When a Therapy Patient Dies

She died last year. This lovely woman might be called a survivor, but her story deserves something more personal than slotting her in a category, no matter how fitting.

Call her Cassie. I met her in a psychiatric hospital. Not her first hospitalization, far from her last. A suicide attempt brought us together. The lady already owned a long and troubled history, one as middle-aged as she was. I’m talking about 35 years ago.

Once an amateur gymnast, as a youth she was fit, flexible, and energetic. Early photos captured an innocent Nordic beauty, as well. Just by her presence, Cassie must have been as fair and welcoming as the first birdsong in springtime.

Nothing in the woman I met suggested any of this. Like other sexual abuse victims, pounds became a bubble wrap to discourage those who might otherwise desire or terrorize her in search of chest-beating rapture and savage control. Now gray, her hair lacked its youthful golden hue, and the innocence remembered by the photos had been forgotten by her lined, questioning face.


The hospital stay progressed. Apparent roots of her clinical depression extended to a male-dominated childhood, a bad marriage, and a ne’er do well, alcoholic adult son often in trouble. Cassie’s husband displayed passivity and incomprehension. Divorce followed.


My efforts continued for a year before I received a call from a hysterical woman en route to murder her offspring within the hour.

Cassie didn’t sound like herself. Her voice turned unearthly; her tone transformed into that of an avenger of outsized energy and purpose, not the beaten-down creature I knew. My patient’s memories were disjointed, recent conversations erased. Cassie’s child, who’d been jailed for murder, had been released on a technicality.

Cassie intended personal correction of the law’s failure.

I talked her down, but the episode brought home a diagnosis everyone missed: Multiple Personality Disorder (MPD), today called Dissociative Identity Disorder (DID). I’d long recognized this woman to be dissociative, but here was a new facet. From that day, treatment inched its way toward goals she would achieve many years later: integrating her system of alter-personalities and reaching depression’s end.


In homes such as this courageous individual inhabited, families create a loving self-image. Parents cloak themselves in the garb of religiosity.

Cassie’s father died not long after her updated diagnosis. The news came during another hospital stay. A breakthrough followed when Cassie began to have nightmares of never reported sexual abuse. The death of her abuser freed her from enough of the fear of more violence to allow her to remember and speak of it.


The mother denied any mistreatment. In her daughter’s presence, she met with us and declared her upstanding husband incapable of it. Yet Cassie recalled her mother seeing a glimpse of her father’s molestation and watched her turn away and depart instead of intervening.

The trauma ended after her tenth birthday. The family relocated to a new home in another state. Upon moving in, she immediately asked which room was hers and found a key in the door. She grabbed and hid the key. The world changed.

During one of her hospital stays, I walked with Cassie off-unit, on the facility’s ground floor for a reason lost to time. Nor do I recall what distracted me. By then, however, I trusted her enough to sit in the lobby while I talked with someone at the front desk. My back turned, she disappeared within a minute.

Rushing through the doors, I spotted her about a half-block away, running toward the main street ahead. The chase began.

Knee surgery was not yet in my foreseeable future, and Cassie’s vanished prime gave her no help. Calls to her went unheeded, but I caught the laboring woman by the arm. She put up no fight.

I’d never read the word “racing” on a psychologist’s job description. I’ve become a more careful reader since.


Cassie’s troubled life left her without medical insurance on another occasion. By then, she’d had many visits to the hospital where I met her. I spoke with the facility’s administrator upon her admission. He agreed to forgive all charges for her stay, no matter its length. God bless you, Phil.

For a significant period of my patient’s lengthy treatment, I also worked with an insurance company nurse. She became like a visiting angel, helping to craft the therapy to include multiple weekly sessions beyond the company’s normal policy. Her employer gave permission. This enabled Cassie’s life to escape some of the disruptions caused by her hospital stays.

Hat’s off to those good samaritans, as well.

At some point, Cassie raised the question of God’s role. Once a faithful Catholic, she now accused an all-powerful, all-knowing Deity who witnessed her father forcing himself on her and who permitted this outrage to continue.

I suggested she speak with a priest, a wise and sensitive soul of my acquaintance. He offered her tenderness and asked her to consider the possibility her rage at God could also be understood as an act of prayer. My patient solidified her religious connection and held it until the end of her life.


Though he never again murdered anyone, Cassie’s son continued a mischievous, substance abuser’s life. His mom told him she would cease contact until he’d been sober for a year. Much time passed, but he accomplished this, found steady and honorable employment, married, and produced a family. Cassie embraced this change and welcomed them all into her life with much gratitude.


Cassie’s road to health never included interest in finding new love. She did have many dear friends, modest professional success, sustained work, and several outside interests. She once said perhaps the only way she could share her life with a man would be if he were both uninterested in sex and unable to be sexual. Psychotherapy often has its limits.


This woman was the only person in my practice with whom I maintained contact from the end of treatment almost to her life’s completion. She would send me a holiday card once a year, and I would telephone her soon after. We both enjoyed the reconnection. The last time we spoke her memory was failing with speed. She died a few months later.

My heart was full at the news. This woman was a kind and determined person, not without an edge, but with an unexpected tenacity not evident when we met. All the memories I offer here pushed themselves to the top of my consciousness. It was my great good luck to have known this lady and others like her.

Adieux, Cassie. Here’s hoping you reside in a heaven made for the most remarkable among us.


