The Effects of Estrangement on Adult Children

What if I told you that the experience of estrangement often feels like someone has died? At least initially. It’s not an easy decision for adult children who estrange from their parents (as one example) and experts have discovered that the grief and loss response to estrangement is similar to our anguish or pain response when someone we love dies. Dr. Kylie Agllias (2016) recognizes that “estrangement is a particularly difficult loss to accept because it has no predetermined outcomes or end points.” Within her research, Agllias (2016) describes a grief response to estrangement where a person is mourning someone as if they have died, which can feel painfully accurate when permanent estrangement occurs and reconciliation isn’t an option.

Symptoms of Estrangement

Even with personal agency to end a relationship through their choice to estrange, many adult children can’t predict the significant reactions and emotions that will arise with their decision, resulting in feeling a sense of shock when they are fully immersed in it. They struggle with grief and loss symptoms, some of which include:

● Sadness

● Anger

● Shock

● Helplessness

● Shame

● Guilt

● Loss of identity

● Feelings of blame

● Feelings of failure

● Social avoidance

The estranged adult child may report strain and mistrust in other relationships due to the circumstances of their estrangement. They may report difficulty trusting others or leaning significantly on their partner or other family members to prove that estrangement is not the fate of all their family relationships. An adult child may report symptoms of anxiety or trauma responses, such as:

● Muscle tension

● Headaches

● Hypervigilance

● Sleep disturbance

● Difficulty controlling thoughts

● Avoidance

● Rumination on all that happened prior to estrangement

● Flashbacks

With prolonged symptoms and repeat triggers for grief, the stress of the relationship rupture can result in chronic stress symptoms for some adult children, especially women including:

● Hair loss

● Weight gain

● Inflammation

● Moodiness

● Elevated cortisol levels

● Adrenal fatigue

● Thyroid conditions

● Sleep disruption

● Water retention

● Brain fog

● Headaches

● Fatigue

It’s not hard to imagine how reporting these symptoms to a medical doctor could lead to a diagnosis of anxiety, depression, or Post-Traumatic Stress Disorder (PTSD). However, are we missing the mark in not asking about relationships and their contribution to an individual’s symptoms? It could generate a clearer clinical picture to ask a client or patient to describe their current relationships by asking questions like, “How are your relationships right now? Who are you closest to in your family? Who do you rely on for support?” By asking several questions about family dynamics and relationships, professional helpers begin to explore the physical, emotional, and relational impact of estrangement on an adult child’s mental health presentation when seeking support or starting therapy. 

It’s important to emphasize that not all symptoms listed above have to be present, nor do they have to be severe or long-lasting. Some folks will have the symptoms they experience from estrangement lessen over time, similar to other grief and loss experiences where symptom intensity may be reduced with time and space. Some healing happens in a process we’ve named the Estrangement Energy Cycle.

The Estrangement Energy Cycle

The Estrangement Energy Cycle starts with a pattern or cycle of abuse. This may be the culmination of various attachment traumas from childhood that were not acknowledged or addressed by a parent, or it can be a series of events that have happened more recently in the adult child’s life.

After gaining awareness about an abuse cycle, an adult child can move into a stage of questioning. This can reflect their ambivalence about the parent-child relationship, including questioning their own part in it not feeling healthy or good enough. This stage can also represent an adult child wondering if they try harder or communicate more effectively, maybe they can get through to their parent.

If an adult child determines that the cycle of abuse and dynamics within the parent-child relationship are damaging to their health, they may then move into relationship rupture. This is a painful stage where the processing of the abuse and the implications for how it’s shaping the adult child’s life in the present cannot be unseen or ignored any longer. Typically an internal process where they recognize the impact of abuse, they may have epiphanies about poor boundaries and people-pleasing, or identify a connection between their quest for perfection and seeking approval and love from a parent. Relationship rupture can also occur from an additional event of hurt or violation from the parent in question, that pushes the adult child from contemplation to preparation for estrangement in wanting the repeated abuse to end. 

From a painful relationship rupture comes the active choice to become estranged. The choice is a challenging one, resulting in a move toward grief and loss. The grief and loss stage includes finding space for the adult child’s emotions and self-doubt about their relationship with their parent. After extensive grief and loss work, an adult child can move to discovering a new sense of self. How will they define themselves now that estrangement from their parent has occurred? What will other relationships look like with healthy boundaries in place? An adult child may seek new communities of connection and new hobbies or interests in feeling unburdened from the unhealthy relationship or repeated conflict with their parent. 

