Death Anxiety: An Exploration of Professional Counselor Experiences

Abstract

This quantitative research study guided by Terror Management Theory (TMT) provides a theoretical framework to understand death anxiety among practicing counselors while providing support for implementing death education into counseling graduate programs. The total sample comprised 97 total practicing counselors and current counseling students who were recruited from online platforms consisting of professional memberships, listservs, private practice, and Facebook groups. This study explored the level of death anxiety in counselors (measured by the Death Anxiety Scale-Extended (DAS-E; Templer et al., 2006) and examined the relationships between religious and/or spiritual affiliation, death education exposure, and years of practice (measured by a demographic questionnaire) through an online survey that measured counselor’s religious and/or spiritual affiliation, death education exposure, years of practice in the field, and their self-reported levels of death anxiety. A Pearson correlation indicated that religious and/or spiritual affiliation and death education were significantly positively associated with years of practice in the counseling field. A regression analysis revealed that death education significantly predicted death anxiety levels. The results of the study indicated that the more death education an individual had received the less likely they were to experience death anxiety. The findings of this study affirm the need for support of a death education curriculum and to encourage CACREP counseling graduate programs to promote knowledge and awareness around death in order to better prepare counseling master’s students to serve clients.

Keywords

death anxiety counseling death education

The field of thanatology involves the examination of an individual’s physical, emotional (Templer et al., 2006), and behavioral aspects associated with death (Fonseca & Testoni, 2012). Death anxiety is a common feeling associated with the anticipation of or the realization of death and dying as a part of human existence (Castano et al., 2011).

There are approximately 2.5 million people that die every year in the United States and each person leaves an average of up to five grieving people behind (Krull, 2021). Additionally, death by suicide is a discernable concern as it is the second leading cause of death in the United States for individuals 10–14 years old and the third leading cause of death for those 15–24 years of age (NAMI, 2024). The topic of death has been in the forefront of the news providing increased awareness, and lived experiences given the COVID-19 pandemic. The generalized anxiety associated with the pandemic brought levels of death anxiety to the foreground. In fact, the level of anxiety, fear, and panic could be viscerally and vicariously experienced simply from reading news articles, social media, or watching the news.

Counselors working professionally in the field regularly discuss topics surrounding grief or loss with clients (APA, 2021). Oftentimes, clients seek counseling due to the recent loss of a loved one, unresolved grief, life changes, and difficulty adjusting, which are all factors that have similar manifestations of coping with death (Cicchetti et al., 2016).

McAdams and Foster (2000) reported that both counseling students in training and professional counselors experienced high levels of stress and negative emotionality related to counseling suicidal clients and the thought of clients dying. Thus, it is vitally important for individuals within the helping professions to be prepared to work with clients experiencing suicidal ideation and can cope with the loss of clients who die by suicide or other circumstances (Bassett, 2007).

Many counselors in training, and even those who are seasoned counselors, report having never received proper training related to counseling clients struggling with death and dying (Horn & Hoskins, 2011; Hannon & Hunt, 2015; Parkes et al., 1996; Wass, 2004). Ober et al. (2012) examined counselor readiness for working with clients experiencing grief. The results of the study indicated that 54% of the licensed counselors had not received any preparation of skills, techniques, or coursework related to working with grieving clients. The insufficient training on death and dying is especially true for students in counselor education programs. The Council for the Accreditation of Counseling and Related Educational Programs (CACREP) provides standards for the preparation of counselors including areas of mental health counseling and addresses various important curricular areas and courses (e.g., counseling skills, theories, and diversity) that are viewed as necessary in novice counselor development. However, death education is not a required course, topic, or a standard, yet, CACREP standards state that “counselor education programs are responsible for coursework that addresses human growth and development” (Hannon & Hunt, 2015, p. 3).

Death is part of the normative developmental process, however, Suomala Folkerds (2019) pointed out that since death may often impact counselors and their clients, there is a significant need for death education in the curriculum. The more integrated the concept of death is within training programs, the more likely that this will foster growth and increased comfort in novice counselors’ own death anxiety. Which in turn, may improve their work with clients in the field (Harrawood et al., 2011).

