Masters Students Self-Assessment of Competency in Grief Education

Chapter 1: Introduction to the Study

Everyone will experience the loss of a loved one sometime within his or her

lifetime. A person can experience loss due to a divorce, separation, breakup, or

estrangement (Breen & O’Conner, 2011). An individual may experience loss of capacity,

loss of a job, or loss caused by natural or human-caused disasters (Humphrey, 2009). An

individual’s response to such a loss is unique (Thirsk & Moules, 2012), and not all

individuals will seek mental health services to assist them with their grief. However,

some people do seek out such services. According to the National Institute of Mental

Health (2007), only 18% of the United States population used mental health services.

The demand for grief counseling in the United States will be on the rise due to a

variety of reasons in the near future. For instance, the aging baby boomer generation

worldwide is estimated to be at 72 million people aged 65 years old or older in the year of

2030, and is expected to grow to be 19% of the population (Hooyman & Kiyak, 2005;

U.S. Department of Health and Human Services, n.d.). Due to the aging generation, we

will see an increase in deaths in the baby boomer population (Hooyman & Kiyak, 2005).

In addition, we might see an increase in the baby boomer population seeking out grief

counselors due to a disability, loss of a loved one, or grieving the loss of quality of life

(Hooyman & Kiyak, 2005; Ober, Granello, & Wheaton, 2012). Ober, Granello, and

Wheaton indicated the request for grief counselors will be on the rise due to the aging

Baby Boomers successive losses and the grief they experience. Breen (2010) indicated

counselors are required to be educated and trained to provide effective and appropriate

grief counseling to clients.

According to Kaskie, Imhof, and Wyatt (2008), one of every five older persons in

America each year experiences a mental health disorder. Robb, Haley, Becker, Polivka,

and Chwa (2003) suggested there is an increase in the use of mental health services in the

older adults’ population ranging in the ages of 65 years and older. The Seniors Mental

Health Access Improvement Act of 2013 (S. 562; bipartisan counselor coverage bill), has

been assigned to a congressional committee (Barstow & Terrazas, 2012). The bill

proposes to cover state-licensed counselors under the same terms as clinical social

workers. The passing of this bill is important because the baby boomer generation is

reaching Medicare eligibility. Therefore, it is important for Medicare to recognize

counselors as providers of mental health services so they can assist the aging population

with their grief and loss issues (American Counseling Association, 2006).

Furthermore, veterans are returning home from war in Iraq and the Middle East

with presenting issues of grief and loss due to the loss of members of their units and

friends (Papa, Neria, & Litz, 2008), as well as with sometimes traumatic injuries or

disabilities. As a result, Veterans reported they are grieving the loss of how life used to

be before their injuries (e.g., Papa et al., 2008). Marshal (2006) stated many veterans are

returning home from war with mental health issues pertaining to grief and loss. With the

changes in the legislature, counselors can apply for positions in the Department of

Veterans’ Affairs clinics to assist Veterans in need with their presenting issues (American

Counseling Association, 2007).

Ober et al. (2012) noted a gap in the research literature that examines master’s-

level counseling students’ self-reported competency, training, and education in providing

grief counseling. Many people deal with grief issues that prevent them from having joy or

purpose in their lives and that leaves them unable to engage in positive opportunities or

relationships (Neimeyer & Currier, 2009). This study is significant and timely in that it

examines CACREP-accredited master’s counseling students’ self-reported competency,

training, and education in providing grief counseling. The implications for positive social

change arising from my research may be to incorporate and promote education and

training in grief theories and skills in a majority of counseling programs, and to provide

motivation to incorporate professional standards for grief training and practice in the

mental health counseling field.

In this chapter, I present the background for my study, the problem that I

addressed, relevant literature on my topic, and my research questions and hypotheses.

Additionally, I discuss my theoretical framework which draws from Bowlby’s (1980)

work on attachment theory in relation to the social problem, the nature and design of my

study, and definitions of the terms used. I then considered my assumptions and the

delimitations, limitations, and the significance of my research. I conclude the chapter

with a summary.

Background of the Study

People commonly experience grief as a result of a difficult life transition or loss.

A person can experience grief due to a divorce, separation, breakup, or estrangement

(Breen & O’Conner, 2011). An individual may also experience grief due to loss of

capacity, loss of a job, or loss caused by natural or human-caused disasters (Humphrey,

2009). Loss and transition are two of life’s constants (Martin & Doka, 2000). No one can

expect to live a life free of challenges, disappointments, change, or loss (Humphrey,

2009). Grief is one’s own personal experience of loss and is manifested in different ways

due to the individual’s own life experiences (Archer, 2001).

Grief is an emotion that is usually generated by a critical life event experience due

to a loss. Grief can apply to non-death related and death-related losses (Doughty Horn,

Crews, & Harrawood, 2012). The experience of grief is unique and multidimensional

(Granek, 2010). Researchers have identified and reported common grief responses as

cognitive, affective, physical, behavioral, and contextual influences that can affect

individuals in a negative way (e.g., yearning for the deceased) or in a positive way (e.g.,

feeling a sense of relief; Cordaro, 2012; Harrawood, 2012).

Individuals who have experienced some type of loss may have grief symptoms

such as sorrow, numbness, depressed mood, lethargic behavior, sleep disturbances, loss

of appetite, preoccupation, disbelief, anger, guilt, decreased interest in socializing, and

the loss of interest in life experiences that use to be pleasurable to the individual

(Cicchetti, 2010; Freeman & Ward, 1998). Neimeyer and Currier (2009) noted that an

individual’s untreated grief issues may result in suicidal ideation, functional impairment,

cardiac events, substance abuse, or issues with high blood pressure. However, if an

individual gradually adapts and integrates the loss into their life, he or she may

experience less intense and less frequent grief symptoms (Humphrey, 2009).

According to Ober et al. (2012), the demand for grief counseling services in the

United States will be on the rise. Ober et al. surveyed 369 licensed professional

counselors (LPCs) in a Midwestern U.S. state on the grief training they had completed,

their personal and professional experiences with grief, and their self-assessment of their

grief counseling competencies. They found that most of the participants had not had any

course on grief counseling (Ober et al., 2012). The authors urged that additional research

be conducted on the education and training on grief counseling provided by counselor

education programs. Research by Breen (2010) also indicated that counselors need to be

educated and trained to provide effective and appropriate grief counseling to the clients

they serve.

However, there are several challenges in assuring that mental health counselors

are prepared to meet the increased demand for providing grief counseling services. For

instance, there is a lack of professional standards for grief training and practice in the

mental health counseling field (Breen, 2010). Additionally, there is limited grief

education and training within counseling programs (Doughty Horn et al., 2012; Ober et

al., 2012). Furthermore, there is a need for defining competency standards in grief

counseling within the counseling profession (Kaplan et al., 2009). Current research has

indicated that many counselors report uncertainty in their ability to provide effective grief

counseling to clients, and has indicated the need to establish grief counseling

competencies (defined below) through education and training in counselor education

programs (Doughty Horn et al., 2012; Ober et al., 2012).

Establishing counselor competencies is an important component in the counseling

profession to effectively and appropriately help clients (Doughty Horn et al., 2012;

Morgan & Roberts, 2010). Moreover, counselor competency assists in promoting self-

regulation and training within the counseling profession (ACA, 2014). According to

McGlothlin and Davis (2004), the Council for Accreditation of Counseling and Related

Educational Programs (CACREP) is the largest counseling accreditation body.

McGlothlin and Davis (2004) stated accreditation standards ensure quality education in

the counseling profession. However, grief and loss competencies and training are not

mentioned in the current CACREP standards (CACREP, 2016; Doughty Horn et al.,

2012).

Crisis and trauma counseling competencies, multicultural counseling competency,

career counseling competencies, and advocacy competencies (social justice) were not

addressed in CACREP core courses until counseling demands and client needs became

evident in the counseling profession (Doughty Horn et al., 2012; Sue & Sue, 2008). Ober

et al. (2012) stated different types of competency standards have been accepted by the

counseling profession and have been integrated into CACREP-accredited counseling

programs of study in response to clients’ needs. Some experts have called for research on

course offerings, coursework, and students’ grief counseling competency to determine

whether competency standards should be accepted by the counseling profession

(Cicchetti, 2010; Ober et al., 2012). In addition, course offerings, coursework, and

students’ grief counseling competency should be investigated to determine if they should

be integrated into CACREP-accredited counseling programs of study to ensure effective

care to meet clients’ needs (Cicchetti, 2010; Ober et al., 2012).

According to the American Counseling Association’s (ACA) “Code of Ethics”

(2014), counseling competency is important for counselors to establish within the

profession. The ACA “Code of Ethics” stated that counselors need to be properly trained

to be competent to assist those in need ethical and effectively in Section Standard C.2.,

including working with clients that have presenting issues of grief and loss in Section

Standard A.9. (Doughty Horn et al., 2012). Sadeghi, Fischer, and House (2003) suggested

that if counselors do not have adequate training they might lack the skills to address the

presenting issues of a client.

The development of grief counseling competencies is an important issue in the

mental health counseling profession due to the projected future need for grief counselors

or counselors who are competent in working with clients who are experiencing grief

(Haley, Kasl-Godley, Larson, Neimeyer, & Kwilosz, 2007). Currently, the counseling

profession lacks an established framework of grief counseling competencies that is

similar to the established framework our profession has on multicultural counseling

competencies (ACA, 2014). Gamino and Ritter (2012) noted counselors approach grief

with their own experiences or biases. Therefore, grief counseling competencies should be

a requirement in the counseling profession to effectively manage one’s own responses to

grief counseling and to provide effective treatment for clients. I sought to provide

additional research on master’s students’ self-assessment of competency in grief

education and training in CACREP-accredited counseling programs.

Problem Statement

Ober et al. (2012) noted there is currently a gap in the research literature that

examines master’s counseling students’ self-reported competency, training, and education

in providing grief counseling. According to Werth and Crow (2009), grief is an

experience that essentially all people experience during their lifetimes, and due to the

aging baby boomers and successive losses, the need for grief counselors or counselors

who are competent in working with clients that are experiencing grief is in high demand

and growing (Marshall, 2006; Papa et al., 2008).

Collier (2011) stated that 10-15% of individuals struggle to adjust to the loss of a

loved one. According to Neimeyer and Currier (2009), many people deal with debilitating

grief that prevents them from having joy or purpose in their lives and that leaves them

unable to engage in positive opportunities or relationships. Howarth (2011) stated that the

lack of effective grief counseling may have negative consequences for a client such as

their grief reactions may become more painful and debilitating. Therefore, I believe that

my study of CACREP master’s counseling students’ self-reported competency, training,

and education in providing grief counseling is significant and timely.

Purpose of the Study

The purpose of this quantitative study was to examine whether master’s

counseling students in CACREP-accredited programs perceive that they have been

adequately trained in identifying clients’ presenting grief issues and in providing grief

counseling to clients in need. These participants were chosen to examine how master’s-

level counseling students rate themselves concerning the education or training they

received about grief theories or counseling skills related to issues of grief interventions in

their CACREP-accredited formal coursework.

I used Cicchetti’s (2010) Grief Competency Counseling Scale (GCCS), which is

an adapted version of the Death Counseling Survey (DCS; Charkow, 2002). Charkow

initially designed the DCS to measure counselors’ perceptions of their training and ability

to assist clients who were experiencing grief due to death. Cicchetti revised the DCS and

labeled the survey the GCCS to reduce possible participant’s bias due to the DCS title. In

my study the independent variables were demographic variables (gender, age, race, and

ethnicity), coursework, and practicum or internship setting. The four grief competency

sub scales on the GCCS were the dependent variables, and the covariate was course

offering.

Nature of the Study

The research method used for my dissertation study was quantitative. The

research design I used is a non-experimental, one shot survey comparative design

(Cicchetti, 2010). I ran the power for the MANOVA using G*Power 3.1.7 software. I

used a medium effect size F test of .25, alpha level of .05, power of .80, and 6 degrees of

freedom. The analysis indicated that a sample size of at least 225 participants was

required (Faul, Erdfelder, Lang, & Buchner, 2007), so, calculating for a low response rate

of 20% (225/.2 = 1125), this required that the survey needed to be sent to at least 1,125

potential participants (S. Jackson, personal communication, August 13, 2015). Basing

this study on a very low response rate takes into account these variables and other

variables that may not have been considered (S. Jackson, personal communication,

August 13, 2015).

Criterion sampling (Franfort-Nachmias & Nachmias, 2008) was used for this

study and included the population of master’s-level students in CACREP-accredited

counseling programs. The data collection method that I used in my dissertation study is

the survey method. The GCCS and the DDS were used to collect data (Cicchetti, 2010).

The GCCS provided participants with the ability to self report on four sub-scales

(personal competencies, conceptual skills and knowledge, assessment skills, and

treatment skills) of perceived competency pertaining to their education or training in grief

counseling. Combining each of the subscales scores provided a total score. Mean scores

were calculated by dividing the subscale scores by the number of items. The DDS

provided data about each participant’s gender, age, race, ethnicity, coursework, and

practicum or internship setting. Students enrolled in Practicum or Internship courses

were asked to participate in the study. A convenience procedure was used to obtain

participants by writing to program directors of CACREP-accredited counseling programs

who were asked to forward the survey to their students. Students were invited to

participate by completing an online survey via SurveyMonkey. The independent

variables were the demographic variables (gender, age, race, and ethnicity), coursework,

and practicum or internship setting. The four grief competency sub scales on the GCCS

were the dependent variables, and the covariate was course offering, whether the

participant’s course curriculum offered coursework in grief counseling theories and

practice.

The research method and data collection method were both appropriate for my

study, because the methods allow the specific research questions to be answered through

the participants’ responses to the questions on the survey instruments in regards to the

participants perceived competency through their education or training in grief counseling

in which the participants obtained in their formal coursework in their CACREP

counseling program. A true experimental design or a qualitative design is not appropriate

for this study. The survey design is appropriate, because it allows me to test the

hypotheses.

Research Questions and Hypotheses

My overall general research question was adapted from Cicchetti’s (2010) study:

How competent do master’s-level counselors view themselves regarding the education or

training they received in grief theories or counseling skills in their CACREP-accredited

studies? My sub-questions and related hypotheses included:

RQ1. How do the demographic variables (e.g., gender, age bracket, race, and

ethnicity) relate to perceived grief counseling competency?

1: There is no significant (α = .05) interaction effect among the demographic

variables and perceived grief counseling competency.

1: There is a significant interaction effect among the demographic variables

and perceived grief counseling competency.

This question was investigated using a 4-way MANOVA with demographic

variables (gender, age bracket, race, and ethnicity) as independent variables and the four

grief competency sub scales on the GCCS as dependent variables.

RQ2. Controlling for course offerings (i.e., whether the participant’s course

curriculum offered coursework in grief counseling theories and practice), what is the

relationship between coursework and grief counseling competency?

2: There is no significant (α = .05) positive relationship between coursework

taken and the four grief counseling competency scales, controlling for course offerings.

2: There is a significant positive relationship between coursework taken and the

four grief counseling competency scales, controlling for course offerings.

This question was investigated using a MANCOVA where the independent

variable was coursework; the dependent variables were the four grief competency sub

scales on the GCCS, and the covariate was course offering.

RQ3. What is the relationship between practicum or internship setting and

perceived grief counseling competency?

3: There is no significant (α = .05) relationship for clinical setting and

perceived grief counseling competency.

3: There is a significant relationship for clinical setting and perceived grief

counseling competency.

This question was investigated using a MANOVA whereas the independent

variable was practicum or internship setting and the four grief competency sub scales on

the GCCS were the dependent variables.

Theoretical Framework

The theory that informed this quantitative study is modern grief theory. Modern

grief theory is based on John Bowlby’s work on Attachment Theory (Carr & Cortina,

2011). Bowlby (1980) stated Attachment Theory can be used as a conceptual framework

for understanding grief (Cicchetti, 2010). According to Bowlby, a person that is

responsive to another person’s needs enables the individual to develop a sense of security

and trust. Bowlby described attachment as a psychological connectedness between a

significant other. Therefore, when the attachment to another person ends due to

separation or death; the remaining significant other than grieves (Bowlby 1980). In the

relational approach to master students’ self-assessment of competency in grief education

and training, Breen (2010) addressed the level of efficacy that develops when grief is

presented in curricula, counselors understand modern grief theories, and implement grief

interventions in their counseling practices. This will be discussed in greater detail in

Chapter 2.

Definition of Terms and Variables

Advocacy: Becoming actively involved in a cause to promote positive social

change and thus to put counseling in action (Osborne, Collison, House, Gray, Firth, &

Mary Lou, 1998). Counselors take the role of promoting societal change by acting as an

agent and working towards an intervention on behalf of the profession, an organization,

and their clients (West, Bubenzer, Osborn, Paez, & Desmond, 2006). Advocating is a

single person or a group of people working together challenging beliefs in our society,

questioning the status quo, challenging the rules and regulations that are in place, and

protesting to influence change through awareness and education (Osborne et al., 1998).

Council for Accreditation of Counseling and Related Educational Programs

(CACREP): A specialized accrediting body for professional preparation in specific

graduate degree programs within the accredited institution (CACREP, 2016; McGlothlin

& Davis, 2004). There are well-defined criteria outlining the national standards and

training of skills to which graduate students must be held accountable (CACREP, 2016).

The vision of CACREP is to promote excellence and to provide leadership through its

accreditation standards by continually improving programs and preparing professionals to

provide services to promote optimal human development (Adams, 2006). CACREP

program assessments are conducted to ensure that all components of the program meet

the CACREP standards in order for the program to receive accreditation by CACREP

(CACREP, 2016). The CACREP accreditation provides recognition that the quality and

content of the program meets the standards set by the profession to reflect the needs of a

dynamic, complex, and diverse society (CACREP, 2016). Students enrolled in a

CACREP-accredited program can be assured the appropriate knowledge and skill areas

are included in the program and the program is professionally and financially stable

(Adams, 2006). Furthermore, graduating from a CACREP-accredited program constitutes

an important credential and distinguishes counselors as having completed a program that

meets the standards of excellence for the profession (CACREP, 2016).

