Rehabilitation Counselors' Experiences with Client Death and Death Anxiety.Based on anecdotal evidence anecdotal evidence, n information obtained from personal accounts, examples, and observations. Usually not considered scientifically valid but may indicate areas for further investigation and research. many counselors experience the death of a client during their professional careers; however, a review of the literature provides little insight into how counselors are affected by this experience or whether they are being trained to deal with it. One area of counseling that addresses the topic of client death, although to a limited extent, is rehabilitation counseling rehabilitation counseling, n counseling started in the United States in 1920 to assist individuals disabled by industrial accidents; originally included physical, psychologic, and occupational training; expanded over the next 70 years and laid the . Because of medical and technological advances, more people are living longer with life-threatening Adj. 1. life-threatening - causing fear or anxiety by threatening great harm; "a dangerous operation"; "a grave situation"; "a grave illness"; "grievous bodily harm"; "a serious wound"; "a serious turn of events"; "a severe case of pneumonia"; "a life-threatening disabilities. Regardless of whether they choose to work with clients with life-threatening or terminal illness or both, it seems likely that rehabilitation rehabilitation: see physical therapy. counselors will experience the death of at least one client during their professional lifetimes. Clients may die as a result of accidents, suicide, or natural causes, in addition to dying from a life-threatening illness. The longer rehabilitation counselors work in the field, the greater is the likelihood that they will experience the death of a client. Despite the probability of increased exposure to client death when working with high-risk high-risk adjective Referring to an ↑ risk of suffering from a particular condition Infectious disease Referring to an ↑ risk for exposure to blood-borne pathogens, which occurs with blood bank technicians, dental professionals, dialysis unit populations, little empirical evidence has documented the level of preparation of rehabilitation counselors regarding the effect of death or death anxiety. The research literature does show, however, that client death has an effect on counselors and on their work with clients. Some counselors may find they have more empathy empathy Ability to imagine oneself in another's place and understand the other's feelings, desires, ideas, and actions. The empathic actor or singer is one who genuinely feels the part he or she is performing. for clients and a better appreciation of life as a result of a client dying (Allen Al·len , Edgar 1892-1943. American anatomist who is noted for his studies of hormones and for the discovery (1923) of estrogen. & Miller, 1988), but some counselors may experience negative reactions as well. For example, negative reactions to clients with life-threatening or terminal illnesses include premature termination of the counseling relationship; feelings of helplessness helplessness, n a perception held by a person because of which he or she feels powerless or unable to act independently. Typically associated with persons diagnosed with chronic disease. , anxiety, and discomfort Discomfort may refer to pain, an unpleasant sensation, or to suffering, an unpleasant feeling or emotion. ; denial or avoidance on the part of the counselor to death with the inevitability of a client's death; and impaired work ability and efficiency (Allen & Miller, 1988; Allen & Sawyer, 1984; Hayes Hayes, river, c.300 mi (480 km) long, rising in a lake NE of Lake Winnipeg, central Manitoba, Canada, and flowing NE to Hudson Bay. It was the chief route used by Hudson's Bay Company traders from Hudson Bay to Lake Winnipeg and the interior; York Factory, an & Gelso, 1993; Humphrey, 1993). Regardless, working with dying and grieving grieving Mourning, see there clients can make counselors confront their own losses, as well as the losses their clients are experiencing (Rando, 1984). Allen and Jaet (1982) surveyed 198 vocational rehabilitation counselors vocational rehabilitation counselor, n term coined in the 1960s and 1970s for a professional who incorporates the best of psychology, social work, and nursing in an attempt to integrate psychology with traditional rehabilitation protocols. about their experiences with client death and bereavement Bereavement Definition Bereavement refers to the period of mourning and grief following the death of a beloved person or animal. The English word bereavement training. Of the respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. , 77% had experienced the death of a client during the previous four years. The range of clients who died was between one and 30, and about half had experienced the death of one to three clients during that time period. Counselors who had experienced the death of a client reported that their work and home life were affected by the death, as well as their emotional state. When asked about training received, 24% said they had received some training in death and bereavement issues, 59% thought training about death and dying issues was needed to perform their jobs, and 70% expressed a need for training specifically to work with people with terminal illness. Allen and Jaet made the call for further training in death and dying issues and expressed a need for onsite support and supervision for counselors who experienced the death of a client on their caseload case·load n. The number of cases handled in a given period, as by an attorney or by a clinic or social services agency. caseload Noun . With respect to training, Bascue, Lawrence, and Sessions (1977) surveyed 54 vocational rehabilitation counselors and found that 61% had had a client with whom they were working die in the previous 12 months. Yet 72% of these counselors reported that they had never received any training related to death education. As a result of their findings, Bascue et al. called for more death and dying education for rehabilitation counselors, stating "the liklihood [sic Latin, In such manner; so; thus. A misspelled or incorrect word in a quotation followed by "[sic]" indicates that the error appeared in the original source. ] that counselors face such death-related issues makes the need for training compelling" (p. 38). Allen and Miller (1988) replicated Allen and Jaet's (1982) study by surveying 627 certified See certification. rehabilitation counselors (CRC (Cyclical Redundancy Checking) An error checking technique used to ensure the accuracy of transmitting digital data. The transmitted