Speaker A: Sam, welcome to the therapist burnout podcast episode 72. So today I’m talking to you about clinical grief and its implications for therapist mental health. I talked about this way back on the podcast in episode 12 in November. It was one of the first episodes that I talked about and I was going to re record something last fall when I lost my beloved border Collie. He was 15. And I wanted to record that when I was in the throes of grief for some reason, because I guess I’m long suffering. But I decided that was not helpful in my grief process for my. My puppy. So anyway, I think I’m putting it here because I think it’s so relevant to our mental health as therapists because there’s just natural grieving that’s inherent in the work. So I’m just previewing on the episode today. I’m going to talk a little bit about my days in the pandemic and the sudden loss of two clients. One very sudden one was somewhat expected. Uh, and then I reflected why this came up for me is it’s, you know, it’s May, and here in the US at least it’s Mother’s Day.
I don’t know if like worldwide Mother’s Day falls on like the, you know, second weekend in May, but maybe it does. Uh, and I always think of her during Mother’s Day. She, I think, had this maternal presence for me in the room, even though I was the one that was caring for her. And I think, you know, she often comes back to me in. And things I see in nature in sometimes just daily routines. And I want to talk about how therapist grief often goes unrecognized due to confidentiality and just our role. We can’t disclose, you know, the. We can tell other peers and people that we lost a client. And I think there’s a unique layer if we’ve had a client die by suicide that I’ve talked about on that past podcast in episode 12. That was not my particular circumstance, but I know it’s a circumstance that many therapists live with. And so I just want to name it that I think that can really shake us in different ways from a grief perspective, but also just a clinical competency, a personal perspective.
I’m going to talk again about ambiguous loss. I weave this in and out of my work here on the podcast, and it’s just been a through line in my career. I was introduced to the work of Pauline Boss around the time where I, I guess in, in grad school, maybe I feel like I remember like, yeah, almost 20 years ago when her book came out. I’m gonna grab it. Yeah. So that was in 26, her seminal work on lost trauma and resilience, therapeutic work with Ambiguous Loss by Pauline Boss. And then I’m going to end with some small rituals and supports that helped me in my process, both acutely, when I first lost my beloved clients, and then how I. How worked through those losses over the years.
It’s been over five years since I lost that client. And I. It’s. You know, it. It comes back to me just like grief does, I think in different aspects, there’s waves of grief that happen. So I want to talk through that. So I’ll just tell you a little bit about my client that I lost in 2020. And I’m doing it in a way that will protect her identity even after her death, because we still maintain confidentiality for our clients. So the pandemic started, obviously, in March of 2020. We all remember that, and I remember distinctly, and I won’t get specific on the particular issue that they said, but they said there was something going on with their health and that they had an appointment coming up. And that was probably the last appointment I had pre pandemic before everything shut down and before I had clients back in the office. So I don’t think I saw clients back in the office for, like, two to three months. I had them come back in May of 2020, some of them with, like, protocols and stuff. And that was the last time I saw her.
That was the last time I saw her. And I had a couple of patchy zoom calls with her, as subsequently she got a diagnosis and was accused acutely, terminally ill and was not expected to live very long. And she did not live very long. She died in May of 2020. Not of COVID So not of COVID of. Of something else. And I think part of it, you know, part of it was the loss of her. And also part of it was where I was in the pandemic. So that time in the pandemic, I feel like March through May was an acute time of being crisis mode. You know, I. I feel like. I think the prolonged crisis of what happened in the pandemic was probably acutely, maybe six months to a year for me before it turned to, okay, this is actually going to be here for a while. Like, we’re in this for a while. I don’t know, maybe not, because I feel like that summer we kind of got glimmers that maybe it was over.
And going into fall, we Thought, oh, okay, like, this is going to pass. This was a time and place. And then it really didn’t let up for quite some. So it was partly that, that, you know, I was figuring out how to move my practice online. I was seeing clients initially. They didn’t come in for a while. You know, if you remember, if you were a therapist, then I. I think everybody was just like, okay, what do I do? I need to hunker down. I need to, like, get toilet paper. I need to get some beans and rice and, yeah, do all the things. That’s what we were all doing. And then I think when. When like the spring sl Summer hit and we all felt that this was going to be a while, I calls. My practice was really picking up and I didn’t have space to grieve. I had two young children at home. And I think now when I sit here five years later, which I just reflecting on that, that this loss is five years and I can still feel tears welling up. Just even talking about her is a testament to the relationship that I had with her. And I know that I’m not alone in having these types of relationships with our clients. She was the type of client who would pick lavender for me.
