Perceived Competency in Grief Counseling: Implications for Counselor Education

Literature Review

 Grief, both death related and non-death related, is a topic that many people are uncomfortable addressing. Helping clients adjust to grief and loss is an important skill for counselors to acquire. In fact, with an aging population, demands for grief counseling is expected to be on the rise to help meet the needs of those presenting with successive losses (Hill, Cicchetti, Jackson, & Szirony, 2018). Despite this increased need, previous research suggests that not all counselors are adequately equipped or feel fully comfortable in providing grief counseling. Some have demonstrated a lack of familiarity with modern grief theory, various grieving styles, and non-death grief. This lack of knowledge can negatively impact the client’s experience in counseling and lead to pathologizing, misdiagnosis, and mistreatment (Beckett & Dykeman, 2015; Hill, Cicchetti, Jackson, & Szirony, 2018) The effectiveness of current grief and loss education on counselors’ clinical competencies and understanding of grief and loss theories is investigated. It is hypothesized that a comprehensive course on grief counseling education will have lasting impact on counselors in training. Specifically, they would be adequately equipped to address grief and loss issues and would be more likely use appropriate interventions.

 There has been very little research on the topic of grief education in graduate counseling programs. Of the literature out there, not much was known regarding either the content or method of teaching grief counseling in counselor preparation program In a preliminary report on grief counseling training, Humphrey surveyed chairpersons of counselor education programs to document the status of grief training (1993). Respondents gave their thoughts on the importance of the inclusion of grief counseling, whether or not their program did in fact include grief education, and provided information over the way that grief counseling was being addressed in counselor education programs. Results from 135 programs indicated that most counselor educators considered grief counseling an important aspect of their curriculum. Most programs do address issues of grief counseling, but it is primarily taught by infusing the topic into various courses as opposed to a specific course dedicated to grief and loss. The most commonly used method for teaching grief counseling was reported to be class lectures and discussion.

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 This research study falls short in a few aspects, in that it solely addressed the existence and professed importance of grief counseling education rather than its impact or effectiveness on counselors’ skills. However, the article served as a decent stepping stone at the time as it illuminated the need for examining how grief and loss is addressed in counselor education coursework, as well as the development of theoretical and clinical competencies. This prompted future research to address attitudes, perceived competence, and skills in this area, although the amount of research done regarding updated grief theories and approaches is still limited. Additionally, the sample size was rather small so generalizability is cautioned.

In a research article by Beckett and Dykeman (2015), different grief styles were defined, and the influence of those grief styles on initial preservice counselor perceptions of the client were examined. The authors described a continuum of grief styles, with “intuitive grievers” on one end, “instrumental grievers” on the other, and a “blended” style of grief in between. Intuitive grievers experience intense emotions and feel the need to express their feelings, reflecting their inner stress. Instrumental grievers grieve in more cognitive or behavioral manners, may tend to be more private about their feelings, and they direct their energy into activities. The authors hypothesized that: counselors would initially rate intuitive grievers as having a higher functioning instrumental grievers; counselors would rate their anticipations of the therapeutic bond to be higher with intuitive grievers than with instrumental grievers; and counselors would be more likely to employ emotional catharsis techniques with instrumental grievers. The study conducted was a quantitative analogue design study. Participants were second-year Master’s students in CACREP-accredited counseling programs in Oregon and Washington.

 The study supported the second hypothesis but not the first and third. In fact, for the first and third hypotheses, significant differences were found in the inverse direction. Of most clinical significance was that 66% of participants reported they would be very likely to encourage emotional catharsis with instrumental grievers, suggesting that this group is likely to be treated with interventions that may be unfitting for them. This suggests that there may be a need for continued training on best practices and interventions for clients with an instrumental grief style. The researchers intended to investigate whether knowledge of grief styles alleviated differences in perception and clinical judgments, but there were too few participants with this knowledge to test the question. Therefore, a similar study with a larger sample or sample of professional counselors informed of different grief styles would be useful to help us understand if this knowledge does make a difference on clinical judgment and competency.

 In another study, Harrawood, Doughty, and Wilde (2011) reviewed how attitudes of counselors-in-training toward death, grief, and loss develop after completing a course on death education. Death and grief are often intertwined, so counselors’ attitudes on this topic, which is considered taboo by many, is important to address as it relates to grief. A study was conducted with 11 graduate counseling students enrolled in a summer elective course over death and grief. Qualitative results using free-response narratives revealed the emergence of themes such as openness to examining death and reduced negative emotional state. Findings also found positive effects of greater comfort and coping. It should be noted that the participants were predominately white and affiliated with the Mormon church, and the sample size is very small. Therefore, the results cannot be generalized so easily.

 The focus of this study was on how death and grief education would influence counseling students’ attitudes on death and grief. This is important because it can be assumed that with a greater openness to loss, death, and grief topics, counselors may be more likely to continue learning about these issues. Counselors who understand the importance of the topic may be more motivated to seek out tools to better assist their clients in this area. However, having a positive outlook on death and grief does not necessarily mean one has the skillset, competency, and understanding of grief styles or interventions. It would have been interesting to see if the students enrolled in this course demonstrated greater competency in providing grief counseling compared to individuals of the same program who were not enrolled in that course.

