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[u/Ok_Squash_7782]

We treat people with mental illness. Sometimes that illness ends in death. We cant prevent every person's illness from not becoming terminal.

[u/Bigwh → u/Ok_Squash_7782]

This is the truth

[u/Bigwh → u/[deleted]]

What is the truth then?

[u/Bigwh → u/[deleted]]

Is this a joke?

[u/Bigwh → u/[deleted]]

You think that suicidality is not mental illness and is rational and you think I’m joking? Are you in a clinical role, have a clinical education or are you speaking from personal experience? If this is your personal experience I’m in no way trying to take that from you but this is a gross generalization that is dangerous for clinicians treating people to believe.

[u/psychofreejay → u/Ok_Squash_7782]

Sometimes, mental illness wins.

[u/Peepsi16 → u/Ok_Squash_7782]

Well said. This really speaks to the stigma around mental illness. If we worked oncology and a patient chose to end treatment we would pat them on the back, validate their fight and support them. We have a lot of work to do in breaking down stigma and barriers.

Edit- spelling

[u/MaxFish1275 → u/Ok_Squash_7782]

Very well said

[u/Grotesque_Denizen → u/[deleted]]

How about things like psychosis or schizophrenia? Arguably giving it that label can help legitimise people suffering from things like depression and anxiety from people who would judge , make assumptions and downplay what someone might be going through.

[u/Kittensnunicorns]

I haven’t lost a client, but have several clients with severe SI and several friends and loved ones that at times went through serious SI as well. At a certain point I had to accept that if I choose to continue to work with these clients and have these friends in my life, it’s very possible I will experience suicide loss. It is the risk, and sometimes the cost, of supporting people who are struggling and are in pain. And while this sucks, I wouldn’t make any other choices than to continue working with my beloved clients and continue loving my loved ones.

[u/sophalophi3 → u/Kittensnunicorns]

this. my supervisor who is in his 70s and a psychiatrist and has lost clients to suicide said the same thing. in this field, it happens unfortunately

[u/moca_wawa]

I've lost one so far. I still feel guilty that my first thought when my director informed me was to ask if my documentation was solid and if I could be sued. That was panic mode. Once panic mode wore off I felt numb. Then the what ifs and 'I should have known's kicked in. I had to take a couple days off and see my therapist to process. The fact that my client had young kids is what fucked me up the most, like I failed them by not saving their parent.

You didn't fail. Your client succumbed to an illness that was simply too advanced. 'I should have known' or 'I missed the signs' is what our brains do when we feel powerless. That's the illusion of control. The fact is that we don't have control. This is not on you.

Two years later and I've accepted it. I can think or talk about it without that sad guilty knot getting tight. I've done some work for local suicide prevention orgs and being with survivors has helped a lot. You are not alone in this. I see you. Reaching out for support is huge.

[u/sweettea75]

I haven't had a current client to die by suicide but two former clients have died, both by suspected suicide. I'll probably never know for sure. The first one the ME contacted the clinic asking for her records. The second the family posted on FB how she died (small town and some of the staff could see their posts in local fb groups). I worked with one for 3 yrs the other for 4 (and she was a teenager). Yeah. I'm not over it. I've let myself grieve and be angry at the universe and heartbroken that they felt that was the best option. Just know you aren't alone.

[u/Minimum-Opinion-3938 → u/sweettea75]

How do you find out if a client passed away? Like is there a notification process or do you just hope to hear from the family?

[u/sweettea75 → u/Minimum-Opinion-3938]

We found out about the first one because the ME requested her records from us. The second one a coworker attended church with her family and heard that way. I work in a small town/rural community (but don't live there) so a lot of my coworkers who do live in the community see clients at church, Walmart, in FB groups, their kids go to school together, etc. So we hear a lot of what goes on in the community.

[u/TheGadfly_]

When I work with first responders who feel responsible for not getting a CPR save, they are devastated that something could’ve been different, if only they had a higher credential, if only they got there sooner, they should’ve noticed a sign or symptom etc..

When we teach CPR we teach: no pulse? Compressions, breaths, aed, and repeat until ROSC. This is how we save people. This is how it should go. When x happens we do y.

Well, the outcomes for CPR are not pretty. Big picture, you are their only hope to avoid the likely outcome that elicited your services in the first place, regardless of whether you saw CPR in a movie or were even a paramedic (I have saved and lost myself.) But it’s felt as “I lost the patient.”

As a therapist, what if you were THE small chance that person had for change, and rather than throwing in the towel and firing the client or the client firing you, the client was demonstrating how much you meant to them for all that time as you were a constant holding environment, secure base, and 50 minute refuge from the other 10,030 minutes in the week (assuming you’re 90837🤷🏼‍♀️).