When novice counselors begin to understand their own attitudes towards death, this could decrease the negative feelings and emotions that arise when confronted with clients who are grieving or experiencing loss, and lead to increased positive client outcome (Veilleux, 2011). Additionally, in their meta-analytic study of death anxiety, Neimeyer et al. (2004) reported differences in death anxiety among a range of disciplines and a number of contextual factors such as age, gender, medical and mental health concerns, religion, and ego among adult and older adult populations; such characteristics that can lead to increased death anxiety symptoms among professionals. Thus, it is important to understand practicing counselors’ attitudes towards death anxiety and its implications for wellness and professional practice.

The research affirms that death anxiety experiences are evident in a range of populations including graduate students, undergraduate students, medical professionals, and older adult populations. However, there appears to be a gap in the research focusing on counseling graduate students and those in the counseling profession (Belviso & Gaubatz, 2013; Chow, 2017; Fortner & Neimeyer, 1999; Neimeyer et al., 2004; Nienaber & Goedereis, 2015).

A Theoretical Framework

TMT was used as the theoretical framework guiding this study. TMT (Bassett, 2007; Juhl & Routledge, 2016; Neimeyer et al., 2004; Pyszczynski, 2004) was developed to provide an understanding of death anxiety. It was largely influenced from the ideas of Becker (1973), suggesting that an individual’s cultural views and individual perceptions will impact the extent to which death anxiety is experienced (Bassett, 2007; Lieberman, 2004; Pyszczynski, 2004). TMT posits that all humans are innately aware of death and because of one’s desire to live, this awareness creates vast amounts of anxiety (Bassett, 2007; Juhl & Routledge, 2016; Pyszczynski, 2004). Juhl and Routledge (2016) also indicated that TMT described how being aware of death increases anxiety and compromises well-being and contentment. To reduce the anxious tendencies in relation to death and dying, TMT suggested that humans use their own cultural worldviews to help maintain self-esteem as a means to address death anxiety (Jessop et al., 2008).

In the context of culture, TMT is viewed as a protectant factor for the counselor’s comfort with death. When individuals begin to experience feelings of death anxiety, they may often rely on their own cultural understandings and worldviews to answer questions about life’s purpose or mortality (Ivers & Myers, 2011; Kashima, 2010). Morality Salience (MS) is a concept that is inherent in TMT. MS is defined as individuals knowing death is certain and that connectedness to one’s own culture can create a reduction in death anxiety (Kashima, 2010).

The literature indicates that anxiety continues to be associated with the anticipation of death and dying which is part of human existence and because of higher-order thinking abilities, the human species is the only creature aware that death will occur at some point in time (Castano et al., 2011; Di Silvestro, 2012; Suomala Folkerds, 2019). Due to the inevitability of death we as humans understand that we exist today and may not exist tomorrow which may create terror and anxiety (Yalom, 1980).

Purpose of the Study

Death education has largely been researched among social workers, human services, nursing, psychology, and in one study among a high school students. However, only one study investigated death education related to counseling students (Harrawood et al., 2011); which pointed to a gap in the investigation of death anxiety in the counseling profession. Each of these studies have demonstrated that death education can lead to a decrease in one’s own death anxiety (Breen et al., 2013; Buckle, 2013; Harrawood et al., 2011; Wallace et al., 2019). Furthermore, these investigations concluded that death education allows for individuals to cope with death, understand it, process it, and notably become more prepared to work with those who are experiencing grief (Haas-Thompson et al., 2008; Veilleux, 2011; Xu et al., 2019).

Suomala Folkerds (2019) conducted a 30-year content analysis of over 5500 American Counseling Association (ACA) journal articles and reported only a total of 59 articles published on the topic of death. The findings suggested that the counseling field appears to be avoidant of the topic of death as very few journals were reported to cover or publish on the topic of death. Furthermore, of the 59 articles published on death, the primary focus was directed at how clients, students, or other helping professionals experience death and loss rather than focusing on counselors’ death anxiety. This suggests that there are certain elements of death including death anxiety that warrant additional investigation.

