capturing the beautiful calamity of healing in therapy

This is what it feels like when a client commits suicide

Initially, it feels like the ultimate failure. It is the manifestation of the therapist’s worst nightmare, the brutal indication that someone could not be reached, that a life could not be saved, that a death to mental illness had to happen.

Initially, there are so many tears.

And everyone will tell you those tears are normal. Everyone will encourage you to embrace them.

Through the tears, the questions of what went wrong keep you up all night. It feels impossible to focus on anything or anyone else, and the world doesn’t necessarily slow down to accommodate your need for space or grieving. And, initially, you assume every other client will follow suit, that every client is suicidal, whether he or she discloses it or not, that you need to check-in immediately, and even if one denies having such intention, you question whether this is truthful.

Initially, the mind is clouded with the endless stream of could-ifs, what-ifs, should-ifs? What signs did I miss? What didn’t I assess? What wasn’t looked at?

What could I have done better?

Could this person have been saved?

We negate the suicides we’ve prevented, and focus on the one that was completed. We negate the success stories, because this one stands out glaringly above the rest. We dismiss what went well because there is no room for anything except the clear indication of what went wrong. 

And, then, the logic and rationalization starts filtering in.

Then, the sage advice that there is no cure for mental illness is told to you over and over again. People will tell you that you cannot account for anyone else’s choices, and that it is narcissistic to believe you actually have the power over anyone else. A friend will hug you and tell you that you are also a human, and that you don’t have the magic potion for recovery or success because nobody does. A supervisor will tell you this happens to every single therapist, that it is not a matter of if but a matter of when, especially when working with severely acute populations. A colleague will tell you that some clients, especially high-risk ones with several attempts and hospitalizations in their pasts, reach a point of no-return.

And, you will believe her for a moment, until you go back into your line of thinking that you were supposed to be the one to save her. 

You never believed the myth of no-return, anyway. You were above that, right?

You will be at war with yourself, with your profession, with everything you thought you believed.

You will never be the same, and people will continue to remind you this is part of the process, that this happens in any helping field.

And you will still stubbornly believe that you are the exception, because this shouldn’t have happened to you, because if you were good enough, you could have done something, you could have intervened better, you could have been the success story against all the odds.

You will have to remind yourself that you are also a human, and maybe that will be the hardest part. You are not a godly miracle worker, and despite any training or intuition, despite any intention or intervention, you still cannot always win the battle against severe, pervasive mental illness. To believe you can is to diminish the tragic complexity that is mental illness and suicide in the first place.

You will have to believe there is still value in your work, and that may also be incredibly difficult. The teacher cannot teach everyone; the doctor cannot heal everyone; the entertainer cannot entertain everyone. There will always be exceptions to any rule. To believe otherwise is to believe in a fallacy that can’t physically exist.

You will be impacted. Forever. At least that’s what I’ve been told. And I believe it. Suicide is death by choice; it is the decision to eliminate the agonizing pain that has become an individual’s life; it has become the only way out. We all know that suicide is a permanent solution to a temporary problem, but knowing holds very little weight to the person who is consumed by such severe depression and crippling trauma. Knowing, in that sense, doesn’t carry the same weight as feeling, which has become overwhelming and consuming.

As a therapist, you will also have some guilt, especially when your own life is going well. You will feel angry at the injustice of the universe, of the fact that some people just inherently are born with harder lives than others. You will wonder if there is purpose in your work.

You will be reminded, constantly, that there is purpose.

You cannot save anyone. You will have to remember that. People can only save themselves. You can only guide. You can only offer support and love and empathy and facilitation on their journeys through life and self-discovery. You will hope for them, but you cannot hold their hands. You will- if you’re lucky- have an hour or two with them a week, maybe more but usually less, and you will impart your wisdom and nurturance on them the best ways you know how. It will work for most, but it cannot cure anyone.

Mental illness is real. Depression is real. And, tragically, suicide is real.

You will remember that client forever.

You will still cry, and that’s okay, too.