Next is the topic of counseling students’ perceptions of grief counseling competency. In an article by Hill et al. (2018), Master’s level counseling students’ perceptions of preparedness for identifying and working with grief issues and providing grief counseling was examined. This study was based on an analysis of students CACREP-accredited counseling programs. Self-perception of competency in counseling clients navigating grief and loss was assessed using the Grief Counseling Competency Scale. The data showed that coursework lent to improved self-perception of grief counseling competency. It additionally supported the need for further investigation of coursework regarding increased competency and training in counselors working with clients on grief and loss issues, in support of modern grief theories. However, the study appeared focused on counselors’ perceptions of their own competence in grief counseling rather than their actual skill acquisition. It would be interesting to compare those perceptions with supervisors or clients to see if they agreed the counselors demonstrated competency and understanding on grief counseling theory and practice.

 The same topic of self-perceived competency, specifically with regard to grief related to loss or disability, was examined by Cicchetti, McArthur, Szirony, and Blum (2016). They aimed to examine if counselors-in-training reported being adequately trained to identify and work with clients dealing with grief-related issues from loss or disability. It was stated that grief from disability presents similarly to grief from death and argued that for this reason, grief education should be comprehensive. It is important to consider this study in this review because non-death grief would be one small aspect of a comprehensive grief education course, and the literature on counselors’ competencies with non-death grief is minimal at best.

A quantitative, nonexperimental survey design was used on a sample of 93 master’s-level rehabilitation counseling students. Results found that students did not perceive themselves as having learned grief competencies in their education, and very few were exposed to coursework of grief counseling and interventions. It should be noted that due to the small sample size, the extent of generalizability is debatable. Nonetheless, this lack of knowledge has serious implications such as misdiagnosis and inappropriate treatment and thus can be a barrier to effective treatment. Similar to the study with Hill et al., this study focused on counselors’ reported self-perception. Assumptions about oneself could be false or misleading, so it is important to address such perceptions by focusing on skill acquisition.

 In another study, Ober, Granello, and Wheaton (2012) surveyed counselors on the status of their grief training and experience and their self-perceived personal and professional competencies with grief. They also looked to see which counselor variables (gender, age, years of counseling experience, personal experience with grief, and training and experience in grief counseling) best predicted grief counseling competence. They found that training and experience were significant predictors of competence in grief counseling. In their findings, participants also indicated little familiarity with dual-process, continuing bonds, and meaning-making theories and most familiarity with stage and task theories. This finding is important because the theories most participants were familiar with have had their utility questioned whereas those they were least familiar with have some evidence of validity. This parallels the interesting finding discussed in the earlier Beckett and Dykeman study. Counselors in that study revealed little understanding of various grief styles, and in this study counselors revealed a lack of knowledge of modern and empirically supported grief theories. It leads one to wonder how other counselors, supervisors, and clients would rate their clinical judgement and performance if they are using treatment methods influenced by those questioned theories.

 This study also was the first known attempt to assess the Grief Counseling Competencies of practicing counselors.  Because of this, the researchers caution that the results should be interpreted carefully as initial findings instead of definitive answers. They further suggest that since this study used assessment instruments that examined self-perceived competence, the development of instruments to use with clients or supervisors would be beneficial to compare the results.

 It can be assumed from these literature reviews that education on grief topics can enhance counselors’ understanding on grief and loss topics. However, the current research of grief counseling education has shown there are still gaps in this area. Although there is quite a bit of focus on how counselors rate themselves, there minimal research on how clients or supervisors perceive their experience in grief counseling, which can be an important aspect to consider in competency. Additionally, very few participants demonstrate a lack of awareness of modern grief theories, various grieving styles, and non-death grief, and it would be beneficial to see how the results would look if that knowledge was reflected in the sample.

References

• Beckett, C., & Dykeman, C. (2015). Preservice counselors’ initial perceptions of client grief style: An analogue study.Omega: Journal of Death and Dying, 71(3), 219-232. doi:10.1177/0030222815575501
• Cicchetti, R. J., McArthur, L., Szirony, G. M., & Blum, C. R. (2016). Perceived competency in grief counseling: Implications for counselor education. Journal of Social, Behavioral & Health Sciences, 10(1), 3-17. doi:10.5590/JSBHS.2016.10.1.02
• Harrawood, L. K., Doughty, E. A., & Wilde, B. (2011). Death education and attitudes of counselors-in-training toward death: An exploratory study. Counseling and Values, 56(1-2), 83-95. doi:10.1002/j.2161-007X.2011.tb01033.x
• Hill, J. E., Cicchetti, R. J., Jackson, S. A., & Szirony, G. M. (2018). Perceptions of grief education in accredited counseling programs: Recommendations for counselor education. Journal of Social, Behavioral & Health Sciences, 12(1), 74-83. doi:10.5590/JSBHS.2018.12.1.05
• Humphrey, K. M. (1993). Grief counseling training in counselor preparation programs in the united states: A preliminary report. International Journal for the Advancement of Counselling, 16(4), 333-340. doi:10.1007/BF01407918
• Ober, A. M., Granello, D. H., & Wheaton, J. E. (2012). Grief counseling: An investigation of counselors’ training, experience, and competencies. Journal of Counseling & Development, 90(2), 150-159. doi:10.1111/j.1556-6676.2012.00020.x