Death education within the counseling profession is vital for counselors to provide best practices for clients. Veilleux (2011) discussed a personal case study about the death of a client. The study affirmed the importance of gaining education and training on how to handle situations when clients may die by suicide or die unexpectedly. Veillieux (2011) indicated novice counselors will likely have more negative reactions to client death than more seasoned counselors due to the inexperience of working with clients around death and dying. Veilleux (2011) suggested counselors in training would benefit from engaging in role-play exercises and discussions about death and loss to prepare counselors to work with clients experiencing grief, loss, and bereavement.

This study provides understanding about counselor’s attitudes toward death and dying, that is, death anxiety which has the potential to impact the design and delivery of death education for counselors. With the limited literature on the counseling profession and death anxiety, this study will add to the limited research addressing death anxiety among counselors.

Statistical Methods

This study examined three independent variables (i.e., religious and/or spiritual affiliation, death education exposure, and years of experience) to predict death anxiety among counselors in the field. A Pearson’s biserial correlation was used to determine both the direction and strength of a linear relationship among the three variables. A standard multiple linear regression analyses was used to predict the outcome of the dependent variable (Death Anxiety) based on the contributions of the multiple independent variables. The data was exported from Qualtrics (2021), cleaned through Microsoft Excel, and then analyzed in the IBM Statistical Package for the Social Sciences (SPSS) version 27 (SPSS; IBM Corp., 2020).

In this study, current practicing counselors completed three forms including the informed consent document, a demographic questionnaire and the Death Anxiety Scale-Extended (DAS-E; Templer et al., 2006) indicating various truths about their feelings of death anxiety. Prior to responding to the forms via the Qualtrics survey, the participants were required to read a statement about the study that included the protocol and purpose of the study. This informed consent process discussed the risks and benefits of participating in the study. The benefits of participating in the study include advancing the field of Counselor Education and Supervision based on the counselor’s experience with death anxiety in the field. Potential participants were informed that there are no negative consequences for choosing not to participate. Furthermore, no identifiable data were collected; ensuring that participants anonymity is safeguarded. This quantitative study was guided by the following two research questions: (1) Is there a relationship between religious and/or spiritual affiliation, death education exposure, and years of practice among counselors? and (2) Does religious and/or spiritual affiliation, death education exposure, and years of practice predict levels of death anxiety in counseling professionals as measured by the Death Anxiety Scale-Extended (DAS-E)?

Participants

A power analysis was conducted to determine the minimum sample size for this study. Specifically, a G* Power a-priori analysis for a multiple regression analysis was first conducted using the Faul et al. (2007) online calculator to determine the sample size. Further, a G*Power a-priori power analysis using F test for multiple regression with a fixed model, R², deviation from zero was conducted to determine the N or the sample size or the study. The G*Power a-priori power analysis included the effect size set at .15, power set at .8, and number of predictor variables 3. The G*Power analysis indicated a minimum sample size of 77 participants.

Participants were recruited through professional counseling membership discussion groups, listservs, Facebook groups, and private practice connections in Minnesota. The inclusion criteria for this study required that participants were at least 18 years of age, currently pursuing a master’s degree in the counseling field or, have graduated from a CACREP or a Non-CACREP counseling program or, were currently practicing as an unlicensed counselor in the field or have an active license within the Continental United States.

The participants completed the surveys through the use of an online Qualtrics survey link and 104 surveys were received. Seven of these surveys were not fully completed and the decision was made to remove the incomplete surveys from the sample. This left a total of 97 participants, which exceeded the minimum required sample size of 77 participants based upon an a priori power analysis. Additionally, three of the respondents did not indicate their age and since this was not part of RQ1 or RQ2, the responses were still recorded and analyzed.

