An Integrative Conceptual Framework for Grief-Informed Clinical Supervision

Abstract

Future mental health providers often receive limited formal preparation in grief counseling and rely on supervision to develop grief-related competencies. However, supervisors may lack explicit guidance for addressing grief in supervision, particularly when supervisees bring personal loss experiences into clinical work. This paper examines grief counseling competencies and contributing factors, including personal loss, training, clinical experience, and supervision, and proposes an integrative conceptual framework for grief-informed clinical supervision. Grounded in supervision and grief counseling literature, the conceptual framework offers structured guidance to support supervisors in attending to supervisees’ developmental needs, grief-related competencies, and personal and professional loss experiences.

Introduction

More than 3 million deaths occurred in the United States (US) in 2023 (Murphy et al., 2024). Based on estimates that each death affects approximately five close individuals (Connor & Rubin, 2021), this suggests that over 15 million people experienced bereavement that year. When non-death losses such as job loss, divorce, or chronic illness are also considered, the number of individuals impacted by grief is even higher than expected (Akmese, 2025). While many individuals gradually adjust to their loss without formal support, a significant number experience prolonged grief symptoms that may necessitate professional help (Wilson et al., 2022). However, preparing future mental health providers to be competent to work with grief and loss issues requires adequate training, experience, and clinical supervision.

Providing grief counseling to address both death and non-death-related issues is an essential part of the mental health professionals’ roles. However, most programs do not include death, dying, grief, and loss-related topics in their curricula because they are not required by their accreditation bodies or related associations that determine the program standards, such as the Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2024) for counseling programs and the American Psychological Association (APA, 2015) for the psychology programs in the US. As a result, future mental health providers graduate and provide clinical services for clients presenting with grief and loss without taking any grief-related courses or programs where grief content is infused (Akmese, 2025; Dodd et al., 2017; Jankauskaite et al., 2025; Ober et al., 2012). Furthermore, a study investigating clinical mental health and school counseling students’ grief competency revealed that more than 70% of participants have never even earned any professional development hours in grief and loss (Imhoff, 2015).

Studies investigating the grief counseling competency across various disciplines and levels of education in mental health professions found some results to be concerning. For example, the majority of counselors, counselors in training, clinical and counseling psychology graduate students are familiar with outdated grief theories, such as Stage Theory, which suggests a linear stage, whereas only a few are familiar with contemporary grief models, such as the Dual Process Model (DPM), which is the most well-known and evidence-informed grief theory (Akmese, 2025; Imhoff, 2015; Jankauskaite et al., 2021, 2025). Yet, results have revealed that many overestimated their competence in grief counseling (Akmese, 2025; Jankauskaite et al., 2021). More importantly, almost all future and current mental health providers across all professions have seen clients presenting either or both death and non-death related issues in their clinical work (Akmese, 2025; Jankauskaite et al., 2025).

Given the circumstances regarding a lack of training, mental health providers often tend to rely on basic psychotherapy skills to address grief and loss. However, grief is a complex phenomenon, and the well-intentioned but intrusive use of basic psychotherapy skills without adequate training may inadvertently cross professional boundaries or lead them to practice outside their scope of competence. This can raise ethical concerns, as outlined in the ACA Code of Ethics (2014), the Ethical Principles of Psychologists and Code of Conduct (APA, 2017), and the Association for Death Education and Counseling (ADEC) Code of Ethics (2004), which emphasize the importance of maintaining appropriate professional roles and ensuring that support remains within one’s qualifications and training.

Alternatively, future mental health providers under supervision may rely on their supervisors to enhance their knowledge and skills regarding grief and loss. However, there are very limited studies investigating grief counseling supervision in counseling and psychology programs. The only original study conducted in this field reported that 53.7% of professional counselors had not received grief counseling supervision (Akmese, 2025). On average, only 10% of participants received more than 10 hours of grief counseling supervision (Akmese, 2025). Additionally, mental health providers often experience loss themselves (whether death or non-death-related), which can significantly impact their work with clients facing similar issues (Swinden, 2023). Such circumstances also call for careful consideration of what and how much should be disclosed during supervision and in sessions with clients presenting similar concerns, as well as the need to address personal loss experiences (Swinden, 2023). These results raise a significant question: Why do mental health providers not engage in grief-related topics during supervision despite the fact that they have received general supervision throughout their training, have seen clients presenting grief and loss issues, and might have experienced grief themselves?

We propose that this gap reflects a lack of explicit supervisory frameworks that integrate grief counseling competencies with supervisees’ personal loss experiences. The purpose of this paper is to propose an integrative conceptual framework for grief-informed clinical supervision that synthesizes grief and loss scholarship, developmental supervision theories, and literature on clinicians’ personal and professional loss experiences. This framework is intended to organize existing knowledge, support supervisors’ conceptualization of supervisee development in grief work, and offer a foundation for future empirical inquiry.