messages are divided into predetermined lengths which, used as dividends, are divided by a fixed divisor. ) about their training and experiences with client death between 1982 and 1985. With respect to death and dying issues, 98% thought training was needed, but only 22% had received such training. Of the CRCs who provided direct client services (n=371), 61% had one or more clients die during a three-year period, with 85% of these people experiencing the death of between one and six clients. CRCs who had experienced the death of a client reported the death had an effect on their professional and personal lives. Of the CRCs who had experienced the death of a client, the majority (59%) reported that peers and colleagues were their greatest source of support at work. On the other hand, only 4% reported receiving support from their supervisors. In a study of 160 master's level rehabilitation counselors-in-training, (Hunt & Rosenthal, 1997) found 34% of the trainees had experienced the death of a client. Of the students surveyed, 31% stated they would prefer not to work with clients who are dying. With respect to training, 83% thought death and dying training would be needed for their jobs, yet only 23% reported receiving any training on the topic. The researchers also assessed the students' level of death anxiety using the Templer Death Anxiety Scale (1970) and found that the majority of respondents (75%) fell in the moderate death anxiety group. Students who preferred not to work with clients with a terminal illness (31%) had higher death anxiety scores. Students who had experienced the death of a client had lower death anxiety scores than students who had not experienced the death of a client. The authors called for more grief and loss training in graduate school and in continuing education continuing education: see adult education. continuing education or adult education Any form of learning provided for adults. In the U.S. the University of Wisconsin was the first academic institution to offer such programs (1904). programs. Thus, the literature provides evidence that rehabilitation counselors do experience the death of clients on their caseload and that their training to deal with such losses has been minimal at best. Knowledge deficits exist, however, regarding two issues: (a) whether the experiences of rehabilitation counselors with respect to client death have changed over the past 12 to 20 years, as people are now living longer with life-threatening and terminal conditions; and (b) whether graduate and continuing education programs have answered the call for more training. Therefore, this study was designed to address these issues, as well as assess rehabilitation counselors' levels of death anxiety (Templer, 1970). Neimeyer and Van Brunt brunt n. 1. The main impact or force, as of an attack. 2. The main burden: bore the brunt of the household chores. (1995), in their review of the death anxiety literature, noted that people who are in contact with death as a result of their profession have shown both increased and decreased rates of death anxiety. Given that higher rates of death anxiety "may adversely affect the quality of care" provided to clients (p. 69), they cite the need for research that addresses the vocational implications of death anxiety. We included the death anxiety component in this study in response to their call, and as a result of reviewing the counseling literature, which shows increased death anxiety and fear of death may negatively affect clients (e.g., Allen & Miller, 1988; Allen & Sawyer, 1984; Hayes & Gelso, 1993; Humphrey, 1993). The current study had two main purposes. First, we wanted to update the previous research about the incidence and experience of client death, as well as the level of grief and loss training rehabilitation counselor received. Second, we wanted to increase the fund of knowledge about rehabilitation counselors and their experiences with client death. We addressed the second purpose of the study by: (a) assessing rehabilitation counselors' levels of death anxiety, which has not been studied to date; (b) asking what would help respondents feel more competent when working with clients with a life-threatening illness; and (c) investigating what client-related death situations respondents thought might be the most challenging. We used both quantitative and qualitative research Qualitative research Traditional analysis of firm-specific prospects for future earnings. It may be based on data collected by the analysts, there is no formal quantitative framework used to generate projections. methods to address the two purposes of this study. Method Participants A cover letter and survey were sent to 400 randomly selected members of the American Rehabilitation Counseling Association (ARCA). Each potential participant's name was obtained from ARCA's mailing list An automated e-mail system on the Internet, which is maintained by subject matter. There are thousands of such lists that reach millions of individuals and businesses. New users generally subscribe by sending an e-mail with the word "subscribe" in it and subsequently receive all new . Because of a low initial response rate, a second letter and survey were sent. Of the surveys distributed, 28 were not useable for this study leaving 372 possible respondents. The response rate was 41% (N = 153). Sixty-seven percent of the respondents were female (n = 102), with an age range from 23 to 78 and a mean age of 43. With regard to ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic , 87% (n = 133) of the respondents self-identified as White, 3% (n = 5) as Black/African American, 3% (n = 5) as Hispanic Hispanic Multiculture A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race Social medicine Any of 17 major Latino subcultures, concentrated in California, Texas, Chicago, Miam, NY, and elsewhere , and 2% (n = 3) marked the "other" category; 5% (n = 7) did not respond to this question. Participants had worked as rehabilitation counselors for an average of 10 years (ranging from 1 to 52 years), and 89% (n = 137) had earned a master's degree master's degree n. An academic degree conferred by a college or university upon those who complete at least one year of prescribed study beyond the bachelor's degree. Noun 1. or higher. Instruments The two-page survey was developed by the authors and consisted of five sections. In section one, respondents were asked to provide basic demographic information including gender, age, ethnicity, highest degree earned, and how long they had been working as rehabilitation counselors. In section two, respondents described their experiences related to death and dying issues, by answering the following questions and