Measures

Death Anxiety Scale-Extended Inventory

Death anxiety among counselors was assessed using the DAS-E, which was updated from the original Death Anxiety Scale (DAS; Templer, 1970) to the Revised Death Anxiety Scale (RDAS; Thorson & Powell, 1992) to include additional scales measuring attitudes towards death (Abdel-Khalek & Neimeyer, 2017). The DAS-E includes 51 items, that provide in-depth information surrounding death attitudes among counselors and is the most updated instrument of the Templer (2006) death anxiety measures. The scores on the DAS-E range from 0 to 51, with each question answered true scored as one point and false scored as zero points with the exception of questions 2, 3, 5, 6, 7, and 15 are reversed scored with one point when answered false (Meija et al., 2018).

Research data supporting the reliability and validity was conducted by Templer et al. (2006). First, the internal consistency was examined that consisted of the homogeneity among the DAS-E test items (Salkind & Frey, 2020). Using the Kuder Richardson Formula 20, the coefficient was .73 which determined that the test items are measuring the same thing (Templer et al., 2006). In regard to the validity of the DAS-E, a factor analysis was conducted to test the correlation between variables on the DAS-E (Salkind & Frey, 2020). The correlation between the DAS and DAS-E was .81. Although .81 suggests high concurrent validity, it should be stated that this may be due to several item overlaps between the measures (Templer et al., 2006). Additionally, Sharif Nia et al. (2014) examined the reliability and validity of the Persian version of the DAS-E among 200 male veterans of the Iran and Iraq war. Using Cronbach’s alpha, the results of the study reported high internal consistency of .89, indicating the DAS-E is a reliable measure (Sharif Nia et al., 2014). With regard to the DAS-E discriminant validity, Sharif et al. (2020) found average discriminant validity (.09) for measuring the construct of death anxiety.

The DAS-E is an available online instrument; therefore, no permission was needed prior to implementing it for this study. The DAS-E was used in this study given its high reliability and validity (Sharif Nia et al., 2020; Templer et al., 2006). The DAS-E was designed to be used as a research tool and has since been widely used in several research studies examining the construct of death anxiety (Abdel-Khalek & Neimeyer, 2017; Cooney et al., 2021; Meija et al., 2018; Sharif et al., 2020; Templer et al., 2006).

Results

The descriptive statistics of the demographic variables are displayed in Table 1. In this sample, age (M = 44.5, SD = 14.2) was measured as a continuous variable. Most participants identified as female (77.3%), while the rest of the participants identified as male (17.5%), transgender (1%), non-binary (3%), and other (1%). Most participants identified as Caucasian (84.5%), while the rest identified as Hispanic/Latino (5.2%), Asian (2.1%), Black or African American (5.2%), and as two or more races and/or ethnicities (3.1%). Additionally, 27.8% of the sample reported they were currently grieving a loss and 61.9% reported current religious and/or spiritual affiliation.

Table 1.

Demographic Information Summary.

Characteristics	N	M	SD	%
Age	94	44.49	14.180	**
Gender identity
Male	17			17.5
Female	75			77.3
Transgender	1			1
Non-binary	3			3
Prefer not to answer	0			0
Other	1			1
Ethnicity
Hispanic/Latino	5			5.2
American Indian or Alaska Native	0			0
Black or African American	5			5.2
Native Hawaiian or other pacific islander	0			0
Caucasian	82			84.5
Other/unknown	0			0
Prefer not to answer	0			0
2 or more	3			3.1
Licensed in counseling field
Yes	63			64.9
No	34			35.1
CACREP training
Yes	71			73.2
No	26			26.8
Death education
Yes	46			47.4
No	51			52.6
0–5 hours of training	13			28.3
6–10 hours of training	13			28.3
11+ hours of training	20			43.5
Self-awareness
Yes	39			84.4
No	7			15.2
Client attempted or death by suicide	69			71.1
Currently grieving	27			27.8
Religious and/or spiritual affiliation	60			61.9
Years of practice	97	9.09	9.209	**

Note. (N = 97).

The demographic survey also collected data regarding each counselor’s licensure status; 64.9% of the respondents reported having a license in the counseling field. Out of the sample, 73.2% reported receiving their master’s education from a CACREP program. Also, 71.1% reported experiencing a client who had attempted or died by suicide and years of practice was measured on a continuous variable (M = 9.09, SD = 9.21).

