The Unseen Mourner: Saying goodbye to a patient after 20 years

On grief, and the loss felt on both sides of the therapeutic relationship.

“One mourns less for what was than for what can no longer happen now.”
—Hans-Jost Frey

One of my long-term clients died recently. I was traveling when her family reached out to tell me she had passed away after a fall while getting dressed. Though she was 90 years old, and her death was not entirely unexpected, I was left unsettled. I had seen her just a few weeks earlier, and though she was growing frailer, she still radiated a light and the lively intelligence that hadn’t dimmed with age. But she had been losing things. She needed a walker and had many falls that sent her to the hospital. We had talked about her mother living to be 100, and I think we both felt she would, too.

We had worked together on and off for over 20 years. Our sessions were intermittent during all the years I worked with her. There were times I hadn’t seen her for several years, and then, she’d call me asking to resume. She first came to therapy after retiring from a demanding, high-level career—a transition that had shaken her sense of self. People often begin therapy during these life transitions, when the roles that once defined them shift. There was no pickleball then, and she wasn’t a golfer. The person she had been and the person she was becoming became an in-betweenness.

Retirement isn’t just the end of work; it’s a loss of identity. The longed-for freedom can feel anticlimactic. The structure that once gave life its rhythm is replaced by time that stretches and is ill-defined. For my client, therapy became a place to reflect on these changes—first the retirement, then over the years, the gradual withdrawal from hosting family gatherings with the smooth grace she had once embodied. Letting go of that self, the family matriarch who made it all seem effortless, was painful. And, as is often the case, others in the family weren’t quite ready to step in because she wasn’t completely ready to let them.

There were other losses, too. Physical changes—hers and her husband’s—meant that their physical connection began to wane. What once had been spontaneous and intimate began to feel like a production. Like so many in late life, these changes were incremental and inevitable—yet each brought a need to redirect and redefine the self.

As therapists, we are trained to hold the container—to offer presence, insight, and stability while remaining attuned to our clients’ needs. But the therapeutic relationship is not a one-way street. Over time, both therapist and client change. Even with clear boundaries, even without reciprocity in the traditional sense, something meaningful is exchanged.

We do not become friends with our patients and guard against the pull to disclose too much. Yet that does not mean the relationship lacks intimacy. On the contrary, the trust that unfolds in long-term therapy work is unlike any other. Week after week, year after year, we meet in that safe and sheltered space, the therapy office. The client entrusts their struggles and triumphs to the process. And the therapist receives them—carefully and respectfully—and is changed in return.

When a long-term client dies, we mourn too. But ours is a particular kind of grief—private, unacknowledged, and often invisible. There is no funeral to attend as “the therapist.” There are no shared stories at the wake. The clinical stance does not include a space for eulogizing, even when we wish to honor the life we came to know during our work together.

Still, we grieve—not just the person but the relationship, the rhythm of sessions, the arc of their life, the privilege of being present for them over the years.

When most therapies are concluded, or as we say in clinical jargon, “terminated,” I might wonder about the stories we didn’t finish, how their relationships or work turned out, and if our work together left an imprint. But when a therapy is over abruptly, as in the death of a client, I grieve the loss of this person who is a reminder of the depth and beauty of the work.

In what was to be our last session, she spoke of the challenge of being old, when goals and dreams no longer give energy for going on:

“Being 90 is different from any other time in my life. You can't expect what you might have had before, and can't get there no matter how you try. So, accepting is half the battle... There has to be a merger for the me that is here and the me I see up ahead. Without anything in sight or something down the road to charge toward, there's a hole in my life that isn't getting filled.”

Her words have stayed with me—not just because they revealed something about her passionate life but because they speak to something larger, something we all wrestle with: how to live in the presence of endings. As therapists, we witness this over and over again in the lives of our patients. But we are not outside of it. We experience it with them and in our own lives as our kids go to kindergarten, have their first date, and leave home. All this happens in our lives while we help our clients through their transitions.

Seth Aronson writes about the analyst as an “undesignated mourner”—a participant in loss who is left outside the circle of formal grieving, yet deeply affected.¹ Anne Adelman reminds us that when a patient dies suddenly, “the hour remains as if suspended in time.”²

That absence echoes. I can visualize her presence with ease and clarity. Her voice, her laughter, and her wisdom all remain vivid.

These relationships are not symmetrical, yet they shape us. The loss lingers in our personal and professional lives. So often, mourning happens in silence. Writing this was a way of honoring and remembering my client. It is how I come to terms with being both witness and mourner. I think she would approve.

Footnotes

1. Aronson, S. (2009). The (Un)Designated Mourner: When the Analyst’s Patient Dies. Contemporary Psychoanalysis, 45(4), 545–560.

2. Adelman, A. (2013). The Hand of Fate: On Mourning the Death of a Patient. In Malawista, K. L., & Adelman, A. J. (Eds.), The Therapist in Mourning: From the Faraway Nearby (pp. 90–91). Columbia University Press.