statements: (a) How important do you think training in death and bereavement issues is for rehabilitation counselors?, (b) Have you received any professional training related to death, dying, and grief issues?, (c) If I had a choice, I would prefer not to work with people who have a life-threatening or terminal illness, and (d) Have any of the clients you worked with in the past 5 years died? If yes, how many? In section three, respondents who had experienced the death of a client were asked to indicate whether they experienced any feelings from a pre-defined list of 11 feelings when they thought about the death of a client. In the fourth section, respondents were asked to respond to two open-ended questions A closed-ended question is a form of question, which normally can be answered with a simple "yes/no" dichotomous question, a specific simple piece of information, or a selection from multiple choices (multiple-choice question), if one excludes such non-answer responses as dodging a : (a) What would help you feel more comfortable and/or competent when working with clients who have a life-threatening or terminal condition?, and (b) When you think about the death of a client, what situation(s) might be the most difficult for you? In the fifth section, respondents completed a revised version Revised Version n. A British and American revision of the King James Version of the Bible, completed in 1885. Revised Version Noun of the Templer Death Anxiety Scale (DAS; Templer, 1970). The DAS contains 15 true/false items and is a widely used paper and pencil assessment (Neimeyer & Van Brunt, 1995). Developed to assess a range of life and death experiences (Templer, 1970), the DAS measures the "extent to which the respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. is preoccupied pre·oc·cu·pied adj. 1. a. Absorbed in thought; engrossed. b. Excessively concerned with something; distracted. 2. Formerly or already occupied. 3. with and anxious about death" (Rasmussen & Johnson, 1994, p. 315). The original DAS has good construct, concurrent, and discriminant validity Discriminant validity describes the degree to which the operationalization is not similar to (diverges from) other operationalizations that it theoretically should not be similar to. (Hayes & Gelso, 1993), with a test-retest reliability test-retest reliability Psychology A measure of the ability of a psychologic testing instrument to yield the same result for a single Pt at 2 different test periods, which are closely spaced so that any variation detected reflects reliability of the instrument of .83 (Templer, 1970). Rather than use the original true-false format for the DAS, respondents used a five-point Likert scale Likert scale A subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc from 1 (strongly disagree) to 5 (strongly agree) to increase the sensitivity of the instrument (Hayes & Gelso, 1993; McMordie, 1979; Thorson & Powell, 1994). McMordie (1979) found that using a Likert scale increased ability to discriminate dis·crim·i·nate v. dis·crim·i·nat·ed, dis·crim·i·nat·ing, dis·crim·i·nates v.intr. 1. a. between high and low scores. Moreover, Hayes and Gelso (1993) found that using a five-point Liken lik·en tr.v. lik·ened, lik·en·ing, lik·ens To see, mention, or show as similar; compare. [Middle English liknen, from like, similar; see like2 scale increased the instrument's sensitivity to differences among respondents. Respondents scored between 1 and 5 points for each answer given in the keyed high death anxiety direction (based on the true/false responses on the original DAS). Responses for five statements (items 2, 3, 5, 6, 7, 15) were reverse scored. Final scores range between 15 to 75, with higher scores indicating higher levels of death anxiety. Given this range, it seemed appropriate to divide the scale into thirds for analysis purposes. Therefore, we determined that scores between 15-35 indicated low death anxiety, 36-55 moderate death anxiety, and 56-75 high death anxiety. Results In response to the question, "How important do you think training in death and bereavement issues is for rehabilitation counselors?," 1% thought training was not important, 16% thought it was somewhat important, 6% were neutral, 44% thought it was important, and 32% believed training was very important. When asked "Have you received any professional training related to death, dying, and grief issues?," 62% (n=95) stated they had received some level of training dealing with dying, death, and grief issues, including lectures in undergraduate and graduate courses and by content of professional workshops and conferences as part of continuing education. Participants were also asked, "Have any of the clients you worked with in the past five years died? If yes, how many?" Of the 153 respondents, 67% (n=102) experienced a client death in the past 5 years (1991-1996), with a range from 1 to 50 deaths. Of the counselors who had experienced client death, 73 had between 1 and 4 clients die and 21 had between 5 and 10 clients die. Of these deaths, 39 were the result of suicide, 78 were other unexpected (e.g., homicide homicide (hŏm`əsīd), in law, the taking of human life. Homicides that are neither justifiable nor excusable are considered crimes. A criminal homicide committed with malice is known as murder, otherwise it is called manslaughter. , accident), and 343 were expected (e.g., chronic or life-threatening condition or disability). In response to the statement, "If I had a choice, I would prefer not to work with people who have a life-threatening or terminal illness," 18% (n=27) strongly disagreed, 33% (n=51) disagreed, 26% (n=40) were neutral, 17% (n=26) agreed, and 5% (n=7) strongly agreed. Two people did not respond to this statement. Feelings of Rehabilitation Counselors Who Had Experienced Client Death Respondents who had a client die within the previous five years were asked which of a list of 11 feelings they experienced using a five-point Likert scale from "strongly disagree" to "strongly agree." The list was adapted from one Harry Allen