The participants in the study were asked to state their experience of death education, however, specific inquiry was not made regarding where and when that training occurred. Nevertheless, 47.4% reported experiences or training in the area of death related issues. Of those who reported experiencing death education, 28.3% reported receiving 0–5 hours of training, 28.3% reported receiving 6–10 hours of training, and 43.5% reported receiving 11+ hours of training. 84.8% reported that the death education training influenced their own self-awareness and professional relationship with death. (Table 2)

Table 2.

Descriptive Statistics Outcome Variable.

Scale	N	M	SD	Minimum	Maximum	Cronbach’s α
DAS-E	97	12.66	8.294	1	41	.91

Note. DASE, death anxiety scale-extended (DAS-E).

Research Question 1 (RQ1) Results

A two-tailed Pearson’s biserial (r) correlational matrix analysis was used to examine the correlation between the three independent variables: religious and/or spiritual affiliation, death education exposure, and years of practice to determine if there were existing relationships between each predictor variable. No outliers were found in the set of predictor variables as examined by Cook’s distance with no values above 1. The results of the analysis found two statistically significant findings. Table 3 includes a summary of the results. A correlation analysis was conducted between years of practice and religious and/or spiritual affiliation. The results indicated a statistically significant small positive correlation between counselors’ years of practice in the field and their religious and/or spiritual affiliation r(95) = .27, p = .007.

Table 3.

Pearson Biserial Correlation Matrix: Religious and/or Spiritual Affiliation, Death Education Exposure, and Years of Practice.

Variables	1	2	3
1. Death education exposure	1	.151	.305**
2. Religious and/or spiritual affiliation		1	.273**
3. Years of practice			1

Note. **Correlation is significant at 0.01 level, two tailed.

The correlation results between years of practice and death education exposure indicated a statistically significant correlation r(95) = .30, p = .002. A moderate, positive correlation between years of practice and death education exposure was found. This suggests that for the sample in this study as years of practice increased so did reported level of death education exposure. There was no statistically significant correlation between religious and/or spiritual affiliation and death education exposure r(95) = .15, p = .14.

Research Question 2 (RQ2) Results

To explore factors influencing death anxiety among counselors, a standard multiple linear regression analysis was conducted. The three independent variables (religious and/or spiritual affiliation, death education exposure, and years of practice) were used to predict the dependent variable death anxiety. The regression analysis was also used to determine any contributions that each predictor variable, religious and/or spiritual affiliation, death education exposure, and years of practice, contributed to the total variance that was explained by counselors’ levels of death anxiety. All statistical assumptions were met for conducting the multiple regression analysis (Laerd Statistics, 2015).

The multiple regression model was analyzed at the .05 level of significance. The correlation of determination R² is the proportion of variance in death anxiety explained by the independent variables religious and/or spiritual affiliation, death education exposure, and years of practice. The R² for the overall model was 10.3% with an adjusted R² of 7.4%, a small effect size. The regression analysis found that religious and/or spiritual affiliation, death education exposure, and years of practice statistically significantly predicted counselors death anxiety, F(3, 93) = 3.56, p < .05. This suggests that the model demonstrated acceptable fit. Hypothesis 2 stated that religious affiliation and/or spiritual, death education exposure, and years of practice will significantly predict counselor’s level of death anxiety (DAS-E total score). Notably, the regression analysis indicated that death education was the only statistically significant independent variable adding to the prediction (β = −.223, t = −2.16, p < .05). Table 4 includes a summary of the results.

Table 4.

Standard Multiple Regression Analyses for Variables Predicting Death Anxiety (N = 97).

Model	B	Coefficients^a
		Unstandardized Coefficients	Standardized Coefficients	t	p
		SE	β	t	p
1 (constant)	21.197	3.498		6.059	<.001
Death education	−3.688	1.708	−.223	−2.159	.033**
Religious and/or spiritual affiliation	−1.216	1.739	−0.72	−.699	.486
Years of practice	−.124	.096	−.138	−1.301	.197

Note. F(3, 93) = 3.562, p < .05, R Squared (R²) = .103, Adjusted R² = .074.

