included an emergency plan, coping skills for the client to use and an emergency contact person for the client. The last time my colleague had seen her client, he had appeared slightly improved. He had assured her that he would attend to the safety contract and would be back the following week for his appointment. Sadly, he took his own life two days later. Perhaps his perceived improvement was simply resolve to follow through with a suicide. We will never know.
I have never lost a client under my care to suicide, but I suppose that even now, in the twilight of my career, such a loss would be devastating to my heart and my esteem. My young colleague was just beginning to gain some confidence in her clinical skills. Approval from the licensing board had helped nudge her professional esteem into a reasonably healthy place — only to have this happen.
The tragic loss of a human being and the lifetime of pain such an act brings to family members is our primary concern, of course. But we counselors have to manage such tragedies too.
What did I miss? If only I’d hospitalized! Maybe more frequent sessions would have been better. These are among the obsessive thoughts that plagued my friend and brought her to tears that day in my conference room.
But the fact is, we cannot control the private lives of any of our clients. Some will be success stories, and others will not. All we can do as counselors is to guide them. A client’s life is their own.
When I began my career, I had a client who was having an affair but wanted to get his marriage back in order. Obviously, to reach that goal, the affair needed to end. But he chose to continue the affair, no matter how many times he acknowledged the damage it was doing to his family. The outcome was inevitable. Predictably, he and his wife eventually divorced.
Perhaps a better therapist could have helped him succeed in achieving his stated goal, but even in hindsight, I think not. He was determined to do what he wanted to do, and there was little I could do to stop him.
In a similar manner, I helped my colleague to see that even her client’s wife — someone who was with him most of every day, someone who slept in the same bed with him — couldn’t stop him from harming himself. He had been determined.
Saying “the client chooses” doesn’t remove responsibility from us as counselors. Therefore, she and I reviewed her procedures with the client to ensure that she hadn’t missed something. She had not. I suspect that even hospitalization wouldn’t have kept her client from eventually taking action.
Our clients will make their own choices. Sometimes they will relapse into addictions, return to abusive relationships and, yes, if you are in the field long enough and work with high-risk clients, some will even take their own lives.
Although we must have compassion for our clients, we must also develop something I call “disinterestedness.” This simply means that we must remain apart from the choices our clients make. We are “disinterested” in the sense that we won’t thrust our ideals upon them. Being compassionate usually comes naturally for counselors. That is why most of us pursue this career. Practicing disinterestedness, on the other hand, is difficult, but it is equally important.
Coping with this loss won’t be easy, but my friend is putting it behind her. So to you, my colleagues, I encourage you to remember disinterestedness in your practice, especially when your clients move in a hazardous direction. You cannot control them, and even if you could, that would overstep our ethical boundaries.
Yes, it is necessary for us to review such cases. If errors were made, put systems in place so that you won’t make the same errors again. But then move forward and do your job. Your clients’ decisions aren’t about you.
Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.
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