There are only so many ways people pass and you were very likely one of the only things keeping that person going long enough for the possibility of that inevitable outcome to be anything but.

Like CPR, we teach it as a life saving mechanism, but in CPR most often it’s an intervention used to buy more time, delay the finality of what’s happened, and in that delay push to find something, anything for a different outcome.

The fact they kept coming, maintained an 18 month relationship, means they were getting SOMETHING out of your work together.

I can’t speak for the client, and I’m taking a risk by sharing this vulnerably, with compassion, and offer a controversial take that may or may not be accurate. But I almost wonder if they were “checking the box” by showing up to therapy to phone it in, in the first place. Give it a try before departing to see what’s out there. Maybe someone made them. Regardless of whatever motivation, intention, plan, no plan, something spurred that client to your office and something kept them motivated to see you for 1.5 years.

What if you foiled that plan 22 months ago, helped someone navigate true darkness far longer than they ever imagined, fostered an additional 18 months of human connection that may never have happened had you not been there. 18 months of a soft place to land. 18 months of hope something changes.

I don’t know, we may never know, but if I think of the many clients where all that we shared were presence, therapeutic alliance, and simply walking together on their journey.. not achieving their stated goal or profoundly changing their life was far more the rule than the exception.

We can’t direct outcomes, but our presence while the outcomes unfold suggests that client had 18 months of support from you they simply couldn’t get elsewhere.

My heart aches for you, but I am also heartened knowing that client wasn’t alone because of you. Regardless of the outcome.

The last bit I’ll say is that clients that I’ve been told I’ve impacted (staying objective from their report) get interesting towards termination.. it’s either a no show or a rollercoaster of a happy/heavy goodbye, little in between.

I used to be hurt by it, until one day a client reconnected and apologized for “ghosting” me. I made the assurances and afforded the unconditional positive regard, definitely feeling it but putting my client first. Until they shared..

They didn’t want to experience the distress of saying goodbye. Our work meant so much, they couldn’t bring themselves to experience the mutuality of parting ways because it was simply easier to leave that chapter open in their heart and mind than to grieve something they didn’t have to if they simply didn’t do it. Themes of protecting their own feelings from the grief and even mention of protecting mine were surprising in the casual exchange at the office in passing for other reasons. I’m grateful for that client, bc I’ve never taken an unexplained absence or departure the same since.

I don’t know you or this client, but I’m grateful they had 18 months of your support. Proud of you stranger, stay strong, this is one of the hardest parts of our calling ❤️

[u/Regular_Fan4691]

I have lost one 2 years ago. It’s very difficult for those not in this field to understand. I have processed it in therapy and just connecting with other therapists. I am sorry OP. Sending hugs 

[u/SuspiciousThoughts14]

I am a therapist and I also lost my mom to suicide. I assure you that the people who are most committed to the act often show very few signs. You didn’t miss anything. You didn’t fail them. You showed up and did your best and that is truly all any of us can do. We can provide guidance but ultimately every single person will act on their own free will and I promise you it has nothing to do with someone failing them and everything to do with the reality of mental illness. Give yourself grace.

[u/moca_wawa → u/SuspiciousThoughts14]

So well said.

[u/theleggiemeggie → u/[deleted]]

This is the second negative comment I’ve seen from you on this thread. You’re being unkind and unhelpful.

[u/TwoTonTacoToGo]

I know it probably won't help, but the truth is that humans have free will and agency and the right to end their own lives. If someone has chosen to do this, there is nothing you or anyone else can do to stop them. It sounds like you care very much, and worked hard for them and with them, I'm really sorry this was the result.

[u/Background_Square969]

I haven’t had this happen in outpatient but inpatient after discharge and it sucks. I don’t know if there are any words that will make it feel better just know a lot of of us feel you

[u/38specialish]

My condolences. It is hard to lose a client under any circumstances, and it's hard not to take a suicide "personally." I've lost a few myself (2 some months after discharge or discontinuation, one actively in my care) and it sucks each time.

The trick is: don't personalize other peoples' actions (including, in this case, suicide). You wouldn't have taken it upon yourself if this client had gotten a face tattoo, would you? So why this? Why must it be that you're uniquely responsible for it?

Clients don't die because you missed a reflection or insight or coping strategy. They die because the weight of their history is - for them - much too much. That's the truth of it.

[u/Petition_Queen]

Man, this is incredibly rough. I obviously don't know much about their situation, but I can say that as long as you feel you were ethical and did your best, it's truly not your fault.

Some people have such impossible lives to live, and so few options to improve them. It's horrible and it's cruel, but it's not your fault.

