Unknown Speaker: Hey therapist. Welcome back to the Joy After Burnout podcast. I’m your host, Dr. Jen Blanchette. If you are new to the podcast, I welcome you to the podcast and our community, really. So today I’m delving into a topic that’s rarely talked about, but it’s experienced by many therapists. It’s something I’m calling secret grief and a very personal struggle to me and also many of the therapists I know personally. I wanted to highlight the topic of secret grief or confidential grief because it’s something that when I had it, I really didn’t know what to do with it. And it was one of the main reasons I think that started my unraveling or breakdown. I love that Brene Brown will put my spiritual awakening and cross out the breakdown piece. But I think certainly, as we can see with our clients and I’ve personally experienced myself that with crisis brings an opportunity for change. And I’m glad that I went through it to know the people that I worked with. Number one. So I’m really reflecting on the relationship that I had with two particular clients that I’m talking about today who are no longer living. And I am grateful, even though I had my own grief about those relationships, that I’m grateful that I knew them and I’m grateful for the warmth and the love that we shared together, really, because I do have love and respect for them as humans. So why I want to highlight this topic is because I know this was part of my burnout and part of my decision of why I wanted to leave the work. For now, I’m saying for now because I can’t completely let go of that possibility that I might come back to therapy. But for now, I am not working as a therapist. And I bet it also might be part of yours, the heaviness that is associated with our work and the losses that you’ve had either with clients losing people in their lives or as therapists, we’re often expected to be pillars of strength. But what happens when we need to grieve and especially need to grieve something that’s based on our clinical work, either directly from the work that we’re doing with clients or grieving the loss of a client? So today I wanted to share one of my personal stories that lingers with me still to this day. And I think many of you will identify with having the stories of your clients inside of you that will always stay there. They are just part of who you are now. So I wanted to share about a former client who passed away during COVID-19. So also just a disclaimer for today’s episode, I am talking about themes of death and suicide. So if those are things that you can’t manage hearing today, certainly listen to it another time or not at all. We were in the midst of COVID It was right before the world was brought to a standstill. My client was sick for a while, like they had some kind of chest issue. And I was just wondering what was going on. Was urging them to be seen by a doctor and a specialist, and they were following up on those concerns. And I knew that they had an appointment coming up, like right before COVID shut down. And then so I met with my client, like the week before the shutdown, and then I knew they were going to this appointment, possibly to oncology, and so I wasn’t sure what was going to happen. And then the world shut down, literally. We all know that happened. And over a really patchy zoom call, I found out during COVID that they did have a cancer diagnosis. So I wasn’t really privy to a lot of their experiences in this. But what happened is that they rapidly declined in their health, and about a month later, they passed away. And I received a call from their partner, which I was actually very grateful for because I know that a lot of therapists don’t receive notification of a client’s death. And I lost another client in the fall, actually, where I didn’t receive any notification. And I was worried about them. I knew they were having surgery and they were still in the hospital, so I thought about calling the hospital, but I did see a obituary for the client, is how I found out about my second client. So I was thankful for that call from their partner. And it was really like a whirlwind of emotions. I was dealing with the whole shock of COVID with losing this very beloved client that I’d seen for a few years. And I was really having a profound sadness, and I didn’t really know a way to express that sadness because I can’t go reach out to the family. I knew a lot about their family, but it’s not like I can just call them up and express how much I miss them and express those feelings of sadness and grief to them because I can’t break confidentiality with my client to really be part of that grief ritual that I wanted to be a part of. And also that client didn’t have that opportunity to have a celebration of life. So even if I’d had the chance to weigh through, like, will I attend this client’s funeral? Will I not attend the client’s funeral? I didn’t have the opportunity because they didn’t have one. And so I know a lot of folks in COVID who lost someone either to COVID or to another concern, had that disenfranchised grief of not getting the grief experience that they really needed or wanted. So that last appointment was this patchy call. We were just figuring out telehealth. I know many of our first telehealth calls were dealing with like, okay, I need to upgrade my router and my Internet is not working as well. Or the client on the client end, they didn’t have the capacity to really do a telehealth call. So a lot of us were figuring that out in the moment as it was happening. But