Grief Counseling Competency

Gamino and Ritter Jr (2012) define death competence as the ability to effectively manage issues related to dying, death, and bereavement through a combination of cognitive and emotional competence. Cognitive competence involves a foundation of rigorous academic knowledge integrated with supervised clinical training, enabling counselors to apply theory to practice with professional proficiency. Emotional competence, on the other hand, refers to a counselor’s capacity to tolerate and regulate personal emotional reactions when working with clients experiencing grief and loss, particularly in cases of traumatic or violent death. This includes processing one’s own experiences with death and maintaining emotional stability to support clients effectively.

Expanding on this, Charkow (2001) presents grief counseling competence as encompassing five domains: personal competencies (e.g., self-awareness, self-care, and openness to humor and spirituality), knowledge and conceptual skills (e.g., knowledge of normal and complicated grief, coping models, and developmental stages), assessment skills (e.g., recognizing unresolved grief, assessing risk, and considering cultural and spiritual factors), treatment skills (e.g., applying interventions in individual, group, and family contexts), and professional skills (e.g., crisis management, collaboration, research engagement, and ongoing education). ADEC (n.d) builds on and integrates these perspectives through its Body of Knowledge (BoK) Matrix, a comprehensive framework designed to guide professional competence in thanatology. The BoK Matrix includes six core content areas, such as dying, loss and mourning, traumatic death, and intervention, cross-referenced with ten interdisciplinary categories like cultural, ethical, religious, historical, and lifespan perspectives. This structure ensures a holistic approach that emphasizes both theoretical knowledge and applied skills, while also addressing broader social and ethical contexts (ADEC, n.d).

While the three models differ in focus, Gamino and Ritter Jr (2012) highlight emotional regulation as central to clinical effectiveness, Charkow (2001) emphasizes skill-based application, and ADEC BoK Matrix (n.d.) offers a wide-ranging, integrative model; they all converge on the idea that effective grief counseling requires a balanced integration of knowledge, emotional regulation, reflective capacity, and professional skill.

Grief Work

Research shows that personal beliefs, attitudes, and past experiences with loss shape the clinical encounter in grief work. Unresolved grief in providers can influence the therapeutic relationship through dynamics like transference and countertransference, either supporting or complicating client progress (Worden, 2018). Cultural background also affects how grief is perceived; some mourning practices may be overlooked or stigmatized when they fall outside dominant norms (Doka, 2020).

A solid understanding of grief theories is essential. While Kübler-Ross’s stage model remains widely known, it has been criticized for oversimplifying grief and lacking empirical support (Akmese, 2025; Ober et al., 2012). More current models offer nuanced, evidence-informed approaches to grief. For example, the Dual Process Model (DPM) emphasizes oscillation between loss-oriented and restoration-oriented coping (Stroebe & Schut, 1999, 2010), a principle reflected in structured interventions such as Complicated Grief Therapy, which integrates exposure to avoided reminders with restoration-focused goal setting. The Two-Track Model (Rubin, 1981, 1999) focuses on both functioning and the continuing relationship with the deceased, while Continuing Bonds (CB) theory (Klass & Steffen, 2018) highlights ongoing symbolic ties, often incorporated into practice through letter-writing exercises, guided imagery, memory projects, and ritual-based interventions that support adaptive connection rather than detachment. On the other hand, the Meaning Reconstruction framework (Neimeyer, 2001) explores sense-making and identity shifts, often operationalized through narrative and meaning-centered techniques that help clients revise disrupted life stories following loss. These models present grief as complex, individualized, and non-linear.

Assessment literature stresses that the nature of the loss, such as traumatic, sudden, ambiguous, or disenfranchised, shapes grief responses (Boss, 2009; Doka, 2020; Wortman & Pearlman, 2016). Factors like developmental stage, cultural background, and attachment quality also impact grief expression (McCoyd et al., 2021). While adaptive grief involves integrating the loss over time, Prolonged Grief Disorder (PGD) refers to enduring, impairing symptoms beyond cultural norms (APA, 2022; World Health Organization [WHO], 2019). Treatment research highlights the need to both process the emotional pain and rebuild life without the deceased, with oscillation between these tasks key to adjustment (Stroebe & Schut, 1999, 2010), and empirical studies have demonstrated that grief-specific treatments may be more effective than depression-focused approaches for individuals experiencing prolonged grief disorder. Meaning-making and maintaining CBs are also identified as beneficial processes (Klass & Steffen, 2018; Neimeyer, 2001). Importantly, grief extends beyond death, with events like divorce, job loss, or pet loss also triggering significant grief responses, especially when these losses are disenfranchised (Adrian & Stitt, 2019; Harris, 2020; Packman et al., 2012).

