Sometimes a client comes along who makes it all feel worthwhile. You begin to feel discouraged and believe that all the hard work you are doing may not make a difference after all, and then a client comes along who really “gets it.” They latch onto recovery and run with it like the wind. Jennifer was one of those clients.

Jennifer’s story is a familiar one; she had survived multiple traumas — physical and sexual abuse as a child, rape, severe domestic violence, and abandonment. She started using alcohol and marijuana at age 12 to numb the painful memories, and by age 16 she had graduated to cocaine, heroin, and methamphetamines. She also had a full-blown eating disorder and was cutting herself.

She truly was a client with “co-occurring disorders.” By her early 20s, she had collected numerous diagnoses — attention deficit hyperactivity disorder, schizoaffective disorder, depression, post traumatic stress disorder, borderline personality disorder, etc. — until the mental health professionals finally settled on bipolar disorder. She had been on at least 10 different medications, and was pretty disgusted with all doctors, and when she arrived at the hospital where I work, at age 29, she had “failed treatment” twice, had her children removed by the child welfare system, and made several suicide attempts. She had alienated her family and sober friends, and was facing legal charges for DUI, prostitution, possession, and theft. She was sick and tired of the lifestyle and ready for a change.

It took Jennifer a while to trust anyone, but once she did learn to trust, she actively engaged in therapy. I saw her in individual and group therapy every week for six months, and the rest of the team saw her in many other groups. Her bipolar disorder was stabilized on medications, and she had no instances of hurting herself or bingeing and purging. She completed a written relapse prevention plan, attended Narcotics Anonymous meetings, and made plans for follow-up outpatient treatment. She had goals and was hopeful about her life. I believed that she would be one of the success stories.

Once the judge decided Jennifer had served her time in the hospital, she was abruptly discharged to the streets. She was homeless, with no money or food, no medications, and no referrals for follow-up care. Within days, Jennifer was found dead in a cheap motel, the result of an overdose. No one knows if the overdose was a suicide or an accident.
This was a beautiful, bright young woman, full of potential, with her whole life ahead of her. She seemed committed to her recovery, and she knew what she had to do to stay clean and sober. I knew that I had done all I could for her, as had the rest of the team, and I was in shock. What went wrong? How could this have happened?

Jennifer’s death was a turning point for me, professionally. To work that hard with someone and have them die anyway made me reexamine myself, the systems we work in, therapy, God, and life itself. I cycled through bouts of anger, sadness, depression and self-doubt. Why was I doing this? Was I really helping anyone or was I just deluding myself into thinking that I was doing something important?

My colleagues were somewhat supportive, but there were only a couple with whom I could really share my feelings. After all, the “conventional wisdom” is that as a therapist, you are supposed to be objective and emotionally detached — to show compassion for clients, but not let their problems affect you. If they do, there is always the fear that a colleague will be thinking, “Boy, she sure got over-involved with this one. She must have boundary issues.”

However, nothing could be further from the truth. No matter how skilled we are as therapists, and no matter how clear our boundaries are, we do (and should) become attached to our clients. If we stop caring or maintain too much “therapeutic distance,” we lose our effectiveness. Our clients need us to really be with them in their pain; our caring is a crucial part of their healing. If we do not acknowledge this fact, we damage ourselves, our clients, and our colleagues. We begin to feel ashamed of having our feelings, and do not allow others to have theirs.

The flip side of this truth is that we do have to monitor our counter-transference. We cannot afford to “take on” as our own the feelings or problems of our clients. If we do this, the emotional burden is too heavy and we will most likely develop “compassion fatigue.” As a result, we will become too burned out to help our clients, colleagues, families, or ourselves.

We have to have just the right mix of closeness and distance. So, how do we find this delicate balance? How do we interact with clients and care about them without taking on their feelings? And, how do we go about supporting each other to have our feelings, care about clients, and grieve when we lose them?

In addition, we must consider the other professional losses we face. While less dramatic, they can still take an emotional toll, especially when they accumulate or are coupled with losses in our personal lives. Some of these may include: a client disappears from treatment without any closure; a client relapses, commits a crime, and is arrested. the systems we work with limit or prevent us from helping a client; a colleague we care about retires, dies, or moves on to another job; a program is restructured and our job description changes to include duties we do not enjoy; or we lose our job due to funding cuts or politics, or we are one of the ìlucky onesî who survives the layoffs but are now expected to do the work of two or three counselors.