The deeper work comes with the support of others, whether it be a spiritual congregation, wellness-focused community, or engaging in ongoing mental health therapy. An adult child may recognize that they’ve done all they can on their own to heal from this estrangement, but find they need additional support and guidance to continue the work. The final stage of the Estrangement Energy Cycle is redefining self- worth. Through hard work, reflection, and developing healthy relationships with others, an adult child can begin to regain self-worth separate from their parent. This may be finding the bandwidth to set boundaries with others, challenging people-pleasing urges, and practicing saying no, as just a few examples.

Each adult child’s journey is different in how they heal from estrangement, however we have some ideas from the clients we’ve served in therapy for the last twelve years. Check out our book Understanding Ruptured Mother-Daughter Relationships: Guiding the Adult Daughter’s Healing Journey through the Estrangement Energy Cycle and access all our therapeutic tools for adult daughters available for download at estrangementenergycycle.com.

Challenging Ten Assumptions about Estrangement

As the author of a book on mother-daughter relationship rupture speaking to adult daughters and the therapists that serve them, I would be doing women a disservice if I didn’t name and challenge the assumptions others make of estrangement. The community at large, as well as a handful of authors, have taken it upon themselves to be the voice of estranged parents everywhere. These parents, in an effort to understand the causes of their estrangement, report a number of similarities in their children that they feel contribute to why they have chosen to disconnect from their parents, which has led to the following assumptions:

1. Selfishness

The first assumption is that adult children who choose estrangement from their parents are selfish. They are accused of being self-centered, narcissistic, and focused only on themselves. We argue that adult children who choose estrangement from their parents do so for a variety of reasons, none of which are solely selfish in nature. Rather, the choice to estrange comes from an effort to protect themselves, partners, and children from further pain or trauma from their parents. Therefore, this difficult choice may be for the well-being of others in addition to themselves and doesn’t omit them from their own grief and loss response when disconnecting from a parent.

2. Suddenness

Many parents of estranged adult children claim that the estrangement came on suddenly, sometimes without warning. Upon further reflection, parents are usually able to pinpoint signs that their sons and daughters were not happy with the relationship, but perhaps didn’t feel it would result in estrangement. Although it may feel sudden, the process of deciding to estrange from a parent takes significant time and energy for an adult child. Contrary to assumptions that choosing estrangement is easy for adult children, many spend significant mental energy evaluating and re-evaluating their options in not wanting to miss an opportunity to improve the situation.

3. Therapist Recommendation

Another assumption is that therapists are encouraging or championing estrangement for their adult clients. Oftentimes found in the same breath as the word ‘boundaries,’ parents and professionals alike feel that therapists are pushing an agenda for adult children to be estranged from their parents in response to trauma. As a mental health professional myself, I can see where certain clients may seek out advice or interpret a conversation about boundaries as permission to cut off a parent. However, a quality professional will remain neutral and help their client explore the implications of remaining in a relationship cycle that feels healthy or unhealthy, reaffirming that the client is the sole decision maker within their own life.

4. Exaggerated Trauma

Trauma remains a primary theme for exploration of estrangement. Several authors lament on how adult children may exaggerate their experiences of trauma to reinforce their decision to become estranged from their parents. To serve as a means to vilify and justify cutting off a parent. The challenge here is that society fails to recognize that trauma is defined by the person who experiences it. It is not our job to argue about what is and is not, trauma. Instead, trauma work remains an appropriate modality in the therapy space in order to explore healing and goals for adult children seeking change in their lives.

5. Refusal to Reconcile

Parents want to believe that reconciliation is an option, and yet for some, it will not be a choice. Rather than seeing this refusal to reconcile as a ploy for power and control by an adult child over their parent, it’s important to explore the circumstances for when reconciliation isn’t appropriate. For families damaged by repeated physical or sexual abuse, for example, reconciliation can feel like wishful thinking. How do we acknowledge the damage a parent-child relationship can suffer when subjected to repeated physical abuse? What supports reconciliation when a mom aligns with a boyfriend who is sexually assaulting her daughter? Each adult child’s choice to reconcile or not is to be respected because reconciliation remains difficult to near impossible for some individuals.