Ethical and relational issues, such as therapist self-disclosure, require careful navigation to avoid undermining therapeutic boundaries (Breen, 2011; Swinden, 2023). Mourning is deeply embedded in cultural, spiritual, and social contexts, and respecting these practices is vital to supporting healthy adjustment (Stroebe et al., 2001). Overall, the literature presents grief work as multidimensional, requiring practitioner self-awareness, a broad theoretical foundation, attention to context, evidence-based interventions, and sensitivity to ethical and cultural considerations, all of which are emphasized across current grief counseling competency models.

Role of Clinical Supervision in Grief Counseling Competency

Clinical supervision is a structured professional relationship between a more experienced professional and a less experienced colleague, aiming to enhance the professional skills of the less experienced mental health providers, ensure service quality, and uphold standards within the profession (Bernard & Goodyear, 2019). According to Blueford et al. (2022), supervision plays a crucial role in preparing mental health providers to work with clients experiencing grief and loss, particularly when their formal training has not adequately addressed these issues. Providers in supervision reported feeling validated and having their challenges normalized while also gaining practical tools and resources from their supervisors to enhance their ability to address grief effectively (Blueford et al., 2022).

The only study examining the relationship between grief counseling training, experience, and supervision with mental health providers found that training and experience are the most significant predictors of grief counseling competency, accounting for 60% of the variance across competencies and overall grief counseling competency (Akmese, 2025). Supervision was significantly correlated with training and experience GCETS (r = .44, p < .001) and overall grief competencies (r = .30, p < .001). Regression analysis results showed that supervision cannot be separated from training and experience, and both formal (i.e., standalone grief courses) and informal (i.e., webinars and conferences) grief counseling training should include supervision while aiming to enhance the grief counseling competency of mental health providers. Although future mental health providers must complete supervision hours (Akmese, 2025), these findings highlight a critical concern regarding the limited focus on grief in supervision, despite the fact that all participants have worked with clients experiencing grief and loss. No studies have explored the supervision experiences of pre-doctoral psychology students working with grief and loss. However, given the similarities in grief training across counseling and psychology programs, it is likely that psychology trainees face similar gaps in supervision on this topic.

Although established supervision models incorporate developmental progression, reflective practice, and emotional processing, processes that are highly relevant to grief-related clinical work, grief counseling competencies are rarely articulated explicitly within these frameworks. As a result, grief-related material may be addressed indirectly or inconsistently rather than through a structured supervisory lens. An integrative conceptual framework for grief-informed clinical supervision may therefore support supervisors in more intentionally identifying and cultivating grief-specific competencies within existing supervision structures.

Grief-Related Issues in Current Clinical Supervision Models

Widely used clinical supervision models incorporate developmental, relational, and reflective processes that are highly relevant to grief-sensitive practice. For example, increased emotional regulation, self-awareness, and case conceptualization capacity among more advanced trainees often enhance their ability to work effectively with complex clinical presentations, including grief and loss. However, while these models provide mechanisms that can accommodate grief-related material, grief counseling competencies themselves are rarely operationalized explicitly within supervision frameworks. Consequently, grief may be addressed as part of broader clinical development rather than as a distinct area of professional competence requiring intentional and structured supervisory attention.

From a developmental supervision perspective (e.g., Loganbill et al., 1982; McNeill & Stoltenberg, 2016; Stoltenberg & McNeill, 2011), supervisees’ capacity to recognize, process, and integrate grief-related experiences is understood to evolve over time. Beginning clinicians may experience heightened anxiety, emotional reactivity, or difficulty managing personal loss responses, whereas more advanced supervisees typically demonstrate greater reflective capacity and increased ability to bracket countertransference. Within this perspective, grief-related competence is conceptualized as developing progressively through clinical experience, supervision, and increased self-awareness rather than as a static skill set.

Bernard’s (1979, 1997) Discrimination Model further contributes to grief-informed supervision by emphasizing supervisors’ flexibility in shifting roles according to supervisee needs. When grief emerges in clinical work or in supervisees’ personal experiences, supervisors may adopt a counselor role to facilitate emotional awareness and processing, a teacher role to provide conceptual understanding of grief processes, or a consultant role to support clinical judgment and professional autonomy. Although the model does not explicitly foreground grief, its role-based structure allows supervisors to attend to both skill development and emotional responses that commonly arise in grief-related work.

