Thank you to everyone who responded to our December Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
December Quandary: My mother recently passed away as a result of COVID-19, and it’s been interfering with my ability to focus on my clients. Sometimes when they mention a parent, I think of my mom and can barely hold it together. I didn’t get to say goodbye properly. I’ve been processing her death in therapy with my supervisor, but I know it’s going to take some time. In the meantime, how can I best get through my work? Should I take a break from practice? If so, what do I say to my clients? What should I do?
1) The Gift That Heals
To this therapist, I say this: I’m so sorry to hear about your mom’s death and how painful it must have been not to be with her at the end, and to not be able to celebrate her life with community and family. It makes complete sense that it’s hard to be fully, emotionally present for clients when your heart is filled with grief and you’re on the verge of tears. Worrying about your grief’s impact on the quality of your care for your clients must be very difficult as well.
Taking a leave may be the right answer for you. But before you do, I would invite you to consider sharing the news of your loss with your clients, as well as your concern that it could get in the way of you being present with them. I think you might be startled to discover the vast majority of your clients will appreciate your openness and respond with appropriate empathy. It might actually allow you to feel closer and more connected. Having shared your grief, you may discover that your painful, sad feelings are much less likely to be overwhelming.
Of course, it’s presumptuous for me to think I would know what’s best for you. So, I certainly hope you’ll explore my recommendation carefully with your therapist, supervisor, or close colleagues. I would completely support taking a leave if this suggestion doesn’t feel right. There’s no such thing as a one-size-fits-all intervention.
If you do decide to take a leave, I’d also recommend the same transparency when telling clients. Life-shattering grief is absolutely a good enough reason to have to take a leave. It not only demonstrates good self-care, but also concern for your clients’ well-being, assuming you can’t be fully present with them. Don’t be afraid to share your vulnerability and need for healing.
It’s important to keep in mind that we therapists have flaws and limitations, right alongside our clients. We’re not all-knowing experts who manage our own lives with ease. It’s how we learn to accept and work with our own pain that’s often invaluable to helping our clients deal with their own. Choosing wisely when and with whom to share our struggles is often the core of a successful therapeutic relationship. It can be the gift that heals.
David Treadway, PhD
Still River, MA
2) The Most Important Question
I’d like to praise this therapist’s dedication to her work, as well as her courage in asking for help getting through a loss that’s so new. In my opinion, the most important question she should be asking herself right now is how she can live while showing herself kindness and support.
Whether she decides to take a break or not, I’d advise that she be authentically herself. If she decides to keep working, she should let her clients know that she’s going through a tough personal loss and trying to balance the emotional toll with being available to them. If showing herself kindness alongside working becomes too exhausting, she should let them know she’s taking a break until she can return and be more fully present. Only she knows when that is. Sometimes we can’t predict the twists and turns of our own healing process.
An elderly client of mine was recently grieving the loss of her only surviving sibling. She’d come from a large, close-knit family, and told me that she felt like a lone planet spinning in a vast, dark, and empty space. All of those she’d loved, whose gravitational pulls had anchored her, were gone. Without them, she said, she didn’t know who she was, to whom she belonged, and what mattered to her.
These kinds of losses charge us with a huge and confusing reorientation. Who will we be, in all the domains in which we live and work, without that person? Like all lived experiences, we can’t figure this out as we would a logistical problem. We have no other choice but to open the door to whatever granular, cathartic moments we can find in the moment that help us hold our grief in a cradling narrative.
However much of an expert you are as a psychotherapist, remember that the continuing education units of lived experience give heart and scope to our work. Right now, the fear, grief and exhaustion accompanying the pandemic and the tumultuous election have linked us all in hardship while also tearing us apart. More than ever, take care of yourself.
Lisa Friedlander, LICSW
3) Tend and Befriend Grief
First and foremost, I want to tell this therapist how sorry I am to hear about the loss of her mother. I’m so sorry that the important rituals of saying goodbye and honoring her were robbed by COVID. Loss is so much more complicated when we can’t practice our grief traditions and rituals.
I remember all too well what it was like to see clients and do supervision after the death of my father. I experienced feelings I’d never felt before. I felt disoriented. I was shocked, embarrassed, and felt inadequate that I was managing my feelings and thoughts during sessions. I’ve learned that when the brain is working so hard to process grief, there’s not much room for anything else. In retrospect, I wish I’d taken more time off after my father’s death. The distress and disorientation I felt at work and home was compounded because I was taking on too much.
It’s only natural to lose focus and become disoriented during grief, especially now that the whole world is grieving. It’s difficult for us therapists to stay present and grounded during sessions, especially when those sessions also focus on loss. What’s more, in our lost states, we’re more susceptible to being critical, judgmental, or feeling shame about ourselves and how we do therapy. Feeling detached and self-judgmental does nothing to help our clients or ourselves.
To this therapist, I say this: I truly recommend that you take time off. You deserve this time to mourn. This time-taking might come in phases. It might mean taking off several days in a row, working part time, working half days, or just listening to your body and intuition. You might determine how and what you tell clients on a person by person basis.
