The Quiet Grief of Counselors and the Complexity of Loss

By Daniel Balva, PhD, LMHC, NCC

Death, dying and grief are often underdiscussed in clinical training programs and professional development. Loss and grief are realities of life that affect every client in some form — whether through the death of a loved one, the passing of a beloved pet, the loss of a job or dream, or the loss of physical ability or independence.

As much as counseling professionals focus on supporting clients during such instances, we must also acknowledge the ways loss inevitably enters our own lives and recognize that we, too, are not immune to profound life circumstances.

When working with clients, we recognize the importance of discussing termination early on and preparing for the eventual conclusion of counseling. When clients successfully complete treatment, we may feel pride and joy in their progress while also experiencing a quiet loss of the end of the therapeutic relationship. As time passes, we may still find ourselves thinking about former clients, hoping they are continuing to flourish in their lives. 

Termination-related loss is a regular part of the cycle of counseling that is experienced repeatedly. However, what is often missing from training — particularly for clinicians outside of palliative care — is the realization that some clients may die during our work together due to medical circumstances, and the alienating and profound sense of loss this can bring. Although we recognize mortality as an inevitable reality and are often called to help clients process grief in their own lives, I could never have imagined how difficult it would be to grieve someone with whom I was still working. 

Managing the Reality of Client Loss

I recently experienced the loss of a client. We had spoken openly about the advanced stage of their diagnosis and understood their time was limited, though the exact time frame was uncertain. So, when I logged into their medical record to initiate a brief follow-up call between appointments, my heart sank at the unexpected sight of a death note indicating they had passed recently. 

I was not prepared for the toll this loss would take. Only a few months earlier, I had experienced my first client loss due to medical complications, and I was still trying to process the impact of the unanticipated loss and subsequent grief. With this client, we knew time was short, yet we both held onto hope there would be more time ahead. 

Care and the Therapeutic Relationship 

As with anyone, counselors’ responses to grief can vary, whether marked by a significant emotional impact, reactions that go unrecognized or unaddressed, or deep reflection on one’s work and purpose. After this recent loss, I found myself thinking about a different client who had told me no one truly cared about them, including me, and that I was simply doing my job and collecting a paycheck. As someone who believes deeply in unconditional positive regard and the power of the therapeutic relationship, their words have stayed with me.

I hope clients leave our sessions with a felt sense of their worth and the knowledge that they are truly cared about. Yet since my client’s passing, I have found myself grieving their loss while also holding the weight of the other client’s words. How often do our clients wonder if we truly care? As counselors, how can we challenge ourselves to be more present, compassionate and intentional? 

Processing and Carrying Grief Forward

Unexpected client loss can bring a profound sense of grief that is often difficult to process. This experience is further complicated by constraints related to the Health Insurance Portability and Accountability Act, which may limit the support we can seek from our usual networks, intensifying feelings of isolation and making grief even heavier to bear. 

Peer consultation, supervision, collegial support and time to pause, take stock and tend to personal needs are essential during this time. However, there is no remedy for processing unexpected client loss. We owe it to ourselves to acknowledge and sit with the resulting emotions when we feel ready. In doing so, might we allow ourselves to also take pride in just how much of an honor it is to connect with clients who let us accompany them on their journey while simultaneously leaving a lasting impact on us? 

Clients deserve to be seen, heard and valued during counseling, while knowing we are rooting for them and accompanying them, sometimes even in their final days. What they may not realize is that we, too, grieve when they are no longer with us, and they continue to hold a special place in our hearts long after they are gone. 

As with any loss, we can hold more than one emotion at once. Alongside sadness and grief, we carry the warmth of a client’s laughter, the impact of the work they did in treatment and the honor of having been part of their lives. Perhaps it is time we speak more openly about the quiet grief counselors carry and explore how we can use that grief to better support ourselves, our colleagues and our future clients.

Note: Opinions expressed and statements made in this blog do not necessarily represent the policies or opinions of ACA and its editors.