She knew that I couldn’t accept gifts, so she would make things like jam. Sometimes she would be on a trip and, you know, get me lavender lotion, which I kept for years after and just used it every now and again to remember her. And there was a space that we held together that was just precious. Even though I was the one holding space for her, she saw me. And not all clients see us. Not all clients think of us. Not all clients are aware when we’re different or when we’re off. When I edit this part of the podcast, it’s like actually 10 minutes of me crying and really feeling this very freshly again.
But I’m so grateful that I met her. And I think part of my grief was also my longing for her, for the stories that I knew, like the closure I wanted for her things and the peace and her relationships that I wanted. She didn’t get that. And. And that was some of that. She didn’t get a funeral that I know of. I was grateful that her partner informed me that she had passed. And a lot of this I could not access at the time. So I could not access a lot of this grief and this emotion during the time because I was so keyed up. My nervous system was just. I was just going session to session. It felt like I had to. To you Know, I was holding the space for people, and so I couldn’t unravel. And it really wasn’t until I lost my second client in the fall of 2020. This was much more expected. They had a chronic illness, not Covid again. But I knew they had a procedure coming up and they were worried about it. We talked about it, about potentially this. Them not recovering from this procedure. So I helped. Helped them process that.
I helped them think about the things they would want to do. And they had done this a number of times because they had been ill for some time over many years, several years. But I didn’t get a call that time. I. They didn’t come in for their session. They planned. And so I called and didn’t get a response, called the hospital. I didn’t get a response. And I googled them, which we’re not supposed to do, I think, ethically, but I googled obituary to see if they had passed and they had passed. And I think all of that, the. The grief and the pandemic, what I was holding in the pandemic for clients, all of it hit me at once. And I took time off. I took about a week. That was what I initially recommend, you know, take time off if you lose a client, allow yourself to have some time to do some grief rituals, to get supported, do all those things. And I did those. And still I didn’t close private practice till. That was 20. Yeah, till 23. But I think those two losses, I think for me, coupled with pushing myself way beyond my capacity and then subsequently struggling with my own mental health from pushing myself continually past my capacity, having bouts of panic disorder and acute depression, and then judging myself for that, you know, that I couldn’t hack it or do it.
The work that I was trained to do and what I see now sitting here is that totally okay that I couldn’t hold it anymore. Connecting the work of Pauline Voss with ambiguous loss. So she defines ambiguous loss as a loss that lacks clarity or closure when someone is gone, but not officially recognized as such. And her work, she started this work in her process of helping people, helping nine, 11 survivors. And as therapists, we experience a ton of ambiguous loss. Some of those experiences are like the one I just shared. When a client dies, also, clients leave therapy. They terminate without saying goodbye. And also, more acutely, I think, in the. The. Really the sequela or the. The. All the things associated with therapy we call therapist burnout. The losses that we have to ourselves, I think I’ve been aware of more often. And this loss lives in our bodies, it changes how we show up as therapists. It changes how we show up as people. And I think when we have unprocessed grief, certainly we can, we can turn that inward, thinking, maybe I cared too much about this person. How could I, like, leave my emotions so wide open that I struggle, hold things now, telling yourselves, like, I should be able to manage this loss. I. Why am I still thinking about them? I think these trigger emotions like shame, self judgment. And I think it can lead us to emotionally detach more because it’s hard. It’s so painful. It’s painful to care and to number one, not have it be reciprocated or witnessed. And I think the big piece in grief is certainly when we grieve and we have rituals of grief, our pain and our.
