I’ll never forget the first time that I received notice that a client had died. I’ll never forget any of them actually. No training truly prepared me and I’ve had far more training than the average thanks to an intense drive on my part and having had some of the best mentors in the field. I can only imagine how folks with minimal training and a lack of good supervision fare.
The longer we are in the field, the more likely we are to have experienced the death of a client. The death may have been through accident or natural causes or by their own or someone else’s hands. Few, if any, clinical training programs spend any great deal of time exploring this issue unless you are specializing in hospice settings. When a death happens, there are many things that tend to be the focus of supervision and consultation sessions. Below are some of the more common issues that I find in my supervision and consulting work when a client has passed.
Processing the loss yourself
Once receiving notice of the death, many clinical professionals attempt to “work through the pain” by continuing their day as they normally would. Though this may work for some, many, if not most, will require time to process the loss either immediately or in the very near future. Be sure to allow yourself to be human, acknowledge the loss, explore the emotions associated with it and whenever possible, do this with the help of a colleague. You do not have to keep everything bottled in. Remember what you would do for and with friends, loved ones and clients who have suffered a loss and allow yourself to be present with your emotions so that you may heal. While there are times when you may need to continue to work to help aid others who are affected, processing it yourself as soon as possible can be a key factor in moving forward healthily.
Could I be liable?
One of the first fears shared by clinicians when a client has died of anything other than natural causes is that they may be sued or otherwise investigated. In most cases, there has been nothing to indicate that this could happen assuming that the clinical professional has given nothing but the best level of care to the client that has passed. This fear is sometimes grounded in the grief process itself: the clinician is blaming themselves for not having been able to prevent the death. Other times it can be a simple fear of being sued by a next of kin that is “just looking for someone to blame” regardless of any real malpractice having occurred. A small fraction of the time (I have personally never encountered anyone in this situation) the clinician has indeed made mistakes that could be considered malpractice. In this case, the fear may indeed be founded. Whether or not you feel you did anything wrong, when in doubt, contact your malpractice/liability insurance provider and discuss the matter with them. It shouldn’t cost you anything more than your time and just may help ease your worries.
Protecting the client’s right to privacy
Today more than ever we find ourselves with the ability to emote freely via venues that were unthinkable just a few short years ago. Many find themselves posting to social media for just about everything. Public grieving is considered the norm to many folks but as clinical professionals we need to remember that the client’s right to privacy does not end with their death, therefore we as clinical professionals should refrain from public expressions of grief that either name or share any information that could potentially identify a client that has passed. I’ve seen very good clinicians make this mistake. Comments such as “I lost a client recently to a drunk driver” or “Cancer took a client today” may seem harmless enough but can lead to ethical issues especially if more information is also shared.
I’ve also seen clinical professionals that have made generic statements on personal or professional pages that would appear to be fine. Comments such as “thinking of those lost to cancer” or drunk drivers, suicide etc. may help the clinician process without potentially identifying a recently deceased client.
Should you get a request from a next of kin to provide copies of the deceased treatment records, be sure to consult with an attorney to learn exactly what the next of kin is allowed to access and what they will need to provide your office in order to allow you to release copies. Here again, your liability insurance provider can be a key resource as well as your supervisor.
To go or not to go to services
Going to the services of a client that has passed can be a controversial decision. One side of the coin says that by your very presence you are saying that the deceased was a client unless they were a known friend, coworker or relative of ours. The other side of the coin says that if the service is open to the public then you are free to go with no need to explain. Many a heated conversation has come from posing this question in a group supervision encounter. One quick way to handle this would be to contact your liability insurance provider for guidance. Please note however that the answer may differ from provider to provider.
For me, I have only attended services if a surviving relative has requested me to attend. Even with such a request I will neither confirm nor deny that I ever had a professional relationship and will instead simply say that we live in a small town and that we all seem to know one another.
“Erasing” the client from your practice
Many a consult has been spent processing feelings of guilt from clinicians who were feeling conflicted about how “easy” it was to “simply remove a person from my schedule.” The actual act of erasing a client from a schedule may indeed only take a moment. For me, in my office I have opted not to use the electronic scheduler that others use and instead use a pencil and paper system. I have literally erased people after a death and can remember the lump in my throat the first time I did so. I also remember hesitating to “give their time” away to a new client. It required some processing and grief work before I was able to truly move forward. Now, I remember that it was not the time slot nor the written name that made a difference, it instead, was the relationship that we had and that cannot be removed with a number two pencil.
Telling a staff member that their client has passed.
If you are a supervisor you likely will be one of the first people to learn of a death of any client. In my practice I have instructed the reception folks to notify me should there be any calls notifying us of a loss of life. They also will keep up to date on local obituaries as well as in some cases there is no next of kin that knows that the deceased was receiving services. While there is no one correct way, I would avoid the use of texting, email, private messenger or other electronic means to advise your staff member of the loss. To me, a phone call is a last resort for notification and instead will call and ask the clinician to come see me the first thing when they come in. Once in, I try not to have it be too formal as in having a large desk between the two of us. Although I would never stage the encounter, I have shared the information while walking on one of the dirt roads on our therapeutic farm, sitting by the brook, walking some of our trails or spending time with our therapeutic animals. How I did it had more to do with the clinician and their normal preferences than it did with mine. Ensuring the privacy of the clinician is paramount as well. Should they need to cry, talk it out, yell a bit or whatever, the ability to do so without an audience is key. Many times, we process not just the passing but the process that the therapy took on, the good work that they provided and what they themselves will cherish from the encounter.
After the basic processing has taken place, it is good to remember that there may indeed be a need for further reflection and moments of pause in the future. Allow yourself to not only be a clinical professional but also a human being. We are not machines. Process as needed.
Be safe, do good
”Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, clinical & executive director of Community Counseling of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). He is internationally certified as a Counsellor and Counsellor Supervisor in the USA and Canada (C.C.C., C.C.C.-S, NCC, ACS). He can be contacted at [email protected] *The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA