Clinical Intersections: Loss and the Edge of Loss

by Peter Zook, MSW, LCSW

     As social workers, we sit with a lot of loss. Depending on the type of social work, the death of a client can be a regular part of the work. For me, that’s not the case, or at least it wasn’t until this year. Losing one client in a year is a lot. Almost losing another one is enough to make you contemplate leaving the profession to go sell furniture at West Elm. Or maybe that’s just what I would do. An almost loss is sometimes close to, or just as scary, hard, and painful, as an actual loss.

     These two experiences could not have been more different, and yet, they felt so similar to me. I’m still in the relatively early stages of being a therapist, and this was my first time having a client die. It was also my first time almost losing a client to a very real suicide attempt. My client who died was too young, too sick, and didn’t have enough support. I’ll call him David. He had multiple chronic illnesses and felt it was time to stop medical interventions; hospice agreed, and so did I. His death took time. It was slow, and difficult to be present with.

     My client who tried to kill herself also feels like she doesn’t have enough support. I’ll call her Nadia. She sits with a lot of despair. She’d been planning, and I tried to stop it. Although I feared an attempt, it still felt sudden.  

     These two losses, one near and one final, intertwined with each other, both in time and in my psyche. I found out about David’s death right before my 4 o'clock client showed up. My co-worker knew from a community member and wasn’t sure how to tell me. She had something to share, but thought maybe it should wait until I was done for the day. But I’m masochistically curious and wanted to know. 

     She was right. I should’ve waited. 

     I sat down, took a breath, and then grabbed my next client. I was barely listening to a word he said. I paused him, went to the front desk, and told our admin to cancel my last two clients. I went back to my client, apologized, and was able to listen better. Then I walked home 16 blocks on a chilly, yet sunny day. 

     The next day was the funeral, so I went. And then I headed directly to work to see the rest of my clients for the day. 

     I didn’t take any time off. I didn’t skip a beat. 

     I talked to my therapist, friends, and family about it. I told myself I was grieving, that I was having my feelings, and kept on going, which is not the same as actually having my feelings. 

     I found out Nadia was in the hospital from our staff administrator. I happened to be finished with my day when she came into my office with a Post-It with my client’s brother’s phone number and a brief, but chilling message. Again, I sat down, took a breath, and then picked up the phone. I don’t remember how I got home that night, or what I did after. The next day, I woke up and decided I couldn’t go in. I needed to stay home and actually be with my feelings this time. I canceled my sessions and booked a massage. 

     It was beautiful out. A rare, crisp summer day with a cool breeze and hug of warmth from the sun. I’d never been so grateful to not be at work. When I showed up for my massage, I wasn’t even thinking about David. Nadia was the only thing on my mind. The deeper the masseuse got, the more I could feel and connect to what I was holding onto. It was then that I realized just how sad I was to have lost David. How unfair it was. How scary it had been. How much I hated that it even happened. Which is exactly how I was feeling about Nadia’s experience. 

     We are asked to hold so much, and sometimes it can feel like too much. Sometimes I really don’t want to hold what I’m being asked to hold. Sometimes I can’t.

     And that’s when it’s time to take a break. 

     Be it a day off, or even more. Looking back, I can’t believe I kept going to work the week David died. I don’t know what would have been different if I had taken a break. I just know that in the future, I’m going to give myself time and space to heal when I need it. 

     The day off wasn’t just for me, either. It was for Nadia and all my other clients. I knew I was going to be needed a lot more in the coming weeks. In order to deliver, I needed to recoup and regenerate. I really did clear my head that day after submerging in and riding the waves of my feelings. I knew what I needed to do and what boundaries to set. I felt a lot less scared and was ready with just having had a little time on my side. 

     I can let myself think and feel about David now, too. I recently had dinner outside, across the street from his hospice building. Originally, I sat myself facing the other direction, but my pregnant friend needed us to change seats. I obliged and stared at the building for a minute. Calmness came over me as I remembered him. I smiled to myself and then went back to the conversation. 

Originally from Ohio, Peter Zook, MSW, LCSW, received his Master of Social Work from Temple University. Peter works as a psychotherapist in Philadelphia at Walnut Psychotherapy Center and privately. He believes in the healing power of the relationship, providing LGBTQ-affirming care that is rooted in social justice and influenced by psychodynamic frameworks.