The Reflective Developmental Model (RDM; Neufeldt et al., 1996) offers additional relevance by conceptualizing emotionally charged experiences as trigger events that prompt reflection and meaning-making. Experiences of grief, whether related to client loss or personal circumstances, may serve as such triggers within supervision. Through guided reflection, supervisors can support supervisees in recognizing countertransference, regulating emotional responses, and developing adaptive clinical strategies. Research suggests that reflective supervision enhances self-awareness, resilience, and the development of self-supervision skills that support ongoing professional competence beyond formal supervision (Guiffrida, 2005). In this way, reflective processes can transform grief-related challenges into opportunities for professional growth.

Taken together, these supervision models suggest that supervision contains implicit mechanisms, such as developmental progression, supervisory role flexibility, and reflective practice, that may support supervisees’ engagement with grief-related material. However, grief is rarely addressed as a distinct area of clinical competence within these frameworks. Given that mental health professionals frequently work with grieving clients, and that many graduate programs provide limited formal training in grief counseling, supervisees may rely heavily on supervision to develop grief-related competencies. The absence of explicit guidance for addressing grief within supervision may limit supervisors’ ability to intentionally support supervisees’ grief-related skill development and processing of personal loss experiences. This gap underscores the need for an integrative conceptual framework that explicitly embeds grief counseling competencies within clinical supervision practice.

Conceptual Framework Development

This framework was developed using a theory-driven, integrative approach grounded in a synthesis of the clinical supervision and grief counseling literature. Established supervision theories, grief competency frameworks, and scholarship on clinicians’ personal and professional loss experiences were examined to identify convergent concepts relevant to grief-informed clinical supervision (Bernard, 1979, 1997; Loganbill et al., 1982; Neufeldt et al., 1996; Servaty-Seib & Chapple, 2021).

Developmental supervision theories were selected because they conceptualize supervisee growth as a dynamic and evolving process, which aligns with the developmental nature of grief-related competence (Loganbill et al., 1982; McNeill & Stoltenberg, 2016; Stoltenberg & McNeill, 2011). Grief competency frameworks were chosen based on their complementary emphases on emotional regulation, clinical skills, and interdisciplinary knowledge (Charkow, 2001; Gamino & Ritter Jr, 2012; Servaty-Seib & Chapple, 2021). Bernard’s (1979, 1997) Discrimination Model was incorporated to provide a flexible supervisory structure that supports role adaptation based on supervisees’ developmental levels and emotional needs.

Integration across models involved identifying areas of conceptual convergence and organizing overlapping domains into broader competency tasks to enhance clarity and reduce redundancy. This process resulted in five core grief counseling competency tasks that consistently emerged across the supervision and grief literatures and could be meaningfully addressed within supervision (Bernard, 1979, 1997; Charkow, 2001; Gamino & Ritter Jr, 2012). When conceptual tensions were identified, integration decisions were guided by relevance to grief counseling practice, allowing for flexibility rather than rigid resolution of theoretical differences. This framework is intended to serve as a conceptual guide for grief-informed clinical supervision and to inform training, practice, and future research.

Grief-Informed Clinical Supervision Framework

To address the need for clearer guidance in grief-informed clinical supervision, this paper proposes an integrative conceptual framework that synthesizes developmental supervision theories, grief counseling competency frameworks, and scholarship on clinicians’ personal and professional loss experiences. Several established supervision models (Bernard, 1979, 1997; Loganbill et al., 1982; McNeill & Stoltenberg, 2016; Neufeldt et al., 1996; Stoltenberg & McNeill, 2011) were selected because, although they do not explicitly address grief, they emphasize developmental progression, supervisory role flexibility, and reflective practice-processes highly relevant to grief-related clinical work.

Developmental supervision theories were incorporated to conceptualize how grief-related competence may evolve across levels of clinical training. In particular, the models proposed by Loganbill et al. (1982) and McNeill and Stoltenberg (2016) were integrated with grief counseling competency frameworks (e.g., death competence, Body of Knowledge, and Charkow’s model) to organize supervisees’ growth in grief-related skills. Conceptual overlap across these frameworks was examined and synthesized, resulting in five core grief counseling competency tasks (self-awareness, conceptual knowledge, assessment, intervention, and ethics), which form the foundation of the framework’s first factor. The framework also accounts for the nonlinear and task-specific nature of supervisee development, recognizing that clinicians may demonstrate varying levels of grief-related competence depending on experience, training, and clinical exposure. Accordingly, developmental supervision models inform the framework’s emphasis on ongoing growth in grief counseling competencies rather than fixed stages of mastery.

Supervisees’ personal and professional grief experiences were incorporated as a central component of the framework, given their influence on clinical functioning and professional development. Drawing on the Reflective Developmental Model (Neufeldt et al., 1996), grief-related experiences are conceptualized as emotionally salient events that may prompt reflection, self-awareness, and adaptive meaning-making within supervision. Finally, Bernard’s Discrimination Model (Bernard, 1979, 1997) was integrated to guide supervisory role selection once supervisees’ grief-related competency tasks, developmental considerations, and loss experiences have been identified. This model provides a flexible structure for supervisors to respond to supervisees’ evolving needs through targeted teaching, counseling, and consultation roles within grief-informed clinical supervision.

