At this time in my life, many of my memories have faded, but the “flashbulb” moments remain. I remember where I was at age 12 when JFK was shot, and where I was several months later when The Beatles first came to America. I know where I was when I heard about Dr. King, Bobby Kennedy, the Challenger, and Princess Diana. And so it is that I remember, with the clarity that accompanies many traumatic memories, exactly where I was when I heard that my client “Mike” was dead.

Although this article is partly about Mike and what he and his death meant to me, it is mostly about the relationships some of us choose to form with our clients. We are taught to have boundaries and ethics. We are taught to be professional. We learn about transference, counter-transference, and self-disclosure. It is rare, however, that we are taught how to make those boundaries permeable—to let an emotional exchange cut both ways without any ethical breach—and, when there is a loss such as the death of a client, how to grieve and how to support one another without judgment.

Mike was in his 30s when I first met him at the outpatient agency where I worked as an addiction counselor. He was very nervous at his intake. He was a professional man who said the only way he would come to treatment was if we would not record his last name anywhere. At first I saw this as the normal paranoia of a “coke head,” but in time I realized that he was simply trying to protect himself as his career was taking off and his name was becoming known.

Amazingly to me, Mike stayed clean and stayed in treatment. After about a year, he decided to take a prestigious job about 50 miles away. I assumed that he would choose to terminate treatment at that time, so I readied a list of agencies closer to where he would be living. Mike, however, had other ideas. “I'm not leaving,” he said. “We're staying on schedule.” I pressed him about the commute. “This is working,” he replied. “I'm staying.” For the next six months he continued to come. He did miss an appointment here and there, sometimes canceling, sometimes forgetting, but when he'd forget he'd call within a few days and reschedule.

So when he missed his appointment on a January day in the mid-'80s, I didn't think much of it. Two days later I received a call. The woman's voice on the other end of the line was unfamiliar. “Are you Dinny McClintock?” she asked. “I'm Mike Smith's mother. I knew he was seeing someone and I found your card in his wallet. Dinny, Mike died suddenly yesterday. We don't know what happened—he told his girlfriend he didn't feel well and later he collapsed and died.”

I could feel my heart pounding and the blood draining from my face. Mike's mother continued, “His brother and I would like you to come to his services if you want to. Do you want the information?” I said, “Of course,” and started fumbling for a pen and paper. I took down the information, we said goodbye, and I proceeded to sit there for a few minutes and then went to speak with the co-worker to whom I was closest at the time.

A few days later I attended the services. I took a friend, another social worker, who is the perfect person for such occasions. She is, if there is such a thing, an “empath.” She will pick up on the feeling in the room and reflect it back. Good, I thought; I'm not crying alone. Later on in the car ride home, still sniffing, we were also laughing as she said, “And I didn't even know him! But he seemed to be so loved.”

Mike's death affected me deeply. It was sudden, tragic, and senseless. It was one of those horrible things that just happen. Although it was in the realm of work, it was also a personal loss. We had worked together for more than 18 months and it was meaningful work. Usually at the end of the type of counseling relationship I had with Mike, there would be a formal termination session. This time there would be none. Looking for closure, I wrote his discharge summary soon after his death, hoping that summarizing our work together would be soothing. It was but small comfort.

Colleagues' reactions

One of the greatest effects of Mike's death for a long time was the way others reacted to it. When word of his death spread, some of my colleagues expressed sympathy and concern but most said nothing. Another day, another closed case. When I said I was going to the funeral, questions were raised as to whether my attendance there was appropriate. “Are you kidding me?” I thought. I wasn't exactly planning to wear a name badge or disclose how I knew him. But I was going, and this wasn't negotiable.

I was surprised at the reaction, or rather the lack of reaction, that I got from many of my co-workers. I came to realize that they had not had this experience in their careers yet, but I also knew that they didn't form the same type of therapeutic alliance that I did. It was around this time that I started to think I needed to find a job in a more nurturing environment, and although it took a while to find this, I eventually did.