Counselor competency: According to the American Mental Health Counselors

Association (AMHCA, 2010) and the ACA (2014) “Code of Ethics”, is important for

counselors to gain competence in the areas of counseling that they provide to the ones

they serve (Morgan & Roberts, 2010). According to the AMHCA (2010) Principle 7,

counselors are expected to recognize their boundaries on their competencies and the

limitations on their expertise. Furthermore, counselors are to provide services and use

techniques that they are qualified by education, training, techniques, or experience to

provide (AMHCA, 2010). The ACA (2014) “Code of Ethics”, Section C.2.a. Boundaries

of Competence stated counselors should practice only within their boundaries of

competence based on their education, training, state and national credentials, and

professional experience.

Grief: According to Humphrey (2009), grief is an emotion that is generated by an

experience of death or non-death-related loss. Grief is often characterized by sorrow or

distress (Jakoby, 2012). Grief is unique to the individual and multidimensional in

responses and contextual influences (Humphrey, 2009). Grief is the process of

experiencing the reaction to the perception of the loss (Cicchetti, 2010; Doughty Horn,

Crews, & Harrawood, 2013; Rando, 1995).

Grief counseling: Grief counseling refers to the therapeutic work with clients who

present with grief symptoms due to death or non-death-related loss (Humphrey, 2009).

Grief counseling may be used in individual, group, couples, or family counseling

sessions. There are theoretical approaches and interventions that counselors may use to

assist grievers to manage their responses (mentally, emotionally, physically, or

spiritually) to the loss they have experienced (Cicchetti, 2010; Doughty Horn, Crews, &

Harrawood, 2013; Rando, 1995).

Grief counselor competencies: Grief counseling competency is when a counselor

obtains and demonstrates that one has the education, training, techniques, experience,

knowledge, and skills to assist the needs of their grieving client. In this study, the grief

counseling competencies are based on the GCCS assessment instrument developed by

Cicchetti (2010), which is an adapted version of Charkow’s (2002) DCS. The GCCS

included five scales: Personal Competencies, Conceptual Skills and Knowledge,

Assessment Skills, Treatment Skills, and Professional Skills (Cicchetti, 2010). The

instrument in this study is a self-report survey and participants were asked to report the

level of agreement with survey items. The survey was used to collect demographic

information.

Holistic: In this study, holistic refers to the whole person in regards to his or her

mind, body, emotions, and spirit that are all interdependent parts. When all the

interdependent parts are in balance, one achieves optimal health and well-being

(Chidarikire, 2012). However, if one part is not in balance, the other parts will be affected

(emotionally, physically, or spiritually) in which can negatively affect one’s overall

health and well-being (Chidarikire, 2012).

Master’s-level student requirements in a CACREP-accredited mental health

counseling programs: Beginning July 1, 2013, all CACREP-accredited “mental health

counseling programs must require a minimum of 60 semester credit hours or 90 quarter

credit hours for all students to meet the academic unit” requirement set by the CACREP

standards (CACREP, 2016, p.5). In addition, the graduate-level core coursework must be

in the following 8 content areas: (a) professional counseling orientation and ethical

practice, (b) social and cultural diversity, (c) human growth and development, (d) career

development, (e) counseling and helping relationships, (f) group counseling and group

work, (g) assessment and testing, and (h) research and program evaluation (CACREP,

2016).

Master’s-level student practicum requirements in a CACREP-accredited mental

health counseling program: Students must complete a supervised practicum experience

with a minimum total of 100 clock hours of which 40 of those hours must be direct client

contact hours providing face-to-face counseling (CACREP, 2016). During practicum, the

student must also obtain one hour per week site supervision and 1 ½ hours per week of

program faculty group supervision (CACREP, 2016).

Master’s-level student internship requirements in a CACREP-accredited mental

health counseling programs: The program also requires completion of a supervised

internship experience with a minimum total of 600 clock hours of which 240 of those

hours must be direct client service hours providing face-to-face counseling and leading

groups (CACREP, 2016). During internship, the student must also obtain one hour per

week site supervision and 1 ½ hours per week of program faculty group supervision

(CACREP, 2016).

Unresolved grief: Unresolved grief is when the grief lasts longer than usual for

the individual’s cultural background (Field, 2006). Often times, unresolved grief is

described as grief that will not go away or that it is interfering with the individual’s

capabilities to care for one’s self daily (Field, 2006). Unresolved grief is abnormal,

pathological, or traumatic grief with loss of feelings, denial, and repression (Cicchetti,

2010; Jacobs, 1999).

The independent variables for my study included demographic variables (gender,

age, race, and ethnicity), coursework, and practicum or internship setting.

The dependent variables for the study include the following:

Level of Competencies, Skills, and Knowledge on the GCCS: Measures the

Personal Competencies, Conceptual Skills and Knowledge, Assessment Skills, and

Treatment Skills estimated by self-using the GCCS on a 5-point Likert scale that was

converted to a mean score to obtain the four subscales on the same 5-point Likert scale,

because each item was measured on a different number of items.

Total Score on the GCCS: An interval measurement on overall competencies,

skills, and knowledge estimated by self on the GCCS, using a 5-point Likert scale on the

37 questions resulting in a range in score 37-185.

The covariate for this study was whether the participant’s course curriculum

offered coursework in grief counseling theories and practice. For this study, the covariate

was held constant in examining the relationship between perceived grief counseling

competency and coursework. The aforementioned was measured by the four sub scales

on the GCCS.

Assumptions

The assumptions made with regard to conducting this study are that the

instruments used to gather data in the study accurately measured the variables as intended

(Cicchetti, 2010). Other assumptions were made in regard to the participants who are

assumed to be attending CACREP-accredited counseling programs and completed all of

their CACREP core course requirements for master’s-level counselors in training. It was

assumed that participants understand and answered all the questions with complete

honesty. The data for this study were collected, analyzed, and reported in an ethical

manner (Cicchetti, 2010).

Limitations

The study had a few limitations. A limitation of using quantitative methods for the

research study is that one cannot obtain an in-depth understanding of the participants

lived experience (Creswell, 2009). A limitation of using the non-experimental, one shot

survey research design is that the respondents are limited in their response to those

permitted on the GCCS (Creswell, 2009). Frankfort-Nacmias and Nacmias (2008) stated

content validity is determined by the degree to which the questions on an instrument are

representative of what the instrument was designed to sample. The GCCS was designed

to assess master’s-level student’s competency in grief counseling (Cicchetti, 2010). The

questions on the instrument are representative of what the instrument was designed to

sample. The data gathered were provided by the master’s-level counseling students about

their perceptions on their grief counseling competencies pertaining to their education and

training.

The data were gathered via self-report which may not be the most objective form

of evaluation (Janesick, 2011). Participants may have answered with bias in which their

answer may reflect negatively upon their institution, therefore, a noted limitation in the

study (Janesick, 2011). The participants were asked to be honest when giving their

answers on their survey questions.

The participants were recruited from CACREP-accredited master’s-level

counseling programs through faculty members from each institution. Therefore, it is

difficult to be certain that all eligible practicum and internship students were informed of

the study in order to participate. The study is intended for master’s-level counselors in

training from CACREP-accredited institutions and did not intended to gather data from

master’s-level counselors in training from non-CACREP-accredited institutions. Due to

the recruitment criteria, generalizability was limited to CACREP-accredited master’s-

level counseling students. Therefore, the findings cannot be generalized to any larger

population.

Time constraints are a noted limitation when using an online survey design to

obtain participants responses (Wilson, Petticrew, Calnan, & Nazareth, 2010). According

to Wilson et al. (2010), response rates for online survey design studies can be low;

therefore, it may take time for me to obtain a large enough sample size of participants.

With that in mind, scheduled follow-up e-mails were used to request participation in

order to obtain the required sample size of participants for this study.

Scope and Delimitations

Criterion population sample was used in this study due to the scope of the

research study. Master’s-level counseling students in CACREP-accredited programs that

are enrolled in their practicum or internship course were invited to participate in this

survey research study. Participants were asked to examine their perceptions on their

education and training in grief counseling in their CACREP counseling program.

CACREP-accredited master’s-level counseling programs were selected for this study, due

to the education and training structured requirements of all its accredited programs. I

delimited non-CACREP counseling programs due to differences in academic education

and training requirements. The populations I am not studying are doctoral level

counseling students or licensed professional counselors. The reason I delimitated the

aforementioned populations is because those groups may have obtained grief education

and training from workshops, conferences, or continuing education classes after their

master’s-level training. Therefore, I delimited the findings and they cannot be

generalized to doctoral level counseling students, licensed professional counselors, or

non-CACREP counseling program students.

Significance of the Study

The significance of this proposed dissertation study is unique because it addresses

an important and under-researched area of the competency of Master’s-level counseling

students in providing grief counseling (Doughty Horn et al., 2012; Ober et al., 2012).

Breen (2010) noted there is a shortage of grief counselors or counselors who have been

trained in grief theories and interventions in the counseling profession. There is little

evidence that graduate counseling programs require coursework in grief counseling (Ober

et al., 2012).

In addition, there are minimal research studies conducted pertaining to grief and

loss theories, interventions, education, and training in the field of mental health

counseling or in the other helping professions (Doughty Horn et al., 2012). Counselor

competency is the professional responsibility of all members of the counseling profession

(ACA, 2014; Cicchetti, 2010). The results from the study provide insight into the

students’ perceived competency in grief training and education through self-reports.

According to Ober, Granello, and Wheaton (2012), everybody experiences some

type of grief, loss, or transition within his or her lifetime. Therefore, it is understandable

that grief counseling is relevant in the mental health counseling field. However, there is

limited research available pertaining to counselors’ training, experience, and

competencies to provide appropriate and effective grief counseling (Ober et al., 2012).

Breen (2010) conducted a study using grounded theory to find out what are some

of the recommendations for incorporating contemporary understandings into policy and

practices for grief counselors. Breen concluded grief counseling could be harmful to

clients if the counselor is not competent in grief counseling. Breen suggested future

research needs to be conducted for grief education and training for counselors. Breen

aligns with Ober et al. (2012) in which the authors noted the importance for counselors to

seek grief education and training to be competent grief counselors.

Gamino and Ritter (2012) conducted a historical literature review on what it takes

to sensitively and effectively counsel grieving clients. The narrative study concluded

grief counselors must manage their own death anxiety in order to be effective in grief

counseling. The authors stated future research needs to be conducted on the training and

education of counselors in regards to competency in working with grieving clients

(Gamino & Ritter, 2012). Gamino and Ritter align with Ober et al. (2012) in that the

authors all noted that specialized skills in grief counseling are needed to assist in

managing clients’ issues related to dying, death, grief, and bereavement issues.

This study in addition helps to fill the gap in the literature and provide counseling

program leaders and accreditation leaders with research-based information that better

informs their decisions about this component of the core curriculum of their counseling

programs. The insight shared with the counseling profession through the results of this

study should help bridge the gap in the literature and promote positive changes to the

curriculum coursework of CACREP-accredited Master’s counseling programs.

Specifically, for CACREP standards to include a thorough discussion of the theories and

skills in grief counseling to assist client’s needs and counseling demands.

Summary

In this quantitative research study, I explored Master’s-level counseling students’

self-assessment of competency in grief education and training in CACREP-accredited

counseling programs. Studying the self reported perceptions of Master students’ level of

competency in grief education and training has many potential benefits for the counseling

profession. For example these benefits may include, increased self-awareness in one’s

perceived competencies in grief counseling, increased ethical behavior in obtaining grief

education and training to promote counseling competencies, increased positive change

for clients seeking counseling for grief related issues, and reduced harm to clients that

counselors serve. The mental health counseling profession ethically values counselor

competency in order to do no harm to the clients we serve; however, there are no core

education and training requirements in grief counseling in CACREP counseling programs

to date.

In Chapter 2, the literature and search strategies used for this study in regards to

grief education and training competency development in counseling students are

discussed. In addition, a detailed review of the theoretical foundation used in this study

and the rational on why the choice of this theory. Lastly, grief strategies and interventions

were discussed. In Chapter 3, information on the research design and rationale,

methodology, population sample, data analysis plan, and ethical procedures were

discussed. In Chapter 4, the results of the study and statistical evidence that lead to the

conclusions of this study are provided. In Chapter 5, an interpretation of the findings,

limitations of the study, recommendations for future research to be conducted, and

present implications of positive social change are presented.

Chapter 2: Literature Review

Everyone experiences grief sometime within his or her lifetime (Humphrey,

2009). According to Ober et al. (2012), with the aging baby boomers the need for grief

counseling will be on the rise as this population experiences loss. In addition, many U.S.

war veterans are returning home from the Middle East with mental health issues related

to grief and loss (Marshall, 2006; Papa et al., 2008). Ober et al. (2012) stated not all

counselors are adequately trained or comfortable in providing grief counseling.

According to Breen (2010), grief is a common experience in life, and grieving

individuals seek counseling to assist them in coping with their loss. In addition, Breen

stated there is a misalignment between contemporary grief research and grief counseling

practices. This may limit intervention effectiveness in grief counseling. Breen conducted

a qualitative research study and used grounded theory. Breen used semistructured

interviews with 19 grief counselors to gain an understanding on their current practices of

grief counseling. Breen provided some recommendations for incorporating contemporary

understandings into policy and practice for grief counselors. The results indicated a need

for grief education and training. Breen noted grief counseling could be damaging to

clients if counselors are not competent, and suggested future research needs to be

conducted on the limited or lack of grief education and training in counselors’ formal

studies. The information may provide a compelling rationale for the inclusion of grief

content in the curricula of counseling programs.

Ober et al. (2012) stated that grief is prevalent in counseling; however, little is

known about counselors’ training, experience, and competencies to provide effective

care. Ober et al. suggested that future research needs to be conducted to investigate

current training on grief counseling across counselor education programs.

In this chapter I include a review of the literature and the search strategies used,

including the databases, key terms, and theoretical foundation. Furthermore, I present the

variables and the value they have added to the mental health counseling field, including

key issues pertaining to grief education and training in the mental health counseling

profession and the effects of grief counseling on clients. Lastly, I discuss implications for

future direction in the mental health counseling field.

Literature Search Strategy

To find literature for this study, I conducted multiple searches using the following

databases and search engines: Academic Search Complete, Dissertations and Theses via

ProQuest, ERIC, Google Scholar, Health & Psychosocial Instruments, Health Science: A

SAGE full text collection, Mental Measurements Yearbook, ProQuest Central,

PsycARTICLES, SocINDEX, PsycINFO, PsycTESTS, SAGE full text collection, SAGE

Premier, and Walden University Dissertations and Theses via ProQuest in which I

accessed the data bases using Walden University Library resources. The key search

terms and combinations of search terms included master’s-level counseling students

education and training, CACREP standards education and training, counselor education

and training, grief counselors education and training, grief and loss education and

training, grief counseling, grief competency, grief counseling competencies, grief, loss,

professionals’ experiences of grief counseling, grief issues, and grief therapy. I also used

these terms: psychodynamic theory, attachment theory, continuing bond theory, stage or

task theories, meaning making theories, and the dual process model of grief.

The focus of this literature review was identify relevant papers published within

the past 10 years. However, I also used earlier research that provided the foundation on

the topics and theories in this dissertation. The types of literature I used were from peer-

reviewed journals, theses and dissertations, and books. There has been an increase in

current research in the area of grief education and training in the mental health counseling

field over the last 10 years (Ober et al., 2012). The available research relating to mental

health counselors’ grief education and training is included in this dissertation.

Theoretical Foundation

In the mental health profession, there are several theories that can be used to

address an individual’s experience of grief and used in grief counseling. In the following

pages I will give a brief overview of several of the different theories of grief. It is

important to understand the disparities which exist between the different theories which

are evident in the most recent research. The theories that I will discuss include

psychodynamic theory, attachment theory, continuing bond theory, stage or task theories,

meaning making theory, and the dual process model of grief.

Psychodynamic Theory

In Western culture, the beginning of modern grief theory started with Freud

(Granek, 2010). Freud (1917/1963) discussed the normal response to loss in Mourning

and Melancholia. Freud suggested a typical reaction to loss is for the bereaved person to

withdraw their emotions and attention from the loved one who died and refocus their

emotions and attentions in other areas of their life – i.e., on something or someone else.

He felt that one must detach his or her feelings and emotions from the deceased in order

to process grief. Freud suggested ongoing emotional relations with the deceased were

pathological grieving (see, e.g., Granek, 2010).

Lindemann (1944) spurred a transformational change in the understanding of

acute grief, because he suggested grief is a psychological response. According to

Lindemann, acute grief seems to be a normal reaction to a distressing situation.

Lindemann conducted and published an empirical study on bereaved individuals in which

he interviewed 101 recently bereaved individuals and documented their grieving process

using a scientific and objective approach. Lindemann suggested the results of the study

provided representation of what the grieving process entailed, listing normal and

abnormal grief symptoms, and patterns of grieving. He stated professionals in the mental

health field should aid their clients in grief work.

Lindemann (1944) suggested that counselors aid grieving clients by helping them

work through grief by confronting the reality of their loss and attending to the loss

instead of isolating oneself from the loss experience (Cicchetti, 2010). He suggested by

helping the client to process feelings associated with the loss of the loved one, the client,

can effectively work towards readjustment to life without the deceased and form new

relationships (Granek, 2010; Lindemann, 1944).

Attachment Theory

Bowlby (1980) explained attachment theory as being based upon the tendency of

humans to develop affection bonds or attachments with their caregivers, as a result of

consistent availability, closeness, security, and the ability to meet their survival needs. In

Bowlby’s earlier work, he explained attachment theory in the context of a child’s

attachment to its mother (primary caregiver) and the disruption due to separation,

deprivation, or bereavement (Bowlby, 1958; Carr & Cortina, 2011). Bowlby (1980)

discussed attachment theory in regards to the loss of a loved one in his book Attachment

and Loss. He explained that during the course of healthy development, a person who is

responsive to another person’s needs enables that person to develop affection bonds and

attachment. He described attachment as a psychological connectedness between a child

and a parent and later between an adult with another adult. When the attachment ends

because of a separation or death; the remaining person then grieves.

Bowlby (1980) wrote about his observations and how individuals responded to

the loss of a loved one over weeks, months, and sometimes years through four phases.

Bowlby noted an individual may move back and forth between any two of the phases.

The four phases that Bowlby discussed are numbing, yearning and searching for the

deceased person, disorganization and despair, and a greater or lesser degree of

reorganization.

In the first phase referred to as the numbing phase, an individual may feel

stunned, in disbelief, tense, or apprehensive as an immediate reaction to the news of a

loved one has died (Bowlby, 1980). Bowlby noted the numbing phase could last a few

hours or up to a week. The griever may or may not have outburst of intense distress or

anger which may be intermittent during this phase (Bowlby, 1980).

