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When we think about loss, as therapists, we are usually able to rationalise it through whatever theory or approach we are akin to, in order to be able to support our client through their process of finding a level of acceptance. We have learnt, both academically and through clinical supervision, how best to support and manage various levels of grief and loss. However, the one type of loss that we are never prepared or trained for, and that is rarely discussed in professional circles, is our silent fear of losing a client through the completion of suicide. My own experience is what prompted me to write this article.

Olivia* was a young person in late adolescence with multiple diagnoses, including emotionally unstable personality disorder, post-traumatic stress disorder and psychosis. She had constant suicidal ideation and was admitted to the mental health inpatient ward seven times during our time working together. She had made two attempts to take her life, and always expected that she would die by suicide, unsure of time or place, but certain of how her life would end.

As lockdown restrictions were introduced in March 2020, and we, as therapists, were finding our way through the dark as to whether we could see our clients face to face, this actually became a safe time for Olivia. She had been admitted to hospital prior to lockdown, but let me know she had been discharged. She said she felt OK being at home with her parents, because they could keep her safe when she was unable to do that for herself. Olivia chose to wait until we could meet face to face again to resume therapy. Little did I know that this would never happen, and that this conversation would be the last I had with Olivia

In May 2020, I found out that a local young woman had lost her life through suicide. I work in a young person’s service, as a counsellor and supervisor, and have supported staff previously with this sort of crisis. However, when I discovered the identity of the young person, I realised the crisis was mine, and it felt very different.

My initial reaction was one of disbelief, followed by shock and then guilt. Why guilt? We are all aware, as therapists, that we can only do what we can in the room, and ultimately, we have no control over the decisions our clients make outside of the therapeutic space. However, even with all my experience, in that moment, I still experienced guilt and shame. I felt guilty that I was unable to keep Olivia alive, and ashamed that I might have missed something. My self-doubt began to take over, and I found myself wondering if I was actually able to do the role I loved so much. What kind of example was I setting to my team? I read over my case notes, trying to identify what I had missed or could have done differently. I wondered, if I should even be feeling the way I was: wasn’t I supposed to be able to detach and leave it in the room?

It was then I remembered that Milton Erickson used to say to his patients, ‘…my voice will go with you’.¹ But what he didn’t say was that our clients’ voices can also go with us. Their stories become part of us, part of our daily lives, or our nightly dreams. Not all those stories are negative – indeed, many are inspiring. The point is that they change us. After taking some time to reflect on my own and with my clinical supervisor, I began to wonder if this event had triggered an element of vicarious trauma. This is the emotional residue of exposure that counsellors can experience from hearing trauma stories and witnessing pain, fear and terror in their clients.² Neurological research has found that similar areas of the brain are activated, both in the person who suffers and the one who feels empathy.³ So empathetic suffering, in neural terms, is a true experience of suffering. We don’t yet know the full consequences that vicarious trauma has on brain function, but it appears to have similar psychological effects for the brain and the body as if we had actually experienced the trauma ourselves.

Learning to surf

I received a call from Olivia’s mother, who wanted to let me know in person of her loss. Her words will stay with me forever, ‘I wanted to thank you for giving us a few more months with our daughter that we might not have had if she hadn’t been working with you.’ I felt guilty again that I could not do more for the family. I decided, after speaking to my supervisor, to take some time off to reflect and process my loss. Prior to going on leave, I shared what had happened with my team, in an effort to be honest, transparent and to show my vulnerability as a human being. One of the things that came back from my colleagues was that they felt there is nothing that trains or prepares you for the impact of such a loss, how you manage it or what it might feel like.

Olivia’s parents asked if I would like to attend the funeral, which would take place virtually, due to COVID restrictions. Even in death, I found myself checking boundaries, asking myself if it was appropriate, looking for guidance. Then I stripped it back to the core; I am human, I care, and I want to say goodbye. On the day of Olivia’s funeral, I was at home, we were still in lockdown and my son was playing in the paddling pool in the garden, having the best fun. Inside, I prepared to watch a family say goodbye to their daughter and sister. I felt like I was straddling two worlds, watching the hurt and pain being experienced by one family and hearing the joy and life 12 feet away from my own. I thank Olivia’s parents for allowing me to attend a lovely celebration of her life, which also allowed some closure for me, to be able to hear their peace, that she was not hurting anymore, no longer in emotional turmoil and finally at rest.Ìý

Months after Olivia’s funeral, I contacted her family as I wanted to ask if there was a favourite quote that was important to Olivia that helped her get through the hard times. I wanted to acknowledge and remember her in some concrete way. Her mother quickly said yes, there was one, ‘You can’t stop the waves, but you can learn to surf.’ When Olivia was struggling, her family would remind her to surf. I had the quote made into a plaque and put it on one of our counselling room doors, with the family’s permission. They were delighted and hoped that these words would support other clients to learn to surf.

I ask myself, why have I written this and chosen to share it? As therapists, we are so good at being present and supporting people in the moment through their emotional turmoil and pain, that all too often there is an unspoken expectation that we should be able to just deal with it. But, we are human, we get tired, we hurt and we have our own turmoil, perhaps more so now than ever, due to the COVID-19 pandemic. We must be aware of who we are as professionals, what we expect from ourselves and whether that equates to what others expect from us.

No matter how much experience you have, no matter how much you may think you have heard it all before and that you are desensitised to most things now, there will always be a moment, somewhere, somehow, that will force you to doubt yourself. Most of us are not trained for the loss of clients, because we are so focused on preserving life. We choose not to think about the times when we have tried everything, but our clients still chose to leave a world that has felt too dark and too painful for too long. Our silent fear should be silent no more. We should voice it and share our painful experiences. Only then will we begin to heal from the guilt and shame that are attributed to the loss, so we can learn from them for the future.

*Olivia’s parents have given their consent to this article being published

Conversations about suicide
Therapy Today, April 2020

Suicide, survivors and supervision
Therapy Today, December 2009