Grief Counseling Competency Tasks

Five developmental grief counseling competency tasks (self-awareness, conceptual skills and knowledge, assessment skills, treatment skills, and ethics) were identified through an integrative synthesis of developmental supervision theories (Loganbill et al., 1982; Stoltenberg & McNeill, 2010) and grief counseling competency frameworks (ADEC, n.d; Charkow, 2001; Gamino & Ritter Jr, 2012). Although some supervision models articulate a broader range of developmental domains, these five tasks were selected because they consistently emerged across frameworks as central to competent grief counseling practice. Conceptual overlap among models was intentionally consolidated to enhance clarity and applicability within supervision.

Self-awareness was informed by personal and emotional competency domains within grief counseling frameworks (Charkow, 2001; Gamino & Ritter Jr, 2012; ADEC, n.d) and reflects the foundational role of clinicians’ awareness of their own beliefs, emotional responses, and loss histories. Research across mental health and healthcare professions indicates that practitioners frequently experience grief reactions following client death, underscoring the importance of countertransference management and self-care in grief work (Dodd et al., 2017; Kaus et al., 2024). Self-awareness within grief-informed supervision must include attention to cultural and spiritual worldviews that shape beliefs about death and mourning. Grief expression varies across individualistic and collectivistic contexts, and Western detachment-oriented models may differ from relational or cyclical understandings of ongoing connection (Rosenblatt, 2020). Because clinicians may unintentionally impose dominant grief norms when operating as cultural outsiders (Rosenblatt, 2020), supervisors must support supervisees in examining how their cultural positioning influences case conceptualization and intervention decisions.

Conceptual skills and knowledge draw from supervision models’ emphasis on theoretical orientation and cognitive development (McNeill & Stoltenberg, 2016) and from grief competency frameworks highlighting contemporary, evidence-informed understandings of grief. Competence in this domain includes understanding multidimensional grief theories, recognizing diverse grief trajectories, integrating cultural perspectives on mourning, and moving beyond outdated stage-based models toward more nuanced conceptualizations of grief (Akmese, 2025).

Assessment skills were derived from overlapping assessment and case conceptualization domains across supervision and grief frameworks (Charkow, 2001; McNeill & Stoltenberg, 2016; ADEC, n.d). This task emphasizes evaluating grief responses, differentiating adaptive from prolonged or complicated grief, assessing risk factors such as suicidality, and determining appropriate timing for intervention within cultural and contextual frameworks. Prior research highlights the importance of accurate assessment and timing to avoid ineffective or potentially harmful interventions (Dodd et al., 2017; Stubbe, 2023).

Treatment skills encompass the application of grief counseling interventions across clinical contexts, including individual, group, and family work. Informed by developmental supervision and grief competency models (Loganbill et al., 1982; Charkow, 2001; ADEC, n.d), this task emphasizes flexibility, cultural responsiveness, and the adaptation of interventions to diverse loss experiences rather than reliance on uniform treatment approaches (Asgari et al., 2023).

Ethics reflects professional ethics domains across supervision and grief frameworks (Loganbill et al., 1982; McNeill & Stoltenberg, 2016; Charkow, 2001; ADEC, n.d). Grief counseling often presents complex ethical considerations, including boundaries, confidentiality, and self-disclosure. Supervisors play a key role in supporting supervisees’ ethical decision-making, particularly in balancing authenticity with professional responsibility in grief-related clinical work (Swinden, 2023). Ethical practice in grief-informed supervision also requires sensitivity to potential worldview differences between supervisor and supervisee. Religious or spiritual dissonance may shape how loss is interpreted, how rituals are valued, and how continuing bonds are understood. Supervisors must exercise cultural humility and avoid imposing dominant cultural norms regarding grief resolution, particularly when working with supervisees serving clients from marginalized or disenfranchised communities (Harris & Bordere, 2016). Ethical supervision, therefore, includes creating space for dialogue about cultural and spiritual meaning systems, clarifying the boundaries between personal belief and professional responsibility, and ensuring that interventions align with clients’ sociocultural contexts rather than the supervisor’s or supervisee’s assumptions (Rosenblatt, 2016). Failure to attend to these dynamics may result in subtle pathologizing of culturally normative grief expressions.

