When clients are in crisis or die: support for clinicians

Hearing about another person’s trauma can bring trauma-like reactions of your own. The National Child Traumatic Stress Network calls this a common occupational hazard for therapists and others who work with traumatized people.

A 2024 review found that, on average, about half of health care professionals in the studies had experienced a patient’s suicide.

OSHA says a clear policy that violence is not tolerated helps make it clear that assaults are not considered part of the job.

The Office for Victims of Crime lists

• Feeling emotionally numb or shut down
• Irritability or pulling away from people
• Physical complaints
• Sleep problems
• Trouble managing emotions

If these last for weeks, or you notice yourself using drinking or risky behaviour to cope, reach out for support.

Try

• Book a consultation or bring it to supervision
• If safety is involved, follow your agency’s on-call or consultation route instead of carrying it alone
• Name it: “That session is still with me.”
• Write down what you’re worried about and one thing you can do tomorrow

Clinicians often feel they have no right to grieve because they were “only” the therapist. But you knew this person in a deep way. Grief, guilt and replaying the last session are human responses.

Things that can help

• A private ritual to remember the person, while protecting confidentiality
• Taking time off if you need it, even a day
• Talking with colleagues who have been through it
• Your own therapy

Guilt and blame are among the most common reactions clinicians report. Going over the last session again and again is part of how the mind tries to make sense of a shock.

Gentle reminders

• Bring the questions to a supportive case review, not to 3 a.m.
• Grief and responsibility are not the same thing
• You can learn from a loss without punishing yourself for it

In the 2024 review, the share of professionals who felt they got enough support ranged from 11% to 87%. Many wished for more.

Informal support from colleagues was highly valued, and workplace culture and the support available may soften the impact.

Consider

• Ask for a peer consultation or case review that is supportive, not blaming
• Before talking with family or attending a service, consult about confidentiality
• If you are in private practice, contact your professional liability insurer or association for guidance on records and next steps
• Tell your supervisor or clinical director as soon as you can

Professional codes allow sharing information to get needed consultation, within the limits of the law. Ask a trusted colleague or your association’s ethics service if you are unsure what you can share.

Many clinicians become more anxious about risk after a client’s suicide. That is understandable. Talk it through in supervision so caution doesn’t turn into fear that harms your work or your health.

Ideas

• Ease back with a lighter caseload if possible
• Notice if you are avoiding clients with similar stories, and bring it to supervision
• Review safety planning skills with a colleague

Anniversaries, a similar case or a familiar name can bring the loss back. Planning support for those days is a normal part of grieving.

Plan ahead

• A lighter schedule around the date if you can
• A check-in with a colleague or your own therapist
• Something restful that evening

Try

• “I heard what happened. How are you doing?”
• “You don’t have to talk about it, but I’m here.”
• “Would it help if I covered something for you today?”

Avoid

• Asking for details out of curiosity
• Questions that sound like blame, such as “Did you see it coming?”
• Telling them to move on quickly

Ideas

• Check in again a week and a month later
• Cover a session or a phone call
• Help them find the right person to consult
• Walk with them to get coffee or some air

The Office for Victims of Crime suggests supervisors talk about these effects in supervision, offer flexible schedules, protect downtime, provide space for reflection, and connect staff with peer support, employee assistance programs or professional help.

Clinicians who lost a patient to suicide asked for supportive case review, debriefing and time off.

OSHA suggests

• Arrange furniture so you have a clear path to the exit
• Good lighting
• Panic buttons, a paging system or a personal alarm
• Seeing agitated clients in open areas that still protect privacy
• Where possible, counseling rooms should have two exits

OSHA suggests

• A buddy system when safety may be at risk
• A code word to signal trouble
• A phone or panic button with you
• Calling the office after each visit, with follow-up if you don’t
• Sign-in and sign-out procedures with the address and expected time
• The right to stop or skip a visit if you feel unsafe

Ideas

• Agree a plan for what you will do if the call drops during a crisis
• Confirm the client’s location at the start of each session
• Keep a local emergency contact on file

The APA Ethics Code says psychologists may end therapy when they are threatened or endangered by a client or someone connected to the client.

OSHA also says a clear policy that violence is not tolerated helps make it clear that assaults are not considered part of the job.

Jumpiness, poor sleep or dread before certain sessions are common after a frightening event. Support soon after can help these reactions settle.

Ask for

• A colleague nearby for the next sessions
• A review of the room or visit setup
• Time to talk it through in supervision

Whether to continue, change the setting or refer is a decision to make with your supervisor or a consultant. The APA code allows ending therapy when a psychologist is threatened or endangered.