“When a Client Dies”: A Commentary

Rena Rubel offers her readers a frank exploration of issues that arose for her when, in successive years, three of her psychotherapy patients died. Ms. Rubel examines each of these losses from at least two perspectives: that of the patient who is dying, and that of the therapist who suffers grief and mourning in isolation following the patient's death. One of her patients died suddenly; the other two suffered from chronic and life-threatening diseases. For the purpose of this response, I will only focus on the most recent loss, which is the impetus for her paper: that of a woman dying of breast cancer.

To be sure, the death of a psychotherapy client interrupts the timelessness, the hopefulness, and the final chapter of any therapy. Death intrudes and the patient and the therapist are unable to review their work fully or to terminate their relationship. Therapists and clients rely on the gift of time, and death undermines the therapeutic ideals of working through issues and bringing conflicts toward resolution. All this is complicated by the fact that the course of dying has changed in recent years. Given the newest medical technologies, neither patient nor therapist ever really “knows” with certainty when a patient is actually dying. In the past, fatal illnesses were progressive; nowadays a disease is often chronic and its course is marked by exacerbation of symptoms and hospitalizations,