^aDependent Variable: Death anxiety (DAS-E Score).

^bPredictor Variables: Religious and/or Spiritual Affiliation, Death Education, Exposure, and Years of Practice.

Discussion

The present analysis has provided additional insight into the relationship of death education and death anxiety. The regression analysis in this study indicated that reported counselor levels of death education significantly predicted the level of death anxiety they experienced. The data indicated that the more death education an individual had received the less likely they were to experience death anxiety. Out of the sample, approximately half of the counselors indicated that they had received some amount of prior educational experiences or training in death related issues. Furthermore, of those individuals who reported having participated in death education indicated that they had received either 0–5 hours or 6–10, or 11 + hours of training. Also, a large portion of counselors in this study who have professional work experience with death, tended to report a higher level of self-awareness and understanding of death. The other half of the sample reported no prior death education experiences. The finding of death education predicting death anxiety was to be expected given the history of research in this area. Early research found counselors often receive limited preparation related to skills, techniques, or course work related to working with grieving clients (Ober et al., 2012). It is concerning that half of the counselors reported they had not received any death education as most counselors in this sample reported obtaining their counseling graduate experience from a CACREP accredited program. This may indicate that death education is lacking in counseling graduate programs, other than the topics of death that are a part of the standard curriculum such as suicide and suicide prevention.

Importantly, most counselors indicated that their death education experience had increased self-awareness and a professional relationship with death. Counselors with a history of death education may profit from continuing education (CE) around death and dying. CE could include webinars, seminars, courses, or conferences that provide additional insight and information about what death means for counselors and the counseling relationships.

This study also informs the counselor education field by exploring death anxiety levels among counselors. Descriptive statistics of the DAS-E were conducted and reported in Table 1. Notably, over half of the counselors reported having a license in the counseling field and the average years of practice was 9 years. This may suggest that this sample largely consisted of counselors who are considered experienced and have completed the required education, supervised experience, and examination requirements (ACA, 2021). These findings indicate that these variables may serve as possible protective factors for lower death anxiety levels. From these results one can surmise that approximately 9 years of experience in the field may provide counselors with an adequate number of experiences and supervision to be on a greater level of comfort with death and/or have obtained additional training in the area of death and death anxiety.

Although most counselors reported lower levels of death anxiety, 73% of the sample reported experiencing a client attempt or client death by suicide. This result contributes to a clearer understanding of how remarkable the reality of death and dying are in counseling relationships. This high rate of client attempted suicide or death by suicide is of great concern for novice counselors. As they are new to the counseling field, novice counselors may experience escalated negative reactions to clients who contemplate suicide or die by suicide including feelings of incompetency, self-blame, and guilt (Veillieux, 2011). This signifies the importance for novice counselors receiving adequate supervision, teaching, and consultation while in a training program to manage difficult feelings and foster growth in death and death related areas. Given the high rate of counselors reporting a history of clients attempted suicide or death by suicide, this also suggests that covering the topic of suicide within a death education curriculum is imperative. This result is also consonant with previous research indicating the need to integrate and infuse topics of death and dying within counseling training programs, which allow counselors to foster growth and acquire comfort in their own relationship with death and with client’s experiences of death (Harrawood et al., 2011; Suomala Folkerds, 2019).

Clearly the findings of this study affirm the need for support of a death education curriculum and to encourage CACREP counseling graduate programs to promote knowledge and awareness around death to better prepare counseling master’s students to serve clients. There is strong empirical evidence (Breen et al., 2013; Buckle, 2013; Haas-Thompson et al., 2008; Hill et al., 2018; Veilleux, 2011; Xu et al., 2019) that death education promotes counselor’s self-efficacy, professional competency, preparedness, and understanding of death and its implications for counselors and their relationships with clients. Counseling graduate programs may benefit from different variations of standardized death education curricula. For example, prior research (Harrawood et al., 2011) has suggested several different topic areas such as understanding death, mourning stages, multicultural differences, and grief counseling fatigue. Death education standardized courses may also include lectures, readings, didactic and experiential trainings (Breen et al., 2013; Buckle, 2013). The current study supports the importance of counselors obtaining knowledge, skills, and awareness around death to decrease levels of death anxiety. Thus, counseling training programs and counselor educators may develop a standardized curriculum that addresses the topic of death and dying. It is also recommended that counselor educators incorporate the topic of death into a range of courses and content areas which may be beneficial for counselors in training.