6. Too Much Toxic

The word ‘toxic' has shown up frequently in media for at least the last decade if not longer. As it became associated with relationship dynamics, this word has been seen alongside the words ‘estrangement’ or ‘family estrangement’ more often. Some folks believe that adult children are using this word to justify their decision to estrange from their parents and to seek sympathy from others by painting themselves as victims. This viewpoint only serves to discount the actual harm victims of abuse have suffered. Toxic as a word, has encouraged folks to cleanse themselves of toxins, including unhealthy relationships. What if describing a relationship as toxic is a means of simplifying something immensely confusing and painful? Toxic may serve as a label for an experience that we don’t have the emotional energy or desire to explain to someone else because of the stigma, judgment, or emotions it stirs up when talking about it. 

7. False Memories

A common disclosure found in interviews and surveys of estranged parents is that they have been accused by their adult children of neglect, abuse, or of being a bad parent. Additionally, parents can claim that their adult children possess false memories of abusive or unsafe situations that did not occur per the parent’s recollection, leaving parents baffled and confused. Trauma has a way of being stored in people’s memories in different ways with different things being the focus, which can mean one person’s recollection can look completely different than another’s. It’s a similar phenomenon to why eye-witness testimony doesn’t hold up well in court. You can interview three witnesses and get three completely different recollections of the events that took place. Parents are left feeling angry that their children are subscribing to false memories in order to validate their decision to separate or abandon a parent when in actuality, an adult child’s reports of mistreatment, however inaccurate to the parent, deserve curiosity and compassion if there is to be any hope of repairing the relationship.

8. Mental Health Problems

Another common culprit in the blame-game of estrangement is mental health. The seeking of mental health diagnoses or labels placed on either the adult child or parent can be problematic and stigmatizing. In several books supporting estranged parents, authors argue that adult children may have undiagnosed mental health issues such as Bipolar Disorder that cause them to seek estrangement from their parents. Which, as a mental health professional, feels like dangerous ground because of how simplified it sounds. It’s possible that some adult children have mental health challenges or diagnoses that make them more likely to pursue estrangement. Equally possible, however, are times where a parent’s mental health could be a factor in why estrangement is pursued when their children grow up. Perhaps it’s severe depression, PTSD, or a personality disorder that prevents a parent from attaching or showing up consistently for their child. By no means is mental health the only factor to consider in the research on estrangement, and if we are going to look at mental health within the family, it’s best to look at the mental health of both adult children and their parents in our quest for answers on the growing rates of parent-adult child estrangement.

9. Control Over Grandchildren

An increasing concern for estranged parents is access to their grandchildren when their adult child chooses to estrange from them. One assumption we saw reinforced in several books on the subject was that adult children use grandchildren and withholding contact from those grandchildren as punishment for parents' poor choices. Although this is a possibility for some adult children who are angry about the mistreatment they’ve felt they’ve received from their parents, the clients I’ve served over the years are more likely to limit contact between grandparents and their grandchildren when they are worried that the abuse or neglect they experienced in their own childhood could be repeated with their kids. In an effort to protect their children or to break an unhealthy relationship cycle, they may prevent contact between grandparents and grandchildren.

10. Pettiness

Our last in the list of assumptions about estrangement is the accusation of adult children being petty in their refusal to reconcile or re-engage in a relationship with their parent(s). The underlying theme of most media representation that sides with parents conveys a concern that adult children are refusing out of spite. To punish their parents. To hold power over them. As you might guess, this remains another narrow view of the complexities that contribute to family estrangement. It may very well feel this way to a parent who is confused or hurt by their adult child’s actions. However, it can also serve as an opportunity to get curious about their adult child’s viewpoint on holding rigid or strong boundaries. What would their adult child say when asked what they need to repair the relationship? 

Assumptions of estrangement are widespread. This could be because of the emotional charge it leaves in both adult children and their parents, as well as the limited research to date that could shed light on why estrangement is being pursued more often in response to family conflict. By challenging these assumptions, we can find ourselves successfully providing a compassionate, judgment-free space for ourselves and others experiencing estrangement in their families. We invite adult daughters to check out our book Understanding Ruptured Mother-Daughter Relationships: Guiding the Adult Daughter’s Healing Journey through the Estrangement Energy Cycle and access all our therapeutic tools available for download at estrangementenergycycle.com. 

What is the Estrangement Energy Cycle for Adult Daughters Estranged from their Mothers?

