needs of bereaved individuals.  This leads to ethical dilemmas as each individual defines the standards within the context of their own particular discipline, or as standards are defined to meet program needs without regard to professional ethics. It is therefore incumbent on individual programs to apply the test of those professional standards applicable for the disciplines delivering to the clear and formal definition service of their own program standards. So doing, when when examining the role of a bereavement group facilitator, for instance, distinctions distinctions will of necessity arise between the role of a sensitive and compassion-ate listener and that of a therapist; philosophical and professional questions will need to be addressed, such as, “if grief is not a pathology, is the service provided therapy?” and “what is the function of group?”; and the ethical code of the “interdisciplinary” disciplines will need to be honored in the context of the systems interdependency.

    Observations regarding professional recommendations and minimum standards for counseling in general, and with regard to the group concept of grief counseling and therapy, may be helpful in bringing some illumination to this issue.

In general, underlying any educational or experiential qualifications, a group facilitator, counselor or therapist must possess these four essential qualities:  (a)  Genuineness, authenticity or self-congruence, depending on which theorist one favors; (b) Non-possessive warmth, unconditional positive regard (Rogers), nonjudgmental-ness, or unshockablity; (c) Accurate empathy, moment-by-moment understanding, or “as if-ness” (Rogers); and though this may rankle some theorists, (d) Love (Ferenczi).  As a standard, one can only seek demonstration of the presence of these qualities in the otherwise qualified facilitator, counselor or therapist.

The question then arises, “Who does grief counseling?”

The “more sophisticated forms of bereavement counseling are offered by professional psychiatrists, psychologists, or social workers, and by counseling services which make use of carefully selected and trained volunteer counselors. These are aimed at…people who are at special risk following bereavement, and …range from individual or family support to…office consultation and group meetings. Several of them have passed the test of scientific evaluation…[and individuals participating in them] had better health and adjustment a year after bereavement than a similar control group who were not counseled.”

“The treatment of pathological reactions to bereavement follows the same principles as those that have been indicated for the support of bereaved people in general. Thus the appropriate treatment for delayed or inhibited grief would seem to be a form of psychotherapy in which it becomes possible for the patients to begin their grief and to overcome the fixations or blocks to realization which have prevented them from ‘unlearning’ their attachment to the lost person.… The therapist, by accepting, without criticism, the anger, guilt, despair, or anxiety that patients express, implicitly reassures them that such feelings, however painful, are not going to overwhelm the therapist or destroy the relationship with the patient. Having discovered that it is safe to express feelings the patient is now free to carry out the grief work and, as Lindemann puts it, pathological grief is transformed into ‘normal grief’ and follows the usual course towards resolution.”

According to William Worden, “Most hospice programs use some combination of professional and volunteers to do the counseling.”

What is the function of the group process?

Again according to William Worden, bereavement counseling in group is a very efficient counseling approach, and is an effective means for providing the needed emotional support.

And finally, what leadership approach should be used for the group?

With the exception of peer support groups, most groups will either be led by mental health care professionals, or by lay persons with professional back-up and supervision. Co-leadership may be beneficial, but is generally only considered essential when groups are large (more than 8 to 10 people). When co-leadership models are used, it is recommended that a period of debriefing follow the group. Not only is this of value in identifying unmet needs of the group, “tensions that may be subtle and disruptive to the group can arise between leaders. This is one way to prevent this from happening.”

    In summary, the group process is an efficient and effective means of grief counseling and grief therapy for bereaved individuals experiencing normal and certain complex grief reactions. The work done in the group process is psychotherapeutic in nature and therefore counselors leading grief counseling or grief therapy groups should either be professionally qualified, possess in-kind or deemed equal experience in individual or group counseling, or should be under the direct supervision of such an individual. Furthermore, the minimum professional qualifications of individuals providing grief counseling or grief therapy should be sublimated by the “essential qualities” of a therapist outlined above.

    Bereavement services in the Hospice community are rendered by Social Workers in 36% of the provider programs, by Nurses in 34.5%, by Clergy in 11.5%, and counselors or Psychologists in 13% of the cases.  Each discipline will understandably bring the views of their representative disciplines to the quality and scope of services they provide. Where grief counseling is provided that view will inform the perception, focus and methodology applied. Because of the various

spiritual care and the universal body of wisdom teachings as applied to separation, loss and grief, they become immensely qualified grief therapists; better qualified in fact than many licensed mental health practitioners and psychotherapists in the field of grief counseling. appropriate training.”

    Finally, to the issue of who is qualified to provide grief counseling, grief support and grief therapy. The boundaries between these three services frequently are not clearly defined and can easily become obscured. For example, most regulatory agencies setting standards for Bereavement Care do not require anything more than that supervision of services be provided by an individual with “education and experience appropriate to the care” and “a demonstrated ability in family and/or individual  Specious reasoning could have a Sophist’s holiday within these perimeters. Using situationally specific definitions for “experience appropriate,” “demonstrated ability,” and “appropriate training,” provider programs may easily apply the standards to the most minimal level of care rather than provide care appropriate to the

Nyo. "As it is," the way things are, without delusion, without illusion.