Reified Misinformation: Examining Practitioner Awareness of Accurate Grief Theory

BACKGROUND: Theory, research, and practice guidance in the field of grief and loss developed rapidly in the 1990s and beyond, yet many clinicians continue to embrace outdated models that can potentially harm clients. Although practitioners recognize that loss and grief attend to many experiences besides death, some persist in using a modified Kübler-Ross model that has been thoroughly discredited for grief after loss. Despite the unequivocal need to desist from such practice, anecdotal evidence suggests misinformation continues to guide social work practice. Our aims were:

Aim 1: Assess the knowledge, self-reported skills, and attitudes of current practitioners in the NJ area regarding developments in grief theory.

Aim 2: Understand practitioners' approach to grief/loss in their practice using: (2a) responses to a small number of hypothetical cases and (2b) self-reporting a typical case related to loss/grief in their own practice.

In this analysis, we focus solely on practitioners’ awareness of change from Kübler-Ross to current theory.

METHODS: Using a large convenience sample recruited from a social work CEU listserv, we distributed an online survey with five sections: Sec1- seven multiple choice (MC) case-based grief knowledge questions, followed by a request for a brief case study of a typical grief-related case in their practice and how they handled it; Sec2- 10 MC questions directly about grief theory knowledge; Sec3- sliders (1-100) indicating familiarity with specific grief theories and how often the practitioner used them; Sec4- demographics; and Sec5- feedback about their experience of the survey itself. Each item had text boxes for comments yielding qualitative data in addition to the case studies. The survey was piloted with DSW students followed by cognitive interviews to assure accuracy and clarity. Data were gathered from January 15, 2020 to March 5, 2020. Descriptive content analysis was used to analyze the qualitative data and Stata was used to analyze the quantitative data. Respondents were categorized into Knowledgeable, Questionable, and Misinformed, reflecting their awareness of the transition from Kübler-Ross to current theory.

RESULTS: Of the 964 respondents who started the survey, 911 completed the survey and 694 completed case studies and optional responses. Qualitative results demonstrated that 10 % of case studies referenced “stages of grief,” while only a small minority used Kübler-Ross’ model exclusively. Many used the language of stages even as they clarified that they do not believe grievers follow set patterns. Our quantitative results raised more alarm with 330 or 34.23% qualifying as knowledgeable; 462 (47.93) % questionable; and 172 (17.84%) misinformed. Self-reported attendance at grief-related CEUs did not improve knowledge, but being a psychiatric hospital or private practitioner did.

CONCLUSIONS: Outdated theories are hard to eradicate, yet potential for harm and evidence-based treatment requires that we attempt to do so. Updated coursework in MSW programs, confrontation of misinformation in public venues, and outreach to clinicians who serve clients experiencing loss should all be employed.