A woman called me to make an appointment for her adult son. We scheduled the appointment for two days later. He did not show up, and the next day I learned that he had killed himself on the day between when the appointment was scheduled and when it was to have occurred.
I had never met or talked with the young man who died. I did not even know what he looked like. Still, it brought up reactions similar to what research shows therapists go through when a client dies by suicide:
- An examination of what I might have done wrong in not preventing the suicide
- Fear about future clients, and changes I might make to better accommodate them
- Feelings of sadness and loss, even for a stranger
- Fear of getting into trouble in some way
What Did I Do Wrong?
I replayed in my head, again and again, the phone conversation with the mother to look for errors. I had asked her if her son was safe for now. She said he was. Even though he talked incessantly of suicide, he gave her a very compelling reason why he would not act on his thoughts for at least a month. We had time – it seemed.
I talked with her about what to do to protect him. To call 911 in the event of an emergency. To remove firearms from the house. To remove anything else that might be lethal, such as prescription medications.
I asked her to ask him to contact me. Normally therapists are advised not to see an adult client without talking with him or her beforehand. In this case, though, I decided I would make it as easy as possible for him to receive help, given his suicidal thoughts. Why provide one more barrier to getting help?
So I told her I would see him regardless, though it would be helpful for me to talk with him. He did not call.
What Could I Do Differently Next Time?
In recalling the conversation with the mother, I could not really find anything to change. But wait, there was one thing. What if I could have seen him the day she called, or the next? What if he had not had to wait two days for an appointment with a psychotherapist?
Perhaps if I had been able to meet with him immediately, I could have recognized the acute danger he was in and kept him safe with hospitalization, voluntary or not. Or maybe I could have helped him tap into hope, some hope, any hope.
On the other hand, he may not have shown up. Or he may not have honestly disclosed his true suicidal intent.
Still, I could not let go of the idea that it is impossible to help someone when they are dead, but the possibility always exists if they are alive. It is a cliché, but it is true: Where there is life, there is hope. Had I seen him immediately, and had he shown up, there would have been at least some hope of helping.
A therapist’s schedule is such that they may not be able to see a client in a day or two. But I wanted to make it as easy as possible for that to happen in the future. So I informed the person who subleases my office from me half time, two months in advance of her lease expiring, that I would not be renewing the lease. I would no longer share the office, in order to have a better chance of seeing a client on short notice.
Feeling Sad, So Sad
Suicide is obviously a profound loss for family, friends, and others who know the person who died. But really it is a loss for everyone. When the poet Sylvia Plath killed herself, her friend and fellow poet Anne Sexton (who herself later died by suicide) wrote “the loss of it, the terrible loss of the more she could have done!” This man’s mother told me of his incredible attributes, his kindness, his talents, his potential. The world would miss out on these treasures.
In the coming days, I found myself carrying a very heavy weight of sadness for the man who died and for his family. He endured so much suffering that he ended his life. Thousands of people do this every year in the United States (almost 40,000 actually). I am well aware of the numbers. But they are numbers – numbers on a page, numbers on a computer screen. This experience reminded me of the humanity behind the numbers, the pain the people behind the numbers experience, the exquisitely painful decision they make to end their life.
Will I Get Into Trouble?
The suicide of a client is one of the most common reasons for malpractice lawsuits. When a therapist has a client die by suicide, the sadness and grief they experience may be compounded by a fear of being sued or reported to their licensing board for perceived omissions or mistakes.
Sometimes the grieving family may merely want to lash out at the person who was supposed to help, and who, despite their best efforts, was unable to. Sometimes the therapist actually did make serious mistakes in judgment that neglected the client’s need to be safe.
Often, just as I replayed the phone conversation in my head, therapists with a client suicide may review the client’s chart, not only to examine where they might do better in the future, but also to look for omissions that may make them vulnerable in the event of a lawsuit.
Because this man was not really my client, I had no reason to worry. But I still did. What if the mother somehow blamed me for failing to help her son? (In fact, she expressed immense gratitude on the phone for my having wanted to help and for my offering her support. She even wanted to pay for my time! Of course, given the circumstances, I declined.)
Overall, my experience of having a prospective client die by suicide is minute in comparison to the others who knew the man well, loved him, and now feel his absence in their life. But it opened a window into the experience of other therapists who lose a client to die by suicide. Their journey is full of pain and self-doubt, as well. Research shows that some even experience PTSD-like symptoms.
The loss of suicide does affect a tremendous amount of people, even those the person never met.
© 2013 Stacey Freedenthal, PhD, LCSW. All Rights Reserved.