The Developmental Process of Grief Competencies

Building on developmental supervision theories and grief competency frameworks, this conceptual framework organizes grief-related supervisee development across five competency tasks: self-awareness, conceptual knowledge, assessment, treatment, and ethics. Supervisee functioning is conceptualized across four developmental levels: Level 1 (beginning), Level 2 (intermediate), Level 3 (advanced), and Level 3i (integrated), reflecting increasing autonomy, reflective capacity, and grief counseling competence. Development is understood as nonlinear and task-specific, with supervisees potentially functioning at different levels across competency domains. Progression may also be shaped by cultural and religious norms that influence emotional expression, authority relationships, and expectations regarding autonomy in supervision. Behaviors that appear as hesitancy, deference, or emotional restraint may reflect culturally normative interactional styles rather than developmental limitation. Supervisors must therefore evaluate grief-related competencies within the supervisee’s sociocultural context.

Level 1: Beginning

Consistent with developmental supervision models (Loganbill et al., 1982; McNeill & Stoltenberg, 2016), supervisees at Level 1 demonstrate high reliance on supervisory structure and limited experience with grief counseling. When working with grief, these supervisees are often new to death, loss, and end-of-life issues, though they may bring indirect or unexamined personal loss experiences into supervision. Clinical focus at this level tends to remain externally oriented toward clients, with limited attention to personal emotional reactions or countertransference (Bernard & Goodyear, 2019).

At this stage, supervisees may have limited self-awareness of the ways in which their own beliefs and cultural backgrounds regarding death and loss shape their conceptualization and practice. Research suggests that without intentional reflection or training, clinicians may avoid grief-related discussions or struggle with unexamined loss experiences (Harrawood et al., 2011; Kaus et al., 2024). Conceptual understanding of grief is often underdeveloped, with reliance on outdated or simplified models and limited familiarity with contemporary grief theories (Akmese, 2025; Ober et al., 2012). Assessment and treatment skills are similarly emerging. Supervisees may have difficulty distinguishing normative from prolonged or complicated grief and may be unfamiliar with grief presentations across developmental or relational contexts (Breen, 2011). Intervention approaches typically rely on general counseling skills rather than grief-specific strategies. Ethical decision-making at this level is also largely dependent on supervisor guidance, particularly in areas such as self-disclosure, boundaries, and managing emotional intensity in grief work.

Level 2: Intermediate

At Level 2, supervisees are in a transitional phase characterized by increasing autonomy alongside fluctuating confidence. Dependence on supervisory structure begins to decrease, and supervision becomes more collaborative, though supervisees may continue to oscillate between self-assurance and uncertainty (Bernard & Goodyear, 2019). In grief counseling contexts, supervisees at this level engage more fully with clients’ grief experiences and demonstrate growing empathic attunement. Their knowledge of grief expands through clinical exposure, training, and supervision, supporting increased independence. At the same time, grief work may activate unresolved personal loss experiences, leading to emotional discomfort or self-doubt if these reactions are not adequately processed within supervision. Supervisees may become more aware of avoidance patterns and begin to grapple with questions related to appropriate self-disclosure in clinical work.

Self-awareness at this level deepens, particularly regarding the influence of personal loss histories, cultural background, and worldview on grief counseling practice. Supervisees increasingly recognize the importance of self-care and the impact of secondary exposure to loss, though consistent implementation may remain challenging. Conceptual understanding of grief continues to develop, with greater recognition of diverse loss types, secondary losses, and variations in grief expression across developmental and relational contexts. Assessment and treatment skills show notable growth, as supervisees become more confident in evaluating grief responses and differentiating adaptive from prolonged or complicated grief, as well as in applying grief-specific interventions. However, guidance is often still needed to determine appropriate timing, selection, and adaptation of interventions. Ethical awareness also increases at this level, with supervisees more actively engaging in ethical reasoning and collaborative decision-making with supervisors rather than relying solely on directive guidance.

Level 3: Advanced

At Level 3, supervisees demonstrate increased autonomy, self-direction, and integration of personal awareness with clinical competence. Professional identity is more stable at this level, and supervision is typically experienced as consultative rather than directive, with supervisees seeking collegial input rather than prescriptive guidance (Bernard & Goodyear, 2019). In grief counseling contexts, supervisees at this level intentionally integrate personal loss experiences and emotional responses into clinical work in ethically appropriate ways, reflecting advanced self-awareness and empathic capacity. They demonstrate confidence in professional judgment, including decisions related to self-disclosure, cultural responsiveness, and the therapeutic use of emotional material.

Self-care practices are more consistently acknowledged and implemented, and discussions of transference and countertransference are approached openly within supervision. Conceptual understanding of grief is well developed and extends to diverse loss experiences, including non-death, ambiguous, and traumatic losses, as well as the intersections of grief with trauma, depression, and anxiety. Assessment skills are more refined, allowing supervisees to confidently evaluate grief responses, differentiate adaptive from prolonged or complicated grief, assess risk factors such as suicidality, and integrate grief assessment into broader clinical formulations. Treatment skills reflect increased flexibility and intentionality, with supervisees effectively selecting and adapting grief interventions across clinical contexts, including individual, couple, and family work. Ethical decision-making at this level is more autonomous and reflective, with supervision primarily serving as a space for consultation, ethical dialogue, and professional refinement rather than directive oversight.