In the second phase, also referred to as the phase of yearning and searching for

the deceased, an individual may be restless, preoccupied with thoughts of the deceased,

pining for the deceased loved one, feeling distressed, or tearful sobbing (Bowlby, 1980).

Bowlby noted the phase of yearning and searching for the deceased could start within a

few hours of receiving the news of the death of a loved one or could start after a few

days. Bowlby noted the yearning and searching phase could last for months and

sometimes even for years depending on the individual.

In the third phase, also referred to as the phase of disorganization and despair, an

individual may examine how and why the loss happened, be angry at others, eventually

accept the loss in order to reorganize, and move forward in life without the deceased

(Bowlby, 1980). Bowlby noted the phase of disorganization and despair could last for

months and sometimes for years depending on the individual and the responsibilities they

now have solely upon them and their situation. Once the bereaved individual recognizes

that they must fill new roles, learn new skills, and are successful the individual becomes

more confident and independent (Bowlby, 1980).

In the fourth phase referred to as the phase of greater or lesser degree of

reorganization, the individual needs to change their old ways of thinking, feeling, and

acting, so they can learn new ways of being in their current life (Bowlby, 1980). Bowlby

noted the phase of greater or lesser degree of reorganization can lasts for years. This

depends on the persistence of relationship with the deceased, children living in the

household or not, duration of grieving, and emotional loneliness of the widowed/widower

(Bowlby, 1980). During this phase, the individual tries to find a redefinition of self to

one’s situation. Bowlby discussed the different phase’s one goes through to process the

responding to the loss of a loved one from emotional responses to emotional detaching

from the deceased loved one through the bereavement experience.

Continuing Bonds Theory

However, Klass, Silverman, and Nickman (1996) countered attachment theory by

suggesting a continuing bonds theory. Klass, Silverman, and Nickman suggested

individuals may not disconnect from the deceased, but stay connected with the deceased

loved one. Continuing bonds theory is different than attachment theory in which the

individual continues a feeling of connection with their deceased loved one. While also

acknowledging the differences from when their loved one was alive when compared to

the present without the loved one (Hastings, 2012). Even though the relationship is

altered between the living and the deceased, continuing bonds will be reconfigured and

an emotional relationship will remain between the living person/people and the deceased

(Hastings, 2012).

Field, Gao, and Paderna (2005) expanded upon continuing bond theory by adding

the attachment theory perspective in coping with bereavement. They examined the

grieving process pertaining to different factors of the relationship between the survivor

and the deceased, and investigated the effect of the death of a spouse or child, culture,

and religion on the type of continuing bonds within the attachment theory framework. As

for the continuing bonds theory, it continues to evolve within the field of bereavement

research.

Stage or Task Theories

In grief counseling literature, stage or task theories are discussed and often

reference the most familiar theoretical works of Elisabeth Kubler-Ross. Kubler-Ross

(1969) provided leadership for the American death and dying movement with the

emphasis on the different stages of anticipation of death. Kubler-Ross discussed the need

to openly address issues surrounding an impending death for the dying person with their

friends and family. Parkes (2013) noted Kubler-Ross’ work focuses on the “stages of

grief” in reference to dying patients (p.95). Kubler-Ross wrote about her experiences

working with terminally ill patients in her book called On Death and Dying. According to

Kubler-Ross, there are five stages of anticipating death: denial, anger, bargaining,

depression, and acceptance.

In the first stage, denial the individual denies whatever the information is being

told to them using the defense the information cannot be true (Kubler-Ross, 1969).

According to Kubler-Ross, denial often functions as a buffer after receiving the shocking

news. She stated individuals used denial as a temporary defense before moving to the

second stage.

In the second stage, anger the individual is no longer able to maintain denial any

longer; their feelings are replaced with anger (Kubler-Ross, 1969). According to Kubler-

Ross, during this stage the individual may ask “Why me?” Sometimes the anger feelings

may be present, because, before the life event the individual may have controlled many

different parts of their life and now they have lost the control of things that they use to be

able to control, hence, anger (Kubler-Ross, 1969).

In the third stage, bargaining an attempt to postpone what is going to happen;

prize offering for good behavior (Kubler-Ross, 1969). For example, a promise will be

made by the individual that they will not ask for more if this one postponement is

granted. During this stage of bargaining, usually the individual will bargain with their

higher power belief system.

In the fourth stage, depression the individual can no longer deny their terminal

illness diagnosis and will have a sense of great loss as they begin to understand

impending death (Kubler-Ross, 1969). During this stage, the individual starts to grieve

the way things used to be and start to feel sad, fear, regret, and uncertainty. According to

Kubler-Ross, when the individual starts to feel those emotions the individual is beginning

to accept the situation and starts to move towards the fifth stage.

In the fifth stage, acceptance the individual begins to come to terms with their

terminal illness and inevitable future death (Kubler-Ross, 1969). Individuals enter this

stage often before the loved ones they leave behind, who go through their own stages of

grief. During this stage, the individual with the terminal illness starts to have a calm view,

stable mindset, and accepts that they need to prepare for the inevitable (Kubler-Ross,

1969).

Kubler-Ross’ stage theory was developed with individuals facing death and not

empirically tested, however, the stages have been referenced and applied to grief and

bereavement in counseling texts, journal articles, and in course content (Hashim, Mei-Li,

& Guan, 2013; Humphrey, 2009; Parkes, 2013). In Kubler-Ross’ book On Grief and

Grieving, she discussed how her theory had previously been applied in a rigid manner.

Readers often seemed to assume that people needed to complete the stages of grief in

sequential order for one to achieve a healthy resolution with one’s loss (Kubler-Ross &

Kessler, 2005). On the contrary, she argued the stages were a guideline to the grief

experience and one can move within the different stages individually or with an overlap

of the different stages (Kubler-Ross & Kessler, 2005).

Furthermore, other theorists in the field have developed their interpretations of

stage/task theories of grief (Rando, 1995; Westberg, 1971; Worden, 2009) and have been

criticized along with Kubler-Ross for the ridged application of the stages/task with clients

in which limits a counselor’s ability to understand the client’s individual and unique

grieving experience (Servaty-Seib, 2004). Richardson (2007) argued the stages/task are

not rigid and exclusive, therefore, one’s feelings in response to the loss such as grief can

change in intensity or fluctuate in various stages/task and in any order. The rigid

application of stages or task theories should be avoided, because it limits the practitioner

in understanding the client’s individual and unique response to their loss of their loved

one.

Meaning Making Theory

In contrast to stage or task theories of grief, the meaning making theory stresses

the importance for the client to find meaning and make sense of the loss (Holland &

Neimeyer, 2010; Neimeyer, 2001). Processing one’s grief is a continual process and does

not end with a specific stage or task. Furthermore, the meaning the client makes is unique

to their loss due to their experiences with the deceased, including age, personality,

gender, and the events which led up to the loved ones death (Holland & Neimeyer, 2010;

Neimeyer, 2001).

In a recent study, D’Amore and Scarciotta (2011) examined meaning making

theory with families confronted with multiple losses. According to D’Amore and

Scarciotta, unresolved grief within a family limits sharing emotions in which results in

poor family meaning making of the loss. Furthermore, they suggested meaning making

theory can be used to recreate, review, and reconstruct the family bonds around the

experienced losses by finding meaning and making sense of the loss.

Dual Process Model of Grief

Strobe and Schut (1999) introduced the dual process model to gain an

understanding on how to help individuals with grief. They used trauma/stress,

attachment, and grief theories to understand the individual’s stressors as loss-orientated

or restoration-oriented. Loss-orientated refers to the loss of the physical relationship with

the deceased. Restoration-oriented refers to decrease of financial resources and an

increase in responsibilities without the loved one around to provide assistance.

According to the authors, bereaved individuals move back and forth processing the loss

of their loved one emotionally or using problem solving techniques/action orientated

(oscillation). The back and forth processing is a healthy way to cope with the loss of a

loved one, because it allows the individual to experience their loss at different times

(Strobe & Schut, 1999).

Richardson (2007) used the Strobe and Schut (1999) dual process model in grief

counseling. According to Richardson, the dual process model endorses the bereavement

process as a dynamic struggle between the pain due to a disability or loss of job (loss-

oriented) and recovery (restoration-oriented). The dual process model of grief suggests

bereaved individuals should alternate between directly working on one’s loss

(confrontation) and taking a break from (avoidance) the process when appropriate

(Richardson, 2007). The dual process model of grief results indicated significant

associations between oscillation and well-being. Findings from other studies demonstrate

the oscillation on grieving promotes positive change (Richardson, 2007).

Educating and Training Counselors in Grief Counseling

Education and training of counselors are consistently being explored and evolve

as the population being served faced different issues and challenges. Therefore, it is

important to investigate current education and training of counselors in grief counseling.

Moreover, it is important to investigate competence in grief counseling and the

contributing factors as to the limited education and training in modern grief theories and

effective interventions. Current studies indicated counseling programs do not require

education and training requirements pertaining to death, dying, grief, or loss related

issues (Breen, 2010; CACREP, 2009 Standards; Horn, Crews, & Harrawood, 2012; Ober

et al., 2012; Werth & Crow, 2009).

According to Breen (2010), grief and loss education and training course work are

not required in most counseling programs (Dougherty Horn et al., 2012; Ober et al.,

2012). However, Breen argued that counselors should be educated and trained in grief

counseling to assist clients with loss and grief issues. The American Academy of Grief

Counseling and The Association for Death Education and Counseling are organizations

that professional counselors can obtain credentialing in grief counseling, however, the

majority of professional counselors do not complete the continuing educational

requirements or take the exam to obtain the special credentialing certification (Breen,

2010; Ober et al., 2012).

In a recent study, Ober et al. (2012) used a simple random sample of 1,000

participants selected from a Midwestern listing of 6,919 state board LPCs and surveyed

them on “Grief Counseling Competencies, personal experiences with grief, and

professional training and experience on grief” (p.152). According to Ober et al., they had

a survey return rate of 37.4% (374 respondents). However, surveys with significant

responses missing were removed and not used in the study. Therefore, there were 369

usable surveys (Ober et al., 2012).

According to Ober et al. (2012), 21.1% (n = 76) identified up to 3 years of

experience as licensed professional counselors, 29.1% (n = 105) reported 4 to 9 years of

experience, 26.0% (n = 94) indicated 10 to 20 years of experience, and 23.8% (n = 86)

reported as having more than 20 years of experience. The majority of the participants in

the Ober et al. study were female (77%) and European American (92.7%) with a reported

age range between 25-78 years old and an average age of 48 years old. Ober et al.

reported that a small percentage of the participants identified as African American

(3.8%), as multiracial (1.6%), Latino (0.8%), Asian American (0.3%), or Native

American (0.3%).

Additionally, Ober et al. (2012) reported 58.4% (190 respondents) reported they

did not complete any courses pertaining to grief education and training. However, 73.2%

(254 respondents) reported they did complete at least one course on grief. Moreover,

69.4% (247 respondents) reported they completed some education and training hours on

grief counseling. Furthermore, 91% (334 respondents) agreed with a statement that

education and training in grief counseling is needed and should be made a requirement

(Ober et al., 2012).

In the demographic survey, Ober et al. (2012) asked licensed professional

counselor participants to report their familiarity with various grief counseling theories in

which most 42.8% (158 respondents) recognized (the not empirical) stage theory by

Kubler-Ross (1969). However, 49.6% (183 respondents) reported only some familiarity

with the Kubler-Ross stage theory. Furthermore, Worden (2009) task theory and

Neimeyer (2001) meaning making theory were known by 28.2% (104 respondents) and

25.5% (94 respondents) had some familiarity with the aforementioned two theories.

However, 40% (148 and 159 respondents) reported that they were not familiar with task

or meaning making theories. In addition, Ober et al. noted 15.4% (57 respondents) were

least familiar with Strobe and Schut (1999) dual-process model and 14.9% (55

respondents) were least familiar with (Klass, 2001) continuing bonds theory. However,

Ober et al. noted 48% (177 respondents) were not familiar at all with Strobe and Schut

(1999) dual-process model and 52.8% (195 respondents) were not familiar at all with

(Klass, 2001) continuing bonds theory.

According to Ober et al. (2012), the findings noted that the LPC participants that

obtained education or training in grief counseling rated themselves more competent in

comparison to the LPC participants that did not complete any education or training in

grief counseling. Furthermore, Ober et al. suggested in the implications and directions for

future research section that an investigation into current grief counseling education and

training should be completed across all counseling programs. Moreover, Ober et al. stated

the information obtained from such a study could provide much needed information to

start establishing standards and competencies for education and training in grief

counseling in the mental health counseling field. In addition, establishing standards and

competencies for education and training in grief counseling will enable counselors to

ethically and effectively assist the growing population of clients with their presenting

needs pertaining to loss, grief, bereavement, death, and dying (Breen, 2010; CACREP,

2009 Standards; Gamino & Ritter, 2012; Horn, Crews, & Harrawood, 2012; Ober et al.,

2012; Werth & Crow, 2009).

Core Skills, Behaviors, and Qualities of Counselors

There is substantial literature published on core skills, qualities, and behaviors

that are important for all practicing counselors (e.g., Aladag, Yaka, & Koc, 2014; Cory &

Cory, 2007; Hansen, 2009; Smith & Moss, 2009; Swank, Lambie, & Witta, 2012). Some

of the noted basic core counseling skills are (a) listening, (b) empathy, (c) genuiness, (d)

unconditional positive regard, (e) focusing the session, (f) boundaries, (g) concreteness,

(h) open-ended questions, (i) counselor self-disclosure, (j) interpretation, and (k)

information giving and removing obstacles to promote change (Cory & Cory, 2007;

Hansen, 2009; Smith & Moss, 2009; Swank, Lambie, & Witta, 2012). Gamino and Ritter

(2012) suggested the counselor’s ability to empathetically listen and understand the

client’s unique grieving experience promotes the counselor and client’s successful

working relationship. In addition to basic core counseling skills, the counselor’s

enthusiasm, confidence, and the belief that the client is able to change are all very

important to build a therapeutic working relationship between the counselor and client

(Bernard & Goodyear, 2009).

In addition to core skills and behaviors, there are noted qualities needed in

counselors such as acceptance, confidence, empathy, emotional stability, fairness,

flexibility, genuiness, and interest in people, open-mindedness, and sensitivity

(Aladag,Yaka, &Koc, 2014; Cory & Cory, 2007; Hansen, 2009; Smith & Moss, 2009;

Swank, Lambie, & Witta, 2012). Roos (2002) as cited in Gamino and Ritter (2012) stated

the six qualities grief counselors need are (a) ability to maintain focus, (b) consistency

with goal-directed work, (c) rational confidence, (d) perceptive and empathetic accuracy,

(e) respectful acknowledgement to the client’s pain, and (f) competency in timely and

parsimonious interventions.

The counselor’s interactions with the client are a powerful tool in the helping

relationship to promote positive change (Janesick, 2011). Clients are likely to reach their

goals when a good working rapport exists in the client-counselor working relationship

(Bernard & Good year, 2009). Understanding the core skills, behaviors, and qualities that

are necessary for counselors to have are very important to be effective in the counseling

field.

Knowledge, Assessment, and Treatment Skills

Counselors are required to have knowledge, assessment, and treatment skills

specific in the area in which they are practicing, and are to ensure competence in their

work and protect the client from harm (ACA, 2014). According to Gamino and Ritter

(2012), a grief counselor’s work should be based on thorough knowledge on modern grief

theories, valid assessments, and effective treatment interventions to ethically and

effectively help clients with their presenting issues pertaining to grief and loss.

Charkow (2002) developed a survey on grief counseling competencies. Her grief

counseling competencies survey is divided into subscales: (a) personal competencies, (b)

conceptual skills and knowledge, (c) assessment skills, and (d) treatment skills. The

personal competencies subscale measures a counselor’s thoughts and feelings about grief,

along with counselor’s overall wellness (Ober et al., 2012). The personal competencies

subscale topics concern self-care, humor, personal philosophy, spirituality, and

counselor’s attitude on loss (Ober et al., 2012). The conceptual skills and knowledge

subscale topics assess one’s knowledge pertaining to normal grief and complicated grief,

effective and ineffective coping skills, knowledge of grief theories, and understanding of

end-of-life/death. The assessment skills subscale topics assess the counselor’s knowledge

in assessing the client for unresolved losses, suicide assessment; assess spirituality,

cultural grief experiences, and medical referrals for treatment. The treatment skills

subscale assess the counselor’s ability to provide psychoeducational information on loss

and grief issues, provide individual, group, and family grief counseling that focuses on

grief and loss issues, build rapport with clients, use active listening skills with clients so

they feel heard, reframe the client’s loss experience, use creative art therapy counseling,

and explore or cocreate new/old mourning rituals (Ober et al., 2012). The Charkow

survey has been used in pilot study, past research studies by Ober et al. and Smith (2003),

and a modified renamed version by Cicchetti (2010) used in this dissertation. Not only is

it important for grief counselors to have knowledge, assessment, and treatment skills in

grief counseling they also need to be efficient in personal competencies, cultural

competencies, and professional competencies in order to practice ethically and

successfully with grieving clients.

Personal Competence

The Council for Accreditation of Counseling and Related Educational Programs

(CACREP) notes that self-awareness is important and a prerequisite for counselor fitness

(CACREP, 2016). Hansen (2009) suggested the construct for self-awareness are as

follows: “(a) the self must exist, (b) this self must be available for introspection, (c) the

self must have an enduring essence, and (d) the self must be able to be represented by

language” (p.186). According to Hansen, “self-awareness is highly valued by the

counseling profession” (p. 186).

Duba and Magenta (2008) highlighted the importance of counselor’s self-

awareness in relation to grief counseling. According to Duba and Magenta, the decision

on whether or not to counsel loss, grief, end-of-life care, decision-making, and

bereavement is an important ethical dilemma for counselors working with individuals,

families, and the aging population. Advance techniques in medical care have assisted

people to live longer (Ober et al., 2012). Furthermore, Duba and Magenta stated the

importance of proper training and education that counseling students and counselors need

in order to assist clients with their presenting issues. Counselors need to be competent

when assisting clients and their families with loss, grief, end-of-life care, decision-

making, and bereavement (ACA, 2014).