Would it surprise you to know that 1 in 12 people is estranged from at least one family member (Agllias, 2016)? With estrangement on the rise, further exploration is needed to best understand the complexities that contribute to making estrangement possible in families. As a mental health professional, I first wrote about estrangement and adult daughters in 2020, asking my therapist colleagues if they too were seeing a pattern in women who were contemplating estrangement from a parent in their clinical work. From that blog, I felt called to take a deeper dive into the cycle of events adult daughters may experience when considering mother-daughter estrangement, a cycle I came to call Estrangement Energy.

There are various stages a daughter may work through by herself or within therapy as she explores her relationship with her mother. Let’s take Gina* as one example. Gina sought out therapy for processing her divorce, expressing interest in grief and loss work as well as reporting feelings of depression and failure when attempting to meet her children’s needs. As Gina moved towards deeper work on her relationships, she began to question why she allowed multiple people in her life to exert power and control over her. She discovered that the start of this relational pattern resided with her mother.

Cycle of Abuse

Gina engaged in a personal narrative that helped her to recognize her mother’s behaviors as physically and verbally abusive. She had learned to cope with her mother’s volatile mood swings by reading her body language, voice, and mannerisms to best determine if she should engage her mom or go hide in her room until the emotional storm blew over. 

Questioning

Having made the connection between an unpredictable and oftentimes unsafe childhood and her honed skill of reading others’ moods, Gina uncovered suppressed feelings of anger and outrage at her mother’s behavior. She began to question her current relationship with her mother and the long term effects it was having on her mental health.

Relationship Rupture

Gina wanted to talk to her mother further about her childhood and the impact on her life, yet every time she attempted to share her memories and feelings about events, her mother told Gina she was exaggerating and remembered things wrong.

Estrangement

Feeling devastated and minimized, Gina determined that she needed some distance from her mother. She started by reducing the amount of time she spent with her, claiming her work and her daughters kept her busy, which were partly true.

Grief and Loss

As the contact between Gina and her mother dwindled, Gina felt a mix of sadness and relief. On one hand, she felt she had more time and energy to give to people in her life who valued and appreciated her. But on the other hand, Gina was grieving the loss of the mother she wanted and needed—one who could respect her and love her unconditionally.

Discovering Sense of Self

Amidst her grief, Gina found herself seeking new experiences that left her feeling vibrant and alive.

Deeper Work

As Gina began to discover herself and her identity without mom, she found she still struggled with the idea of dating and intimate partner relationships. Her latest therapeutic goal was to address underlying fears of intimacy and connectedness, which resulted in uncovering negative core beliefs of being unworthy, unlovable, and not enough.

Redefining Self-Worth

Gina’s therapeutic journey left her feeling stronger and more present that she had in the past. She celebrated having stability at work and solid relationships with her friends. Gina took her role as a mother seriously, wanting something completely different for her daughters than what she’d had with her own mother.

Each client’s story is unique, and yet Gina’s story is one inspired by multiple clients seeking therapy at a critical point in their relationships with their mothers. Estrangement is a challenging and emotional choice that oftentimes leads to an adult daughter seeking therapy for additional support. Whether her goal is reconciliation with mother or full estrangement, having a solid understanding of the estrangement process and stages, as well as tools that can support her on her journey supports each woman in doing this deep and oftentimes difficult work.

For more on mother-daughter estrangement and the Estrangement Energy Cycle, check out our book Understanding Ruptured Mother-Daughter Relationships: Guiding the Adult Daughter’s Healing Journey through the Estrangement Energy Cycle and access all our therapeutic tools available for download at estrangementenergycycle.com. 

The Human in the Helper: I’ve had it happen twice

Caitlin loves her job and it shows. She works with youth involved in the juvenile justice system and has loved that system for over 15 years. It’s a career choice not many colleagues would commit to, especially when working with a population that assumes greater risks of loss, compassion fatigue, and vicarious trauma. Even though she finds her work rewarding, Caitlin has also experienced every Adverse Psychological Event (APE) known within our field, including the not often talked about ones, like client violence directed towards others. “I had two clients murder people in the community.”

Caitlin is willing to share her story to help others while also acknowledging how difficult it can be. “I had four deaths in an 18 month span,” she recalls. For her two clients who killed people, these tragedies happened after they had closed out of services. “The support I received around this happening was different because they weren’t active clients.” Caitlin reflected on how the support was minimal in supervision and consultation because of the clients not being active on her caseload. She named how it felt like leadership was relieved to not have to staff these cases, and redirected her to focus on her current caseload of at-risk kids. She heard messages like, ‘It sucks that that happened. What are you doing for your current suicidal kids?’