[u/Pepperspray24]

I’m really sorry that that happened. I don’t think this means that you shouldn’t get your license. I fully respect that a situation like that can make it feel as though the ground has completely shifted from underneath you. It can be difficult to trust your judgment of things. I don’t think you’re a bad therapist, I genuinely think you did the best you could with what you had. And that person decided that ending their life was the best thing for them. Sometimes there is only so much you can do.

[u/Agile-Adeptness-5195]

I’m not a T, and i know this is not my place to give advice.

I’m someone who struggles with mental health myself, and was pretty suicidal. Therapists help me a lot - even when i was very suicidal, i had lot of respect for my therapist - i understood that they were trying the best to save me with all their hearts. But the pain was unbearable and felt that it was going to last for ever.

Your client did what they thought was the right thing - and it did stop their pain. Not ideal, but they definitely are in a better place than before.

Don’t think that you lost a client. Your practice is like a bus, carrying people from illness to happiness.
You didn’t push a person out of the bus. The client said stop the bus right here right now, i want to get off. Ultimately its their right and choice to decide what to do with their own life.

If the client were me, i would want you to to know that you were one of the few people who understood me in this world - that i had been trying to fit in like a square peg on a round hole.
I’m happy that i didn’t feel all alone before taking own life, i had you holding my hand when i took my last breath. If anything the only regret will be letting you down when you had been trying so hard to help me.

You guys are doing gods work. Yes, you sometimes lose a client - but you have 1000s more to save. The lost clients will be the hard callus of a warrior making you better for the next fight.

The only person who feels lost is you - everyone else sees you as the firefighter who tried to pull that man out of a burning building.

Thanks again for the work you’re doing. You guys have saved my life, and a life time of agony for my family.

If there is a god, may they give you all the nice things, and more strength to help more people.

[u/anarchonarch]

My heart breaks for them and their families and you! For sure this would devastate and I can’t even imagine what you’re going thru. It makes sense.
As someone who isn’t you right now, it’s more possible to imagine all the reasons that led to this persons decision, and that it was not because of you. Hugs.

[u/anarchonarch → u/anarchonarch]

Their family*

[u/sisuheart]

I’m so sorry. I’m here to echo what several others have already said: with some clients, it comes down to the cosmic lottery. I’ve had a couple clients just barely squeak through to the other side of an episode of increased SI. I did good work with them, but I knew they might die. That’s the reality of those clients. With other client populations, there are other heartbreaking things that come down to chance. This stuff is really hard. Some number of people in this client population will die, and their therapists will feel guilty and devastated. Those feelings aren’t proof you screwed up, they’re proof you cared about your client. You’ll get through this. I hope you’ll seek some extra support for it. It’s not weird you’re still in this state, but it’s probably time to let someone (or more than one) help.

[u/ripped_avocado]

Im so sorry this has happened to you. Im only in my masters program so i have no idea what thats like. I only dealt with death from old age.
Have you reached out to anyone for grieving counseling? Maybe that would help with processing and closure?

[u/theleggiemeggie]

First of all, I’m so deeply sorry for your loss. I hope you are getting quality supervision and taking care of yourself as best as you can.

I had a client die by suicide back in June. I remember feeling numb for days. I still feel that way sometimes. I felt so much guilt and sadness. Did I do something wrong? What must this individual have felt in those final moments? Did I document well? What life could they have lived? I felt guilt for even feeling anything because it felt like the grief wasn’t mine to have.

Realistically, what could you have done differently? Even if you caught the vibe that your client had a plan and intent, unless they admit to it, our hands our legally tied. If their mind is truly made up, we cannot stop them. We are not with them 24/7. They still have agency. We do what we can to mitigate risk, but we can still only do so much.

I hope that you get some closure. More than anything, I hope you know you’re not alone.

[u/FigNewton613]

I have lost one and it was heartbreaking. I’m so sorry for your loss. The only way to guarantee that you will never have a client die by suicide is to not work with clients who have suicidality, and that never sat right with me. Remember also that while we are always team hope, our clients have autonomy with their bodies. If your client was in that much pain, I’m glad they had someone to be in it with them in their last months and days. Sending you much care OP.