Level 3i: Integrated

Drawing on developmental supervision models (Loganbill et al., 1982; McNeill & Stoltenberg, 2016), supervisees at Level 3i demonstrate fully integrated, autonomous professional functioning and a coherent grief counseling identity. Supervision at this level is largely collegial and consultative, with supervisees independently integrating feedback into a personalized and flexible clinical approach (Bernard & Goodyear, 2019). In grief counseling contexts, supervisees sustain emotional and cognitive presence across complex and atypical loss situations. Personal grief experiences are integrated intentionally and ethically into clinical work, enhancing empathy while maintaining clear professional boundaries. Supervisees demonstrate nuanced awareness of emotional, cognitive, and physiological responses and may initiate advanced discussions of transference, countertransference, and parallel process within supervision or peer consultation.

Conceptual understanding of grief at this level is comprehensive and critically informed, including awareness of emerging research, cultural considerations, and contemporary debates in the field. Supervisees apply grief counseling principles fluidly across individual, couple, family, and systemic contexts and may assume mentorship, consultation, or leadership roles in grief-focused practice. Assessment skills reflect advanced clinical judgment, allowing for nuanced differentiation among complex grief presentations, trauma responses, and co-occurring conditions, with confident and contextually sensitive risk assessment. Treatment skills are intentional, adaptive, and integrative, with supervisees flexibly drawing on multiple theoretical approaches to meet diverse client needs. Ethical functioning is highly developed, with supervisees independently identifying and addressing subtle ethical dilemmas. At this level, supervision serves as a collaborative space for reflection, professional refinement, and continued growth rather than structured oversight.

Consistent with the framework’s developmental assumptions, functioning across competency tasks remains nonlinear. Supervisees may demonstrate differing levels of competence across domains, and personal or professional loss experiences may temporarily shift supervisory focus. This variability underscores the dynamic interplay between professional development and personal grief within grief-informed clinical supervision.

The Supervisees’ Loss Experiences in Their Professional and Personal Lives

Loss of a Loved One

The loss of a loved one is a universal experience, triggering unique emotional, cognitive, and behavioral responses such as sadness and isolation (Shear et al., 2011). While grief generally becomes more integrative over time, some individuals experience prolonged grief disorder (PGD), characterized by persistent emotional pain lasting more than a year (APA, 2022). Counselors facing such losses may struggle with their professional work, especially when the loss is unexpected.

When addressed, mental health providers’ grief can enhance their ability to support grieving clients (Worden, 2018). However, providers with unresolved grief may find it difficult to assist clients experiencing similar loss (Worden, 2018). New providers working under supervision may need additional support to address personal grief while maintaining focus on client welfare, as emphasized in the ACA Codes of Ethics (2014). Ignoring providers’ grief can lead to disenfranchised grief, where the loss goes unacknowledged, potentially exacerbating grief complications (Doka, 2002). For instance, one provider in Swinden’s (2023) study was assumed to have resolved her grief, which went unaddressed in supervision. This assumption contradicts the understanding that grief is non-linear and fluctuates (Stroebe & Schut, 1999, 2010). Another provider shared that grief sometimes felt overwhelming, other times manageable (Swinden, 2023).

Studies show that mental health providers’ grief affects their professional work. For example, Vamos (1993) felt she failed her clients after her husband’s death, and Shapiro (1985) struggled to be present after losing her mother. Providers may hesitate to discuss their grief in supervision due to fears of judgment (Swinden, 2023). One provider described feeling “awkward” discussing personal grief (Swinden, 2023, p. 373). Grieving clinicians also face challenges deciding when to return to work. Swinden (2023) found that providers sought advice from family and colleagues but were discouraged from returning due to concerns about emotional collapse. Additionally, providers often struggle with how much to disclose about their loss when rescheduling or referring clients. Over-disclosure risks shifting focus from the client, while under-disclosure can undermine authenticity and damage the therapeutic relationship (Swinden, 2023). Kingston and Nel (2022) highlight the importance of self-reflection for providers, noting that personal grief can be a valuable resource in therapy.