Although Caitlin understood the focus of leadership on current clients, this messaging didn’t help her healing process as a person. She found herself questioning if she’d done enough for her clients. If there was something she missed. And then there was the grief. “I was surprised that I felt so much grief for the kids who engaged in violence. I thought things must have been pretty bad for them to do this.” Caitlin’s compassion confused colleagues, who did not hold compassion for her former clients at all, instead labeling them murderers and engaging in black and white thinking. “They are still traumatized kids,” Caitlin named.

A trauma lens helps Caitlin remain in this work with her clients, as well as her abundant compassion for what her clients have been through.  Even so, the losses still took a toll on her. She felt acute symptoms of grief in the first month, with flare ups anytime she saw her former clients in the news for their trials or sentencing. She had recurring nightmares with her clients in them. “They were always calling out for help. Someone had to help them.” What helped Caitlin most was having one colleague who understood what she was going through, because they worked with the same population. “One time I came into her office and cried,” Caitlin shared. “My mentor said, ‘Caitlin, you are working with people through some of the darkest moments of their lives. That doesn’t always mean they come out of the darkness by following your light.’”

Caitlin reflects on the importance of having a colleague or mentor who can hold this heaviness with us. Someone who aligns with our beliefs and gives us space to heal. Someone who supports the ugly cries and the dark humor. Someone who reinforces we aren’t alone. She also encourages colleagues to do their own psychological first aid, making sure to eat, sleep, and move their bodies. “You will want to freeze. Honor all your feelings. You will experience every stage of grief.” Caitlin doesn’t have any plans to pivot from this population because she operates from a belief that what we do as mental health professionals still matters. “For every horrible thing that happens, there are 10-20 that don’t end up that way. Those horrible things are still the minority.” Caitlin’s story provides a beacon of hope in light of something that feels so heavy and so powerless. We feel honored to be able to share her messages here.

Things happen to us as humans, even as we support our clients as professional helpers. Do you have a story you want to share the mental health community? Email us at croswaitecounselingpllc@gmail.com to learn more about the Human in the Helper Series!

The Human in the Helper: I was too busy to feel anything

Keiko is pursuing her doctorate in social work. When she’s not serving mothers and women in her private practice, she enjoys spending time with her two children. Although Keiko has big goals for herself, they were accelerated after her diagnosis with breast cancer in her late 30s. She shared how she and her doctor caught it at an early stage, but it was happening at the same time she’d joined a group practice and was building her caseload. “How do I deal with this?” Keiko reflected, “there’s no good time to have cancer.”

Keiko understood that as a small business owner, she couldn’t take time off or slow down without the risk of lost income. “I think I was in shock at first, then I was too busy to feel anything.” She recalls how she focused on making each doctor appointment and continuing to work. “I had to wait 1.5 months to get answers on what my treatment was going to be.”

After that stressful waiting period, Keiko was told she would undergo radiation and hormone treatments, but not chemotherapy. She elected to not tell her clients what was going on, especially as she was still unclear of the outcomes. “I didn’t want to worry them or have them caregive me as the result, “ she shared. Keiko also recognized some survivor’s guilt in her experience. “I didn’t go through the same process (chemo) as them, I can’t be glad in front of them.”

What helped Keiko most was doing her own therapy work with an oncology psychotherapist. “Cancer is weird, it was nice to work with someone who understands it.” She was grateful to connect with peers and cancer survivors as well, who continue to give her hope for her future.  Keiko has spent time reflecting on her priorities. “I want to see my children graduate, get married, and live happy lives.” So she evaluated her next steps and decided to pursue a doctorate in social work. “We think cancer equals death, and that’s not true.” Keiko is hopeful that her story will inspire others to fight cancer and pursue their passions. “It’s almost like having cancer can make us think, ‘let’s do this,’ giving us permission to do the things we want to do.”

Things happen to us as humans, even as we support our clients as professional helpers. Do you have a story you want to share the mental health community? Email us at croswaitecounselingpllc@gmail.com to learn more about the Human in the Helper Series!

Why Financial Therapists Like Loud Budgeting

Photo by Priscilla Du Preez 🇨🇦 on Unsplash

Have you heard the term “loud budgeting” in 2024? It’s trending and describes the phenomenon of naming out loud when you can’t afford something, or more accurately, when you have enough money but don’t want to spend it on the thing that’s being asked of you.