Limitations

This study attempted to understand death anxiety specifically among counselors, the results therefore should be interpreted carefully due to generalizability. Though the demographics were representative of counselors in the field, the majority were Caucasian and identified as female. Therefore, the results of this study may not generalize to larger groups of counselors across the United States and/or other gender identities.

Since the study included the DAS-E standardized measure, concerns with socially desirable responding (SDR) and self-reporting must be considered. SDR occurs when participants respond in a desirable way (He et al., 2015). SDR was attempted to be controlled by setting time limits, providing an introduction and reasoning for the study, describing the role of participants, and ensuring participant’s anonymity. Additionally, the DAS-E self-report measure includes the possibility of invalid reports of death anxiety. For example, some participants may have underreported or overreported their thoughts or feelings related to death anxiety which may impact the validity and reliability of the DAS-E scores.

Limitations of selection bias may also affect the interpretation of results. Although this study included several different types of data collection procedures, the selection of data collection only included counselors who have access to online memberships, listservs, and email. Therefore, this systemically excluded counselors who may not have access to the internet or professional memberships due to cost factors, desire to be professionally active, connected with other counselors in the community, or involved in ongoing education. Lastly, several of the demographic questions were asked in a dichotomous format which may have limited the type of information obtained. With questioning using more continuous variables, participants would provide additional information that may lead to further richness in understanding the influence of these variables on death anxiety in counselors.

Future Directions

Guided by the literature (Chow, 2017; Haas-Thompson et al., 2008; Maglio & Robinson, 1994; Xu et al., 2019) this study concentrated on three commonly used predictor variables, religious and/or spiritual affiliation, death education exposure, and years of practice that may predict death anxiety among counselors. It may be valuable for future researchers to explore other common variables used in death anxiety research such as purpose of life, family atmospheres and culture, medical and mental health history, or exposure to death (Chow, 2017; Maglio & Robinson, 1994; Xu et al., 2019). Although more research attention is warranted to consider additional variables that might predict death anxiety, it is important to note that while the regression analysis of the three predictor variables accounted for a small portion of the variance in the death anxiety, this finding contributes to a better understanding of the experience of death anxiety in counseling.

It is recommended that future research further investigate other aspects of the counselor’s experience that may have led to reporting lower death anxiety. Specifically, examining death anxiety levels among novice counselors or current master’s counseling students could be informative.

Future research may also benefit from additional detailed follow-up questions regarding the type of training that was received (e.g., course, seminar, conference) to provide additional information about where counselors death education has been obtained. In addition, to enhance the internal validity of individuals from cultural and ethnic backgrounds, future research may incorporate diverse populations that are part of different online platforms, universities, or professional memberships.

Furthermore, future research should conduct a longitudinal extension of this study to assess counselors experience over time, for example, novice (i.e., pre-licensed), and experienced counselor (i.e., licensed), or add more evidence by assessing masters level counseling students at the beginning of practicum to the end of the internship experience. An additional strategy may be to consider years of practice and death anxiety would be to use a larger sample size and breaking up years of practice (e.g., 0–5 years, 6–10 years, 11+ years). This could explain how much the groups may differ on levels of death anxiety.

There may also be value in examining religious and/or spiritual affiliation in greater detail rather than simply reporting yes or no. This may be achieved by adding more options about different religions or spiritual beliefs one holds and having each counselor select which one they are aligned. Another way to examine this would be to holistically examine how culture may impact counselors’ death anxiety. The theoretical framework used for this study, TMT, encompasses cultural components such as worldviews, attitudes, and beliefs influencing one’s ability to cope with death anxiety (Pyszczynski et al., 2006). While several studies have asked about religiosity (Chow, 2017; Maglio & Robinson, 2004; Xu et al., 2019), there is limited information reported about how culture influences death anxiety. To add more understanding around counselor death anxiety levels, adding culture as a variable may provide insight into how other racial and ethnic backgrounds or other populations practices and beliefs impact experiences of death anxiety.