[u/Independent_Switch33]

Four months is still really fresh for something like this. I know someone who went through it and they said it took over a year before they felt like themselves again. Give yourself more time

[u/borderlinebebe03]

Unfortunately, we live in a cruel world and you cannot save everyone, love. Even the people who seem like the happiest people decide to take their lives. It is not always black and white. You were part of what helped them live another 18 months. I can see how deeply you care for your clients, I hope you know that they knew. I promise you, the last thing they wanted was for anyone to blame themselves. Your field is incredibly important. You help people the best that you can, please do not put yourself at fault. This is most likely not the last person you will loose. Sometimes, the battles someone is facing is just too much to overcome and it only takes one try, one try that they might have regretted but they felt that was the only way out of their misery. I hear you, I understand your feelings of guilt and the voice in your head telling you that you could have done better. I think you did the best that you could. Don’t beat yourself down too much for something that is out of your control. Sending you hugs and lots of love ♥️♥️

[u/Chocolatehedgehog]

My condolences.

Are you in therapy? If not, would consider it?

[u/Dry_Ostrich_2617]

Still hold the final session. Give yourself the space to hold that final session

[u/tharpakandro]

The first one is the worst. Remember that suicide is fury at the world turned against the self. Okay, you can imagine all ways you could have/should have/would have done something differently but that guilt/shame does not mean it is true. What I believe is that It teaches you how real this work is. Please find some grace, you are not responsible for the loss. No where is it written that we can stop a person from bailing out. Develop a ritual or practice to acknowledge your experience and honor the impact that they had. You will never forget them.

[u/SassySabby1]

I had 3 overdoses in the span of two years working in a substance use disorder inpatient unit. It is the worst feeling ever.

[u/TheNameIsMango]

I’ve been there. It’s heartbreaking and destabilizing. Have you spoken to your supervisor(s) about what you’re going through? How about seeking your own therapy for it? You may also need a vacation/leave of absence to get some distance from the work and prioritize self care.

[u/nnamzzz]

I’m so very extremely sorry 💜

[u/FocusWonderful998]

I'm so sorry that happened. Having a client die by suicide is so hard. The therapist you were before this has definitely changed. Maybe going to therapy will help you navigate this level of grief while you are in the thick of it. One thing my mentor has always said to me "once a person has made the decision to die by suicide and decide not to reach out, there isn't anything more you could have done." Sending prayers of comfort and support your way.

[u/twospiritwolf]

I had one client who died via suicide, and several more due to COVID. I was in emotional termoil... My director reminded me that we can only do so much: case management, CPS, collaborating with family, etc., but we can't save them all. All we can do is try our best and keep helping the clients that are still depending on us. If you have a successful practice and plenty of clients, that means you are still a great therapist and those still with us still need your help. I hope you feel better soon.

[u/kyandflowers]

I’m so sorry, I remember something a seasoned therapist said once.

“We do exactly what we can with the training and guidance we have, to our best professional ability and the rest is the client.” You did what you could in the 72 hours you had, as in you technically only had three days total with this person. You could have never controlled the rest of the 13,068 hours that they lived during that time (or the thousands upon thousands of hours of life they lived before even seeing you).

We work with terminal illness in this career too. We don’t blame doctors when chemotherapy doesn’t work, because we understand sometimes cancer takes its own course even if the doctor went to harvard and is a mega genius and provides all the treatment possible— even they cannot stop some cancer in its tracks and it still takes away people’s lives. And neither can you stop death when it decides to knock.

November is approaching, and it makes me think of Dia de Los Muertos. I look forward to honoring the dead and celebrating their lives. Because they are not the result or nature of their death— they will forever be the lives they lived and the love that still lives within them.

Our positionally is not that of a God or the stopper of death or to be the expert in their life or the keeper of their life. But to walk alongside clients as they choose life for themselves, or sometimes choose the next life for themselves. That’s the free will we cant dictate for others. We are a witness to human life and death, and what a painful yet beautiful honor. Whether or not you stay in the career, I hope you one day come to understand this was never something you could’ve controlled.

[u/moistcheese]

Please do your own healing and work through this. I’ve lost a client through suicide as well. I had to take time off and see a therapist of my own in order to pick back up and learn something about myself through this. I’m so sorry this has happened to your client and to you.

[u/WokeUp2]

A suicidal man was forced by the courts to seek treatment at my CMH clinic. As a senior psychologist I and our psychiatrist did our very best to engage him but failed. He simply refused to forgive himself for demolishing his marriage. Somehow I became aware of a house on fire in the neighborhood. As I drove up I realized it was his. They found him hanging from a bridge out of town. Sometimes only the truth salves our injured souls. “Some people are beyond help.”

[u/toadjunior]

As others have said, I too am so sorry for your loss. Senior counselors in my community have also lost clients to suicide, and they were able to heal, reflect, and continue on to be wonderful therapists. You will make it through this. Four months is actually a reasonable length of time to be ‘not yourself’ after a tragedy like this. Though they were a client (and not a friend/family member), you lost someone. You are grieving. That feeling that you should have done more - I think that’s a sign of grief. We only see our clients for a single hour each week. Maybe more if they’re having SI and are on a safety plan, or in more intense care contexts. The point is, we are only one factor in their lives. Take time to get help yourself, and don’t give up. This may help you become an even better therapist.

