“I Want You to Be There.”: Accompanying a Client Through a Death By Kevin Hull, PhD on 8/29/19 - 4:45 PM

“Hey Kevin? My mom has had a stroke and is in the hospital. It’s really bad this time.” My client’s voice quivered, and I could hear fear rippling through it. After asking a series of preliminary questions, I closed my computer and headed to the car to drive to the hospital. It had been, until that moment, a free afternoon of writing and grading assignments. I pushed aside the nagging voice listing all the things that would not get done and focused instead on my client and his mother.

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He was about five years old when I first met him and his mother nearly seventeen years prior. A single mother, her son was attending an afterschool program where I had been counseling for about a year. He had many neurodevelopmental challenges, along with ADHD, anger and emotional outbursts that resulted in physical altercations with teachers and peers. I worked with him through elementary, middle and high school, and eventually helped him through the transition from high school into adulthood. Each year of development brought new challenges, but with those came developmental achievements so that by high school, he no longer experienced meltdowns and functioned very much like a neurotypical adolescent.

If ever there was a picture of the analogy of “mama bear,” it was my client’s mother. She had lived a hard life, complete with childhood attachment trauma and a string of relationships with adults that had neglected and abused her. She had finally found love in my client’s father and had managed to create a safe and loving home for the three of them. They did not have much in terms of money or possessions, but she was committed to doing whatever was necessary to get her son the help he needed. I had numerous parenting sessions with her to help her understand her son’s challenges and how she could him. Over the years, due to a lack of available counseling as a result of low income, I ended up doing a lot of individual counseling with her to overcome previous traumatic events that had plagued her for many years.

She had also experienced health problems for many years which was a constant source of worry for my client. He, like many young people on the autism spectrum, found a special sense of safety with his mother. She was a source of strength for him, and while they had their battles during his teen years, she was the most important person in his life. As I drove to the hospital, my mind raced with thoughts of worry over how he would cope if he lost her. And what about his father who was now on full disability? How would my client navigate it all? Upon arriving at the hospital, we found out the news was not good. My client’s mother was not breathing on her own and there was little brain activity. For the next several days, there was no change and finally the doctors met with my client and other family members to tell them that there was nothing that could be one. The process of shutting off life support would be necessary.

I remember feeling a number of conflicted feelings. I truly cared for this woman and admired her strength and resolve in the face of many life challenges. A survivor of childhood neglect and abuse, she had a special place in my heart. I felt the sadness and anger of immediate grief, and an overwhelming sense of helplessness seeing her lying in the hospital bed hooked up to tubes and wires. But my client needed me. Right now. He was scared and worried, having immense responsibilities and decisions thrust upon him in just a matter of hours. I found myself having to shove aside the grieving and shift my focus to him. Finally, after much deliberation, my client chose a date and time for the removal of life support. He called me to let me know. “I want you to be there,” he said; “I want you to be with me when it happens.” I assured him that I would be.

The final hours were excruciating at times, yet it brought a sense of honor to be a witness and to help my client say goodbye to the person he loved more than anything in the world. I stood by my client and his family members, laughing at funny stories, and offering words of comfort and encouragement. As his mother took her final breath, I held him and felt the heaving tension of unadulterated grief in the muscles of his back and shoulders, and the hot tears flying from his eyes. I prayed silently and wept too, for I realized that I had lost a dear client who had trusted me with her most valuable possession. I stayed with my client through the evening as he navigated the details of the handling of the remains and made preliminary funeral plans. The funeral soon followed, and he delivered one of the most beautiful eulogies I have ever heard. It was an amazing experience to witness the poise and spiritual grounding of this young man who, at one time, struggled with social situations and expressing himself.

The ethics codes divide our world as therapists into neat little boxes that work so well on paper. Yet, at times, thrown into the fray of life with all the ugly that comes with it, we find ourselves in roles that are uncomfortable and unfamiliar. My journey into the shadow of death with my client forced me to be a case manager, community liaison, spiritual guide, and at times, just a simple human being who joined another human being in the process of grief and loss. I have learned through this experience that our work is sacred, and that the therapeutic relationship can stretch far beyond the 50-minute safety zone of an office. At times, I did not want to be in this position, and I was uncomfortable. Now; however, I see that in the discomfort, both mine and my client’s, was growth for which I am now very thankful.  

File under: The Art of Psychotherapy