Harry Allen (1911- August 15, 1992) was one of Britain's last executioners, officiating between 1941 and 1964 when he was the chief executioner at 29 executions and (personal communication, September 25, 1995) used in two previous studies (Allen & Jaet, 1982; Allen & Miller, 1988). The list was expanded to 11 words (i.e., sad, shock, frustration, anger, confusion, despair, depression, irritability irritability /ir·ri·ta·bil·i·ty/ (ir?i-tah-bil´i-te) the quality of being irritable. myotatic irritability the ability of a muscle to contract in response to stretching. , guilt, ambivalent am·biv·a·lent adj. Exhibiting or feeling ambivalence. am·biv  a·lent·ly adv.Adj. 1. , and relief) after reviewing the literature on feelings commonly experienced in grief and loss situations. Results indicated that sad (M=2.51, SD=2.21) and shock (M=2.15, SD=2.038) were the most common feelings respondents associated with client death. At the other end, ambivalent (M=1.23, SD=1.34) and guilt (M=1.15, SD=1.28) were the least associated. Responses to Open-Ended Questions To hear, in their own words, what rehabilitation counselors said would help them feel more effective when working with clients who have life-threatening or terminal conditions and what these counselors saw as their major challenges when in these situations, we included two open-ended questions. Responses to these questions were coded using content analysis, a procedure commonly used in qualitative research (Lincoln Lincoln, city and district, England Lincoln, city (1991 pop. 79,980) and district, Lincolnshire, E England, in the Parts of Kesteven, on the Witham River. & Guba, 1985; Patton, 1980). Using this type of analysis allows themes or categories to emerge from the data (i.e., the participants answers to the questions) based on consensus among responses. To conduct the analysis, the authors individually read all of the responses and grouped them into similar content categories. Having the researchers code the data separately and then meeting to compare their results allowed for greater inter-rater reliability Inter-rater reliability, Inter-rater agreement, or Concordance is the degree of agreement among raters. It gives a score of how much , or consensus, there is in the ratings given by judges. . Once the final categories were developed, representative samples of responses were selected for each category. The results of the content analysis follow. Because of space limitations, however, only condensed con·dense v. con·densed, con·dens·ing, con·dens·es v.tr. 1. To reduce the volume or compass of. 2. To make more concise; abridge or shorten. 3. Physics a. category descriptions will be provided. For a more complete description of the responses, please contact the first author. A total of 131 people responded to the first open-ended question: "What would help you feel more comfortable and/or competent when working with clients who have a life-threatening or terminal condition?" Content analysis of the responses revealed 12 categories. The top category was labeled need for more training and knowledge with 60 responses, including "more extensive education on this issue." The second category was labeled need for more medical knowledge and information with 14 responses, including "being more medically informed overall and also being well versed Versed® Midazolam Pharmacology A preoperative sedative in specific illnesses/conditions." The third category, counselor personal issues, contained 13 responses including "the opportunity to have worked through my own issues relating to relating to relate prep → concernant relating to relate prep → bezüglich +gen, mit Bezug auf +acc death and loss" and "increased comfort with my own feelings about death." The fourth category, need for consultation and supervision, contained 12 responses, including "backing from supervisor that we are being supported in this effort" and "support of experienced coworker co·work·er or co-work·er n. One who works with another; a fellow worker. or supervisor." The next six categories were: (a) already comfortable with this population (n = 11), (b) need for both training and experience (n = 8), (c) need for more experience (n = 7), (d) knowledge about community resources (n = 5), (e) knowledge about the client's level of spirituality (n = 4), and (f) need for a support system for counselors who experience client death (n = 4). The final two categories were labeled nothing would make me feel more comfortable (n = 3) and unsure what would help me feel more comfortable (n = 3). The second open-ended question asked: "When you think about the death of a client, what situation(s) might be the most difficult for you?" A total of 130 people responded to this question. Content analysis of the responses led to 11 categories. The top four categories and examples of statements are provided below. The first category, client suicide, contained 40 responses, including "suicide during ongoing outpatient outpatient /out·pa·tient/ (-pa-shent) a patient who comes to the hospital, clinic, or dispensary for diagnosis and/or treatment but does not occupy a bed. out·pa·tient n. treatment" and "clients committing suicide after threatening to do so." The second category, working with surviving family members, contained 22 responses including "working with `charged' emotion of family" and "the sadness & pain of the family." The third category, labeled counselor personal issues, contained 16 responses including "anything with similarities to family members or self" and "getting over the shock related to the death." The fourth category, violent death or murder, had 12 responses including "death due to violence (murder)" and "violence/torture." The remaining seven categories were (a) long or close relationship with the client (n = 8), (b) death of children or youth (n = 9), (c) unexpected death/accidents (n = 9), (d) long and/or painful dying process (n = 8), (e) client nonacceptance of death (n = 9), (f) negative effect on surviving children (n = 6), and (g) being present when the client died (n = 4). Responses to the Templer Death Anxiety Scale (DAS)and Analysis of Variance The discrepancy between what a party to a lawsuit alleges will be proved in pleadings and what the party actually proves at trial. In Zoning law, an official permit to use property in a manner that departs from the way in which other property in the same locality Results As stated earlier, part of the second purpose of this study was to determine what level of death anxiety, if any, rehabilitation counselors expressed. This level was determined using the DAS. Final scores ranged from 22 to 66, with a possible range from 15 to 75. The mean score was 40.49, with a standard deviation In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. of 8.42. As stated earlier, the authors categorized cat·e·go·rize tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es To put into a category or categories; classify. cat total scores into three groups-low, moderate, and high death anxiety. For this study, 31% (n = 48) of the respondents fell into the low anxiety group, 66% (n = 100) fell into the moderate anxiety group, and 3% (n = 5) in the high death anxiety group. See Table 1 for specific responses to the DAS. Table 1 Templer Death Anxiety Scale Questions (Number of Responses to Each Question, N=153)
NR SD D N A SA
0 41 49 32 25 6 I am very much afraid to
die.