Due to limitations of generalizability, it is recommended that future quantitative research incorporate data collection processes that involve additional online platforms, universities, or professional memberships that are more inclusive of expanded populations of counselors. Adding diverse recruitment procedures may contribute to the findings and allow for a sample more generalizable to the population. Also, this study included data collection processes that were conducted nationally. One recommendation would be to investigate counselor’s death anxiety at the regional level which may provide insight into a more refined look at how regional differences may impact death anxiety in comparison to other parts of the country. It is also recommended that the question of whether counselors have had a client attempt suicide or complete death by suicide be asked separately. The results of this question in this sample may have led to a higher value than typically expected in this population. Therefore, asking about client attempted suicide and then death by suicide will be beneficial to see the differences in experiences of both situations and could provide more understanding about death anxiety.

To be inclusive of individuals who may not have internet access or access to counseling memberships, conducting research on death anxiety a qualitative approach may lead to findings that contribute to gaining insight into one’s own lived experience with death, culture, death anxiety, or death education experiences and how that may impact practice with clients. Additionally, narrowing the sample inclusion criteria to include only current counselors in training could provide additional information about death anxiety experiences. If identified early while training, this would provide an opportunity to have greater understanding of how the predictor variables may contribute to the prediction of death anxiety for novice counselors versus those who have been in the field for many years. Several of the demographic questions in this study were asked as dichotomous variables which may limit the type of information obtained. Future research may benefit from a mixed methods research approach that qualitatively asks about counselor’s experience with either death education, client history of suicide, suicide attempts, or their own grieving process which may lead to further understanding of these variables and reported death anxiety.

Conclusion

The pervasiveness of death and dying comes in many forms. Counselors will be faced with challenges regarding death both in the counseling room and when personally conceptualizing how the thought or experience of death affects their professional judgment, work, and client relationships. This study informs the need for higher education accrediting boards (e.g., CACREP) to consider death and dying as an essential component to be specifically addressed within the standards. Through creating a standard course or curriculum that focuses on the topic of death, may decrease levels of death anxiety and fear and promote counselor’s self-efficacy, self-awareness, and understanding of the impact death has on who they are as a person, a counselor, and in their work with clients (Harrawood et al., 2011; Wallace et al., 2019).

Supplemental Material

Supplemental Material - Death Anxiety: An Exploration of Professional Counselor Experiences

Supplemental Material for Death Anxiety: An Exploration of Professional Counselor Experiences by Kaitlyn Kaus, Diane Coursol, and Aaron Suomala Folkerds in OMEGA - Journal of Death and Dying

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Kaitlyn Kaus

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Kaitlyn Kaus, Ed.D., is a full time licensed professional clinical counselor (LPCC) working in private practice with the pediatric population. She holds her doctorate degree from Minnesota State University, Mankato. She is also an adjunct professor at Minnesota State University, Mankato and teaches courses within the counseling and student personnel (CSP) department.

Diane Coursol, Ph.D. is a Professor in Counseling at Minnesota State University, Mankato. She has been a counselor educator for 37 years and currently teaches the Practicum, Internship, Assessment, Diagnosis and Treatment Planning, Technology and Counseling Skills courses in the masters and doctoral programs at Minnesota State University, Mankato. Dr. Coursol has worked in a variety of settings, including hospital, private practice, and agency settings.

Aaron Suomala Folkerds is an Assistant Professor in the graduate counseling program at Minnesota State University-Moorhead. He also serves as the part-time wellness coordinator at the Moorhead Police Department. He holds a B.A. in psychology from University of Minnesota-Morris, an M.Div. from Lutheran School Theology at Chicago, an MS in mental health counseling from Minnesota State University-Mankato, and Ed.D in counselor education and supervision from the same institution. He is also Licensed Marriage and Family Therapist (LMFT-MN).

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