Financial therapists know that words have power, so we aren’t about asking people to keep saying “I can’t afford this. I can’t afford that.” That self-talk has a negative effect on mental health and often keeps people living in scarcity. In contrast, loud budgeting is about saying no to spending.

So how do financial therapists see loud budgeting working? What if it can serve as an empowerment tool? What if it names out loud your values and priorities for saving and spending. Loud budgeting from this perspective could sound like:

I don’t want to prioritize that right now.

I don’t want to spend money on that.

That’s not a priority.

I have other goals in mind right now.

I’m saving my money for xxx.

I’ve already met my budget this month for (coffee/eating out/shopping/etc).

No thank you.

Meeting your money goals AND practicing boundaries with others sounds pretty good doesn’t it? So here’s your invitation to experiment with loud budgeting from a place of owning where you stand. It can serve as tool that isn’t about reinforcing your ability to afford something but focuses on not wanting or choosing to afford something, stating it isn’t a priority right now. It’s a new response to financial peer pressure, and I think financial therapists couldn’t be more excited for folks to try it out.

The Human in the Helper: You can't make someone live for you

Shannon isn’t a stranger to grief. She lost her brother to addiction in 2008 and has dedicated her career to helping clients through trauma and substance healing as a social worker and addictions counselor. As she was preparing to expand her family, her dad approached her to share that he was ready to die. “My dad was suffering from a lot of health issues. He’d been unhealthy most of his life.” Shannon’s dad had received permission from his doctor for Medical Aid in Dying, a year-long process that requires two physicians to sign off to receive the medication, which a patient then administers to themselves in order to remain fully in control of the process of dying.

Of course Shannon was devastated and overwhelmed at hearing her dad’s decision, although he had been speaking to wanting to die for over a decade. “I was six months pregnant when he called me up to tell me,” she remembered. “I asked him to wait until after my son was born. I explained postpartum and the impact this grief would have on me and the family, and he agreed to wait.” But Shannon didn’t immediately feel at ease. Instead she and her sister went through a rollercoaster of emotions, alternating who would hold hope and conviction to try something new to save his life, while the other named how it was inevitable that their dad would die because he wanted it to be so. “We looked at medication changes, a new psychiatrist, psilocybin, but nothing changed his mind.”

Shannon recalled how her dad’s biggest worry was that she was going to ask him to continue to delay his death date. He said there was never a good time to die, and she had to ultimately agree. However, Shannon and her sister had an opportunity to weigh in on his death date and be present for his end of life journey. “It was so sad and special to be there. It meant everything to him that we were there.” Shannon was six weeks postpartum when her dad died, and she vividly remembers him dying and her going into another room to pump breastmilk for her baby. “It was so strange. I think I was in shock for months.”

Shannon went right back to work days later, and after six months, a new wave of grief hit Shannon as she realized he was truly gone. “I recognized that I was missing him and that I had to live the rest of my life without him.” The experience has impacted her both personally and professionally in how she engages others around death and dying. “Now I see it is not our responsibility to keep someone alive. It was his body, it was his life.” Shannon hopes that fellow therapists will work further to understand the difference between Medical Aid in Dying and suicide. “My dad wasn’t afraid of dying. He was ready.”

Therapists, out of feelings of responsibility, often struggle to hold their own fears in check when faced with a client who is thinking about death. How do we strive for neutrality, holding space for client experiences from a place of compassion for their pain and suffering? Shannon has found the stories of Near-Death Experiences influential in her ability to connect with others on a human level regarding dying, to fully see what people are experiencing including her dad. “I realized that no amount of time would be enough with him. Two months, six months, a year. It was really eye-opening and helped me move towards acceptance of not trying to demand one more day, one more day. That was a huge turning point in my thinking.” Shannon was able to show up for her dad, even in her own grief. “Dying isn’t the worst thing that can happen, suffering is worse.”

Things happen to us as humans, even as we support our clients as professional helpers. Do you have a story you want to share the mental health community? Email us at croswaitecounselingpllc@gmail.com to learn more about the Human in the Helper Series!

Breaking Free of Confidential Grief

Photo by Luke Besley on Unsplash

I first discovered the term confidential grief when researching for my latest book on helping clinicians heal from client suicide. In what felt like a sign from the universe, the September edition of the Counseling Today magazine arrived, and had an article titled Counselors Share What It’s Like to Lose a Client to Suicide. I felt compelled to reach out to Dr. Lena Salpietro, one of the quoted professionals who shared the importance of validation and empathy from mental health leadership to clinicians who’d lost a client to suicide. I couldn’t agree more with her statements and I was beyond excited that not only were people talking about the life-changing experience that is losing a client to suicide, but that there was a name for the behind-closed-doors experience of grieving a client loss.