1 12 49 49 28 14 The thought of death
seldom enters my mind.
3 1 16 19 66 48 It doesn't make me
nervous when people talk
about death.
0 27 36 33 35 22 I dread thinking about
having to have an
operation.
1 14 48 31 39 20 I am not at all afraid
to die.
0 33 46 30 37 7 I am not particularly
afraid of getting cancer.
0 11 73 28 31 10 The thought of death
never bothers me.
1 17 29 42 45 19 I am often distressed by
the way time flies so
very rapidly.
0 16 25 31 55 26 I fear dying a painful
death.
0 78 38 26 10 1 The subject of life
after death troubles me
greatly.
0 43 43 49 12 6 I am really scared of
having a heart attack.
0 43 43 49 12 6 I often think about how
short life really is.
0 55 30 42 15 11 I shudder when I hear
people talking about a
World War III.
2 35 45 44 22 5 The sight of a dead body
is horrifying to me.
0 13 33 42 43 22 I feel that the future
holds nothing for me to
tear.
Note. NR = No Response, SD = Strongly Disagree, D = Disagree, N = Neutral, A = Agree, SA = Strongly Agree As part of our study of death anxiety, we analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. how the following variables affected the respondents' levels of death anxiety: (a) gender, (b) age, (c) training received, (d) experience with client death, and (e) desire to work (or not work) with dying clients. These variables were selected by reviewing the death anxiety literature to determine which variables were most commonly used in previous research and by considering the research questions for this study. This study utilized a static, group-comparison, pre-experimental design (Campbell & Stanley Stanley, town (1991 pop. 1,557), capital of the Falkland Islands, S Atlantic Ocean, on East Falkland island. It is the main port and trading center of the islands. The name is sometimes written as Port Stanley. , 1963) in which the DAS scores were compared across status variables. For purposes of this study, participant ages were converted into categorical That which is unqualified or unconditional. A categorical imperative is a rule, command, or moral obligation that is absolutely and universally binding. Categorical is also used to describe programs limited to or designed for certain classes of people. variables depicting younger ([is less than or equal to] 44) and older ([is greater than or equal to] 45) respondents using a median split as the cutoff criterion. The dependent measure DAS scores were analyzed as continuous variables. One-way analyses of variance (ANOVA anova see analysis of variance. ANOVA Analysis of variance, see there ) were conducted investigating death anxiety scores in relation to the variables listed above. Results of the ANOVA indicate, of the variables investigated, only age, F(1, 151) = 5.12, p [is greater than] .05, and preference to work with dying clients, F(1, 109) = 16.07, p [is less than] .05, were found to demonstrate significant group differences across respondents' death anxiety scores. The variables gender, F(1, 151) = 2.75, p [is greater than] .05; training received, F(1, 151) = .0076, p [is greater than] .05; and experience of client death, F(1, 149) = 1.76, p [is greater than] .05; were found to be nonsignificant non·sig·nif·i·cant adj. 1. Not significant. 2. Having, producing, or being a value obtained from a statistical test that lies within the limits for being of random occurrence. . Data in Table 2 provide mean scores, standard deviations, and significance of the analyses. Table 2 Templer DAS Mean Scores, Standard Deviations, and Analysis of Variance
N M SD
Age
[is less than or equal to] 44 73 42.08 8.43
[is greater than or equal to] 45 80 39.03 8.18
Gender
Female 102 41.28 8.91
Male 51 38.90 7.14
Training
Had Training 95 40.53 8.49
No Training 58 40.41 8.37
Preference to Work
Yes 78 37.69 7.40
No 33 44.39 9.43
Experienced client death
Yes 102 39.93 8.37
No 49 41.87 8.54
F Ratio p Value
Age 5.12 .025(*)
[is less than or equal to] 44
[is greater than or equal to] 45
Gender 2.75 .099
Female
Male
Training .0076 .930
Had Training
No Training
Preference to Work 16.06 .0001(***)
Yes
No
Experienced client death 1.76 .186
Yes
No
(*) p < .05 (**) p .01 (***) p < .001 Discussion Results of this study provide preliminary information about rehabilitation counselors and their thoughts and reactions to possible client death. Of the 153 respondents, 22% stated a preference not to work with clients who have a life-threatening or terminal illness. This choice, however, may not be one that rehabilitation counselors are able to make. Even if counselors can avoid working with people with a terminal illness, results of this and other studies show that more than half of rehabilitation counselors surveyed have had the experience of a client dying. Moreover, in this study approximately a quarter of these deaths were unexpected. Participants who preferred not to work with clients with life-threatening illnesses scored significantly higher than other respondents on the DAS, although the mean was still in the moderate death anxiety range. Respondents who said they would work with clients with a life-threatening illness had lower DAS scores and more experience with client death. Women in this study did not have significantly higher levels of death anxiety than men. Younger respondents ([is less than or equal to] 44 years of age) had higher level of death anxiety than older respondents. Both of these findings are contrary to previous studies (e.g., Neimeyer & Van Brunt, 1995; Templer & Ruff, 1971; Templer, Ruff, & Franks, 1971; Thorson & Powell, 1994). Based on previous research (e.g., Brent Brent, outer borough (1991 pop. 226,100) of Greater London, SE England. The area is a rail and industrial center. Its manufactures include automobile parts, clocks and watches, and electrical equipment. , Speece, Gates, Mood, & Faul, 1991; Neimeyer & Van Brunt, 1995), we expected there to be significant differences on death anxiety scores between rehabilitation counselors who had worked with a client who died and those who had not, but that was not the case. This finding is contrary to a previous study of nursing students (Brent et al., 1991). The authors of this study found that students with a wide range of