I didn’t know that that last call would be the last call that I would have with that person. And that sits with me today of kind of wanting to have that experience, wanting to be able to say goodbye and being with them. So I really longed to be with them in that process, even though intellectually, I knew they would likely be with their family, and that’s what they needed at that time. I felt like I wanted to be there if they wanted me there, but I didn’t really have that opportunity to know if I could have been there. But that call was our last connection. So this client was one of those who stayed with you. They would pick lavender outside. I had some lavender plants outside, and they would pick lavender for me and just bring it in and give that to me and say, Just smell this. I just want you to have some calm in your day. I know you have a really difficult job, and I just want you to have this. And so they would do little things like that that were just really sweet and caring and human, and one of those clients that saw your humanity and you were able to kind of be more of yourself in the session. Not that we can’t with all of our clients, but there’s some sessions where we have to feel like we show up differently, and that’s just reality. Clinically, they were the type of client who knew when I was having a bad day, when I looked tired or depleted, they could say, oh, are you okay? Are you sleeping okay? And some clients don’t ask those questions. So it was one of those types of clients. I really felt lost. Clinically, while the pandemic raged on, I knew I had to show up for my clients, even as I grappled with my own pain. Spring of 2020, I still held this loss. But in the shock of the mental health cris that really unfolded for many of my clients that year. So I’ve heard from many therapists that their clients were getting sicker because we were all under stress, right? So our caseloads are getting more difficult to manage. And our quote unquote easy clients, those clients with fewer psychological difficulties had increased problems or new problems that we weren’t even aware of, and there was so much scarcity. So I think in the first few months of the COVID crisis, there was no calls. So a lot of my clients dropped off. They were like, I’m kind of dealing with this crisis. I think I’m going to end therapy. They wrapped up other clients. I saw more, but there wasn’t an influx of clients coming in. So I didn’t receive any calls for new service or anything like that, probably until May or June and then it just kept coming. So new requests for therapy kept coming after that time. But it felt like, oh, I have to take on new clients because I don’t know if all the clients are going to dry up. Which doesn’t even make sense that we have this crisis that’s happening. People probably will need mental health services. But my brain was not logical. It was in fight or flight. It was trying to deal with this protracted crisis and I was also dealing with my own drama during all of that. So as I alluded to earlier, I lost another client again that fall who was another long term client and this was more of a somewhat anticipated loss. The client had long standing medical issues, again, not due to COVID, but an unexpected loss. To lose two clients in one year, that really took a toll on me, honestly. I think I actually had a presentation that I think within the same week and I canceled it. I took care of myself. I tried to do my best to attend to my grief and do more research on understanding my personal grief and how I can deal with that. I tried to reduce my caseload taking breaks, and I think that everything just stacked in the pandemic for me. And it was this piece of secret grief that I think because I couldn’t really share that with other people, I could with my clinician friends. But I think there’s also this space where there’s only so much room to feel like you can share with your clinician friends to where it feels like I don’t want to burden them as well. So I wanted to talk about this concept of secret grief that we all carry. I believe it’s the emotional weight we bear when we lose a client, or especially with one. We shared a profound connection. I believe it can also be the grief that we hold for our clients who have gone through their own losses. So perhaps we’ve had a client who’s dealt with some kind of traumatic death in their life or a traumatic loss and we vicariously experience their grief. So certainly it can be a vicarious secret grief. I had worked with clients in many situations where they had their own secret grief. And I’m frequently reminded of one case where I worked on an infant death case where it was an accidental death. So I’m reminded of a case where there was an accidental child death and the individual I was working with didn’t feel like they could share in their grieving process. And I can’t share a lot of the details of any of that, but it was just really heavy. And I had vicarious trauma symptoms from that case and also felt that piece of secret grief that they had for not being able to grieve because of feeling shame or responsibility for that death. So my thoughts on secret grief are really informed by the work of Dr. Pauline Boss and her framework of ambiguous loss. Dr. Boss has illuminated that losses that are not typical or traumatic can be more difficult to overcome and secret grief can often fall into this category as it’s not openly acknowledged or socially validated. The framework helps me understand why such grief can be