How to Grieve a Client’s Death Ethically
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Even when proper therapeutic boundaries are held, it is not unusual for a counselor to grieve a client’s death. Counselors often form emotional bonds with their clients because therapeutic relationships are relationships. These feelings a counselor develops are not unethical but rather what grows naturally between two people when deeply felt feelings are shared, in an honest manner.
Therapy is intimate and for many, an authentic connection is formed. Counselors rejoice in their client’s progress, as well as feel the pain clients go through in difficult times. These moments of healing and growth are an honor, for a counselor, to witness.
There is no formal training on how to deal with client loss. If you are a counselor long enough, you will face your client’s death at least once. Many times what takes place in therapy occurs behind closed doors and the counselor’s grief does too. It is for this reason many counselors mourn alone. A client’s death can occur through natural causes, illness, suicide, murder, or an accident.
Protecting Client Confidentiality
What makes these grief experiences unique is the fact that counselors are bound by confidentiality. Ethically, counselors cannot share client details with other people. Confidentiality never dies and it is a counselor’s duty to protect the client’s identity and what was said in the session, after the client’s death.
If a spouse, family member, or other agency requests the deceased client’s records, it is the counselor’s duty to protect the confidentiality of the records and information. Resist disclosing, unless a court order is supplied to release said records or there was a signed release of information by your client, prior to his or her death.
The American Counseling Association’s (2014) code of ethics; Respecting Clients Rights B.1.c. Respect for Confidentiality indicates this:
“Counselors protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification.”
Due to confidentiality, many counselors choose to not openly mourn with their client’s families and friends. This means you may not be able to go to the funeral, send a card, or flowers. The reason for this would be because of the common question, How do you know the deceased? This puts the counselor in an uncomfortable situation of lying or breaking confidentiality.
Some counselors decide to cross a boundary in these situations. When faced with the question, How do you know the deceased? He or she will respond, From work. One must use caution because, if someone inquires more deeply into the work you do, your client’s confidentiality may get broken.
Crossing a Boundary
If you consider crossing this boundary, seek professional and/or peer supervision. Also, refer to the American Counseling Association’s Ethical Code (2014) regarding A.6.b. Extending Counseling Boundaries:
“Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters. Examples include attending a client’s formal ceremony (e.g., a wedding/commitment ceremony or graduation), purchasing a service or product provided by a client (excepting unrestricted bartering), and visiting a client’s ill family member in the hospital. In extending these boundaries, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no harm occurs.”
Keep in mind, after your client is deceased, you cannot obtain informed consent.
Documentation of the boundary extension or crossing is required in the client record. The American Counseling Association’s code of ethics (2014) A.6.c. Documenting Boundary Extensions covers this topic: If counselors extend boundaries as described in A.6.b.:
“They must officially document, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. When unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, the counselor must show evidence of an attempt to remedy such harm.”
Any ethical codes which apply to a client while living, also apply to a client in his or her death. If you are considering crossing a boundary, it is always wise to ask, Is this serving my own need or the need of my client?
A Sudden Death
An unexpected death, through accident, suicide, or murder can leave the counselor in a state of shock or disbelief. It is important to validate this part of the grieving process. There are many unanswered questions about these types of deaths. In these instances, it would be unethical for the counselor to reach out to the client’s family in order to obtain details. This lack of information can leave a counselor ruminating about the death in an attempt to fill in the blanks. Often counselors need to accept that they will not know all of the answers or have their questions answered.
In the event of a suicide, counselors may wrestle with self-blame. It is natural when a client commits suicide, the counselor may question his or her own competency and wonder if he or she is qualified to be a counselor. Clients often share suicidal ideations and intents in therapy, which need to be taken seriously and acted upon by the counselor. There will be times, even when you listen carefully to the hidden messages clients share, he or she may not reveal their intention to end their life. Counselors cannot predict every client’s suicidality. This is an uncertainty to be aware of.
A client’s suicide can be a traumatic event for many counselors. The less experienced counselor may feel more affected than a counselor with years of experience.
Do not make any impulsive decisions to leave the profession. Seek out professional supervision and peer supervision. Assess your strengths and where you need to grow as a counselor. Save any final decisions after you have processed this grief.
