Rehabilitation Counselors' Experiences with Client Death and Death Anxiety

Abstract

Based on anecdotal evidence many counselors experience death of a client during their professional careers; however, a review of 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 topic of client death, although to a limited extent, is rehabilitation counseling. Because of medical and technological advances, more people are living longer with 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 counselors will experience 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 field, greater is likelihood that they will experience death of a client. Despite probability of increased exposure to client death when working with high-risk populations, little empirical evidence has documented level of preparation of rehabilitation counselors regarding 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 for clients and a better appreciation of life as a result of a client dying (Allen & 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 counseling relationship; feelings of helplessness, anxiety, and discomfort; denial or avoidance on part of counselor to death with inevitability of a client's death; and impaired work ability and efficiency (Allen & Miller, 1988; Allen & Sawyer, 1984; Hayes & Gelso, 1993; Humphrey, 1993). Regardless, working with dying and grieving clients can make counselors confront their own losses, as well as losses their clients are experiencing (Rando, 1984). Allen and Jaet (1982) surveyed 198 vocational rehabilitation counselors about their experiences with client death and bereavement training. Of respondents, 77% had experienced death of a client during previous four years. The range of clients who died was between one and 30, and about half had experienced death of one to three clients during that time period. Counselors who had experienced death of a client reported that their work and home life were affected by 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 call for further training in death and dying issues and expressed a need for onsite support and supervision for counselors who experienced death of a client on their caseload. 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 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] that counselors face such death-related issues makes need for training compelling (p. 38). Allen and Miller (1988) replicated Allen and Jaet's (1982) study by surveying 627 certified rehabilitation counselors (CRC) about their training and experiences with client death between 1982 and 1985. …