Our sadness, our loss is witnessed in the rituals that we have, normal grieving. I think when we’re overloaded with a lot of these unprocessed endings or we’re grieving, we detach as a normal human trauma response. As I said last week, what looks like professionalism, detaching can sometimes be protective numbing or dissociation. I think it’s adaptive. We can only handle so much before our bodies say, nope, we’re not doing that today because I need you to. Where they’re keeping us safe because they’re, they’re seeing a threat response. You are not. You are not able to basically live your life being emotionally wide open like that. So their numbing has to happen. That’s a trauma response. That’s also a response to grief at times that’s unprocessed. So certainly I think we can mistake grief for burnout, for unprocessed grief, or unfortunately, or for complicated grief in the case of losing a client. And many mental health symptoms overlap. Fatigue, disconnection, hopelessness overlap, but the source is different. I think it’s complicated in therapists because of isolation. So confidentiality, ethics, and shame keep us silent, especially in the case of death by suicide. I think many clinicians feel like they don’t want to open up to their peers or anyone when they’ve lost a client, especially by suicide. Furthermore, as I alluded to earlier, without community or ritual grief compounds, leading to loneliness, emotional exhaustion, and sometimes despair. A loss of a client can trigger our own identity disruption. I talked about that earlier. You supported your client. And especially if the relationship was really meaningful or long, it can leave you questioning your purpose, your role, your emotional stability. I think we all have those clients in our caseload where we call them Quote, unquote, easy clients. But why are we calling them easy clients? Are they easy because they see us and there’s just resonance between us maybe.
And I think when our own identity as therapists and as people shaken can manifest in depression of doubt or desire to even leave the field. And I think at the root of this is most. Most people want to avoid painful experiences. That is very adaptive versus processing this and integr it into our lives about what it means for us. There’s really no way that we can grieve as therapists openly, even though ethics state that we can attend a funeral. When I’ve talked with therapists about this practice, I was just talking with one recently who attended a funeral and they were saying, you know, it’s pretty awkward for them. They wanted to attend the service but then immediately leave because they didn’t want to identify how they knew the client. And that’s difficult. I think what we really want to do is to be able to share all the beautiful things that we noticed about the client, client. And we’re also holding maybe the things that were really hard in their family relationships, who we might see at this funeral and then have a lot of our own responses to that. And I think this, this really kind of drives at home for me. There’s no funeral for the relationships. And sometimes we can attend them and sometimes we can’t. A lot of times we don’t have that final closure session with clients, whether they passed or we just need a closure anyway. If I’m talking, zooming out, just talking about the closure that we need. And obviously, as you heard at the beginning of this episode, our clients stay with us. The space that we hold doesn’t disappear when they’re no longer with us. So I just wanted to share for you maybe a framework for a way supporting a loss, whether that be an ambiguous loss that you have for a client who’s left therapy if they’ve died or if they’ve left without closure. And let’s just say this is a framework for supporting ambiguous loss for you from the death of a client. First, if you can at all take time off, whether that be a day, a week, a few days, allow yourself the space that you need to feel your feelings, to also ask for support from those who love you.
Peer consultation. So reach out to a trusted colleague and just getting validation as well, especially if you are a clinician, maybe you, you know, reach out to find another clinician who’s had a similar loss. I think the thing that I keep hearing from therapists around peer supervision is that it’s hard to find, it’s hard to schedule with another therapist period. So I think just the nature of our work that we have little bandwidth for other types of appointments. And I think I’ve met some therapist unicorns who, you know, meet regularly with other people but and talk about their work. And that’s great. And I think some of it is that perhaps it’s kind of baked into the environment they’re in, maybe that they’re in like they’re in a group practice or perhaps they’re in an organization where they actually have the social support of having co workers. I think this can be more challenging if you’re in private practice. So certainly it’s not impossible. I just think it’s really tricky, I think sometimes to get the support that we need as therapists. And so perhaps I’m changing my mind on the peer consultation. I sometimes it works and then other times formal consultation might be a better fit. So for me, I was an EMDR clinician at the time when I was in therapy, when I was working as a therapist, I think I actually went through. Yeah, no, I did my EMDR training in 2020. I did a non emdria EMDR training several years before that. So I’d been doing EMDR for several years before I was EMDRIA trained. And so I kind of call it like I was doing EMDR gypsy therapy. But I actually like that I was kind of doing it off script a little bit. Although I do appreciate appreciate the EMDRIA training and I. I just think that like with any manualized therapy it can be become constraining in some way. So I think it was good for me to learn how to be unconstrained with the therapy and more integrative in other works that I’ve done and then also to kind of see the quote unquote by the book model. So anyway, so I not right at that time did I do clinical consultation. But I did it after that point. But I don’t think, I don’t really know if clinical grief came up in that. So segue into what else was helpful for me.
