Rehabilitation Counselors' Experiences with Client Death and Death Anxiety

Article excerpt

Based on anecdotal evidence 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. 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 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 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 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 the counseling relationship; feelings of helplessness, anxiety, and discomfort; 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 & Gelso, 1993; Humphrey, 1993). Regardless, working with dying and grieving 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 about their experiences with client death and bereavement training. Of the respondents, 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.

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] 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 rehabilitation counselors (CRC) about their training and experiences with client death between 1982 and 1985. …