According to the original research study published in July 2023, confidential grief describes the secrecy of our pain and grief when losing a client to suicide. Out of fear, shame, and perceived judgement from our peers, mental health professionals don’t feel safe to share that they are going through grief and loss, and thus attempt to grieve in private. It also feels confidential because client matters remain confidential, which means we can’t share our experience as openly as if it was a loss from a different part of our life. All of these things add up to an experience where clinicians are suppressing their emotions, attempting to compartmentalize their grief, and could result in them leaving the field due to the lack of support.

So here I am inviting colleagues to break free from confidential grief. How do we bring client suicide into the light? How do we prepare clinicians for this life-altering experience? For folks who’ve felt comfortable sharing with me thus far, I’ve often heard that nothing prepared them for this experience. With 1 in 4 therapists predicted to lose a client to suicide in their career, this is adding another layer of pain that could be easily addressed. How do we create safe spaces for this grief? Here are a few ideas for mental health leadership:

1. Attend to the person first, professional second.

When a client dies by suicide, the first thing we focus on as mental health leaders should be the clinician standing in front of us in shock. How do we help them navigate this event with compassion? Do they want to talk about it? Do they want to sit here and experience the flood of emotions with someone they trust? Do they need us to cancel their appointments for the day so they can go home? We can offer various things that could support them in a time where they may feel frozen in place.

2. Talk about it!

Let’s normalize that clients die by suicide. Let’s talk about it in graduate school, in community mental health, in internships, and in private practice. Let’s explore it with supervisees as a possibility so they can feel more prepared. So much more healing can be accessed if we normalize the possibility of this happening within our field.

3. Create spaces for healing

Since suicide will happen for 25% of us, how do we create spaces for healing? Is it a one-on-one conversation? A support group? A journey to self-discovery? A healing retreat? The more healing spaces we can offer, the more clinicians can move towards post-traumatic growth. What spaces do you know of? What more can be added for colleagues experiencing client loss?

There are lots more ideas in my book Moving from ALERT to Acceptance: Helping Clinicians Heal from Client Suicide. This book captures ideas for clinicians wanting to heal, as well as ideas for the mental health leaders helping them with that healing. You don’t have to do this alone. I recently shared with a colleague that I identify as a Confidential Grief Specialist to therapists amidst other roles of consultant, trainer, and course creator. For years, colleagues have been sharing with me their hardships and challenges, everything from family abuse to trauma, to substance use, to client death. It’s one of the reasons I started surveying colleagues on their career experiences with Adverse Psychological Events (APEs) as mental health professionals. Although confidential grief exists because of the loss of clients to suicide, I believe this term can be expanded to cover all sorts of career-related stressors, which create the potential for burnout within our field. Adverse Psychological Events can include client suicide, client death, client violence, subpoena, and grievance. All are disruptive and painful for clinicians, all are not spoken about freely because of fear, shame, and judgement.

Let’s break free of confidential grief together. We have a name for the experience, now we can offer something different! I know there are many of us out there wanting to create a safe, empowered container for clinician healing. Let’s share what we are doing to combat confidential grief and connect soon in our efforts to support colleague healing!

The Human in the Helper: I felt like my life had been thrown in a blender

Michelle is known in her community for helping colleagues become CE providers because she believes in what they have to share, she recognizes the freedom course creation brings, and she wants colleagues to have additional income streams. She is also known for her fun glasses and for being a breast cancer survivor. “I was diagnosed in January 2020.” Michelle describes a moment in her life that was sheer terror as she waited for official results. She recalls the experience as being told there was something abnormal and that they were pretty sure what it was, but required two weeks to formally confirm. “I would rather go back to chemo than relive those two weeks of hell.”

Michelle wasn’t sleeping. She felt dissociated. Her heart rate stayed high, even when trying to sleep. Her daughter kept waking up in the middle of the night worried and finding reasons to engage her mom to make sure she was okay. Michelle struggled with what to tell her clients. “I feel bad for the clients in that waiting period, I showed up the best I could.” It’s understandable that Michelle had a hard time being present as she waited for the game plan for fighting her cancer, which ended up being a very aggressive type of breast cancer with the worst prognosis. “I notified my clients about needing two weeks off to address my medical care.”