particularly challenging to navigate. So in my work with brain injury survivors over the last twelve years, I frequently discussed the ambiguous loss that occurs in brain injury. Dr. Boss talks about the losses that were experienced during 911 where family members didn’t have the closure of knowing if their loved ones were alive or dead. In the weeks that followed 911, there was no body for service, for example, and their grief became entangled with the loss of not having a physical body to mourn. And additionally, Dr. Boss talked about the loss of psychological presence that occurs in the case of dementia, mental illness or brain injury. I worked for over ten years in the brain injury world and I still am an advocate. I love when they experience their previously experienced selves as a result. So in the case of brain injury, the individual really grieved their former self. They knew what they were capable of, they interpersonally work wise physically, even if they couldn’t do some of the things like go skiing anymore or play their favorite sport, or do one of their favorite activities. And also loved ones needed to grieve the person that they felt like they lost due to the brain injury, so the psychological differences that they were noticing in their loved one. For therapists, we experience a number of ambiguous losses over our careers. We may never have closure with some of our clients. We invest our emotional resources into this work and by the nature of our relationship it can’t be reciprocated in the ways that we often need. Sometimes, for example, we’re ghosted by clients and left to feel inadequate about our abilities or just wonder what the hell happened. Sometimes we can feel anger with not being given the human consideration of a discussion before someone leaves therapeutic relationship. And as I talked about before, we too grieve with our clients in their pain and losses as they experienced horrific traumas or pain. And I wanted to illuminate this point. Sadly, many of us may experience a death by suicide of one of our clients. I read that that can be as high as 80% of clinicians. I saw other research that was saying somewhere in the range of 20%. So I’m going to dive further into the research and see what are the percentages with regard to that and maybe have an expert in that particular field come on the podcast and share a little bit about their research. So in my own grieving of my client, I stumbled upon the Facebook group Confidential Grief that was actually suggested by my therapist when I was going through this. Thank you my therapist. You know who you are if you listen to this. So the confidential grief group is mostly focused on supporting clinicians who have suffered is focused mainly on supporting clinicians who have experienced a death by suicide. However, I did receive some support in that group for the loss that I experienced. So I’ll definitely link that Facebook group in the show notes and as well as some other resources that I’ll talk about in a minute. So another resource is the Clinician Survivor Coalition, which has support groups for therapists who have gone through a death by suicide by one of their clients, which is cliniciansurvivor.org. So what I know about grief work is that a loss is a loss. So we’re not comparing apples and oranges that your pain is the worst pain and somebody else’s pain is their worst pain. So we can’t compare pain. I got that from David Kessler when I was going through my own grief work. And as well as helping other clients through grieving loved ones, we know that our exposure and proximity to the person that we help will often increase our likelihood for struggling with more loss. And I guess if I could say anything to a clinician who’s experienced a client who’s passed away, is to maybe tell you some words that I wish I knew at the time, is that it’s okay to take a break. It’s okay to take time off. It’s okay to notice what you’re feeling in your body and to allow space for that, to allow time to attend to that. I think oftentimes we have to put our own needs aside so many times to be present for clients and we don’t realize how many times we do that and what the cumulative toll of that can be. And I think in concert with the secret grief experiences that we or the secret pain, the secret losses that we experience, it starts to stack. We start to feel like our own needs are not important or they’re not acknowledged and they’re not seen. So I think having a group of clinician friends or your own therapy group, your own therapy where you can feel like you can share these deeply painful experiences that you are either vicariously experiencing or have directly experienced, I think is vital. Doing grief work can be very helpful as well. So whether it’s a formalized grief modality or just choosing your own practices to attend to your grief, I kind of came up with the concept. So I would often suggest that my clients do a grief walk where they have a beginning, middle and end to this experience and then try to either write or transition into their daily life. A lot of times with grief, it is overwhelming and you feel like you’ll never feel normal again and you’re consumed with the thoughts of your loved one. And that doesn’t change if the person is your client or the person is someone in your family. So I think to think about what do we need to do to attend to our grief regarding our clients. So the grief walk that I would suggest, because if we’re thinking about the stress cycle, emotions have a beginning, middle