Acknowledge and accept the loss
In substance abuse treatment, we talk about addiction as a “progressive and fatal disease,” and a disease fraught with relapses. If this is true, we are bound to have some clients who die, relapse, disappear, or end up in prison. Constant changes in regulations, policies, and funding produce other losses. Grief and loss is an inevitable part of working in this field. We would do better to accept it openly rather than pretend that it does not affect us.

Don’t blame yourself
Especially when a client disappears or dies, you may be plagued with “what ifs” and “if onlys.” Use the skills you would teach your clients to stop these thought processes. It was not your fault and you probably could not have done anything to save your client.

Look for other losses
Look to see if there are other not-so-obvious losses happening in our lives, or old unresolved losses that are being triggered by this loss. It should have been obvious to me that Jennifer’s death probably hit me harder that it might have ordinarily because it came at the same time that my mother was battling cancer and my close friend and co-worker retired. I didn’t see the connection until a colleague pointed it out to me. No wonder I was struggling to force myself to come to work in the morning. I was grieving three losses at once!

Feel the feelings
This is the advice we would give our clients, so why do we have such a hard following it? The answer is simple: Because it doesn’t feel good! We would much rather drown the feelings in overworking, overeating, smoking, computer games, TV, sex, risk-taking behaviors ... the list goes on. So, let yourself grieve.

Develop rituals
Whenever possible, it is important to say good-byes and have a sense of closure. Memorial services, good-bye parties for colleagues, and graduation ceremonies are all ways of ritualizing loss. If you are unable to attend a client’s memorial service or it is inappropriate, clinically, then hold your own service.

Seek balance
One thing that mental health and substance abuse professionals often do not do very well is play. We become too serious, and we can forget how to laugh, have fun, and enjoy life. Our relationships with family and friends suffer as we get caught up in the seriousness of the traumas our clients have experienced.

Nurturing healthy relationships outside of work is important, to avoid getting a skewed view of reality. We all need exercise, sleep, nutrition, down time, fun, and time spent on spiritual growth. Take breaks during the day, and make sure that you get away at lunchtime. Practice setting boundaries and saying “no” to trying to do too much. Lastly, many healthy counselors engage in some type of creative “right brain” hobby such as music, painting, or writing.

Support each other
Talk about grief and loss as a team ahead of time, before the crisis hits. Develop case consultation groups and make them a priority, especially when you are most stressed out and don’t think you have time to attend. Agree to give each other permission to talk about clients you are struggling with and how you are emotionally affected by a case. Be gentle with one other, validate each other’s feelings, and encourage each other to practice self-care. Be purposeful in finding specific ways to create a healthy environment of safety and trust. Talk about this issue with supervisors and administrators to get their “buy-in” for systems changes.

Know when it’s time to go
Most systems can be changed, even if slowly. Sometimes, however, a system is so dysfunctional that it is damaging to your physical and mental health. If you are unable to implement needed changes in your agency, you may need to consider leaving the job and finding a healthier environment.

We have much to learn from Jennifer and the other clients we have lost. I still and the other clients we have lost. I still believe that treatment does work, and I see the evidence of this in many other clients. If Jennifer’s death can teach us to be more compassionate and caring with ourselves and our colleagues, we will ultimately be even better therapists. Our clients will benefit, and so will we. Then, her death will not have been in vain.

Author’s Note: Jennifer’s name and some of the facts in this case have been changed for purposes of confidentiality.

Beth Andrews is a Licensed Clinical Social Worker and Certified Addiction Counselor in Colorado and an adjunct Professor at the University of Phoenix. She can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

This article is published in Counselor,The Magazine for Addiction Professionals, February 2006, v.7, n.1, pp.42-44.

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LzyOldFrt   |68.206.146.xxx |2007-05-03 03:33:19 [smiley=sad] Reply | Quote 0   0

Curtis Tate   |205.241.48.xxx |2007-08-03 09:38:13 This article really get's to the heart of the matter with connnecting counter transferrence to compassion fatigue. Thanks for the timely and informative article! Sincerely, Curtis Reply | Quote 0   0

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