Once she had her plan, which included chemo, surgery, and radiation, Michelle focused on referring out her newest clients and her acute clients to other providers. “It was hard to make those calls while also trying to take care of myself.” Michelle kept clients she’d had longer on her caseload, who also had more rapport for this next season of her life. Then she experienced the pandemic shutdown. “It was sort of a blessing to move to working from home. I had lost my hair, I was wearing a wig.” She moved everyone to online and tried to keep up with her medical appointments.

Another challenge Michelle faced was maintaining boundaries around her cancer treatment with clients who were worried. “I let them know there was going to be a boundary and set the timer for five minutes. They could ask me anything they wanted regarding my cancer and treatment, but once the timer was up, it was back to being focused on them.” Michelle reports this worked well for clients. Some only wanted to know that she was okay, while others had more detailed questions to ask. She navigated this dynamic with her clients through ten months of treatment.

Michelle is in good health now, and has had time to reflect on her process. “I wish there was more support in our community for things like this.” She described wanting a way to notify a trusted colleague when awful things happen, someone who could make the calls and outreach the clients when their therapist has to pause or regroup. Michelle felt this need again when she got the call at the end of a client session that her father had died. “How do we let people know when life things happen? We worry about client abandonment. We worry about liability.” Until a tool that supports this communication is created, Michelle has some other ideas for colleagues. “Be gentle with colleagues online. We don’t know the whole story as to why they didn’t show up, why they didn’t call back. They could be going through something.” She hopes that mental health professionals can support connection and community with one another, two things that feel so important when coming back from crises that happen in our lives. We couldn’t agree more.

Things happen to us as humans, even as we support our clients as professional helpers. Do you have a story you want to share the mental health community? Email us at croswaitecounselingpllc@gmail.com to learn more about the Human in the Helper Series!

The Human in the Helper: I was a shell of a person

Laura is known as a leader in the mental health community. With her passion, wisdom, and integrity, she is showing colleagues ways to level up their practices. Yet her own practice had to take a pause when she found herself struggling with significant anxiety and OCD behaviors postpartum. “I anticipated that postpartum would be awful, and I was right,” she shared. Laura was struggling with sleep, and wouldn’t get the sleep she needed after nursing her daughter at night. “I went into my support group and asked them if they were sleeping and they all said they slept like logs. That’s when I knew something was wrong.” She described insomnia that would keep her awake and when she’d finally feel tired, it was time for her daughter to nurse again. “My husband would leave the house for work and I’d cry, knowing I was left home alone with my baby, I was so tired.”

Laura noticed that her insomnia contributed to her anxiety as she worried about the insomnia itself and not getting enough sleep each night. Then she noticed some OCD behaviors showing up in her life. “I think I was looking to feel in control of something,” she reflected. Laura found herself using an app to track all of her infant daughter’s activities, which isn’t uncommon. What felt disruptive was that she was methodical about logging every activity and exact times for all the activities, which she recalls felt obsessive and made her anxiety worse. “I focused on every minute and every activity. I was in the app all the time. “ She didn’t know how much of a hold it had on her until someone said to delete it. “It was when my daughter was 18 months old that a friend suggested I delete the app in not needing it anymore, and after some hesitation I did.”

Although Laura was able to break away from the app and the behaviors associated with it in her postpartum recovery, she shared that it took her longer to recover from the sleep deficit of motherhood and insomnia. “It was probably a solid four years before my sleep was back on track.” The thing that helped her most was getting trained in CBTI, Cognitive Behavioral Therapy for Insomnia, which she used on herself as well as with her clients.

Laura is honest with herself that her postpartum journey was challenging and that her experience isn’t everyone’s experience in becoming new parents. She does have some advice for therapists who are planning for maternity or paternity leave, however. “Save for your leave.” Laura identified that she was fortunate to have saved enough for several months of maternity leave, which allowed her to be more honest with herself on her timeline of coming back to work. “If I’d come back at 12 weeks, I wouldn’t have been a very good therapist. I was a shell of a person.” Through her saving and thanks to a supportive spouse, Laura was able to extend her maternity leave to allow herself more time to adjust, before slowly easing back into private practice two days a week to start. “Set aside money for your leave, you don’t know what your postpartum will look like.”

Things happen to us as humans, even as we support our clients as professional helpers. Do you have a story you want to share the mental health community? Email us at croswaitecounselingpllc@gmail.com to learn more about the Human in the Helper Series!