Losing a client to suicide or a substance overdose can bring up a layered, complex concern for counselors, who may be faced with the duality of their professional obligations and liability to the deceased client, alongside the loss of a deeply personal therapeutic relationship. Upon losing a client due to mental health concerns, several clinical supervisors and agencies may often focus exclusively on the several ethical and liability issues and concerns surrounding intervention reassessment and suicide prevention planning, there is very little research or standardized policy on professional support offered to the bereaved clinician. The confidential nature of the therapy relationship results in disenfranchised grief for the clinician, who is unable to publicly acknowledge or grieve the loss, necessitating the need for policy implementation for agencies as well as greater awareness, sensitization and training on supporting bereaved clinicians for therapists and their supervisors alike. This paper aims to offer a comprehensive literature review on the experiences of bereaved clinicians and the role of the clinical supervisor in supporting the clinician during the grief process. This paper also examines existing protocol recommendations for clinical supervisors of mental health counselors and therapists in the aftermath of client death, to support clinicians navigating such losses.
BernardJ. M.GoodyearR. K. (2018). Fundamentals of clinical supervision (6th ed.). Pearson Allyn & Bacon.
6.
DardenA. J.RutterP. A. (2011). Psychologists’ experiences of grief after client suicide: A qualitative study. Omega, 63(4), 317–342. https://doi.org/10.2190/OM.63.4.b
7.
DokaK. J. (1989). Disenfranchised grief. In DokaK. J. (Ed.), Disenfranchised grief: Recognizing hidden sorrow (pp. 3–11). Lexington Books/D. C. Heath and Com.
8.
DraperB.KõlvesK.De LeoD.SnowdonJ. (2014). The impact of patient suicide and sudden death on health care professionals. General Hospital Psychiatry, 36(6), 721–725. https://doi.org/10.1016/j.genhosppsych.2014.09.011
9.
DupreM.EchterlingL.MeixnerC.AndersonR.KieltyM. (2014). Supervision experiences of professional counselors providing crisis counseling. Supervision Experiences of Professional Counselors Providing Crisis Counseling, 53(2), 82–96. https://doi.org/10.1002/j.1556-6978.2014.00050.x
10.
FairmanN.ThomasL. P.WhitmoreS.MeierE. A.IrwinS. A. (2014). What did I miss? A qualitative assessment of the impact of patient suicide on hospice clinical staff. Journal of Palliative Medicine, 17(7), 832–836. https://doi.org/10.1089/jpm.2013.0391
11.
FordD. (2010). Junior clinical, psychologist experience of processing, the date of a therapy, client, from a cause other than suicide: A qualitative study [doctoral dissertation, University of Hertfordshire]. University of Hertfordshire, PhD Theses Collection.
12.
GillI. J. (2012). An identity theory perspective and how trainee clinical psychologist experienced the death of a client by suicide. Training and Education in Professional Psychology, 6(3), 151–159. https://doi.org/10.1037/a0029666
JorgensenM. F.BenderS.McCutchenA. (2021). I’m haunted by it: Experiences of licensed counselors who had a client die by suicide. Journal of Counselor Leadership and Advocacy, 8(2), 100–115. https://doi.org/10.1080/2326716X.2021.1916790
16.
KleespiesP. M.PenkW. E.ForsythJ. P. (1993). The stress of patient suicidal behavior during clinical training: Incidence, impact, and recovery. Professional Psychology: Research and Practice, 24(3), 293–303. https://doi.org/10.1037/0735-7028.24.3.293
17.
KnoxS.BurkardA.JacksonJ. A.SchaackA. M.HessS. A. (2006). Therapists-in- training who experience a client suicide: Implications for supervision (4). College of Education Faculty Research and Publications. https://epublications.marquette.edu/edu_fac/4
18.
Kramen-KahnB.HansenN. D. (1998). Rafting the rapids: Occupational hazards, rewards, and coping strategies of psychotherapists. Professional Psychology: Research and Practice, 29(2), 130–134. https://doi.org/10.1037/0735-7028/29.2.130
19.
