Learning from a Therapist's Death

When a Therapist Passes Away

Therapists are only human, too.  Like anyone, we get sick, have accidents, are faced with the unexpected, and there is so much we cannot control in life despite our defenses and denials of mortality.  But therapists have an important responsibility to confront what makes us uncomfortable.  Our life’s work involves creating deep relationships with vulnerable individuals who often rely on us.  What is our ethical duty to them, even in the face of our own emergencies?  How do we ensure that we protect our clients from unintentional abandonment?  

All mental health disciplines recognize the ethical obligation of therapists to put in place plans for patient continuity of care and the confidentiality of medical records in the event of the therapists’ incapacitation or death.  Specific ethical guidelines that apply include

1. Beneficence- Serve clients only to help and do good.
2. Malfeasance- Avoid doing damage to the client, wittingly or otherwise.
3. Confidentiality- Protect personal health information according to law
4. Autonomy- Ensure clients have volition and choice in their treatment and its impact on their lives.
5. Avoid Abandonment- Plan for and facilitate the provision of client care even in the event of the therapist departure, whether planned or sudden.

In addition, the state-specific codes of practice that govern the conduct of psychologists, counselors, social workers and other clinicians require a plan to be put in place in the event of sudden incapacitation or death.  These codes frequently reference accepted practice and ethical guidelines that concern this ethical guideline and sometimes have their own specific requirements that are specific to one particular state.

When my friend and colleague, Kim, a vibrant and seemingly healthy woman in her 40s, was suddenly diagnosed with a terminal illness and died a few weeks later, I stepped in to notify all her patients, support them through the shock and assist them with referrals.  I took custody of the medical records, issued billing invoices for the practice, sent notice of transfer of records to former patients, changed voicemails and social media, cancelled malpractice insurance, and a slew of other administrative tasks.  While managing my own full-time practice and my significant family demands.  While grieving the loss of my close friend and supervision partner of 17 years.  

This was incredibly difficult, but essential and meaningful work, to protect the clients in their efforts to cope with the significant and sudden loss, and to honor the ethical practice my friend had operated with compassion and integrity.  Based on this trial-by-fire experience, and by serving in this role a second time for another friend who faced a life-threatening emergency, I began to write and offer trainings on what happens when a therapist dies, and how we must put a plan in place for the possibility, no matter how unlikely, that such a situation would befall any one of us and our own clients.

Lessons for Therapists

My experience underscores the importance of preparation. Here are some key takeaways for therapists:

1. Have a Professional Will: A professional will is considered instructional, though is likely not legally enforceable, and it is not your personal last will and testament.  Clearly outline your wishes, including the name of your practice executor, patient records management, and plans for notifying patients.  
2. Choose Your Executor Wisely: Consider someone who is reliable and prepared for the emotional and logistical challenges.  Who will have the availability and resources to handle the urgent aspects of your practice in the face of their ongoing demands?  Recognize that you are depending on someone who may not have the skills or experience to dismantle a practice.
3. Provide Detailed Instructions: Leave information about your caseload, referral recommendations, and access to practice systems like billing and scheduling.  Consider how the executor will get access to your passwords, even when they change over time, and even with two-factor-authentication procedures.  What about payments due, or paperwork clients may need for reimbursement?  Be very clear and specific on how all the details will be accessed so that the executor can administer your will.
4. Think About Boundaries: Decide in advance how much your patients should know about your medical condition or ongoing status, as well as whether they’ll be welcome at memorial services.
5. Know the State Regulations pertaining to retention of medical records and duty to notify.

What are the obstacles?

In a recent survey I conducted, 68% of therapists said they do not have a Professional Will or Executor.  The primary reasons are:

1. Denial of Mortality: We do not want to think about it so we procrastinate and avoid.
2. Who to rely on to accept this heavy duty of Practice Executor?  Many therapists shared that they don’t want to burden a colleague, friend, or loved one.  Many shared that they do not know anyone to ask.  Also, a one-to-one arrangement with a colleague has risks:  Will they be available?  Will your estate need to compensate them?  This is often much more costly than anticipated because the job is a very time-consuming one.  Joining a group of colleagues who agree to cover for one another is a better plan, but it also has risks, as who will supervise and be sure none of the clients or responsibilities fall through the cracks?
3. Overwhelmed by how to arrange this complicated agreement: The legal and logistical processes can be quite complicated.  You can hire a lawyer at significant cost or find a template of a will on the internet and hope it suites your situation.  Either way, you are back at obstacle #2:  who will serve your practice and fulfill your instructions to help your clients cope if faced with such a tragedy, and who will handle the mess of your practice so that your grieving practice won’t have to?

A Solution

In face of these obstacles, I decided to create a solution.  I thought about how to unburden therapists who want to do the right thing but are so stressed out by the prospect of making a Professional Will that they feel stuck.  To make it easier for therapists to be compassionate and ethically compliant without anxiety and overwhelm, I decided to professionalize fulfilling the duty to plan by creating is the first therapist professional executor service.

Now therapists have the option of outsourcing this dilemma to experts in grief and practice closure.  Designed to be a modern and comprehensive answer to all the enumerated challenges, an executor service provides therapists with:

1. A tailored legally reviewed Professional Will
2. Compassionate clinicians on retainer to serve as your Practice Executor
3. In the event of an incapacitation or death, we follow your plan and provide:

• Immediate sensitive notification of current clients
• Record retention and transfer to ensure continuity of care
• Available tailored referrals matched to client need
• Billing completion with funds transferred to your estate
• Resolution of business aspects of practice such as lease and autopays
• Fixed costs so that your estate is not saddled with unexpected bills

Therapists, too, are vulnerable to life’s uncertainties. Painful experiences can be a catalyst for innovation.  I hope offering this new resource can assist therapists in pushing through denial and procrastination to get it done so that they can practice without guilt, and instead know they’ve truly done all they can do for the people who trust them.  Preparing for the unexpected ensures that, even in the face of loss, the work of healing can continue.

‍