_______________________________________

when you counsel grieving people

William G. Hoy

Whether one counsels grieving people as a professional or volunteer, and whether or not one has received specific training to do this task, there are some important considerations to keep in mind. The application of good counseling skills not only helps to assure that help is given and harm is avoided, but their use also reassure the professional or lay counselor that we are “making a difference” in the lives of the people we are called to serve.

My colleagues at Scott & White Medical Center in Temple, Texas, Louis Gamino and Hal Ritter (2009), have done a masterful job of articulating seven “mandates” for grief counselors, “procedural rules of thumb” that provide broad practice guidelines when counseling the dying and bereaved. I summarize these mandates here, but their book, Ethical Practice in Grief Counseling is essential reading for everyone engaged in our fiedl

Screen clients carefully. Bereaved people who affirmatively answer the question, “Are you having trouble dealing with the death?” fare better in grief groups and individual counseling sessions than those who have been recruited just because somebody died. Gamino and Ritter recommend adding the simple question, “Are you interested in seeing a grief counselor to help with that?” While your colleagues or the potential client’s significant others may suggest someone needs counseling even when he or she answers one or the other questions negatively, the bereaved person may just not yet be ready for that step.

Employ risk-factor algorithms. Whether one uses Rando’s (1993) seven high-risk factors for complicated mourning, Worden’s (2009) “mediators of mourning,” or some other model, looking for risk factors that may complicate bereavement makes sense. Common among these models are risk factors like death circumstances (with higher risk to unexpected or traumatic deaths), perception of poor social support, pre-existing mental health problems such as chronic anxiety or clinical depression, and concurrent stresses. The more risk factors that are present, the greater an individual’s need and potential benefit from a counseling intervention.

Monitor potential growth factors. Good grief counseling presents not only relief from suffering but also holds out hope for transformative growth. I believe counselors who supervise interns, volunteers, and less experienced counselors leading groups need to be especially mindful of this mandate. Make sure groups always have an element of hopefulness and growth, rather than simply becoming “misery loves company” share sessions.

Assess quality of attachments. Counselors and group leaders must be attentive to attachment styles (Worden, 2009; Rando, 1993) as part of the screening and assessment process. Understanding attachments in current relationships as well as past relationships can be extraordinarily significant in resolving loss issues.

Use proven methods. Gamino and Ritter suggest that grief counseling is both science and art. Interventions should start from proven methods like empathic listening, psycho-education, journaling and normalization. Those with the training and experience to do so might want to employ an experiential method such as play therapy, art therapy, or the Gestalt technique such as empty chair work.

Exercise caution in group work. Not every person benefits from involvement in a bereavement support group, but much positive growth can occur for those who do connect with one. As Gamino and Ritter point out, however, groups should not be employed merely because they are a cost-effective way to serve more people. Furthermore, good counselors with individuals do not inherently possess good group leadership skills so additional training is warranted. While lay volunteers can provide excellent group leadership, I believe that bereavement group leaders should always be supervised by experienced professionals who have training and expertise in bereavement counseling theory, techniques and group leadership.

Educate the public. Because of the nature of our work, grief counselors will inevitably be called on to help in times of community tragedy and perhaps offer our expertise to public gatherings of people. I cannot count the number of times I have stood before a room full of parents to talk about child or teen grief after a classmate has been killed in a car crash. But these occasions provide outstanding opportunities to gently shatter myths about what mourning is (and is not). These arenas provide a time for me to make the compelling case that just because a person has experienced a death, does not mean he or she needs the assistance of a counselor (professional or otherwise).