How to Navigate Confidentiality and Contact with Family After a Client’s Suicide

The ethical and legal obligations of confidentiality remain after a psychotherapist’s client dies, but how much? There is a lot of confusion around this. Here, I address what therapists can say or do with the client’s family while honoring the client’s confidentiality.

First, be warned: I am not a lawyer, so my opinions represent a synthesis of various scholarly materials that I have read about client/patient confidentiality after suicide. I cite some of my sources in the material follows. For legal advice, please consult a lawyer.

Therapist Contact with Family After a Client’s Suicide

Consider this scenario: A man’s wife dies by suicide over the weekend. That Monday, he calls the wife’s therapist and tells him about her suicide. “I thought you would want to know,” the man says through his sobs.

What can – and should – the therapist do?

In a recent online discussion, I was shocked when some people said that in such a situation, the therapist should say, “I can’t confirm or deny that your family member was my client.”

No doubt the people offering this feedback have good intentions. They are being mindful of the laws governing confidentiality of mental health treatment. And when a client is alive, if someone calls and tries to talk to a psychotherapist about the person, the therapist cannot, in fact, confirm or deny whether the person is their client.

But still, my heart breaks. Except for obviously sadistic responses, I can’t think of many things more hurtful that a therapist could say besides, “I can’t confirm or deny that your family member was my client.”

If I were the surviving family member, such a response would give me whiplash, especially if I already had known that the person was in therapy with this therapist. I would feel invalidated, uncared for, and more than a little angry.

“There may be times when following the letter of the law [about confidentiality] may actually antagonize or cause more harm to a family member than disclosing certain impressions and information.” Those are the words of psychologists Vanessa McGann, Nina Gutin, and John R. Jordan, from their book chapter titled,  “Guidelines for Postvention Care with Survivor Families after the Suicide of a Client.”

Dr. McGann and her colleagues recommend balancing the need for confidentiality with the need for compassion:

“We believe that the guiding ethical principle in all interactions with surviving family members after a suicide should be a wise and flexible combination of compassion, support, and adherence to the standard of ‘first do no harm’ rather than a rigid adherence to a legalistic view of the situation.”

I couldn’t agree more.

When a person loses someone they love to suicide, they are not only grieving. They also are living moment-to-moment in an ongoing trauma. The suicide of a loved one is a qualifying event for a PTSD diagnosis. As therapists, we need to not add to the surviving loved ones’ trauma.

What Should You Say to Family After a Client’s Suicide?

Not only should you take surviving family’s calls and engage in conversation with them after their loved one’s suicide, but you also should reach out to the family as soon as possible. And you should offer to meet with them, too.

But this can be easier said than done. If you experience the devastating loss of a client to suicide, a maelstrom of emotions may overcome you. Many therapists report experiencing emotions similar to those of family and friends who loved the person: profound sadness, shock, grief, disbelief, self-doubt, anger, a sense of inadequacy, and feelings of betrayal. On top of that, therapists may painfully question their professional skills and abilities in light of their inability to stop the suicide from happening.

It can be hard to manage your own emotions, let alone attend to those of surviving family. It can be harder still to know what to say and how to say it.

Be careful not to say anything to the family that could be construed as an admission of guilt. You may well fear you made mistakes or somehow contributed to the person’s suicide, but telling the family this could expose you to a malpractice lawsuit.

In talking with family, you should express your condolences, be a listening ear as they process their memories, questions, and emotions about their loved one’s suicide, prepare them for some of the emotions and questions that can come with suicide bereavement, assess what they need, and try to connect them with resources that can help them. You might choose to share other information, too, like what we know so far – and don’t know – about what causes suicide.

Communication with the family can help them, and it can also help you. Talking with the client’s family can give you a greater understanding of the client’s life, as well as a sense of closure. However, these rewards should be byproducts, not objectives, of any meeting you have with family. The family is not there to meet your needs, nor should they be.

A Major Exception to Confidentiality after a Client’s Suicide

You can talk with family without revealing confidential details of the person’s treatment. And you shouldn’t reveal those details, but do keep in mind that a family member may be entitled to the person’s treatment records down the road.

According to HIPAA,the privilege of confidentiality passes on to the dead person’s “personal representative,” such as the executor of the person’s estate or “other person who has authority under applicable State or other law to act on behalf of the decedent or the decedent’s estate.”

In many cases, the person with authority to act on behalf the person who died is the suicide victim’s next of kin, such as a spouse, parent, son or daughter. And the person’s next of kin may well decide to give himself or herself permission to view the therapy records. Before handing over such records, though, always consult with an attorney to make sure you are required to do so.

Lawsuits After a Client’s Suicide

Compassion calls for a humane response to family after a suicide, but there’s also a more pragmatic concern: lawsuits.

A client’s suicide is one of the most common (and some say the most common) reasons for lawsuits against a therapist. Even if you did nothing wrong as the therapist and feel confident you would be exonerated in legal proceedings, the process is still traumatic and always best to avoid.

There is some evidence, based on qualitative interviews with suicide loss survivors, that family members are more likely to sue if they feel that the therapist treated them coldly or dispassionately after the client’s death. It is recommended, then, that you proceed with warmth and compassion, which  is what we should do as therapists, anyway, even without the risk of a lawsuit serving as motivation.

Compassion, Legal Concerns about Confidentiality after a Client’s Suicide

In sum, there are both humane and risk-management reasons to respond to family with care and compassion after a client suicide.

The obligation to keep clients’ disclosures confidential after death (mostly) remains, but we also have a humane and ethical imperative to treat the surviving family with kindness and concern.

Respect confidentiality, but don’t be rigid.

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Copyright 2017 Stacey Freedenthal. Written for Speaking of Suicide. All Rights Reserved.

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  1. Nina Gutin PhD says:

    Eric Harris, who was (may still be) the lawyer/consultant for the American Psychological Association, has urged “Compassion Over Caution” when dealing with the family of the deceased. And Skip Simpson, an attorney who deals with suicide malpractice cases, agrees.

  2. Paul says:

    I know that if I had lost a family member to suicide and had talked to their therapist and they said that they can’t confirm or deny that they were their client that the next phone call that I would likely make would be to a lawyer. Anything else really does not make sense to me, as they are in my mind covering up something much as what people do when they are doing something “secret, or eyes only” I am aware of such projects and documentation. Also people that work under such things know about not saying anything. However not talking to a family member that already knows them and knows that they have been seeing them, is in my mind saying that are basically admitting guilt by their response.

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