and end. In the book burnout by the Nagasaki Sisters. By the Nagasaki Sisters, I just repeated that. I erased it from the podcast, but I said it three times to say it more correctly. I don’t even know if I said it right. So anyway, in their book, which I love, which I think is just required reading, especially that first chapter where they talk about the stress cycle in the way they conceptualize it, I think is really helpful to think about that beginning, middle and end of an emotion and how we can complete the stress cycle. One thing, I just heard a recent podcast on another Burnout podcast actually, and they were talking about how or she I think I love the concept that they talked about with regard to completing the cycle. So the first chapter, I think, is just genius of the way they conceptualize it. Like I said again, but they really define stress and what the effects are on our body, especially as it pertains to women and how that affects our bodies. They talk about all the reasons we get stuck in the stress cycle. And if we have chronic stress and therapists likely have chronic stress, we are masters of chronic stress because we keep saying like, oh, I just have to keep going, I keep have to care, I keep having to do this care. It’s important that I continue to do this. And they talk about some of the most efficient ways of completing the cycle. And for that, I think oftentimes it’s movement. So if we can incorporate movement and I always would talk to my clients about getting a double win, like, how can you help your nervous system and do something that’s also good for your wellness, like walking or doing some kind of other movement based activity. So doing literally anything that moves your body enough to get you breathing deeply is going to be helpful. So if we’re thinking about needing to complete the stress cycle every day, let’s think about something everyday, movement related, whether that be doing yoga, walking, weightlifting. I play tennis, so tennis is my therapy. And I just love how I feel. I don’t think about anything else when I’m playing. I think I always would think about how movement and the way you like to move is the best way for you to move. And in their book, the Nagasaki Sisters say physical activity is the single most efficient strategy for completing the stress response cycle. And research across. So I read a lot of fitness research because I have a personal training certification and I have a brain injury certification. The trauma literature is telling us so. The exercise literature is telling that the psychological literature is telling that exercise and an interesting study which I have in my mind but not I have to find where it is physically, is that even complex movements help executive functions. So I do executive functioning testing as well. And so they did a study of looking at kind of a yoga activity versus like a martial arts where it involves more complex movement, was better for executive functioning. So movement is just great and how we can help our clients in ourselves. Move is very important. They also talk about a lot of different ways to complete the cycle such as breathing, a lot of the things we know, positive social interaction which is huge, we don’t think about. There’s pretty clear research on the effects of interconnectedness in our lives. So feeling like you are deeply known by people and it’s hard as we get older, it’s hard to feel like more people deeply know us, especially if we’re struggling with holding a practice together, meeting the demands of our family, doing all the things literally, how are we going to invest in friendships? I still struggle with that. You try to do your best with that. Movement, I think, can be your first tool. If you’ve been struggling with secret grief, especially around the holiday time, I would invite you to reach out for support whether that be your own therapy, some friends who are clinicians who you can talk to and be more vulnerable with. Find someone you feel like you can feel like you’re known by and consider movement and how that can help you move through your emotions. Because we have so many depleting emotions that really have to move through our bodies in our therapeutic work, we don’t often consider that every depleting emotion that happens, we have to have a renewing emotion. So thinking about not balance but counterbalance of the depleting exercises and sessions that we have. So with that, I hope this has been helpful for you to get some resources on secret grief. And if you’re struggling with Burnout or dealing with some of this stuff and you are overwhelmed with your caseload, overwhelmed with doing one to one therapy, I have been there, I have worked in an agency, I had my own practice close that practice and I understand the pressures that it creates. So if you’re at a crossroad, you’re not sure about what you need to do next in your career, jump on a call with me. I offer a free 20 minutes career refresh consult call just to kind of look at some of those options about what could be possible for you and if you like, what are your next steps. So if you’d like to do that, the link to do that is in the show notes in your podcast player thanks and have a good holiday season. Thank you for listening to the Joy After Burnout podcast. Be the first to hear new episodes by following the podcast in your podcast player. This is an informational podcast only. Any information expressed by the host or guest is not a substitute for legal, med school or financial advice.