However you decide to take time off, try to create rituals—large and small—that remember your mother. Integrate them into your day and your life. Invite your family and friends to join you, however possible. Plan how you’ll memorialize your mother after COVID. Ask yourself how you’ll share her memory with others. Maybe even set aside a few minutes every day to focus on the memories you created together.
Whatever it takes, don’t rush it. Go easy on yourself. Even if you take time off, it’s very possible that you’ll still lose focus from time to time. After my father’s death, I’d forget words. Everyday tasks became difficult. I had a hard time tracking conversations—years before I could blame old age. Being good to yourself takes time. Grief is our natural process toward healing. As we tell our clients, “tend and befriend” grief. In doing so, you’ll be kind to yourself and your clients.
Mary Jo Barrett, MSW
4) Practicing What We Preach
Losing a parent is huge, and deserves its own chapter in one's book of life. Losing a parent is like losing a thread that connects us to the unanswered questions about ourselves and our relationships. It forces us to face the fragility of life, the quality of our relationships, and what the passing symbolizes. For some, it may mean the loss of being a child, or the act of becoming an adult. For me, it meant losing a safe landing pad where I’d come to refuel.
I do my best therapy work when I’m grounded, meaning when I’m fully present with my clients and not only aware of what’s happening interpersonally between myself and the client, but also of what’s happening within me. In the past, the flicker of strong, personal emotions has derailed my sessions, like when I lost my beloved father-in-law. I tried to console myself by saying he wasn’t my father and that life would go on. But it did not. Luckily, I had an amazing supervisor at the time who helped support me. The experience made me realize that I should’ve taken time off to mourn the loss of a father figure who loved me as much as his own children.
Today, with this knowledge, I’d definitely recommend taking some time off—if financially possible—to let the heart heal, to mourn, and to pay tribute to a parent. It's hard to be present with clients when we’re hurting or having a parallel process. Showing them that we’re human, fragile, and have a breaking point is a strong reminder that we’re equals. By letting our clients know that we, too, need to practice self-care, we’re modeling what we ask them to do for themselves. We help them learn to hold themselves with compassion, practice self-care, and realize the value of vulnerability. What a gift.
Pallavi Kumar, LMFT
Isla Vista, CA
5) Vulnerability, a Two-Way Street
First off, I’m very sorry to hear about this therapist’s loss. During the COVID-19 pandemic, many clinicians have been supporting clients who’ve experienced personal losses, grief, and the added hardship of not being able to say goodbye properly. From this therapist’s note, it sounds like she’s already decided to seek support from her supervisor. I might also advise that she consider seeing a therapist as well.
This therapist also mentioned that when clients bring up a parent, she can barely hold it together. I think it’s absolutely fine to be open with clients if you can’t hold back emotion. It might start a larger dialogue about what kinds of statements can be triggering, and could ultimately be good for the therapeutic process. We therapists are human beings, and we struggle with losses just as clients do. Still, this doesn’t make it any easier to support clients through their personal losses while simultaneously dealing with our own.
In therapy, expressing emotion is a two-way street: therapists and clients should feel free to do so. It’s a sign of openness and authenticity. This doesn’t mean that therapists should share every feeling that comes up, but this particular situation is an exception. As long as it doesn’t change the dynamic enough to make clients feel like they have to support the therapist, and as long as the emotions you express don’t make the therapy hard to bear, I believe it’s perfectly acceptable to show emotion.
Last, if taking a break feels right for this therapist, I’d advise that she do it. It will give her time to concentrate on herself. In creating space for grief and a way to say goodbye properly, I’m confident that she’ll be doing what’s best for herself and her clients.
Andrea Stoll, couples counselor
6) You Don’t Need to Be Perfect
The fact that this therapist is keenly aware that her clients are triggering thoughts of this loss is a healthy step toward healing. If we aren’t aware of our triggers, it can often lead to countertransference. Some therapists say that transference and countertransference are normal parts of the therapeutic process. But that doesn’t mean that if it happens, we shouldn’t take any steps to address it. We need to lean into these emotions when this occurs, and get supervision or seek therapy ourselves.
As for the question of whether or not to take time off, I’ve found that therapists are often their own best judges as to whether taking time off is appropriate. We need to keep in mind that even though we’re clinicians, we’re people too. On this note, I’ve found that clients are usually receptive to their therapists taking time off for self-care. They want to know they’re in the presence of a human being, not a one-dimensional figure who teaches them something from a book. They want an authentic experience. Don’t get me wrong—it’s our job to show up in a clean, professional manner, and our ethical obligation is to put clients first, but we have to define for ourselves exactly what this looks like. Our field has made strides in dismantling the stigma that therapists need to be perfect. Let’s keep it up.
Angel Powers, social worker (RSSW)
Next Month's Quandary: Many of my clients like to talk about their New Year’s resolutions, like eating better, exercising more, being kinder to their spouse. But I’ve found over the years that as excited as they may be at first to change their habits or behaviors, they often get discouraged, even despondent, when big changes don’t occur and they don’t meet their expectations for themselves. What are some concrete strategies, or even metaphors, I can use to help my clients start the new year with hope and not get overwhelmed with disappointment?