Duba and Magenta (2008) suggested different strategies that counseling students

and counselors can do as part of their own self-awareness and reflecting. For example,

counselors and counseling students should go to a funeral or wake. The idea of this action

is to have some exposure to death to assist in the process of desensitization to death

(Duba & Magenta, 2008).

Also, Duba and Magenta (2008) suggested that a counseling student should attend

hospice or grief/bereavement support groups and listen to the participants talk about their

concerns, thoughts, and feelings, in order to understand their views. Counselors and

counseling students should process their own personal feelings and thoughts on the

subject of loss, grief, end-of-life care, decision-making, and bereavement (Duba &

Magenta, 2008; Jones, 2010). Counselors and counseling students should also

acknowledge their values and feelings about loss, grief, end-of-life care, decision-

making, euthanasia, and bereavement. Self-awareness and processing one’s feelings will

assist the counselor’s growth and development to ethically and effectively assist one’s

clients (Duba & Magenta, 2008).

Professional Competence

The American Counseling Association (ACA, 2014) “Code of Ethics” Section

C.2. professional competence stated counselors are to practice within their boundaries of

competence based on their education, training, supervised experience, license,

credentials, and professional experience. Moreover, multicultural counseling

competency is a requirement across all mental health counseling specialties (ACA, 2014).

Multicultural counseling philosophy is culture based and the client’s problems may be

external or culturally based. Multicultural counselors understand that the client’s belief

system is important. Therefore, the counselor’s goals are cultural understanding,

awareness of biases and values, and understanding change in oppressive systems. The

common techniques used in multicultural counseling are worldview considerations and

self-awareness (Sue & Sue, 2008). However, techniques vary based on client population

and the client's presenting needs (Sue & Sue, 2008). According to Hays (2008), the

applicable aspects that will assist counselors with self-awareness pertaining to

understanding different worldviews, values, and biases. The three elements that are

considered the foundation are compassion, humility, and critical thinking skills - these

will assist in counselor’s work with culturally dissimilar clients (Hays, 2008).

Therefore, it is important to keep an open-mind in order to understand other's

views, beliefs, traditions, and behaviors, especially since people grieve differently

(Humphrey, 2009). In addition, counselors need to be realistic in what they have to offer,

their own limitations, and accepting the contribution of their clients' worldviews and

traditions (Doughty Horn, Crews, & Harrawood, 2013). Counselors should increase

openness, use critical thinking skills to identify and challenge assumptions, influences,

and alternatives of their own beliefs when working with grieving clients (Doughty Horn,

Crews, & Harrawood, 2013). Finally, counselors need to be kind, warm, and

compassionate when communicating with their clients to continuing building a good

working relationship to promote change (Hays, 2008).

Responsibility of CACREP Programs

The vision of CACREP is to promote excellence and to provide leadership

through its accreditation standards by continually improving programs and preparing

professionals to provide services and to promote optimal human development (Urofsky,

2013). CACREP accreditation provides recognition that the quality and content of the

program meets the standards set by the profession to reflect the needs of a dynamic,

complex, and diverse society (CACREP, 2016). Students and supervisees enrolled in a

CACREP-accredited program can be assured the appropriate knowledge and skill areas

are included in the program and the program is professionally and financially stable.

Furthermore, graduating from a CACREP-accredited program constitutes an important

credential and distinguishes counselors as having completed a program that meets the

standards of excellence for the profession (CACREP, 2016; Urofsky, 2013).

Counselor Training in CACREP Master’s Programs

The Council for Accreditation of Counseling and Related Educational Programs

(CACREP) is a specialized accrediting body for professional preparation in specific

graduate degree programs within the accredited institution (CACREP, 2016; McGlothlin

& Davis, 2004). There are seven specialized standards noted in the 2016 CACREP

Standards, as follows: (a) addiction counseling, (b) career counseling, (c) clinical mental

health counseling, (d) clinical rehabilitation counseling, (e) college counseling and

student affairs, (f) marriage, couple, and family counseling, and (g) school counseling

(Bobby, 2013; CACREP, 2016). There are well-defined criteria outlining the national

standards and training of skills in which graduate students must be held accountable

(Urofsky, 2013).

According to the CACREP standards, training in CACREP master’s-level mental

health counseling accredited programs require a minimum of 60 semester credit hours or

90 quarter credit hours for all students to meet the academic unit requirement (CACREP,

2016). In addition, the master’s-level core coursework must include the following eight

content areas: (a) professional counseling orientation and ethical practice, (b) social and

cultural diversity, (c) human growth and development, (d) career development, (e)

counseling and helping relationships, (f) group counseling and group work, (g)

assessment and testing, and (h) research and program evaluation (CACREP, 2016).

Additionally, students are required to successfully complete supervised practicum

experience with a minimum of 100 clock hours in which 40 of those hours are required to

be direct client service hours. During the supervised practicum experience, the master’s-

level student must obtain one hour of site supervision per week and one and a half hours

of program faculty group supervision per week. Furthermore, after the master’s-level

student successful completes the practicum experience requirements they need to

successfully complete a supervised internship experience of 600 clock hours in which

240 hours must be direct client service hours and leading groups. During the supervised

internship, the master’s-level student must obtain one hour of site supervision per week

and one and a half hours of program faculty group supervision per week (CACREP,

2016).

However, the CACREP standards do not mention nor do they require course work

pertaining to loss or grief (Doughty Horn, Crews, & Harrawood, 2013). Eckerd (2009)

and Wass (2004) also noted that loss and grief are not noted in the CACREP standards.

Therefore, this topic may be overlooked in master’s-level counseling education and

training programs (Doughty Horn, Crews, & Harrawood, 2013; Eckerd, 2009; Wass,

2004). Eckerd noted that education on the college level would be useful to assist students

with developing knowledge and skills set to help those with presenting issues due to loss

or grief.

Effectiveness of Grief Counseling

Research results indicated that grief counseling is effective when provided to

individuals who self-referred to obtain help or individuals that are referred by a

professional due to grief symptoms (Gamino, Sewell, Hogan, & Mason, 2009; Currier,

Neimeyer, & Berman, 2008; Schut, Stroebe, van den Bout, & Terheggen, 2001).

Additionally, Jones (2010) noted individuals who receive grief counseling after the loss

of a loved one appear better able to cope with the loss of a loved one compared to

individuals that did not receive services. Furthermore, Jones suggested grief counseling

prior to the death of a loved one could potentially reduce post bereavement care.

Neimeyer and Currier (2009) conducted a meta-analysis of controlled outcome

research on grief therapies. The authors reviewed 48 peer-reviewed published articles and

16 unpublished dissertations, totaling 61 outcome studies. The results suggested that grief

therapy can be beneficial in helping people with grief and loss issues.

Education and Training for Counselors to provide Grief Counseling

According to Doughty Horn, Crews, and Harrawood (2013), research is sparse

pertaining to loss and grief education/training in the field of mental health counseling.

Harrawood, Doughty, and Wilde (2011) conducted a qualitative study of master’s

students who were enrolled in a loss and grief course specific to death and dying issues.

The results of the study, the researchers identified three themes the participants reported

and they are (a) increased openness to the constructs of death, (b) better understanding of

one’s own beliefs regarding death, and (c) fear of death decreased (Harrawood, Doughty,

& Wilde, 2011). The results of the themes identified in the study suggested the

participants who took a loss and grief course specifically pertaining to dying and death

issues may be less likely to personalize, project, or impose unexamined beliefs or values

onto the client dealing with loss or grief (Harrawood, Doughty, & Wilde, 2011).

Furthermore, the authors stated due to the themes noted in the study, the participants that

took a class may have less fear when addressing loss, grief, death, and dying issues with

their clients. Furthermore, the findings are consistent with previous studies which

indicated education on grief and loss issues may have a positive influence on counselor’s

comfort level in assisting clients with presenting issues pertaining to grief and loss

(Doughty Horn, Crews, & Harrawood, 2013; Ober et al., 2012; Smith-Cumberland, 2006;

Wong, 2009).

Doughty Horn, Crews, and Harrawood (2013) conducted a quantitative study and

sent out a questionnaire to random ACA members to investigate counselor trainees’ and

counselors’ anxiety levels when dealing with loss and grief. The study included 161

participants who attended workshops on grief reported a significant decreased anxiety

levels while working with loss, grief, and death issues with clients. According to Ober et

al. (2012), counselors’ experience and training were predictors pertaining to knowledge;

skills set, and comfort level when working with client’s presenting issues of loss and

grief.

Doughty Horn, Crews, and Harrawood (2013) provided a questionnaire to a list of

random ACA members. The study results noted 135 participants (83.9%) indicated they

did not take loss or grief courses as part of their graduate studies. Currier, Neiymeyer,

and Berman’s (2008) meta-analysis of research study results indicated grief counseling

interventions can help a client with their loss and grief issues. Similarly, the Doughty

Horn, Crews, and Harrawood results indicated the need for counselors’ to have more

exposure to the aforementioned topics and suggested incorporating loss and grief

education and training into core curriculum in CACREP graduate counseling programs.

Competency in Grief Counseling

Counselor competence is an important component of our ethical principles

regarding beneficence and nonmaleficence (Gamino & Ritter, 2012). Beneficence means

accomplishing something helpful for the client and/or society by knowing how to address

the presenting issue, promoting mental health, and well-being (ACA, 2014; Gamino &

Ritter, 2012). Nonmaleficence is to avoid actions that can cause harm to the client or the

population one serves through incompetent and ineffective actions (ACA, 2014; Gamino

& Ritter, 2012).

Grief counseling competencies are important and needed in the mental health

counseling field to provide a foundation for all counselors to work from the grief

experience of the counselor and the client and how it impacts the daily living of a

growing society experiencing loss (Ahmed, Wilson, Henriksen Jr., & Jones, 2011).

According to Smith, Klaus, Russel, and Skinner (2009), it is important for counselors to

be educated, trained, and competent in grief counseling, because people will experience

grief sometime during their lifetime. Breen (2010) noted that loss is universal; however,

an individual’s grief experiences are culturally determined and unique.

According to Gamino and Ritter (2012), the importance of professional

competence when working in grief counseling that one should continually strive to attain

professional competence through continuing education and attending workshops to

promote one’s professional growth in obtaining up-to-date knowledge and current skills

in grief counseling. Counselors should only practice within the limits and boundaries of

their competencies (ACA, 2014). Competency in grief counseling is important to

culturally, ethically, and effectively assist clients with their presenting grief issues.

According to Schoulte (2011), throughout history cultures have grieved the loss of

a loved one using practices, rituals, and expected roles that people from outside the

culture may not have understood or appreciated. Latino/a American culture will

collaborate with all adult family members about end of life care decisions for a terminally

ill parent. In addition, Latino/a American culture prefers for the dying loved one to be in

the home with friends and family members beside the loved one and with the women as

the caregivers (Schoulte, 2011). Doran and Hansen (2006) conducted a qualitative study

on three Latino/a American families that had lost a child. The results indicated that the

families maintained relationships with their deceased child through “dreams, storytelling,

keepsakes, and a sense of presence, faith-based connections, proximity connections,

rituals, and pictorial remembrances” (Doran & Hansen, 2006, pp 208-209; Schoulte,

2011, p. 14). Moreover, the grieving processes were culturally reasonable for Latino/a

American culture (Schoulte, 2011).

It is common for those identifying with African American culture to gather

together for prayer and meditation to assist the deceased loved one with their transition to

the spirit life and to the afterlife (Schoulte, 2011). African American families prepare

food, clothing, chanting, singing, and prayers to welcome the dead into the spiritual life

(Schoulte, 2011). Schoulte noted some African American cultures believe the spirits of

the deceased loved one are actively in touch with the living loved ones (hearing deceased

in dreams or feeling deceased presence). African American Christians view death as a

beginning of a new type of life and not the end. African American children and women

express grief freely and sometimes “falling out” in other terms fainting which is

considered a reasonable emotional response of grief (Schoulte, 2011).

Wellness

Working with client’s that have experienced grief and loss can be emotionally and

mentally draining for a counselor. According to Wester, Trepal, and Myers (2009),

counselor wellness is being (a) mentally, physically, and emotionally stable, (b) self-

aware of any biases or impairments, (c) able to recognize when one is stressed, and (d)

will take appropriate actions to promote well-being. Researchers have noted counselors

that are well themselves are most likely to produce well clients (Skovholt, 2012; Wester,

Trepal, & Myers, 2009; Witmer & Young, 1996). In counseling, the counselor is the

professional instrument; therefore, the counselor must take care of himself or herself to

be able to ethically and effectively assist the client (Janesick, 2011; Skovholt, 2012).

Research has indicated that an impaired or unwell counselor may harm the client

(Skovholt, 2012; Wester, Trepal, & Myers, 2009; Witmer & Young, 1996). With that in

mind, counselors have the responsibility to the profession to take the necessary steps to

promote their own well-being to promote the well-being of the ones they serve.

Professional Responsibility

To work ethically and effectively with clients that present with issues pertaining

to loss and grief, counselors need to reflect and be aware how their own loss or grief

experience has affected them. Most people including counselors have experienced some

type of loss or grief in their life, but many never talked to anyone about their experience

(Morgan & Roberts, 2010). Counselors have a responsibility to monitor one’s self and

work through any unresolved issues of loss and grief before working with clients, so, they

do not limit the clients’ grieving process and success (Morgan & Roberts, 2010). With

that being said, it is the responsibility of the counselor to effectively deal with his or her

own loss or grief. Therefore, the counselor can be present to enhance the treatment

effectiveness with their grieving clients – anything else would be unethical.

Ethical Concerns

In the field of professional mental health counseling, there are many ethical

concerns when working with the population one serves. It is important that the counselor

works within and adheres to the ethical codes of the profession to protect the counselor

and the client. The key ethical concerns are those relating to education and training, grief

counseling, and counselor wellness, according to the ethical codes of the ACA, and

American Mental Health Counselors Association (AMHCA).

American Counseling Association

The purpose of the ACA “Code of Ethics” is to outline, describe, and provide

direction concerning the ethical behaviors and responsibilities that counselors should

aspire to implement in their practices (ACA, 2014). One ethical issue is to be educated

and trained to provide effective grief counseling. According to the ACA (2014) “Code of

Ethics” section C.2.a. boundaries of competence, counselors should only practice within

their competency in skills based on one’s education, training, experience, and

professional credentials.

According to the ACA (2014) “Code of Ethics” section C.2.b. new specialty

areas of practice, counselors must know the limits of their boundaries and practice within

the limits of their specialty areas after appropriate training, education, and supervised

experience to ensure competence of their work and to protect the client from possible

harm. Assisting clients to adjust to loss and grief require special counseling skills and the

need for grief counselors will be on the rise in the coming years (Ober et al., 2012).

Therefore, an ethical issue is where should grief counselors obtain the appropriate

training, education, and supervised experience since it is not part of the core curriculum

requirements in master’s-level counseling CACREP-accredited programs. According to

Breen (2010), grief counseling is a delicate area of counseling and could be detrimental

or even damaging to a client if the counselor is not competent.

Another ethical issue is a counselor’s self-awareness of his or her continuing

education and best practices for working with the diverse population served. The ACA

(2014) “Code of Ethics” section C.2.f. continuing education recognizes the need for

counselors to acquire continuing education and maintain awareness of current

professional and scientific information in the counseling field. An ethical issue is where

should grief counselors obtain continuing education and best practices for working with

diverse populations pertaining to loss and grief work, since it is not part of the core

curriculum requirements in master’s-level CACREP-accredited counseling programs.

Not only do counselors need awareness they also need to promote self-care to be

ethical and effective in their work with others. According to the ACA (2014) “Code of

Ethics” section C.2.g. impairment, it is suggested that counselors should self monitor for

signs of impairment and reframe from providing services when impaired to prevent harm

to clients. Impairment can result from physical, mental, or emotional issues; therefore, it

is important for counselors to engage in self-care to assist in avoiding the ethical issue of

impairment.

American Mental Health Counselors Association

The AMHCA (2010) “Code of Ethics” section C.1. competence stated mental

health counselors must maintain high standards of professional competence in order to

best serve the interest of the client and the population one serves. Additionally,

counselors are to be able to recognize their own boundaries of their areas of competence

and the limits of their expertise and provide only the services in which they have

achieved a sufficient level of competence through education, training, or professional

experience. Furthermore, it is important that a counselor maintains knowledge through

continuing education and ongoing education related to professional practice in grief

counseling. Counselors need to be competent in cultural diversity and how the individual

deals with loss or grief through rituals, cultural expectations, and values. Self-awareness

is important for counselors to recognize effectiveness which is dependent on one’s

mental, emotional, and physical health. Therefore, it is ethically important for counselors

take the steps to promote their own well-being to be professional competent with the ones

they serve (AMHCA, 2010). Counselors are professionals and are expected to adhere to

the ethical codes in their professional practice to avoid harming their clients.

Summary

As discussed above, research has shown that the need for grief counseling is on

the rise and that grief counseling is beneficial to clients who experience issues due to loss

and grief. Grief counseling has been shown to be effective; however, grief education and

training are not part of the core curriculum requirements in master’s-level CACREP-

accredited counseling programs. Counselors have ethical responsibilities to be educated

and trained to provide effective grief counseling. In addition, it is the counselor’s ethical

responsibility to know the limits of his or her boundaries of expertise, and to practice

only within those to protect the client from possible harm. Furthermore, it is the

counselor’s ethical responsibility to obtain continuing education and to be up-to-date on

best practices for working with diverse populations in reference to their members’

individual unique experiences pertaining to loss and grief issues. In addition, it is

important for counselors to explore and understand their own beliefs and level of comfort

in providing grief counseling to others. The self-reported levels of competency, skills,

and knowledge on the GCCS survey will be used in this study to understand master

students’ self-assessment of competency in grief education and training in CACREP-

accredited counseling programs to assist in closing the gap that exists in the literature. In

Chapter 3, I discuss information on the research design and rationale, methodology,

population sample, data analysis plan, and ethical procedures.

Chapter 3: Research Method

The purpose of this study was to examine whether master’s counseling students in

CACREP-accredited programs feel they have been adequately trained in identifying

grieving clients and providing grief counseling to them. The research questions that

guided my research study were adapted from Cicchetti (2010). The research questions are

as follows: How competent do master’s-level counselors view themselves regarding the

education or training they received in grief theories or counseling skills in their

CACREP-accredited studies? How do the demographic variables relate to perceived

grief counseling competency? Controlling for course offerings, what is the relationship

between coursework and perceived grief counseling competency? What is the

relationship between practicum or internship setting and perceived grief counseling

competency? Additionally, I tested related hypotheses, as well.