death-related experiences, such as training and personal and professional experiences, had more positive and accepting attitudes toward patients who were dying. We did find, though, that counselors who would choose to work with terminally ill Terminally Ill When a person is not expected to live more than 12 months. Notes: Any gifts given out by the afflicted person at this time may be considered as a dispersion of the estate rather than a gift. clients, given the option, saw a greater need for training on the issues of death and dying (with 65 respondents viewing training as "important" and "very important"). This finding is in comparison to respondents who did not want to work with this population (21 viewed training as "important" or "very important"). Implications of this finding might be that people who do not want to work with this population may not seek out the necessary training when they are working with a client who has a terminal or life-threatening illness. Comparison of Results to Related Studies Comparing the results of the current study to previous studies sheds light on where we are now with respect to rehabilitation counselors' experiences with client death and their training on this topic. Sixty-seven percent of the rehabilitation counselors in this study experienced the death of a client in the past 5 years, which is comparable to the results of previous research (Allen & Jaet, 1982; Allen & Miller, 1988; Bascue et al., 1977). In the current study, 62% of the respondents had received some level of death and dying training, compared to 22 to 28% in previous studies (Allen & Jaet, 1982; Allen & Miller, 1988). Because the rehabilitation counselors in the current study had been working an average of 10 years in the field, this finding may serve as evidence that counselors are receiving more education and training related to death and dying issue, both in school and as continuing education. When comparing rehabilitation counselors with rehabilitation counselors-in-training, Hunt and Rosenthal (1997) found 34% of the trainees had experienced client death. When asked whether they would prefer not to work with a client with a terminal or life-threatening illness, 31% of trainees would prefer not to compared to 22% of rehabilitation counselors in this current study. With respect to death anxiety, the mean score for counselors-in-training was 44 (out of a range of 15 to 75) and the mean score for counselors in the present study was 40. Both groups fell within the moderate death anxiety range. Only 23% of students reported receiving any training on death and dying issues, compared to 62% of practicing rehabilitation counselors. Limitations of the Study There are several limitations that should be considered when interpreting the results of this study. First, this study relied on a self-report paper-and-pencil measure and, as such, may not generalize generalize /gen·er·al·ize/ (-iz) 1. to spread throughout the body, as when local disease becomes systemic. 2. to form a general principle; to reason inductively. to all rehabilitation counselors, or even all members of the American Rehabilitation Counseling Associate. Second, 59% of the people surveyed did not respond. Participants who did respond may have done so because they thought the topic was an important one or vice versa VICE VERSA. On the contrary; on opposite sides. . Although significant group differences were not found for most of the variables with respect to the aims of this study, further investigation seems warranted to establish the meaning of such findings. For example, why was there no difference in death anxiety scores between counselors who had worked with clients who died and those who did not? Due to the lack of specific information regarding types and length of grief and loss training, the similar death anxiety scores between respondents who indicated they had no training and those indicating they had should be interpreted with caution, because previous research showed a difference between these two groups (e.g., Brent et al., 1991; Neimeyer & Van Brunt, 1995). Recommendations for Rehabilitation Counselors and Educators Results from this and other research studies document that the majority of rehabilitation counselors will experience the death of at least one client during their careers. This experience can have positive and negative implications for both counselors and for their clients. Based on the qualitative responses of participants in this study, it seems important to provide rehabilitation counselors with opportunities to explore their thoughts, feelings, and reactions with respect to client death, if they choose to, in a variety of ways. For example, agencies that provide services primarily to clients with life-threatening or terminal illness can develop support groups and in-house In-house In the context of general equities, keeping an activity within the firm. For example, rather than go to the marketplace and sell a security for a client to anyone, an attempt is made to find a buyer to complete the transaction with the firm. training programs to give staff avenues to process their feelings and experiences surrounding sur·round tr.v. sur·round·ed, sur·round·ing, sur·rounds 1. To extend on all sides of simultaneously; encircle. 2. To enclose or confine on all sides so as to bar escape or outside communication. n. client dying and death. For agencies that typically have a low incidence of client death, allowing counselors time during staff meetings to talk about their feelings and reactions when a client dies or setting a meeting specifically for this purpose can be very helpful. Such meetings not only provide opportunities for the counselor whose client died to talk, but also provide opportunities for other counselors to talk about their experiences with client death in the past. Also, counselors who have not had the experience can talk about their fears and concerns in a safe and supportive environment. If supervisors are not trained or do not feel prepared to lead such a discussion, one option is to bring in a facilitator from another agency, for example a counselor from a local hospice hospice, program of humane and supportive care for the terminally ill and their families; the term also applies to a professional facility that provides care to dying patients who can no longer be cared for at home. or an AIDS support organization, to run such a group. To reciprocate re·cip·ro·cate v. re·cip·ro·cat·ed, re·cip·ro·cat·ing, re·cip·ro·cates v.tr. 1. To give or take mutually; interchange. 