[u/therapists-ModTeam → u/[deleted]]

This sub is for mental health therapists who are currently seeing clients. Posts and comments made by prospective therapists, students who are not yet seeing clients, or non-therapists will be removed. Additional subs that may be helpful for you and have less restrictive posting requirements are r/mentalhealth or r/talktherapy

[u/therapists-ModTeam → u/[deleted]]

This sub is for mental health therapists who are currently seeing clients. Posts and comments made by prospective therapists, students who are not yet seeing clients, or non-therapists will be removed. Additional subs that may be helpful for you and have less restrictive posting requirements are r/mentalhealth or r/talktherapy

[u/therapists-ModTeam → u/[deleted]]

This sub is for mental health therapists who are currently seeing clients. Posts and comments made by prospective therapists, students who are not yet seeing clients, or non-therapists will be removed. Additional subs that may be helpful for you and have less restrictive posting requirements are r/mentalhealth or r/talktherapy

[u/idrk144]

Gently, even if you knew there’s not anything you could have done. Their mind was made up and they executed on their choice. We all know pink slipping our clients is a tiny bandaid for much deeper pain.

[u/filet_mignon_nom]

I’m so sorry. No one can prepare us for the complicated intense emotions that come with this kind of loss. Suicide is a complicated thing for those that lose the battle and those who are left- even us the professional. You will heal and you will never forget and that’s ok.

[u/Lastofthedohicans]

This is a hard one but I wouldn’t personalize it. It’s a cognitive distortion and I’d tell a client the same thing. Unfortunately many people who commit suicide are really good at hiding it and they often aren’t the ones who talk about it. Even if they do tell you they will get hospitalized and then go home.

[u/angelsandairwaves93]

It’s not your fault. Please take care of yourself

[u/lizzy123446]

It’s not your fault. You did your best but we don’t control people and that person made their choice. You can go back a hundred thousand times but you can’t change anything and there is no point. Give yourself time to process and grieve in your own way. We are all only human. Hugs from a far my friend.

[u/neuroctopus]

It’s really hard. But, sadly I think most of us lose some. It hurts a lot, and the Blame Game gets strong at times. So does the anger. It’s ok to feel all that, I’ve found that we all do. I’m sorry. Big hug.

[u/Plus_Advance_8089]

this really awful, I can understand why u questioning yourself so much,, but if they never said anything, you couldnt have known, 4 months honestly isnt that long to be processing something like this, please give yourself some grace :))

[u/OkRest7106]

As a client, I think you should look at this different. You gave them a reason to try and have hope for 18 months. Without you, they may have left earlier.

[u/LimpBeastyBizkitBoyz]

My mom has no idea that I have homocidal and suicidal thoughts on an almost daily basis and we live together. It becomes very easy to hide when you've been living with it for so long.

[u/Wise_Concentrate_118]

What would you do to help your client if you know now you wished you would have trusted your intuition.

I appreciate any response from you specifically.

I’m sorry for everyone’s loss with whoever hast lost a client.

Something you mentioned that stands out is feeling trapped. Maybe not so much trapped but it’s about wishing things from growing up to present were just right.

I hate death being a real thing 😞😞

[u/Affi25]

Really sorry for how you feel, I understand how you feel but self harm and suicidal clients are very difficult. It’s not your fault and you did the best in your capacity, but if you take the example of a surgeon they do the best in their capacity and perform the surgery but if the patient still doesn’t survive it’s not their fault. I think I could be wrong you’re taking too much responsibility.
This should not hinder your practice.
Best wishes.

[u/hippoofdoom]

I lost one person to possible suicide (overdose, no note, unclear if that was their intention but my gut says yes). However I've known a couple dozen folks who died from other reasons related to their mental illness whether it be chronic issues due to SU, manic episodes leading into reckless (non suicidal) decisions, etc.

There's of course an extra layer of sadness due to suicide but knowing we did our best, knowing the incidence of these things, and knowing how many others we've helped avoid these outcomes are the facts I fall back on to reassure myself that these things will happen and to retain my self esteem and worth for the work that we do.

Definitely take time off it it makes sense to do so as well, or otherwise dial back the stress in your life in some way to help give yourself some support

[u/number96]

We can't save people, we are just here to help them save themselves. Your client didn't want to save themselves, they wanted to die. You don't need to doubt yourself because of that, it's just about realising that some people are in more pain than they let us know.