In this chapter, I restate the purpose of the study, present the research questions,

and provide a rationale for the research design method that I used. I provide the planned

sampling and sampling procedures, instrumentation, data analysis plan, internal and

external validity, and ethical considerations. In addition, I discuss in depth the research

design, procedures, and instrumentation for my study. I conclude the chapter with a

summary.

Research Design and Rationale

In this quantitative study, I used a non-experimental, one shot survey comparative

design to investigate the perceptions of master’s students in CACREP-accredited

counseling programs. Data were collected using the GCCS (Cicchetti, 2010) and the

DDS. These instruments were used to measure the counseling students’ self reports of

their perceived competency in education and grief counseling on four sub-scales

(personal competencies, conceptual skills and knowledge, assessment skills, and

treatment skills). The DDS was also used to also collect demographic data on

participants’ gender, age, race, and ethnicity. Information about participants’ coursework

and practicum and internship setting were also recorded. The independent variables

included the demographic variables of gender, age, race, and ethnicity, coursework, and

clinical setting (i.e., practicum or internship setting). The four grief competency sub

scales on the GCCS were the dependent variables, with a covariate of course offering.

The research method and data collection method were both appropriate for my study,

because the methods allow the specific research questions to be answered through the

participants’ responses to the questions on the survey. The instruments were appropriate

for my study, because it allowed the participants’ to provide their perceived competency

through their education or training in grief counseling in which the participants obtained

in their formal coursework in their CACREP counseling program. The survey design was

appropriate, because it allowed me to test the hypotheses. Detailed operational definitions

are in Table 1 and Table 2.

Table 1

Operational Definitions of Independent Variables

Demographic variables Included gender, age, race, and ethnicity.

Practicum/Internship Setting Where the participant completed practicum or internship at the

time of data collection and included such setting as

community/mental health setting, school setting, hospital setting,

rehabilitation facility, state agency, or residential setting

(Cicchetti, 2010).

Coursework Did the participant take any courses in grief theories and

interventions and the relationship between courses taken and

grief counseling competency (Cicchetti, 2010, p.61).

Table 2

Operational Definitions of Dependent Variables

Personal Competencies Defined by nine items on the GCCS (Cicchetti, 2010) related to

participants’ reported self-care, self-awareness with grief issues,

humor, spirituality, and personal beliefs pertaining to loss and

grief. Sample questions on the GCCS on Personal Competencies

are “I practice personal wellness and self-care” and “I have self-

awareness related to my own grief issues and history” (Cicchetti,

2010, p.60).

Conceptual Skills and

Knowledge

Defined by nine items on the GCCS (Cicchetti, 2010) related to

participants’ reported level of confidence in defining normal

grief, describing effective and ineffective coping skills, and the

ability to apply counseling theories to case conceptualization.

Sample questions on the GCCS on Conceptual Skills and

Knowledge are “I believe that there are no one right way to deal

with grief” and “I can define and articulate the nature and

symptoms of complicated or unresolved grief situations”

(Cicchetti, 2010, p. 60).

Assessment Skills Defined by nine items on the GCCS (Cicchetti, 2010) assessed

participants’ ability to evaluate clients for unresolved losses,

suicide assessments, assess spirituality, recognize cultural

influences, and make appropriate referrals. Sample questions on

the GCCS on Assessment Skills are “I can assess for unresolved

losses that may not be stated as a presenting problem” and “I can

conduct suicide assessments” (Cicchetti, 2010, p. 60).

Treatment Skills Defined by 19 items on the GCCS (Cicchetti, 2010) assessed

participants’ belief in ability to provide psycho-education on grief

and loss issues; facilitate individual, group, or family counseling

sessions on grief; build rapport with clients; use active listening

skills; reframe loss experience; use creative arts in counseling;

and identify cultural influences affecting treatment. Sample

questions on the GCCS on Treatment Skills are “I can facilitate

family grief counseling sessions” and “I can facilitate individual

grief counseling sessions” (Cicchetti, 2010, p. 61).

Covariate: Institutions

offered courses in grief

theories and interventions

Examine the relationship between coursework and perceived

grief counseling competency, measured by the GCCS four sub

scales (Cicchetti, 2010).

Research Questions and Hypotheses

The overall general research question adapted from Cicchetti (2010): How

competent do master’s-level counselor’s view themselves regarding the education or

training they received in grief theories or counseling skills in their CACREP-accredited

studies?

RQ1. How do the demographic variables (e.g., gender, age bracket, race, and

ethnicity) relate to perceived grief counseling competency?

1: There is no significant (α = .05) interaction effect among the demographic

variables and perceived grief counseling competency.

1: There is a significant interaction effect among the demographic variables

and perceived grief counseling competency.

RQ2. Controlling for course offerings (whether the participant’s course

curriculum offered coursework in grief counseling theories and practice), what is

the relationship between coursework and grief counseling competency?

2: There is no significant (α = .05) positive relationship between coursework

taken and the four grief counseling competency scales, controlling for course offerings.

2: There is a significant positive relationship between coursework taken and the

four grief counseling competency scales, controlling for course offerings.

RQ3. What is the relationship between practicum or internship setting and

perceived grief counseling competency?

3: There is no significant (α = .05) relationship for clinical setting and

perceived grief counseling competency.

3: There is a significant relationship for clinical setting and perceived grief

counseling competency.

Setting and Sample

According to Sandelowski (2007), criterion sampling involves selecting cases in

which there is a predetermined criterion of importance. Criterion sampling can be useful

for identifying and understanding cases that are information rich. Therefore, I used

criterion sampling (Franfort-Nachmias & Nachmias, 2008) to sample the population of

master’s-level students in CACREP-accredited counseling programs. I chose master’s-

level students meeting the criteria of being in their practicum or internship in a CACREP

counseling program as the population instead of LPCs. I wanted to examine the student’s

formal education on grief theories, skills, and grief counseling as opposed to the

experience and training they may receive after completing their counseling program.

Master’s-level counseling students in their practicum or internship were asked to

participate in the study.

Creswell (2009) suggested a survey method uses different sampling procedures

such as single or multi-stage, random, or convenience sampling. According to Frankfort-

Nachmias and Nachmias (2008), “researchers obtain a convenience sample by selecting

whatever sampling units are conveniently available” (p. 168). For this study, I used a

convenience sampling (non-probability sampling) procedure to obtain participants. I sent

a letter to program directors of all CACREP-accredited counseling programs listed on the

CACREP website introducing the study and requesting that the program director forward

the invitation to participate and the SurveyMonkey link to their practicum and internship

master’s-level counseling students. One of the limitations of using this sampling

procedure is that the results of this study will not be generalizable to larger populations

(Franfort-Nachmias & Nachmias, 2008).

Electronic surveys sent via e-mail are a way to collect data in descriptive studies

(Creswell, 2009). To obtain the sample size for this study, I used the e-mailing

recommendations of Rovai, Baker, and Ponton (2013). Rovai, Baker, and Ponton stated

e-mail surveys should (a) allow two weeks minimum for collecting electronic surveys,

(b) initiate electronic survey early morning on a business day, (c) follow up contact to

promote positive response rates, (d) provide a short justification of survey promoting the

importance of study, (e) keep the survey short, (f) assure confidentiality or anonymity, (g)

provide periodic reminders, and (h) offer to provide feedback regarding the study.

According to Rovai, Baker, and Ponton, a large sample size with reasonable response

rates are required to minimize nonresponse error. The common criteria for survey

response rates are that higher than 85% is an excellent response rate, 70% to 85% is a

very good response rate, and 60% to 70% is an acceptable response rate. If the response

rate of the participants is 60% or higher, nonresponse error is minimized (Rovai, Baker,

& Ponton, 2013).

I sent the e-mail to the program directors in a way to avoid the email being

detected as spam. The letter was written to be appealing and was sent early in the

morning on a business day to all CACREP program directors listed on the CACREP

website. The letter introduced the study and asked them to forward the invitation to

CACREP master’s-level students currently enrolled in their practicum or internship field

experiences. I used an anonymous data collection procedure to eliminate any pressure for

CACREP master’s-level counseling students currently enrolled in their practicum or

internship field experience to participate. I sent an additional email to program directors

after 10 days to promote positive response rates.

A sample size of 225 participants was needed for this study as determined by

using G*Power 3.1.7 software. G*Power 3.1.7 was used to calculate the minimum

number of participants for a medium effect size F test of .25, alpha level of .05, power of

.80, and degrees of freedom of 6. Results indicated that 225 participants would be

required (Faul, Erdfelder, Lang, & Buchner, 2007).

Instrumentation

Demographic Data Sheet

The demographic data sheet included items requesting each participant to

complete information about gender, age, race, ethnicity, and practicum or internship

setting (See Appendix C). In addition, participants were asked to complete questions

pertaining to participants’ knowledge attainment on grief theories and interventions in

graduate school. The following questions were adapted from Cicchetti’s (2010) study:

1. Is your program CACREP-accredited?

2. Does the institution you attended offer courses in grief theories?

3. Does the institution you attended offer courses in grief interventions?

4. How many courses did you complete in grief theories?

5. How many courses did you complete in grief interventions?

Grief Counseling Competencies Survey

This study used a modified version with written permission (see Appendix B) of

Cicchetti’s (2010) GCCS to assess for personal grief counseling competencies and skills

and knowledge in grief counseling competencies. The only noted modification in the

GCCS (see Appendix D) used for this study was the removal of the word “disability” in

the section labeled Part II. The word “disability” was removed from the following

numbered questions 12, 14, 15, 23, 25, 30, 31, and 32. The rest of the survey remained

the same as used in Cicchetti’s (2010) study.

Cicchetti (2010) noted he used a modified version of the Death Competency

Survey (DCS; Charkow, 2002). According to Cicchetti, Charkow’s DCS consist of two

parts. The first part of Charkow’s DCS inquired about Personal Competencies using nine

questions. The second part of Charkow’s DCS inquired about Skills and Knowledge

Competencies using 36 questions. The two parts of Charkow’s DCS had four

subheadings, as follows: (a) personal competencies, (b) conceptual skills and knowledge,

Charkow’s (2002) revised version of the DCS, which was renamed GCCS by

Cicchetti (2010) is a 46-item questionnaire survey using a Likert scale to assess the

participant’s personal competencies, conceptual skills and knowledge, assessment skills,

and treatment skills in regards to grief intervention and counseling working with clients

with presenting issues related to loss or grief. The participant chooses the number on the

GCCS which best identifies the participant’s self-reported perceived competency for each

of the questions on the survey. The responses on the survey are 1 (this does not describe

me), 2 (this barely describes me), 3 (this somewhat describes me), 4 (this describes me),

and 5 (this describes me very well) (Cicchetti, 2010).

Part I and II of the GCCS were scored independently. For example, Part I of the

GCCS personal competencies has nine questions using a Likert scale rating 1 through 5

with the higher score representing a greater perceived competency level reported by the

participant in the specific part of the assessment; therefore, the scoring range was 9 to 45

in Part I of the GCCS assessment. Part II of the GCCS skills and knowledge

competencies area of the assessment has 37 questions using a Likert scale rating 1

through 5, therefore, the scoring range was 37 to 185 in that part of the GCCS

assessment. The subscales in Part II of the GCCS skills and knowledge competencies are

distributed within three scales as follows: the assessment skills has nine questions,

treatment skills has 19 questions, and conceptual skills and knowledge has nine questions

in the Part II of the GCCS assessment (Cicchetti, 2010).

In adapting the DCS (Charkow, 2002) to create the GCCS, Cicchetti (2010)

removed seven questions specific to death and bereavement. In addition, Cicchetti,

reframed seven questions for the purpose of his study. Cicchetti’s GCCS focused on grief

counselor competencies and were not specific to death and bereavement. For example,

one of the focused questions on death were changed as follows: “I have experienced the

death(s) of a family member and can verbalize my own grief process, to: I have

experienced loss and can verbalize my own grief process” (Cicchetti, 2010, p. 67).

Charkow (2002) contacted 34 experts in grief counseling to develop the DCS. Of

the 34 contacted experts in grief counseling, 27 of them provided feedback and ratings on

the DCS. The definition for expert was noted as an individual with “at least 5 years of

experience in grief counseling, completed three individual surveys regarding (a)

characteristics important for grief counselors to possess, (b) content to be included in

courses/lectures on grief, and (c) general competence” (Cicchetti, 2010, p. 67). The

results were the instrument was used in a pilot study, refined, and used in Charkow’s

(2002) dissertation as the instrument DCS (Cicchetti, 2010).

Validity and Reliability

According to Etchegaray and Fischer (2010), researchers place importance on

validity to ensure the inferences made from the design and measurement used are

meaningful, appropriate, and useful, it measures what it claims to measure, and important

decisions can be made from the information obtained. Frankfort-Nacmias and Nacmias

(2008) stated content validity is determined by the degree to which the questions, tasks,

or items on an instrument are representative of the universe of behavior the instrument

was designed to sample.

As discussed by Charkow (2002) and Cicchetti (2010), a demographically-diverse

group of 27 grief experts rated and provided comments on the importance of the included

competency items and the efficacy of the modified Delphi procedure to determine

competency items. The individuals in this group of experts reported expertise in grief

counseling including clinical, research, and educator roles. All experts reported a

minimum of 5 years of experience in grief counseling activities, and 20 of the 27 reported

more than 10 years of experience in the field in grief counseling activities. The terminal

degrees of the individuals in the group of 27 included 14 experts with Ph.D. degrees, 12

experts with Master’s degrees, and 1 expert with an Educational Specialist degree.

Eighteen of the experts were female and 9 were male, and were regionally diverse within

United States. The professional fields represented by the experts included counseling,

counseling education, social work, psychology, family studies, and thanatology. Half (13

of the 27) of the experts reported holding certification in grief counseling, grief therapy,

or death education, and in the modified Delphi study, there were 15 expert participants in

the final survey iteration (Charkow, 2002). Content validity was indicated by 14 of the

15 (93. 3%) experts which agreed the included competency items in the survey

adequately or completely addressed the characteristics and the competencies required for

grief counseling (Cicchetti, 2010; Charkow, 2002).

The original instrument (the Death Counseling Scale) has been determined to

have a Cronbach alpha (α) of .87, indicating it is a reliable instrument (Charkow 2002).

Subscales of the instrument lie within the range .79 ≤ α ≤ .94. Specifically, the personal

competency subscale has α = .79, the conceptual skills and knowledge subscale has α =

.92, the assessment skills subscale has α = .87, treatment skills subscale has α = .94, and

the professional skills subscale has α = .83 (Charkow, 2002). Charkow reported a

correlation between DCS and Burgen’s Coping with Death Scale of г = .73, suggested

concurrent validity. Cicchetti (2010) reported the Grief Counseling Competency Scale is

also a reliable instrument with a Cronbach alpha value for the personal competency

subscale of α = .79 and for the skills and knowledge subscale of α = .97. Cicchetti

reported the 3 subscales of the skills and knowledge subscale have Cronbach alphas of

conceptual skills and knowledge subscale (α = .52), assessment skills subscale (α = .60),

and treatment skills subscale (α = .60).

Cicchetti (2010) sent the GCCS to two experts in rehabilitation counseling field,

and one grief studies expert to make sure the GCCS was appropriate for his study.

Cicchetti reported he wanted to obtain feedback on the questions in the GCCS in relation

to loss and grief for individuals with disabilities. Cicchetti stated experts in his study

were defined as professionals in the field who had at least five years of teaching

experience in grief theories or interventions in a CACREP master’s-level counseling

program or in a CORE master’s-level rehabilitation counseling program. In addition, the

experts in Cicchetti study also had at least five years of clinical counseling experience

working with clients with presenting grief issues or clients with rehabilitation presenting

issues.

Cicchetti (2010) sent the GCCS and the DCS surveys, information on content

validity and reliability, and the first three chapters of his study to the three experts to

analyze the GCCS and to determine if it was pertinent to the study. The grief counseling

expert suggested adding the question, “I can listen in a non-judgmental way to stories that

clients tell about their losses” (Cicchetti, 2010, p. 69). After Cicchetti incorporated the

feedback, the revised GCCS was sent back out to the three experts, along with the DCS

survey and the information on content validity and reliability, and the research questions

for the final review. The three experts concluded the GCCS survey was pertinent for the

study (Cicchetti, 2010).

I sent the GCCS and the DCS surveys, information on content validity and

reliability, and the first three chapters of this study to four experts to analyze the GCCS

and to determine if it was pertinent to the study. The four experts concluded the GCCS

survey was pertinent for the study. The experts had at least five years of clinical

counseling experience working with clients with presenting grief issues.

Data and Collection Procedures

I began data collection began shortly after I received the approval notice from

Walden University’s Institutional Review Board (IRB) for Ethical Standards in Research

(see Appendix A). I recruited the participants by writing e-mail invitations to CACREP-

accredited master’s-level counseling program directors listed on the CACREP website

and asked them to please forward the invitation to CACREP master’s-level students

currently enrolled in their practicum or internship counseling field experience (See

Appendix E). The invitation to participate via e-mail provided the criterion required of

participants to participate in the study and it also provided a link which allowed the

participant to enter the entry page of the survey. The entry page had information about

the study including overview and background, including procedures, voluntary

commitment to participate in the study, benefits and risks of participating in the study,

information on zero compensation, confidentiality, contact information, and statement on

consent (see Appendix F). After the participants had reviewed the implied consent on the

entry page, participants were directed to enter the survey, verify consent, and complete

the Demographic Data Sheet (see Appendix C), and the GCCS survey (see Appendix D).

Following the participant’s completion of the DDS and the GCCS survey, the

participant received a debriefing statement form (see Appendix G). The debriefing

statement was used to express gratitude for the participant’s participation, shared

information about how to contact the researcher if needed, reiterated the voluntary

participation in the study, reviewed informed consent information, discussed future

requirements for the study, provided counseling services resources, and shared the study

overview. To increase the response rate for participants, I used the recommendation of

Rovai, Baker, and Ponton (2013) as discussed above. I used MonkeySurvey, which uses

secure encryption technology to ensure confidentiality. After the completion of the study,

data was downloaded to SPSS on a password protected computer.

Data Analysis

Descriptive statistics were calculated (frequency, percent, mean, standard

deviation, and range) to examine the data from the survey. Data from the survey was

analyzed in order to answer the overall general research question adapted from (Cicchetti,

2010): How competent do master’s-level counselors view themselves regarding the

education or training they received in grief theories or grief counseling skills in their

CACREP-accredited studies?