So I did a formalized time and grief therapy and specifically complicated grief work that I think assisted to some degree in helping me process that that particular loss. So I think I mentioned this on this podcast. I thought I recorded this whole episode and then the back half of it didn’t record. So this is coming out late to you on. So as I’m telling you this, this is actually Monday So it’s really fresh. So prolonged grief, Columbia Edu they have a center for prolonged grief where they provide clinical training, workshops and research and they also have a section for grievers and they have a self assessment tool and guides and other resources. So if you want to look at that. And it has like healing milestones, what to expect when you’re grieving, managing difficult times, and a little bit about prolonged grief and its treatment. They also have some informational podcasts and reasons why grief might last more time than we expect it to. And they also have a find a therapist section where you can find a therapist who’s trained in prolonged grief and might be more understanding of grieving and just maybe the complexity that might be part of grieving as a therapist. So I’d have you look there to see if there’s a therapist that has that particular specialty, if that’s something you’re dealing with. So I’m wanting to go down so many grief rabbit holes right now, but I won’t do that because I’m trying to get more of an overview. But perhaps if you guys want more on this topic, I can have someone come on and talk more about this model if it’s something you’re interested in. I think it’s something that grief has always been a part of my work as a therapist. When I did therapy, I worked with folks after a brain injury and so many times I used the ambiguous loss model because after brain injury, many times people lose a lot. They lose relationships.
Maybe they’re doing different work than they were able to do. Maybe they can’t work at all. They have a lot of personal losses themselves. Like they don’t think the same, they can’t do the same things. And so there’s no like lasagna people continue to bring after you’ve had a brain injury. They’re like, okay, yay, you’re better and oh, you’re not working and life is completely different and you’re still struggling with this. So I, I think in many ways it’s just been a touchstone in my work for me for a long time and it continues to be as I continue to talk with therapists in a non therapy capacity. So a big thing that helps me has been rituals again, walking and my client’s favorite park, allowing myself to have a beginning, middle and end of a grief experience. So I’ve mentioned some examples, but some examples of that could be lighting a candle, remembering your loved one, remembering your client, and then blowing the candle out. A grief walk where again, a Beginning, middle and end, where you start the walk, you think of your client and then you have a time where you try to put that, that memory aside for the moment until you have more resources to deal with the grief, to deal with the emotion. I think music is huge for me. I love music. I always have. And so perhaps it’s listening to song that I think my client might like or that’s healing to me and letting emotion come, letting myself feel that emotion of grief and paying attention to it. So I think all those rituals really help us to attend to our grief and give it space.
And we might have to do that really intensely in those initial phases of grief and then we come back to it. Right as I’m doing this podcast, I reminder remembering, perhaps I need to come back to this, come back to some of the losses that I have experienced over the many years of my work as a therapist. So I’d leave you with this. What would it look like to create a space for your own grief? Perhaps what rituals sense for me and that particular client. It’s lavender. But I’m also reminded of the other client that I lost in 2020 who was very playful and silly. And they also gave me a few touchstones. One of them is a snow globe that I have in one of my spaces and I frequently did a meditation with snow with that client and that’s why they give it to me. So I think of that meditation often. So thinking of these things, what are these rituals? How can you attend to grief to give it space? So tomorrow I am going to be kind of giving you a little guide on my pen pal list, on the email list for therapist. So that is the space. So the therapist pen palace. I’m sorry, I’m just. This has been a very emotional episode for me. So. Yeah. But tomorrow I am going to be releasing kind of a guide for you to think through some of these things. If you have grief from different aspects of the work, whether you’ve lost a client or perhaps you walked through a really traumatic situation where a client had a loss and you have your own secondary traumatic experiences around that loss, this can also be really helpful in that respect. So that all includes that on that email tomorrow. So if you want to sign up for that, the link is at the top of the show notes and I do write back and I just thank you so much for listening to this podcast. I’m just honored to be able to provide this platform and to, I think have hear back from you guys that it’s resonating, have a Good one, Sam.