Although many counseling businesses and organizations you work for carry liability insurance, it is wise for counselors to carry their own. There are many companies online which offer services to individual counselors. If your client commits suicide, you would want to contact your liability insurance company for guidance.
A Group Therapy Client
When a client dies who attends group counseling sessions, the entire group must be informed of the death. Due to confidentiality, the specifics of the death cannot be discussed. It is not unusual for some group members to know more about the client’s death than others.
In the group counseling session, tell the group members the basics of the death (e.g., the client died unexpectedly or suddenly). Next, have the members discuss how the person entered the group, their feelings about the client’s death, any memories clients would like to share, and possible rituals to remember the group member.
Use this opportunity to educate the clients about the stages of grief and normalize their feelings. Invite the clients to discuss their feelings and thoughts beyond this group, whether it is in an individual counseling session or future counseling group.
The Bottom Line: How to Grieve a Client’s Death Appropriately
There is no guidebook or ethical parameters to follow in this particular type of situation. Due to confidentiality, you cannot talk about these feelings or your experiences of your client with your family or friends. Even if you did, they would not understand the complexities of such a loss. Sometimes, it takes a counselor to understand a counselor. A counselor’s work is unique and challenging to explain unless you experience it.
Often, there is no one the counselor can connect with to share memories of this person or grieving rituals. For these reasons, many counselors often feel isolated and have difficulty finding an outlet for their grief. You may wonder if what you feel is normal and how you can pay tribute to your client’s life. Some counselors leave the client’s appointment time open in their schedule for a period of time, as a way to honor the deceased.
Below are five ways counselors can ethically grieve a client’s death.
- Utilize supervision times- Talk with your supervisor about the client’s case and your feelings surrounding the death. Often clients remind us of our own personal relationships, where we have unfinished business. Process any countertransference you may be experiencing.
- Peer consultation and support- Other counselors can understand the uniqueness of a therapeutic relationship. Find two or three peers you trust, who act ethically. You can find validation for your feelings and experiences from peers, who are counselors.
- Attend short-term therapy for yourself- If you have faced a previous death, which was unresolved, your client’s death may bring those feelings and experiences to the surface again. Your own grief therapy can help you process and find meaning. It also can be helpful to talk to a counselor, whom you do not work with or for, to gain alternative perspectives.
- Use the art of writing- Put pen to paper and express all of your feelings in a letter to your deceased client. Write about how you found out about the death, the circumstances surrounding the death, the last time you spoke, your own grief, the therapeutic relationship, and your personal goodbye. You may choose to discard this letter safely, after writing it. Journal writing can be helpful to process the experience of a client’s death, through expressing your thoughts and feelings daily.
- Increase your own self-care and self-compassion- As you grieve, it is important for the counselor to take care of themselves. This includes getting adequate rest, eating well, exercising, and engaging in activities that are enjoyable for the counselor. Make time to spend with friends and family, while engaging in stress management practices. Counselors may want to consider taking time off, reducing client hours or cutting back on their schedule.
Honor all of your feelings and take some time to grieve, process, and integrate this loss. Find the grief methods which work for you. It is important to do the grief work that we encourage our own clients to do. This is done not only for your own health but also for your future and present clients’ best care.
Lisa Hutchison, LMHC
Writer & Contributing ExpertLisa Hutchison, LMHC, is a licensed mental health counselor for the Commonwealth of Massachusetts. She works for professionals who want to treat and prevent compassion fatigue. With over 20 years of psychotherapy experience, she helps her clients assert themselves, set boundaries, and increase their coping skills. Her specialty is decreasing stress, anxiety, and depression while increasing realistic methods of self-care for those who help others. Ms. Hutchison’s psychological advice has been featured in Reader’s Digest and the Huffington Post. Her articles have been published in numerous magazines, including Grief Digest and Today’s Caregiver.
Lisa is the bestselling author of I Fill My Cup: A Journal for Compassionate Helpers and a faculty member writer for NetCE. Her latest continuing education unit publication is “Setting Ethical Limits for Caring and Competent Professionals.” She has taught creative writing in colleges and presented on boundaries for the compassionate helper; the use of expressive art to heal grief, anxiety, and depression; inspirational and motivational topics; and creative writing techniques.