RQ1. How do the demographic variables (e.g., gender, age bracket, race, and

ethnicity) relate to perceived grief counseling competency?

1: There is no significant (α = .05) interaction effect among the demographic

variables and perceived grief counseling competency.

1: There is a significant interaction effect among the demographic variables

and perceived grief counseling competency.

This question was investigated using a 4-way MANOVA with demographic

variables (gender, age bracket, race, and ethnicity) as independent variables and the four

grief competency sub scales on the GCCS are the dependent variables. The first

demographic variable gender examined for differences on perceived grief counseling

competencies on the GCCS survey. The next demographic variable age examined as a

function of perceived grief counseling competencies on the GCCS survey. The last two

demographic variables race and ethnicity examined for differences on perceived grief

counseling competencies on the GCCS survey.

RQ2. Controlling for course offerings (whether the participant’s course

curriculum offered coursework in grief counseling theories and practice), what is the

relationship between coursework and grief counseling competency?

2: There is no significant (α = .05) positive relationship between coursework

taken and the four grief counseling competency scales, controlling for course offerings.

2: There is a significant positive relationship between coursework taken and the

four grief counseling competency scales, controlling for course offerings.

This question was investigated using a MANCOVA where the independent

variable is coursework; the four grief competency sub scales on the GCCS are the

dependent variables, and the covariate is course offering. This analysis examined the

relationship between course work taken and the four grief competency sub scales on the

GCCS survey.

RQ3. What is the relationship between practicum or internship setting and

perceived grief counseling competency?

3: There is no significant (α = .05) relationship for clinical setting and

perceived grief counseling competency.

3: There is a significant relationship for clinical setting and perceived grief

counseling competency.

This question was investigated using a MANOVA whereas the independent

variable is practicum or internship setting and the four grief competency sub scales on the

GCCS are the dependent variables. This analysis examined the relationship between

practicum or internship setting and perceived grief counseling competencies on the

GCCS survey.

The assumptions of MANOVA are the same for MANCOVA (Rovai, Baker, &

Ponton, 2013). These include that observations are independent and the sample is without

any pattern. MANOVA and MANCOVA assume the dependent variables are continuous

or scale variables and independent variables are categorical. However, the MANCOVA

covariates can be continuous, ordinal, or dichotomous (Rovai, Baker, & Ponton, 2013).

Absence of multicollinearity assumptions of MANOVA and MANCOVA

indicates that the dependent variables are not correlated to each other (Rovai, Baker, &

Ponton, 2013). According to Tabachnick and Fidell (2012) no correlation should be

above r = .90. In addition, the assumptions of MANOVA and MANCOVA are

multivariate normality is the dependent variable is normally distributed in the data and

homogeneity of variance is equal between groups. The one additional assumption made

in the MANCOVA that is not in the MANOVA is the relationship between covariate and

dependent variables. Choosing what covariate to use and assessing if an existing

statistical relationship between covariate and dependent variables using a correlation

analysis (Rovai, Baker, & Ponton, 2013).

The assumption of homogeneity of variance can be evaluated using the Levene’s

test of equality of variance (Rovai, Baker, & Ponton, 2013). The Levene’s test of equality

of variance is used to examine if the variance between IV groups are equal. If the

Levene’s test shows non-significant values this indicates equal variance between groups.

The MANCOVA assumptions test homogeneity of regression is important to use

when including a covariate (Rovai, Baker, & Ponton, 2013). Homogeneity of regression

assumes the interaction of the IV by the covariate is not significant. However, slopes

relating to the covariate to the DV are equal across all levels. For example, for each level

of IV, the slope of the prediction of the DV from covariate must be equal (Rovai, Baker,

& Ponton, 2013).

Results shared with dissertation committee, Walden University, possible future

publication article, sharing a summary of the results with participants, and professionals

in the mental health field.

Limitations

The threats to internal validity in using the non-experimental, one shot survey

research design is important to discuss on how they may affect this study (Creswell,

2009). However, the threats to internal validity are not a concern for this study. Threats to

internal validity would be (a) history, (b) maturation, (c) regression, (d) mortality, (e)

diffusion of treatment, (f) compensatory/resentful demoralization, (g) compensatory

rivalry, (h) testing, and (i) instrumentation (Creswell, 2009). The participants in this study

were asked to complete a one-time survey online with no interaction and no lapse of time

between participation, therefore, reducing the internal validity threats pertaining to (a)

history, (b) maturation, (c) mortality, (d) diffusion of treatment, (e)

compensatory/resentful demoralization, (f) compensatory rivalry, and (g) testing.

Furthermore, the participants volunteered anonymously and no information was known

about the participants which reduced the internal validity threat of regression (Creswell,

2009). The instruments that were used for this study are the same instruments used for all

participants (no changes), with the same written instructions provided at the beginning of

the study to all, therefore, reducing the internal validity threat of instrumentation

(Creswell, 2009).

The threats to external validity that do apply to this study are (a) interaction of

selection and treatment, (b) interaction of setting and treatment, and (c) interaction of

history and treatment (Creswell, 2009). Due to the recruitment criteria of the participants

in this study, generalizability was limited to CACREP-accredited master’s-level

counseling students. Therefore, the findings cannot be generalized to the larger

population or other populations. Additionally, future research during different times of

counseling student’s development may be appropriate. Moreover, replication of this study

at a later time may be useful to determine if the results are the same in both studies.

Obtaining the sample through written request to Program Directors of CACREP

counseling programs was reasonable, since previous researchers used this method

(Cicchetti, 2010; Creswell, 2009; Dillman et al., 2009). According to previous

researchers the response rate for online surveys remains low still today (Cicchetti, 2010;

Creswell, 2009; Dillman et al., 2009). For example, if one does not have emails for the

population of potential participants it would be difficult to send a request to participate in

an email survey. Additionally, response to participate may be low, because participants

may have difficulty sharing that they may have a deficit in grief education and training,

even though the survey design is designed to keep the participants identity anonymous.

Limits of confidentiality, anonymity, ethical concerns, and availability of counseling

services were addressed in the consent and debriefing forms of this study.

Ethical Considerations

There are many ethical considerations when working with human participants in a

research study. I made sure the participants understood the risk of participating in this

study, obtained consent, and provided clear guidelines about the purpose of this study and

how to obtain follow-up information if the participant desired. Participants were

informed and information concerning the intent of this study was provided. Information

provided will be kept confidential except for the information obtained on the surveys

which was used in this study. The participants of the study are not members of a

vulnerable population by IRB definition; therefore, no additional ethical considerations

are needed to protect human participants in this study. Before any data collection began,

the IRB application was completed and submitted, reviewed, and approved by Walden

University.

The participants for this study were Master’s-level students in CACREP-

accredited counseling programs currently enrolled in their Practicum or Internship field

experience, who have completed all of their required program courses of study, and who

volunteered to participate after they had been contacted through email via their program

director at their university. I provided a link in the email inviting participants to

voluntarily participate in the study, if they so desired. The first document the participants

reviewed pertained to the study information. This information included (a) implied

consent, (b) purpose of the study, (c) procedures, (d) voluntary participation of the study,

(e) benefits and possible risk, (f) confidentiality, and (g) researcher’s contact information.

The consent clearly stated that participation was voluntary and can be withdrawn at any

time. Once participants chose to voluntarily participate in the study they were direct to

the SurveyMonkey link. Clicking on the link implied consent and the survey began.

In order for the participants to remain anonymous, I did not request names and no

personal information was collected in this study. Upon completion of the study, I

downloaded the participant’s responses to a password protected computer using SPSS

software. In SurveyMonkey, I deleted participant’s responses from storage after the data

were downloaded.

Summary

The purpose of this study was to examine whether master’s-level counseling

students in CACREP counseling programs report they have been trained to identify and

work with clients who are experiencing grief related issues from a loss. I used both

MANOVA and MANCOVA analyses. For example, research question 1 investigated

using a 4-way MANOVA with demographic variables (gender, age bracket, race, and

ethnicity) as independent variables and the four grief competency sub scales on the

GCCS are the dependent variables. The first demographic variable gender examined for

differences on perceived grief counseling competencies on the GCCS survey. The next

demographic variable age examined as a function of perceived grief counseling

competencies on the GCCS survey. The last two demographic variables race and

ethnicity examined for differences on perceived grief counseling competencies on the

GCCS survey. Research question 2 investigated using a MANCOVA where the

independent variable is coursework; the four grief competency sub scales on the GCCS

are the dependent variables, and the covariate is course offering (whether the

participant’s course curriculum offered coursework in grief counseling theories and

practice). This examined the relationship between course work taken and the four grief

competency sub scales on the GCCS survey. Research question 3 investigated using a

MANOVA whereas the independent variable is practicum or internship setting and the

four grief competency sub scales on the GCCS are the dependent variables. This

examined the relationship between practicum or internship setting and perceived grief

counseling competencies on the GCCS survey.

This study was one of the first to examine CACREP requirements for master’s-

level counseling students which may be deficient in their education and training in grief

theories and interventions. The study will benefit CACREP counseling programs by

examining accreditation standards of programs by requiring course requirements in grief

theories and interventions for master’s-level counseling student in order to meet the

populations growing service needs. There may be a need for CACREP counseling

programs to expand current requirements of master’s counseling programs and develop

core curriculum requirements to be included on grief theories and interventions.

Chapter 4: Results

The purpose of this quantitative study was to examine whether CACREP-

accredited master’s counseling students in training perceive they have been adequately

trained in identifying clients’ presenting grief issues and in providing grief counseling to

clients in need. The purpose of this study was to examine the question: How competent

do master’s-level counselors view themselves regarding the education or training they

received in grief theories or counseling skills in their CACREP-accredited studies?

RQ1. How do the demographic variables (e.g., gender, age bracket, race, and

ethnicity) relate to perceived grief counseling competency?

1: There is no significant (α = .05) interaction effect among the demographic

variables and perceived grief counseling competency.

1: There is a significant interaction effect among the demographic variables

and perceived grief counseling competency.

RQ2. Controlling for course offerings (whether the participant’s course

curriculum offered coursework in grief counseling theories and practice), what is

the relationship between coursework and grief counseling competency?

2: There is no significant (α = .05) positive relationship between coursework

taken and the four grief counseling competency scales, controlling for course offerings.

2: There is a significant positive relationship between coursework taken and the

four grief counseling competency scales, controlling for course offerings.

RQ3. What is the relationship between practicum or internship setting and

perceived grief counseling competency?

3: There is no significant (α = .05) relationship for clinical setting and

perceived grief counseling competency.

3: There is a significant relationship for clinical setting and perceived grief

counseling competency.

Upon the approval of the IRB application, implementation, and the data collection

occurred over 40 days. In this chapter, I discuss the purpose, research questions, and

hypotheses. First, I discuss data collection, recruitment of participants, response rates,

demographic and descriptive characteristics. The results of analysis are presented

pertaining to the evaluation of statistical assumptions, results pertaining to each

hypothesis, and information regarding the covariate. Lastly, I included a summary to

answer the research questions based on the results.

Data Collection

The survey was sent via email to program directors and to program designees, in

lieu of a director of CACREP-accredited counseling programs that were listed on the

CACREP website. I followed the mailing recommendation design of Dillman et al.

(2009) to promote response rate. Specifically, on Day 1, the invitation to participate in

the study and the survey were sent to CACREP accredited program directors. On Day 10,

an additional request to participate in the study and to complete the survey was sent. On

Day 20, final requests to participate in the study and to complete the survey were sent.

The survey invitation was sent the fourth week of January 2016 and data

collection was completed in the last week of February 2016. On Days 1, 10, and 20 (see

Appendix E), the survey invitation to participate was sent, including thank you response

emails. Program directors or program designees of CACREP-accredited counseling

programs were asked to forward the survey invitation to their master’s-level students

enrolled in their practica or internships via blind carbon copy. The summary of program

directors’ or their designees’ contacted as follow:

• Three hundred fifteen program directors or program designees received

the survey.

• Seven did not have valid e-mail addresses and therefore were not included.

• Seven had automatic response that they were on sabbatical.

• Fourteen had automatic response that they were out of office for travel.

• Four program directors or program designees reported that their college or

university required IRB approval for the survey to be distributed.

• Seven program directors or program designees were unavailable but

provided another contact name, to which an e-mail was sent.

• Two program directors or program designees stated the e-mail to

participate in survey was sent to their colleagues in the department to

distribute to students as per their discretion.

• Twenty-two responded that the e-mail was sent to their students or posted

on listserv.

The survey invitation provided detailed instructions to participants who were

interested in participating in the study and to click the “next” button to begin their review

of the consent form. Participants who continued to the survey from the consent form

provided implied consent ensuring anonymity. Participants were able to cease voluntary

participation at any time. The final sample size was 153 total respondents, of whom 123

answered all questions.

Sample Demographics

I used convenience sampling at CACREP-accredited institutions, in addition to

criterion sampling techniques to ensure that participants were master’s-level counseling

students enrolled in their practicum or internship experience. I selected CACREP-

accredited master’s-level counseling programs to provide a unified level of standards and

expectations in the counseling field. Of the 153 participants who responded to the survey,

all met my criteria, but only 123 participants completed all required responses to the

study. Participants were informed in the Study Information “if there is a question that you

choose not to answer, you may skip the question”. After participants consented to the

study (see Appendix E), they completed the DDS and GCCS (Cicchetti, 2010) (see

Appendices C and D). After completing both instruments, participants received a

debriefing letter (see Appendix F).

Of the 153 master’s-level CACREP-accredited counselor trainees who were in

either their practicum or internship participated in this study, 136 (89.47%) reported

being female, while 16 (10.53%) reported being male, and one participant chose not to

respond. Regarding the demographic questions on ethnicity, 142 (92.81%) identified

themselves as No, not Hispanic, Latino, or Spanish origin, 4 (2.61%) identified

themselves as Yes, Mexican, Mexican American, Chicano, 3 (1.96%) identified

themselves as Yes, Puerto Rican, and 4 (2.61%) identified as Yes, another Hispanic,

Latino, or Spanish origin, however, 0 identified as Cuban. On the demographic questions

regarding race, 126 (82.89%) identified themselves as White, 18 (11.84%) participants

identified themselves as Black, African American, or Negro, 3 (1.97%) identified

themselves as American Indian or Alaska Native, 1 (0.66%) identified them self as

Filipino, 2 (1.32%) identified themselves as Other Asian, 1 (0.66%) identified them self

as Guamanian or Charnorro, 1 (0.66%) identified them self as Other Pacific Islander, and

one chose not to respond. All 153 participants responded to the age bracket question, 47

(30.72%) responded in the age bracket of 18-24 years old, 69 (45.10%) responded in the

age bracket of 25-34 years old, 13 (8.50%) responded in the age bracket of 35-44 years

old, 19 (12.42%) responded in the age bracket of 45-54, and 5 (3.27%) responded in the

age bracket of 55 plus years old. Reporting on their practicum or internship setting,

respondents indicated 72 (47.68%) were at Community Mental Health settings, 51

(33.77%) were at School settings, 2 (1.32%) indicated at Hospital settings, 1 (0.66%) at

Rehabilitation setting, 4 (2.65%) indicated at State Agency, 2 (1.32%) at Residential

settings, 19 (12.58%) indicated Other not Specified settings, and 2 (1.32%) of the

participants did not respond.

Of the 153 respondents, 153 reported the program they attended was CACREP-

accredited. The list of CACREP-accredited universities was obtained directly from

CACREP via the CACREP website, verified as current accreditation on the CACREP

website, and noted each university’s department program chair. Twenty-two CACREP-

accredited master’s-level counseling programs responded that the e-mail with the survey

link (study) was sent to their practicum or internship students. Since information

pertaining to which school respondents attended was not obtained, there was no way of

knowing how many students from each school or state participated in the study.

Ninety-nine participants (66%) reported the university they attended did not offer

courses in grief theories, 51participants (34%) reported the university they attended did

offer courses in grief theories, and 3 participants did not respond to the question. Ninety-

five participants (62.91%) reported the university they attended did not offer courses in

grief interventions, 56 participants (37.09%) reported the university they attended did off

courses in grief interventions, and 2 participants did not respond to the question. One

hundred and twenty-two participants (80.26%) reported they had not taken any courses in

grief theories, 27 participants (17.76%) reported they had taken one course in grief

theories, 3 participants (1.97%) reported taken two courses in grief theories, and one

participant did not answer the question. One hundred and thirteen participants (76.87%)

reported they did not take any courses in grief interventions, 30 participants (20.41%)

reported they had taken one course in grief interventions, 4 participants (2.72%) reported

they had taken two courses in grief interventions, and 6 participants did not answer the

question. The missing data points are participants’ who did not answer the question.

Participants were informed on the Study Information “if there is a question that you

choose not to answer, you may skip the question”. Participant’s characteristics can be

found in Table 3.

Table 3

Participant Descriptives

Variable

Frequency (N)

Mean Median

Mode Std. Deviation

Valid

Missing

What is your gender? 152 1 1.11 1 1 .31

What is your age

bracket?

153 0 2.12 2 2 1.08

Is this person of

Hispanic, Latino, or

Spanish origin?

153 0 1.17 1 1 .71

What is this person’s

race?

152 1 1.47 1 1 1.77

Is your program

CACREP-accredited?

153 0 1.00 1 1 .00

Does the institution you

attend offer courses in

grief theories?

150 3 1.66 2 2 .48

Does the institution you

attend offer courses in

grief interventions?

151 2 1.63 2 2 .48

How many courses did

you complete in grief

theories?

152 1 1.22 1 1 .46

How many courses did

you complete in grief

interventions?

147 6 1.26 1 1 .50

Current

Practicum/Internship

Setting.

151 2 2.31 2 1 2.01

Distribution of Data

Descriptive statistics was calculated to examine the data from the survey. Data

from the survey was analyzed in order to answer the overall general research question

adapted from (Cicchetti, 2010): How competent do master’s-level counselors view

themselves regarding the education or training they received in grief theories or grief

counseling skills in their CACREP-accredited studies?

There are nine questions on Section 1 of the GCCS pertaining to personal grief

counseling competencies. The scores for each question ranged from 1: “This does not

describe me,” to 5: “This describes me very well.” The higher total score, the higher

perceived personal grief counseling competency. The total score can range from low of 9

to high of 45.