2. To show, feel, or give in response or return. v. , rehabilitation counselors could offer to give a training program about counseling people with disabilities or some other rehabilitation topic. Counselors who are deeply affected by the death of client should be encouraged to talk to colleagues and supervisors as a way to cope with their experience. They may also need to be reminded that it does not necessarily mean that counselors are overly involved or enmeshed en·mesh also im·mesh tr.v. en·meshed, en·mesh·ing, en·mesh·es To entangle, involve, or catch in or as if in a mesh. See Synonyms at catch. if they experience intense feelings when a client dies. It is a shared sense of humanity and the ability to empathize em·pa·thize v. To feel empathy in relation to another person. that allow rehabilitation counselors to be truly effective at their jobs, so of course they may have strong reactions when a client dies. Some counselors may need to talk with their supervisor about reducing their caseload for some period of time, or they may need to take a brief leave of absence to grieve grieve v. grieved, griev·ing, grieves v.tr. 1. To cause to be sorrowful; distress: It grieves me to see you in such pain. 2. over the death of the client. Personal counseling may also be helpful. Finally, and most importantly Adv. 1. most importantly - above and beyond all other consideration; "above all, you must be independent" above all, most especially , counselors should be given the opportunity to talk about the experience with supportive colleagues and supervisors as a way to normalize normalize to convert a set of data by, for example, converting them to logarithms or reciprocals so that their previous non-normal distribution is converted to a normal one. the experience. Based on the qualitative responses given in this study, many participants were aware of the issues that would be most difficult for them to address. This information could be used to develop graduate and continuing education programs that meet the stated needs of practicing rehabilitation counselors. Providing training opportunities for supervisors to help them learn how to be supportive to counselors who experience the death of a client would also be useful. In addition, rehabilitation practitioners could be encouraged to give presentations at state and national conferences sharing their own experiences about what was helpful for them. Another way to increase the level of information practitioners receive is to publish more articles related to this topic in rehabilitation journals. Examples could include articles about grief and loss, pathological 1. pathological - [scientific computation] Used of a data set that is grossly atypical of normal expected input, especially one that exposes a weakness or bug in whatever algorithm one is using. grief, anticipatory grief Anticipatory grief refers to a grief reaction that occurs in anticipation of an impending loss[1]. Anticipatory grief occurs when a loved one receives a terminal diagnosis.[2] Dying individuals can also experience anticipatory grief themselves. , and effects on the family. While experience and anecdotal evidence point out that client death does present challenges for counselors, we do not know necessarily what those specific effects are or how counselors can be prepared to work through them. For example, do counselors have a different response depending on whether the death is a result of a life-threatening or terminal illness, an unexpected death (such as homicide or accident or suicide)? What level and kinds of grief and loss training are most effective? What kinds of support mechanisms are most helpful for counselors who experienced the death of a client? Answers to these questions could positively influence the kinds of training experiences educators provide to rehabilitation counselors. When rehabilitation counselors experience the death of a client, many domains of counselor's lives are affected. Further research and training in this area can assist counselors in better understanding themselves and their responses and can potentially diminish the negative impact of such experiences on their practice. This result can only help counselors to provide more effective and appropriate services for clients with disabilities. Acknowledgement We wish to thank the editor and anonymous reviewers for their thoughtful and helpful comments on this manuscript manuscript, a handwritten work as distinguished from printing. The oldest manuscripts, those found in Egyptian tombs, were written on papyrus; the earliest dates from c.3500 B.C. . We also want to thank the rehabilitation counselors who participated in this study. References Allen, H. A., & Jaet, D. N. (1982). The rehabilitation counselor's experience of client death. Journal of Applied Rehabilitation Counseling, 13(2), 17-21. Allen, H. A., & Miller, D. M. (1988). Client death: A national survey of the experiences of certified rehabilitation counselors. Rehabilitation Counseling Bulletin, 32, 58-64. Allen, H. A., & Sawyer, H.W. (1984). Individuals with life-threatening disabilities: A rehabilitation counseling approach. Journal of Applied Rehabilitation Counseling, 15(2), 26-37. Bascue, L. O., Lawrence, R. E., & Sessions, J. A. (1977). Counselor experiences with client death concerns. Rehabilitation Counseling Bulletin, 1, 36-38. Brent, S. B., Speece, M. W., Gates, M. F., Mood, D., & Faul, M. (1991). The contribution of death-related experiences to health care providers' attitudes toward dying patients: I. Graduate and undergraduate nursing students. Omega, 23, 249-278. Campbell, D. T., & Stanley, J. C. (1963). Experimental and quasi-experimental designs for research. In N. L. Gage (Ed.), Handbook
This article is about reference works. For the subnotebook computer, see .