Several years later I returned to graduate school for my master's degree in social work. While taking “micro” we used Lawrence Shulman's 1992 book The Skills of Helping: Individuals, Families, Groups and Communities. It is one of only a few books I thoroughly read and still have not thrown out. Parts of it read like a good supervision session, while other parts read more like a novel.

The story that helped me the most was one a student told to Shulman of being in her office and having a client stop by to share news of an extremely tragic nature. Because this had not been a scheduled session, the office door was slightly ajar. The counselor put her hand on top of the sobbing client's hand. At this moment the counselor's supervisor walked by. In their next supervision session, the supervisor challenged the counselor's action of physically touching a client, and asked the counselor what she learned. “I learned to shut my door,” she wisely replied.

Gaining insight

The next two decades following Mike's death have brought other deaths, both personal and professional. All in all I have lost six clients or former clients. One former client committed suicide. Another's death was a possible suicide or drug overdose. One former client drank himself to death. One died in a motorcycle accident. I'm relatively certain he was sober at the time because when he was smoking crack there was no bike to ride.

Then there was “Jane.” I saw Jane through the private practice I had at the time. She had been referred after her significant other of more than 30 years died. Jane didn't want to live. She just wanted to be with him in heaven, but somehow she moved forward. We worked together for several years and there was a slight improvement. We terminated over a six-month period when I gave up my private practice to take care of my ailing parents. It was a rough termination for Jane and I knew she was extremely attached to me, probably too attached, but she made the transition as best she could.

I knew Jane needed to make as complete a break as possible, so I told her I would likely not be in contact with her even if she contacted me. I received a newsy letter from her about every eight months. In her last letter, she said she was likely dying of cancer. I phoned the counselor to whom I had transferred her and she confirmed the news and said Jane was coping well with her treatment. The next time the counselor and I spoke was after Jane's death. The irony was that in the end she fought the cancer and had wanted to live. I ultimately questioned my decision to remain out of touch with her, but since she did not ask for me to contact her I let things alone. In retrospect, I often wonder if this was the right choice.

Through the years I've gotten better support for myself, but the questions of how much to care, how permeable the boundaries should be, and how much to risk sharing with peers remains filled with land mines. I also have watched the other side of this. I have seen counselors leave, relapse, and on rare occasions die. I've watched clients' reactions and lack of reactions. It's fascinating to me how we as professionals seem to have one set of expectations for how “they” are supposed to react and another set of expectations for how “we” are supposed to react. Should it really be so different?

We are sad to see some clients go when they leave treatment, while in other cases we are filled with relief. Some want us to like them but we don't, while others with whom we want to connect keep us at a distance. I have had many clients say, “I thought about what you said when …”, showing me I had made an impact. So is it that surprising that I should think of them outside of their sessions, especially when I know they are having a difficult time?

We all know of cases where counselors have crossed a line and had inappropriate relationships. Would this be as common if the counselors believed that they could talk about their thoughts and feelings with no judgment before those thoughts and feelings turned into actions? We speak of compassion fatigue and counselor wellness. Doesn't it make sense that our ability to discuss our feelings without fear of judgment is part of what we need in order to be well?

Conclusion

I still miss Mike. More than 20 years after his death, his memory lingers, as does the memory of our therapeutic relationship. There have been many other losses besides the deaths, including relapses and incarcerations. Some have felt like “just business,” but some, like Mike's death, have been painful. I don't think, however, that there is much I would change in terms of my actions or my emotional attachments.

I believe we need to find ways to fully support one another, especially the next generation of therapists. We need to create safe and supportive working environments that encourage the “sacred trust” of a strong therapeutic bond while simultaneously promoting counselor wellness. We encourage our clients to share their thoughts and feelings with us. We listen to clients with open minds and often with open hearts. We can do no less for one another.