One hundred and forty participants reported in Section 1 of the GCCS (M =

38.03, SD = 4.34). The median score for this section was 38.5 with a mode score of 40,

with a frequency of 15, and total scores ranging from a low 21 with a frequency of 1, to

high of 45 with frequency of 7 (see Table 4 and Figure 1). The distribution scores were

Kurtosis 1.72 and negatively Skewed -.95, (see Table 5).

Table 4

Part 1:

Personal Grief Counseling Competencies Response

Totals

Frequency

Percent

Valid

Percent

Cumulative

Percent

Valid 21.00 1

24.00 1

1.4

25.00 1

2.1

26.00 1

2.9

30.00 2

1.3

1.4

4.3

31.00 1

5.0

32.00 5

3.3

3.6

8.6

33.00 7

4.6

5.0

13.6

34.00 7

4.6

5.0

18.6

35.00 10

6.5

7.1

25.7

36.00 9

5.9

6.4

32.1

37.00 14

9.2

10.0

42.1

38.00 11

7.2

7.9

50.0

39.00 11

7.2

7.9

57.9

40.00 15

9.8

10.7

68.6

41.00 14

9.2

10.0

78.6

42.00 12

7.8

8.6

87.1

43.00 8

5.2

5.7

92.9

44.00 3

2.0

2.1

95.0

45.00 7

4.6

5.0

100.0

Total 140

91.5

100.0

Missing System

8.5

Total 153

100

Figure 1. Frequency distribution of personal grief counseling competencies

Table 5

Part 1:

Personal Grief Counseling

Competencies Response Totals

N Valid 140

Missing 13

Mean 38.03

Median 38.50

Mode 40.00

Std. Deviation 4.34

Skewness -.95

Kurtosis 1.72

Range 24.00

Minimum 21.00

Maximum 45.00

An interquartile range was completed to examine the distribution of 50% of the

scores around median and found scores ranged from 3.9 to 4.6 out of possible 5. This

data shows there was a .7 range of scores on the personal grief counseling competencies

section of the GCCS while the majority of scores were between “this somewhat describes

me” and “this describes me.” Part 1 of the GCCS in reference to personal grief

counseling competencies mean, median, mode, and standard deviation can be found in

Table 6.

Table 6

Mean, Median, Mode, and Standard Deviation of Personal Grief Counseling

Competencies

Item

Mean Median

Mode

S.D. Valid

Missing

Part 1: Personal Grief Counseling

Competencies

1. I practice personal wellness

and self-care.

140

3.9071

4.00

.79473

2. I have experienced loss and

can verbalize my own grief

process.

140

3.8071

4.00

1.0655

3. I have self-awareness related

to my own grief issues and

history.

140

3.9643

4.00

.90092

4. I believe that grief is a result

of a variety of loss

experiences which include but

are not limited to death.

139

4.7050

5.00

.58301

5. I display empathy,

unconditional positive regard,

and genuineness when talking

with friends and

acquaintances.

140

4.5643

5.00

.60228

6. I view grief as a systemic as

well as an individual

experience.

140

4.3500

5.00

.86436

7. My spirituality is important to

my understanding of grief.

140

3.7000

4.00

5.00

1.3233

8. I believe that there is no one

right way to deal with grief.

140

4.5071

5.00

.90161

9. I have a sense of humor. 140

4.5571

5.00

.77061

100

There are 37 questions on Section 2 of the GCCS pertaining to skills and

knowledge of grief counseling competencies. The section has three areas of

concentration: conceptual skills and knowledge, assessment skills, and treatment skills.

conceptual skills and knowledge had nine questions. Assessment had nine questions, and

treatment skills had 19 questions. The scores for each question ranged from 1: “This

does not describe me,” to 5: “This describes me very well.” The higher total score, the

higher perceived skills and knowledge of grief counseling competency. The total score

can range from low of 37 to high of 185.

One hundred and seven participants reported in Section 2 of the GCCS (M =

118.23, SD = 29.352). The median score for this section was 122 with a mode score of

129, with a frequency of 4, and total scores ranging from a low 60 with a frequency of 1,

to high of 182 with frequency of 1 (see Table 7 and Figure 2). The distribution scores

were Kurtosis -.606 and Skewness .049, (see Table 8).

101

Table 7

Part II: Skills and Knowledge Grief Counseling Competency Response Totals

Frequency Percent Valid Percent

Cumulative

Percent

Valid 60.00 1

64.00 1

1.9

65.00 1

2.8

66.00 1

3.7

67.00 1

4.7

70.00 1

5.6

73.00 1

6.5

76.00 2

1.3

1.9

8.4

77.00 2

1.3

1.9

10.3

79.00 1

11.2

81.00 1

12.1

82.00 3

2.0

2.8

15.0

84.00 1

15.9

85.00 1

16.8

86.00 1

17.8

88.00 1

18.7

89.00 2

1.3

1.9

20.6

90.00 2

1.3

1.9

22.4

91.00 1

23.4

92.00 1

24.3

94.00 1

25.2

95.00 1

26.2

98.00 2

1.3

1.9

28.0

99.00 2

1.3

1.9

29.9

102.00 2

1.3

1.9

31.8

103.00 1

32.7

105.00 1

33.6

106.00 2

1.3

1.9

35.5

102

Part II: Skills and Knowledge Grief Counseling Competency Response Totals

Frequency Percent Valid Percent

Cumulative

Percent

109.00 1

36.4

111.00 2

1.3

1.9

38.3

112.00 2

1.3

1.9

40.2

113.00 1

41.1

114.00 3

2.0

2.8

43.9

116.00 1

44.9

117.00 3

2.0

2.8

47.7

119.00 1

48.6

120.00 1

49.5

122.00 3

2.0

2.8

52.3

123.00 1

53.3

124.00 1

54.2

125.00 2

1.3

1.9

56.1

126.00 1

57.0

127.00 3

2.0

2.8

59.8

128.00 1

60.7

129.00 4

2.6

3.7

64.5

130.00 1

65.4

131.00 2

1.3

1.9

67.3

132.00 1

68.2

133.00 2

1.3

1.9

70.1

134.00 2

1.3

1.9

72.0

135.00 1

72.9

138.00 2

1.3

1.9

74.8

139.00 2

1.3

1.9

76.6

140.00 2

1.3

1.9

78.5

141.00 2

1.3

1.9

80.4

142.00 1

81.3

144.00 2

1.3

1.9

83.2

146.00 1

84.1

103

Part II: Skills and Knowledge Grief Counseling Competency Response Totals

Frequency Percent Valid Percent

Cumulative

Percent

147.00 1

85.0

148.00 1

86.0

149.00 1

86.9

150.00 1

87.9

153.00 1

88.8

155.00 1

89.7

156.00 1

90.7

158.00 1

91.6

160.00 1

92.5

164.00 1

93.5

166.00 1

94.4

171.00 1

95.3

174.00 1

96.3

178.00 2

1.3

1.9

98.1

179.00 1

99.1

182.00 1

100.0

Total 107

69.9

100.0

Missing System 46

30.1

Total 153

100.0

104

Figure 2. Frequency distribution of skills and knowledge of grief counseling competency

105

Table 8

Part

II:

Skills and Knowledge Grief

Counseling Competency Response

Totals

N Valid 107

Missing 46

Mean 118.23

Median 122.00

Mode 129.00

Std. Deviation 29.35

Skewness .049

Kurtosis -.606

Range 122.00

Minimum 60.00

Maximum 182.00

Percentiles

25 94.0

50 122.0

75 139.0

An interquartile range was completed to examine the distribution of 50% of the

scores around median and found scores ranged from 2.5 to 3.8 out of possible 5. This

data shows there was a wide 1.3 range of scores on the skills and knowledge of grief

counseling competencies section of the GCCS while the majority of scores were between

“this barely describes me” and “this somewhat describes me.” Participants’ were

informed in the study information “if there is a question that you choose not to answer,

you may skip the question”. Part 2 of the GCCS in reference to skills and knowledge of

106

grief counseling competencies mean, median, mode, and standard deviation can be found

in Table 9.

107

Table 9

Part II: Skills and Knowledge Grief Counseling Competency

Mean Median

Mode

S.D. Valid

Missing

Conceptual Skills and Knowledge

5. I can define and articulate the

nature of "normal" grief and loss as

detailed by theoretical models.

123

2.7561

3.00

2.00

1.28255

9. I can describe general

differences in grief and loss as a

function of personality style.

123

2.7724

3.00

4.00

1.26629

12. I can articulate a grief

consultation model for parents,

teachers, and other adults about

how to talk to children about grief

and loss.

123

2.4065

2.00

1.00

1.27933

14. I can define and articulate the

nature and symptoms of

complicated/unresolved grief

situations.

121

2.7603

3.00

1.21809

25. I can describe common

dysfunctional coping styles of a

person who is grieving loss.

121

3.3967

3.00

1.10664

29. I maintain an updated library of

grief and loss resources for clients.

123

2.3496

2.00

1.00

1.43140

108

Part II: Skills and Knowledge Grief Counseling Competency

Mean Median

Mode

S.D. Valid

Missing

32. I can describe common

functional coping styles of the

person who is grieving.

122

3.2787

3.00

4.00

1.17313

34. I can describe how various

individual counseling theories can

be applied to grief counseling with

individuals and families.

122

2.8279

3.00

4.00

1.25766

36. I can describe how various

family counseling theories can be

applied to grief counseling with

individuals and/or families.

121

2.4628

2.00

1.00

1.29770

Assessment Skills

1. I can assess for unresolved loss

and grief that may not be stated as a

presenting problem.

123

3.1138

3.00

.97681

4. I can provide educational

workshops and activities to

community members about loss and

grief.

123

2.3008

2.00

1.00

1.13755

10. I can conduct suicide

assessments.

122

3.9918

4.00

5.00

1.01636

13. I can provide crisis intervention

services to schools and/or

community settings.

123

3.0325

3.00

2.00

1.29902

109

Part II: Skills and Knowledge Grief Counseling Competency

Mean Median

Mode

S.D. Valid

Missing

16. I can assess a client’s sense of

spirituality.

123

3.5528

4.00

1.01790

18. I can work on an

interdisciplinary team by

interacting with staff from different

professions.

123

4.2846

4.00

5.00

.87329

20. I can utilize family assessment

techniques to examine interaction

patterns and roles.

123

3.1951

3.00

1.19190

26. I can assess individuals'

progress on theoretically defined

grief tasks.

121

2.7686

3.00

2.00

1.25007

30. I can identify cultural

differences that affect assessment in

relation to loss and grief.

122

3.0820

3.00

1.18942

Treatment Skills

2. I can provide psycho-education

to clients related to the grief

experience for themselves and

others.

123

3.2358

3.00

4.00

1.08704

3. I can facilitate family grief

counseling sessions.

123

2.3333

2.00

1.17812

110

Part II: Skills and Knowledge Grief Counseling Competency

Mean Median

Mode

S.D. Valid

Missing

6. I can facilitate individual grief

counseling sessions.

123

3.1220

3.00

4.00

1.27128

7. I can provide developmentally

appropriate programs about grief

and loss issues in schools.

121

2.4298

2.00

1.30273

8. I can facilitate group grief

counseling sessions.

120

2.7667

3.00

1.25513

11. I can facilitate multi-family

group grief counseling sessions.

123

2.0325

2.00

1.00

1.13755

15. I can teach clients how to

obtain support and resources in the

community in relation to grief and

loss.

123

3.3821

3.00

1.21817

17. I can develop rapport with

clients of all ages.

122

4.3934

4.00

5.00

.66254

19. I can identify cultural

differences that affect treatment.

123

4.0081

4.00

.78402

21. I can provide appropriate crisis

debriefing sessions.

122

3.1475

3.00

1.23095

22. I can exhibit effective active

listening skills.

123

4.6667

5.00

.62288

111

Part II: Skills and Knowledge Grief Counseling Competency

Mean Median

Mode

S.D. Valid

Missing

23. I can read and apply current

research and literature related to

grief and effective treatment

interventions.

123

3.8455

4.00

1.00843

24. I can facilitate a reframe of loss

experience and grief reactions for

client empowerment.

123

3.4146

4.00

1.20059

27. I can use the creative arts in

counseling to facilitate grief

expression.

122

3.2131

3.00

4.00

1.28069

28. I can appropriately self-

disclose related to my own grief

and loss experiences.

122

3.6475

4.00

1.12023

31. I can recognize and work with

grief related resistance and denial.

122

3.0410

3.00

1.15277

33. I can participate in informal or

formal support groups for

professionals who work with issues

of grief and loss to prevent burnout

and vicarious traumatization.

122

3.0000

3.00

1.27273

35. I can recommend helpful

articles and books for grieving

individuals and families.

122

2.7705

3.00

2.00

1.36537

112

Part II: Skills and Knowledge Grief Counseling Competency

Mean Median

Mode

S.D. Valid

Missing

37. I can listen in a non-judgmental

way to stories clients tell about their

losses.

122

4.6393

5.00

.59008

a. Multiple modes exist. The smallest value is shown.

The second portion of the survey was furthered studied, by examining the three

sub-sections individually. The first sub-section examined was perceived conceptual skills

and knowledge, which had nine questions. The scores for each question ranged from 1:

“This does not describe me,” to 5: “This describes me very well.” The higher total score,

the higher perceived conceptual skills and knowledge of grief counseling competency.

The total score can range from low of 9 to high of 45.

One hundred and sixteen participants reported in conceptual skills and knowledge

section of the GCCS (M = 25.20, SD = 9.20). The median score for this section was 25

with a mode score of 18, with a frequency of 9, and total scores ranging from a low 9

with a frequency of 2, to high of 45 with frequency of 2 (see Table 10 and Figure 3). The

distribution scores were Kurtosis -.87 and Skewness .23, (see Table 11).

113

Table 10

Conceptual Skills and Knowledge Response Totals

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 9.00 2

1.3

1.7

10.00 2

1.3

1.7

3.4

11.00 1

4.3

12.00 4

2.6

3.4

7.8

13.00 2

1.3

1.7

9.5

14.00 4

2.6

3.4

12.9

15.00 6

3.9

5.2

18.1

17.00 3

2.0

2.6

20.7

18.00 9

5.9

7.8

28.4

19.00 7

4.6

6.0

34.5

20.00 4

2.6

3.4

37.9

21.00 3

2.0

2.6

40.5

22.00 3

2.0

2.6

43.1

23.00 3

2.0

2.6

45.7

24.00 3

2.0

2.6

48.3

25.00 5

3.3

4.3

52.6

26.00 5

3.3

4.3

56.9

27.00 3

2.0

2.6

59.5

28.00 7

4.6

6.0

65.5

30.00 4

2.6

3.4

69.0

31.00 3

2.0

2.6

71.6

32.00 2

1.3

1.7

73.3

33.00 4

2.6

3.4

76.7

34.00 5

3.3

4.3

81.0

35.00 2

1.3

1.7

82.8

36.00 6

3.9

5.2

87.9

37.00 2

1.3

1.7

89.7

38.00 4

2.6

3.4

93.1

114

Conceptual Skills and Knowledge Response Totals

Frequency Percent

Valid

Percent

Cumulative

Percent

39.00 1

94.0

41.00 2

1.3

1.7

95.7

42.00 1

96.6

44.00 2

1.3

1.7

98.3

45.00 2

1.3

1.7

100.0

Total 116

75.8

100.0

Missing System 37

24.2

Total 153

100.0

115

Figure 3. Frequency distribution of conceptual skills and knowledge

116

Table 11

Part II: Conceptual Skills and

Knowledge

Response Totals

Statistics

N Valid 116

Missing 37

Mean 25.20

Median 25.00

Mode 18.00

Std. Deviation 9.20

Skewness .23

Kurtosis -.87

Range 36.00

Minimum 9.00

Maximum 45.00

Percentiles

25 18.00

50 25.00

75 33.00

An interquartile range was completed to examine the distribution of 50% of the

scores around median and found scores ranged from 2 to 3.6 out of possible 5. This data

shows there was a wide 1.6 range of scores on the conceptual skills and knowledge sub-

section of the GCCS while the majority of scores were between “this barely describes

me” and “this somewhat describes me.” The conceptual skills and knowledge sub-section

of the GCCS mean, median, mode, and standard deviation can be found in Table 9.

The second sub-section examined was perceived assessment skills, which had

nine questions. The scores for each question ranged from 1: “This does not describe me,”

to 5: “This describes me very well.” The higher total score, the higher perceived

117

assessment skills on the GCCS survey. The total score can range from low of 9 to high of

45.

One hundred and nineteen participants reported in assessment skills section of the

GCCS (M = 29.29, SD = 6.70). The median score for this section was 29 with a mode

score of 34, with a frequency of 10, and total scores ranging from a low 14 with a

frequency of 2, to high of 45 with frequency of 1 (see Table 12 and Figure 4). The

distribution scores were Kurtosis -.426 and Skewness .068, (see Table 13).

118

Table 12

Part II: Assessment Skills Response Totals

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 14.00 2

1.3

1.7

17.00 1

2.5

18.00 2

1.3

1.7

4.2

19.00 4

2.6

3.4

7.6

20.00 2

1.3

1.7

9.2

21.00 6

3.9

5.0

14.3

22.00 4

2.6

3.4

17.6

23.00 5

3.3

4.2

21.8

24.00 4

2.6

3.4

25.2

25.00 7

4.6

5.9

31.1

26.00 3

2.0

2.5

33.6

27.00 6

3.9

5.0

38.7

28.00 8

5.2

6.7

45.4

29.00 9

5.9

7.6

52.9

30.00 5

3.3

4.2

57.1

31.00 4

2.6

3.4

60.5

32.00 7

4.6

5.9

66.4

33.00 7

4.6

5.9

72.3

34.00 10

6.5

8.4

80.7

35.00 1

81.5

36.00 7

4.6

5.9

87.4

37.00 2

1.3

1.7

89.1

38.00 2

1.3

1.7

90.8

39.00 2

1.3

1.7

92.4

40.00 2

1.3

1.7

94.1

41.00 1

95.0

42.00 2

1.3

1.7

96.6

43.00 3

2.0

2.5

99.2

119

Part II: Assessment Skills Response Totals

Frequency Percent

Valid

Percent

Cumulative

Percent

45.00 1

100.0

Total 119

77.8

100.0

Missing System 34

22.2

Total 153

100.0

Figure 4. Frequency distribution of assessment skills

120

Table 13

Part II: Assessment Skills Response Totals

Statistics

N Valid 119

Missing 34

Mean 29.29

Median 29.00

Mode 34.00

Std. Deviation 6.70

Skewness .068

Kurtosis -.426

Range 31.00

Minimum 14.00

Maximum 45.00

Percentiles 25 24.00

50 29.00

75 34.00

An interquartile range was completed to examine the distribution of 50% of the

scores around median and found scores ranged from 2.6 to 3.7 out of possible 5. This

data shows there was a wide 1.3 range of scores on the assessment skills sub-section of

the GCCS while the majority of scores were between “this barely describes me” and “this

somewhat describes me.” The assessment skills sub-section of the GCCS mean, median,

mode, and standard deviation can be found in Table 9.