LinkeS.WojciakJ.DayS. (2002). The impact of suicide on com-munity mental health teams: Findings and recommendations. Psychiatric Bulletin, 26(2), 50–52. https://doi.org/10.1192/pb..26.2.50
20.
McAdamsC. R.IIIFosterV. A. (2000). Client suicide: Its frequency and impact on counselors. Journal of Mental Health Counseling, 22(2), 107–121.
21.
McAuleyA.ForsythJ. (2011). The impact of drug-related death onstaff who have experienced it as part of their caseload: An exploratorystudy. Journal of Substance Use, 16(1), 68. https://doi.org/10.3109/14659891.2010.487555
22.
MenningerW. W. (1991). Patient suicide and its impact on the psychotherapist. Bulletin of the Menninger Clinic, 55(2), 216–227.
23.
MitchellJ. T. (1983). When disaster strikes. The critical incident stress debriefing process. Journal of Educational and Management Studies, 8(1), 36–39.
24.
MurthyV. H. (2017). Facing addiction in the United States: The surgeon general’s report of alcohol, drugs, and health. JAMA, 3(17), 133–134. https://doi.org/10.1001/jama.2016.18215
NeimeyerR. A. (Ed.), (2001). Meaning reconstruction & the experience of loss. American Psychological Association. https://doi.org/10.1037/10397-000
27.
O’BrienJ. (2011). Wounded healer: Psychotherapist grief over a client's death. Professional Psychology: Research and Practice, 42(3), 236–243. https://doi.org/10.1037/a0023788
SalpietroL.AusloosC. D.ClarkM.ZacariasR.PerezJ. (2023). Confidential grief: How counselors cope with client suicide. Journal of Counseling and Development, 101(4), 461–474. https://doi.org/10.1002/jcad.12484
31.
SperandioK. R.GoshornJ. R.MohY. S.GonzalezE.JohnsonN. G. (2023). Never ready: Addictions counselors dealing with client death. Journal of Counseling and Development, 101(1), 29–45. https://doi.org/10.1002/jcad.12440
32.
Substance Abuse and Mental Health Services Administration. (2009). Clinical supervision and professional development of the substance abuse counselor. National Institute of Health. https://www.ncbi.nlm.nih.gov/books/NBK64848/
33.
Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 national survey on drug use and health (HHS pub. No. SMA 18–5068, NSDUH series H-53): Center for Behavioral Health Statistics and Quality. https://www.samhsa.gov/data/
34.
TingL.SandersS.JacobsonJ. M.PowerJ. R. (2006). Dealing withthe aftermath: A qualitative analysis of mental health social workers’reactions after a client suicide. Social Work, 51(4), 329–341. https://doi.org/10.1093/sw/51.4.329
35.
TsuiE. K.FranzosaE.CribbsK. A.BaronS. (2019). Home care workers’ experiences of client death and disenfranchised grief. Qualitative Health Research, 29(3), 382–392. https://doi.org/10.1177/1049732318800461
36.
ValentineC.BauldL.WalterT. (2016). Bereavement following substance misuse: A disenfranchised grief. OMEGA-Journal of Death and Dying, 72(4), 283–301. https://doi.org/10.1177/0030222815625174
37.
VeilleuxJ. C. (2011). Coping with client death: Using a case study to discuss the effects of accidental, undetermined, and suicidal deaths on therapists. Professional Psychology: Research and Practice, 42(3), 222–228. https://doi.org/10.1037/a0023650
38.
WagnerN. J.GrunhausC. M. L.TuazonV. E. (2020). Agency responses to counselor survivors of client suicide. The Professional Counselor, 10(2), 251–265. https://doi.org/10.15241/njw.10.2.251
39.
WhisenhuntJ.DuFresneR.StargellN.RovnakA.Zoldan-CalhounC.KressV. (2017). Supporting counselors after a client suicide: Creative supervision techniques. Journal of Creativity in Mental Health, 12(2), 1–17. https://doi.org/10.1080/15401383.2017.128118
40.
WordenJ. W. (2004). Grief counseling and grief therapy (3rd ed.); A handbook for the mental health practitioner (3rd ed.): Brunner-Routledge.