Hayes, J. A., & Gelso, C. J. (1993). Male counselors' discomfort with gay and HIV-infected clients. Journal of Counseling Psychology Counseling psychology as a psychological specialty facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental, and organizational concerns. , 40, 86-93. Humphrey, K. M. (1993). Grief counseling
Loss and grief are inevitable at some time in everyone's life [1] and at any age[2]. training in counselor preparation programs in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. : A preliminary report. International Journal for the Advancement of Counselling, 16, 333-340. Hunt, B., & Rosenthal, D. (1997). Rehabilitation counselors-in-training: A study of levels of death anxiety and perceptions about client death. Rehabilitation Education, 11,323-335. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic nat·u·ral·is·tic adj. 1. Imitating or producing the effect or appearance of nature. 2. Of or in accordance with the doctrines of naturalism. inquiry. Newbury Park, CA: Sage Publications This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article. . McMordie, W. R. (1979). Improving measurement of death anxiety. Psychological Reports, 44, 975-980. Neimeyer, R. A., & Van Brunt, D. (1995). Death anxiety. In H. Wass & R. A. Neimeyer (Eds.), Dying: Facing the facts (3rd ed., p. 49-88). Washington, DC: Taylor & Francis. Patton, M. Q. (1980). Qualitative evaluation methods. Beverly Hills Beverly Hills, city (1990 pop. 31,971), Los Angeles co., S Calif., completely surrounded by the city of Los Angeles; inc. 1914. The largely residential city is home to many motion-picture and television personalities. : Sage Publications. Rando, T.A. (1984). Grief, dying, and death: Clinical interventions for caregivers. Champaign Champaign (shămpān`), city (1990 pop. 63,502), Champaign co., E central Ill.; inc. 1860. It adjoins the city of Urbana and is a commercial and industrial center in a fertile farm area. The Univ. , IL: Research Press Company. Rasmussen, C. H., & Johnson, M. E. (1994). Spirituality and religiousity: Relative relationships to death anxiety. Omega, 29, 313-318. Templet, D. I. (1970). The construction and validation See validate. validation - The stage in the software life-cycle at the end of the development process where software is evaluated to ensure that it complies with the requirements. of a death anxiety scale. The Journal of General Psychology, 82, 165-177. Templer, D. I., & Ruff, C. E (1971). Death anxiety scale means, standard deviations, and embedding 1. (mathematics) embedding - One instance of some mathematical object contained with in another instance, e.g. a group which is a subgroup. 2. (theory) embedding - (domain theory) A complete partial order F in [X -> Y] is an embedding if . Psychological Reports, 29, 173-174. Templer, D. I., Ruff, C. F., & Franks, C. M. (1971). Death anxiety: Age, sex, and parental resemblance Resemblance may refer to:
Thorson, J. A., & Powell, F. C. (1994). A revised death anxiety scale. In R. A. Neimeyer (Ed.), Death anxiety handbook: Research, instrumentation instrumentation, in music: see orchestra and orchestration. instrumentation In technology, the development and use of precise measuring, analysis, and control equipment. , and application (pp. 31-43). Washington, DC: Taylor & Francis. David A. Rosenthal University of Wisconsin--Stout Brandon Hunt, Ph.D., Counselor Education, Counseling Psychology, and Rehabilitation Services, 327 CEDAR Building, The Pennsylvania State University Pennsylvania State University, main campus at University Park, State College; land-grant and state supported; coeducational; chartered 1855, opened 1859 as Farmers' High School. , University Park, PA 16802. Email: bbh2@psu.edu |
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