The last sub-section examined was treatment skills, which had 19 questions. The

scores for each question ranged from 1: “This does not describe me,” to 5: “This

121

describes me very well.” The higher total score, the higher perceived treatment skills on

the GCCS survey. The total score can range from low of 19 to high of 95.

One hundred and thirteen participants reported in treatment skills section of the

GCCS (M = 63.49, SD = 14.35). The median score for this section was 65 with a mode

score of 71, with a frequency of 6, and total scores ranging from a low 33 with a

frequency of 1, to high of 95 with frequency of 1 (see Table 14 and Figure 5). The

distribution scores were Kurtosis -.426 and Skewness .068, (see Table 15).

122

Table 14

Part II: Treatment Skills Response Totals

Frequency

Percent Valid Percent

Cumulative

Percent

Valid 33.00 1

34.00 1

1.8

39.00 2

1.3

1.8

3.5

40.00 2

1.3

1.8

5.3

41.00 1

6.2

42.00 1

7.1

43.00 5

3.3

4.4

11.5

44.00 2

1.3

1.8

13.3

45.00 1

14.2

47.00 4

2.6

3.5

17.7

48.00 2

1.3

1.8

19.5

49.00 2

1.3

1.8

21.2

50.00 1

22.1

51.00 4

2.6

3.5

25.7

52.00 1

26.5

53.00 1

27.4

54.00 2

1.3

1.8

29.2

55.00 3

2.0

2.7

31.9

56.00 1

32.7

57.00 1

33.6

58.00 1

34.5

59.00 3

2.0

2.7

37.2

60.00 2

1.3

1.8

38.9

61.00 3

2.0

2.7

41.6

62.00 2

1.3

1.8

43.4

63.00 3

2.0

2.7

46.0

64.00 4

2.6

3.5

49.6

65.00 3

2.0

2.7

52.2

123

Part II: Treatment Skills Response Totals

Frequency

Percent Valid Percent

Cumulative

Percent

66.00 1

53.1

67.00 5

3.3

4.4

57.5

68.00 2

1.3

1.8

59.3

69.00 3

2.0

2.7

61.9

70.00 1

62.8

71.00 6

3.9

5.3

68.1

72.00 5

3.3

4.4

72.6

73.00 6

3.9

5.3

77.9

74.00 4

2.6

3.5

81.4

76.00 3

2.0

2.7

84.1

77.00 3

2.0

2.7

86.7

79.00 1

87.6

80.00 1

88.5

81.00 1

89.4

83.00 2

1.3

1.8

91.2

84.00 1

92.0

85.00 1

92.9

88.00 3

2.0

2.7

95.6

89.00 1

96.5

90.00 1

97.3

91.00 1

98.2

92.00 1

99.1

95.00 1

100.0

Total 113

73.9

100.0

Missing System 40

26.1

Total 153

100.0

124

Figure 5. Frequency distribution of treatment skills

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Table 15

Part II: Treatment Skills

Response Totals Statistics

N Valid 113

Missing 40

Mean 63.49

Median 65.00

Mode 71.00

Std. Deviation 14.35

Skewness -.037

Kurtosis -.674

Range 62.00

Minimum 33.00

Maximum 95.00

Percentiles 25 51.00

50 65.00

75 73.00

a. Multiple modes exist. The smallest value is shown

An interquartile range was completed to examine the distribution of 50% of the

scores around median and found scores ranged from 2.6 to 3.8 out of possible 5. This

data shows there was a wide 1.2 range of scores on the treatment skills sub-section of

the GCCS while the majority of scores were between “this barely describes me” and “this

somewhat describes me.” The treatment skills sub-section of the GCCS mean, median,

mode, and standard deviation can be found in Table 9.

Findings for Research Question 1

How do the demographic variables (e.g., gender, age bracket, race, and ethnicity)

relate to perceived grief counseling competency?

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1: There is no significant (α = .05) interaction effect among the demographic

variables and perceived grief counseling competency.

1: There is a significant interaction effect among the demographic variables

and perceived grief counseling competency.

This question was investigated using a 4-way MANOVA with demographic

variables (gender, age bracket, race, and ethnicity) as independent variables and the four

grief competency sub scales on the GCCS are the dependent variables.

The first demographic variable gender was examined. Here, 93 females and 12

males were examined for differences on perceived grief counseling competency on the

GCCS survey. No significance for females and males as a function or perceived grief

counseling competency was found (see Table 16).

Table 16

Relationship between Gender and Grief Counseling Competency

Dependent Variable F p η

Personal Competency .148

.702

.002

Assessment Skills .531

.468

.007

Treatment Skills .133

.716

.002

Conceptual Skills and Knowledge .280

.598

.003

Next, demographic variable age was compared to the perceived grief counseling

competencies on the GCCS survey for the 105 respondents. A main effect was found for

the presence of age and perceived personal competency related to grief F (16, 236) =

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2.736, p = .034, indicating that we can reject the hypothesis that there is no significant

interaction effect among the demographics variable age and perceived grief counseling

competency in personal competency. The multivariate η

= .12 indicates 12% of

multivariate variance of the dependent variable personal competency is associated with

age (see Table 17).

Table 17

Relationship between Age and Grief Counseling Competency

Dependent Variable F p η

Personal Competency 2.736

.034

.120

Assessment Skills .603

.661

.029

Treatment Skills .682

.607

.033

Conceptual Skills and Knowledge .713

.585

.034

One hundred and five participant’s demographic variable race was compared to

the perceived grief counseling competency on the GCCS survey. There was no

significance found for race and perceived grief counseling competency (see Table 18).

Table 18

Relationship between Race and Grief Counseling Competency

Dependent Variable F p η

Personal Competency 1.867

.097

.123

Assessment Skills .319

.925

.023

Treatment Skills .666

.678

.048

Conceptual Skills and Knowledge .414

.867

.030

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One hundred and five participant’s demographic variable ethnicity was compared

to the perceived grief counseling competency on the GCCS survey. There was no

significance found for ethnicity and perceived grief counseling competency (see Table

19).

Table 19

Relationship between Ethnicity and Grief Counseling Competency

Dependent Variable F p η

Personal Competency 1.136

.340

.041

Assessment Skills .769

.515

.028

Treatment Skills .042

.988

.002

Conceptual Skills and Knowledge .260

.854

.010

In summary, there was no effect found for demographic variables gender, race,

and ethnicity and perceived grief counseling competency, however, there was

significance found for demographic variable age and perceived grief counseling

competency in regards to personal competency on the GCCS survey. Overall, the

hypothesis was partially supported.

Findings for Research Question 2

Controlling for course offerings (whether the participant’s course curriculum

offered coursework in grief counseling theories and practice), what is the relationship

between coursework and grief counseling competency?

2: There is no significant (α = .05) positive relationship between coursework

taken and the four grief counseling competency scales, controlling for course offerings.

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2: There is a significant positive relationship between coursework taken and the

four grief counseling competency scales, controlling for course offerings.

This question was investigated using a MANCOVA where the independent

variable is coursework; the four grief competency sub scales on the GCCS are the

dependent variables, and the covariate is course offering. This analysis examined the

relationship between course work taken and the four grief competency sub scales on the

GCCS survey.

Controlling for course offerings, a main effect was found having taken course

work in either grief theories or grief interventions, and competency in the grief

counseling competency scales dependent variable assessment Skills, treatment Skills, and

conceptual skills and knowledge (see Table 20). A main effect was found for the

presence of coursework taken and perceived assessment skills related to grief counseling

competency F (12, 254) = 3.134, p = .029, indicating that we can reject the hypothesis

that there is no significant positive relationship between coursework taken and perceived

grief counseling competency in assessment skills, controlling for course offerings. The

multivariate η

= .087 indicates 8.7 % of multivariate variance of the dependent variable

assessment skills is associated with coursework taken and grief counseling competency

(see Table 20). A main effect was found for the presence of coursework taken and

perceived treatment skills related to grief counseling competency F (12, 254) = 3.252, p

= .025, indicating that we can reject the hypothesis that there is no significant positive

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relationship between coursework taken and perceived grief counseling competency in

treatment skills, controlling for course offerings. The multivariate η

= .090 indicates

9.0% of multivariate variance of the dependent variable treatment skills is associated with

coursework taken and grief counseling competency (see Table 20). A main effect was

found for the presence of coursework taken and perceived conceptual skills and

knowledge related to grief counseling competency F (12, 254) = 4.986, p = .003,

indicating that we can reject the hypothesis that there is no significant positive

relationship between coursework taken and perceived grief counseling competency in

conceptual skills and knowledge, controlling for course offerings. The multivariate η

.131 indicates 13.1% of multivariate variance of the dependent variable conceptual skills

and knowledge is associated with coursework taken and grief counseling competency

(see Table 20).

Table 20

Relationship between Course Work Taken and Grief Counseling Competency

Dependent Variable F p η

Personal Competency 1.527 .212 .044

Assessment Skills 3.134 .029 .087

Treatment Skills 3.252 .025 .090

Conceptual Skills and Knowledge 4.986 .003 .131

In summary, there was no effect found for coursework taken and perceived grief

counseling competency in relationship to personal competency. However, there was

significance found for a relationship between coursework taken and grief counseling

competency in the dependent variables assessment skills, treatment skills, and conceptual

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skills and knowledge on the GCCS survey. Overall, the hypothesis was partially

supported.

Findings for Research Question 3

What is the relationship between practicum or internship setting and perceived

grief counseling competency?

3: There is no significant (α = .05) relationship for clinical setting and

perceived grief counseling competency.

3: There is a significant relationship for clinical setting and perceived grief

counseling competency.

This question was investigated using a MANOVA whereas the independent

variable is practicum or internship setting and the four grief competency sub scales on the

GCCS are the dependent variables. This examined the relationship between practicum or

internship setting and perceived grief counseling competencies on the GCCS survey.

Of the 107 participants who responded to this section of the GCCS survey, no

significant relationship was found between practicum or internship setting and the

following: perceived personal competency, F (24, 340) = .982, p = .441, η

= .056,

perceived assessment skills, F (24, 340) = 1.464, p = .198, η

= .081, perceived treatment

skills, F (24, 340) = .751, p = .610, η

= .043, or perceived conceptual skills and

knowledge, F (24, 340) = .633, p = .704, η

= .037 (see Table 21). Hypothesis was

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supported; there is no significant relationship for clinical setting and perceived grief

counseling competency.

Table 21

Relationship between Practicum/Internship Setting and Grief Counseling Competency

Dependent Variable F p η

Personal Competency

.982

.441 .056

Assessment Skills

1.464

.198 .081

Treatment Skills

.751

.610 .043

Conceptual Skills and Knowledge

.633

.704 .037

Summary

In summary, Research Question 1: How do the demographic variables (e.g.,

gender, age bracket, race, and ethnicity) relate to perceived grief counseling competency?

There was no effect found for demographic variables gender, race, and ethnicity and

perceived grief counseling competency, however, there was significance found for

demographic variable age and perceived grief counseling competency in regards to

personal competency on the GCCS survey. Overall, the hypothesis for research question

1 was partially supported (see Tables 16-19). Research Question 2: Controlling for course

offerings (whether the participant’s course curriculum offered coursework in grief

counseling theories and practice), what is the relationship between coursework and grief

counseling competency? There was no effect found for coursework taken and perceived

grief counseling competency in relationship to personal competency. However, there was

significance found for a relationship between coursework taken and grief counseling

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competency in the dependent variables assessment skills, treatment skills, and conceptual

skills and knowledge on the GCCS survey. Overall, the hypothesis was partially

supported (see Table 20). Research Question 3: What is the relationship between

practicum or internship setting and perceived grief counseling competency? Hypothesis

was supported; there is no significant relationship for clinical setting and perceived grief

counseling competency (see Table 21).

In Chapter 5, an interpretation of the findings, limitations of the study, and

recommendations for future research to be conducted will be addressed. Furthermore,

implications of positive social change will be presented. Lastly, recommendations for

professional practice will be discussed.

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Chapter 5: Discussion, Conclusions, and Recommendations

The purpose of this quantitative study was to examine whether CACREP-

accredited master’s-level counseling students in training perceive they have been

adequately trained in identifying clients’ presenting grief issues and in providing grief

counseling to clients in need. These participants were chosen instead of LPCs because I

wanted to examine how master’s-level counseling students assess themselves in regards

to the education or training they received about grief theories or counseling skills related

to issues of grief interventions in their CACREP-accredited formal coursework in

contrast to knowledge possibly obtained post master’s degree in the field.

Perceptions of CACREP-accredited master’s-level counseling students were

examined by using an adapted version of the GCCS (Cicchetti, 2010). Cicchetti noted he

used a modified version of the DCS (Charkow, 2002). According to Cicchetti,

Charkow’s DCS consist of two parts. The first part of Charkow’s DCS inquired about

personal competencies using nine questions. The second part of Charkow’s DCS inquired

about skills and knowledge competencies using 36 questions (Cicchetti, 2010). The two

parts of Charkow’s DCS had four subheadings, as follows: (a) personal competencies, (b)

conceptual skills and knowledge, (c) assessment skills, and (d) treatment skills.

Charkow’s revised version of the DCS, which was renamed GCCS by Cicchetti (2010) is

a 46-item questionnaire survey using a Likert scale to assess the participant’s personal

competencies, conceptual skills and knowledge, assessment skills, and treatment skills in

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regards to grief intervention and counseling working with clients with presenting issues

related to loss or grief.

Internal consistency reliability for the GCCS was established by calculating a

Cronbach’s alpha for each section and the sub-scales. An alpha level calculated for the

GCCS was calculated for the two sections of the survey which included Part I: Personal

Competency and Part II: Skills and Knowledge Section. The alpha level for the Personal

Competency section was found to be .69 while the alpha level for the Skills and

Knowledge section the alpha was .97. The alphas for the three subscales of the Part II:

Skills and Knowledge scale were the following: for the Conceptual Skills and Knowledge

scale the alpha was .94, for the Assessment Skills scale the alpha was .85, and for the

Treatment Skills scale the alpha was .93. The alphas for the three subscales of the GCCS

suggested relatively high internal consistency. In addition, the alpha for the overall

section Skills and Knowledge was .97. It was deemed acceptable.

Convenience sampling was used for this study to take advantage of the diverse

populations enrolled in CACREP-accredited institutions listed on the CACREP web site.

The participants for this study were recruited from CACREP-accredited master’s-level

counseling programs throughout the United States. After obtaining the CACREP-

accredited master’s-level counseling programs from the CACREP website, I verified they

were current on CACREP accreditations via the website; I contacted the department chair

via email to explain the study and requested that the information of the study and link be

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sent to all practicum and internship students to participate in the study. The request had

instructions on where to access the study through SurveyMonkey, which is a secure

online survey builder used to collect data.

Using SurveyMonkey, I created the survey and a survey link was emailed to me. I

copied the survey link into the email I sent out to CACREP-accredited master’s-level

counseling program department chairs in the email inviting the students from their

institution to participate. The invite email was forwarded to CACREP master’s-level

counseling students enrolled in practicum or internships informing them about the study

and inviting anonymously them to participate.

When the participants clicked on the SurveyMonkey link, the entry page has

information about the study including overview and background, procedures, voluntary

commitment to participate in the study, benefits and risks of participating in the study,

information on zero compensation, confidentiality, contact information, and statement on

consent (see Appendix F). After the participants have reviewed the implied consent on

the entry page, participants were directed to enter the survey, verified consent, and

completed the DDS (see Appendix C), and the GCCS survey (see Appendix D). There

was no time limit placed on the participants in completing the survey once they started

the survey.

Following the participant’s completion of the DDS and the GCCS survey, the

participant received a debriefing statement form (see Appendix G). The debriefing

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statement was used to express gratitude for the participant’s participation, shared

information about how to contact the researcher if needed, reiterated the voluntary

participation in the study, reviewed informed consent information, discussed future

requirements for the study, provided counseling services resources, and shared the study

overview.

Interpretation of the Findings

Of the 153 master’s-level CACREP counselor trainees who were in either their

practicum or internship participated in this study, 136 (89.47%) were female, 16

(10.53%) were male, and one participant chose not to respond. On the demographic

questions regarding ethnicity, 142 (92.81%) identified themselves as No, not Hispanic,

Latino, or Spanish origin, 4 (2.61%) identified themselves as Yes, Mexican, Mexican

American, Chicano, 3 (1.96%) identified themselves as Yes, Puerto Rican, and 4 (2.61%)

identified as Yes, another Hispanic, Latino, or Spanish origin, however, 0 identified as

Cuban. On the demographic questions regarding race, 126 (82.89%) identified

themselves as White, 18 (11.84%) participants identified themselves as Black, African

American, or Negro, 3 (1.97%) identified themselves as American Indian or Alaska

Native, 1 (0.66%) identified them self as Filipino, 2 (1.32%) identified themselves as

Other Asian, 1 (0.66%) identified them self as Guamanian or Charnorro, 1 (0.66%)

identified them self as Other Pacific Islander, and one chose not to respond. All 153

participants responded to the age bracket question, 47 (30.72%) responded in the age

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bracket of 18-24 years old, 69 (45.10%) responded in the age bracket of 25-34 years old,

13 (8.50%) responded in the age bracket of 35-44 years old, 19 (12.42%) responded in

the age bracket of 45-54, and 5 (3.27%) responded in the age bracket of 55 plus years old.

Reporting on their practicum or internship setting, respondents indicated 72 (47.68%)

were at Community Mental Health settings, 51 (33.77%) were at School settings, 2

(1.32%) indicated at Hospital settings, 1(0.66%) at Rehabilitation setting, 4 (2.65%)

indicated at State Agency, 2 (1.32%) at Residential settings, 19 (12.58%) indicated Other

not Specified settings, and 2 (1.32%) of the participants did not respond.