The “Please Touch Gently” photo comes from Marduw Quigmire. The Paessaggio sculpture, “A Helping Hand,” was photographed by Safiyyah Scoggins –PVissions1111. Last are “Fungi Located on a Log Near the Forest Floor” by Mfoelk13. All were sourced from Wikimedia Commons.

20 thoughts on “When a Therapy Patient Dies

  1. Wonderful to see your smiling face again Dr. S. A touching story and so very hopeful. Thank you!

    Liked by 1 person

  2. My heart goes out to Cassie, and to you and all in your field who walk this Earth with the intimate knowledge of not only your own suffering but that of others. It’s a heavy burden you bear.


    • Thank you, Ricardo. We also get a great deal in return, including the satisfaction of helping and the growth that follows from what our patients teach us. Be well.


  3. I love this story. Sounds like you were in extraordinarily Good Samaritan!

    Sent from my iPhone



  4. What a special tribute and touching story of a hard journey. I still puzzle at the therapeutic relationship and this provides a new facet of the prism. While your practiced and professional heart is likely well provisioned for the road, still I offer my condolences on your loss. What ache is there is likely very meaningful, even if unknown, to her.

    May you continue to take care of and take heart.


    • Thank you for your condolences, Rebecca. As we age, I think many losses become more philosophical, pensive, and wistful than they were when experienced at an earlier time in life. That, at least, has been my personal experience. Of course, my relationship with Cassie was still set apart by professional distance, leaving it a hard attachment to describe or even for me to fully understand. I suppose I’d say there are many avenues that are available to connect two hearts. Best wishes, Rebecca.

      Liked by 1 person

  5. I was very moved by your memories of Cassie. She was indeed lucky to survive and have you as her therapist. Some of Cassie’s background reflects mine, some doesn’t. I, too, am lucky enough to have a wonderful psychologist who is helping me heal. I also have a very skilled psychiatrist who has found a pretty effective combination of medications for my treatment-resistant depression. Together with my husband, my pets and my dancing, I am able to do more than just survive. I can live! I cannot thank them and you enough for your kindness and dedication. With sincerity,


    • You are very kind, Dr. Cindy, if I have properly approximated your name. As you might have guessed, I tried to simplify the story and change it enough to protect the privacy of Cassie’s survivors. Other people who played big roles in her life and treatment were not included. None of us is self-made, but there are times in the life of a therapy patient in distress when her will alone bridges the distance between herself and the next hand extending itself to help lift her. All of you have my admiration.

      Liked by 1 person

  6. Stories like Cassie’s wound my heart and soul. Blessed are you to have had the skills to break through her defenses and help her to lead a less tortured life ❤


    • Thank you, Rosaliene. It is both an innate and acquired skill. Therapists almost all give it up, in part, when their effort costs more than it gives back. Until then, even if is not always a calling, it provides meaning and personal growth. The confidence and vulnerability others show to us makes it a privilege.


  7. gentleintegration

    Dr. S, I want you to know I really feel touched by your depth and your heart. You have such gentleness. I am a fellow psychotherapist in Hudson, NY, and I really can feel a resonance in the art you choose, your lovely turns of phrase and writing, your depth of knowing both suffering and beauty. I appreciate your helping in the service of humanity, and in this case, Cassie. I resonate with Cassie and my siblings resonate with Cassie and her son. Isn’t it just the way it is… we are all helping each other back home? Some of us get to touch into that poignant beauty of that place, even if only for moments. Perhaps like your wrote before, your client who spoke to the priest about her rage– we are all just praying together— every feeling a prayer. Thank you so much. I grew up in Winnetka, IL, and I think you are in Chicago, which ALSO touches my heart!

    Liked by 1 person

    • You are very sweet. Thank you. Your own gentleness is reflected in the way you wrote this, as well as the name by which you call yourself. Yes, I was raised in West Rogers Park and live on the Northshore. I’ll keep you in mind the next time I drive through Winnetka.


  8. I can relate to this article on so many levels, and I had my heart in my throat while reading this as it brought me right back to my former life-long employment. I expected her suicide because I dealt with this on so many occasions, and I even discovered a couple of patients deceased. I am glad there is a happy ending. I cannot disclose much but reading your events in what I think was in a similar system as I worked, causes me to realize the stress we were under and probably did not know it. I felt wound-up while reading this and it brought me right back to the job, even after a number of years since retirement.


  9. If part of a writer’s job is to create something gripping, then it appears I’ve done my job, though I regret my grip reached your throat, Nancy. I can recall attending a play in a tiny theater about a sex abuse survivor. The actress playing the victim at times was only 10 feet away. Without a doubt, it was the most disturbing such experience I have ever had, recalling the worst of the stories I was told by survivors in my clinical practice. It is no wonder so many in the world look away from human suffering and prefer to blame the victim. No one wishes to imagine such a thing could happen to them or someone they love. Thank you for sticking with the story despite the discomfort it caused you. Writers write for readers like you.

    Liked by 1 person

    • Yes, Dr. Stein…your writing was gripping for sure. I worked crisis for a number of years and the call with your suicidal patient grabbed my attention initially. These calls are difficult to handle, but I am proud to say I did well with it and as stressful as it could be, I loved that position.


  10. I’ll bet you are right that you did well — and did much good!

    Liked by 1 person

  11. What a touching and beautiful post. Thank you for all you did to help this former lost soul. As a therapy client myself, I know just how valuable and beautiful our relationships are with a warm and determined therapist.


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