Loss of a Client

Mental health providers’ emotional responses to the death of a client often resemble the universal human reactions to losing someone meaningful, while also including professional and role-specific responses related to their clinical responsibilities and ethical accountability. Research has reported that bereaved therapists experience personal and professional responses to the death of a client, including shock, disbelief, anger, sadness, guilt, relief, difficulty concentrating, sleep disturbance, the feeling of incompetence, increased attention to suicide cues, and record keeping, and/or avoiding working with severe clients (Linke et al., 2002; Ting et al., 2006; Veilleux, 2011). Although there are no studies investigating risk factors for bereaved clinicians, based on the literature investigating general risk factors, unexpected (violent) deaths may cause higher grief severity for clinicians. For example, those who lost a client to suicide may more likely experience grief complications due to professional responsibility (Veilleux, 2011). In addition, years of experience is also a significant factor influencing grief responses. Gitlin (2007) noted that counselors-in-training typically report more intense grief reactions to losing a client to suicide.

In addition, bereaved clinicians may struggle to adjust to the reality of the loss if they had no experience with death before the client’s death. In an autobiographical case study reflecting on the death of a client who died due to a heart attack but with suspicion of suicide, Veilleux (2011) reported that “let alone the knowledge of how to process a death with professional implications… I attempted to find guidance from the literature on how I was ‘supposed’ to feel” (p. 226). Moreover, the clinician indicated actively searching for more information regarding the client’s death and whether his intention was to die (Veilleux, 2011). The sense of being left behind with unanswered questions seems to be causing complications regarding the clinician’s role in the client’s death. Furthermore, the clinician noted a need for their emotions to be normalized when they felt relief because they no longer needed to deal with being challenged by the client, which led to “overwhelming professional guilt” (Veilleux, 2011). Fear of contacting a client’s family is also common for clinicians, especially following the death of a client to suicide. Clinicians may struggle to make decisions regarding attending funerals and how much information to disclose to the family.

Overall, the death of a loved one and/or a client presents numerous personal and professional challenges for clinicians, which can be overwhelming and impact their ability to work with clients effectively. Therefore, clinical supervision becomes crucial in addressing grief and offering support to counselors as they navigate the adjustment to a personal loss while continuing to provide grief counseling.

Roles Identified to the Supervisor in the Grief-Informed Clinical Supervision Framework

According to the discrimination model of supervision, three basic roles have been identified in supervision: teacher, counselor, and consultant (Bernard, 1979, 1997). The role of the supervisors is dynamic and may change based on the needs of the supervisee (Timm, 2015). As it was stated in the development of supervisee’s grief counseling competencies and the grief competency tasks, supervisee’s needs can differ, and the supervisor’s role can be shaped based on the supervisee’s personal loss experiences, competency in grief, and the resolution status of that loss.

Figure 1 illustrates how supervisory roles align with these variables across different developmental levels of grief counseling competence. For example, if the supervisee with personal loss experience has low competency in grief (level 1) and the personal grief experience is resolved, the primary identified role in supervision is a teacher. At this level, supervisees need to learn about grief, death, and dying. The supervisor needs to teach and help the supervisee explore grief and bereavement. The supervisor also has a role to inform and/or teach evidence-based practices while working with clients who are experiencing grief and loss.

Figure 1.

Roles identified to the supervisor

Alternatively, the supervisor may take on a counselor role when a supervisee, regardless of competency level, is navigating unresolved personal grief. Supervisors may help supervisees increase their self-awareness of their experiences and worldviews and the potential impact of them on conceptualizing supervisees’ clients. Supervision may explore supervisees’ grief only as it affects clinical work. When personal issues exceed this scope, supervisors should maintain boundaries and recommend personal counseling. On the other hand, the supervisor’s primary role is consultation if the supervisee experiences a personal loss, has high competency in grief (level 3 or 3i), and the personal grief experience is resolved. Finally, in situations where the supervisee has low competency (1) and unresolved grief, the supervisor often assumes a blended role of both teacher and counselor, simultaneously facilitating skill development and personal reflection to address emotional barriers to effective grief counseling. These roles are not fixed and may shift within and across supervision sessions as supervisee needs evolve.

The effectiveness of grief-informed clinical supervision may also be shaped by relational dynamics within the supervisory dyad. Research in grief-specific treatment contexts indicates that early alliance quality and agreement on therapeutic tasks are associated with improved outcomes in Complicated Grief Therapy, underscoring the importance of relational safety when engaging emotionally activating loss-related material (Glickman et al., 2018). Attachment-informed models of supervision conceptualize the supervisor as a potential secure base, particularly when supervisees encounter vulnerability, countertransference, and existential themes related to grief (Mammen, 2020). Empirical synthesis further suggests that supervisee attachment strategies are significantly related to supervisory relationship quality, although the magnitude of this association is modest (McKibben et al., 2023). Given the emotionally evocative nature of grief work, attention to supervisory alliance and relational patterns may therefore facilitate effective implementation of grief-informed supervision.

Proposed Supervisory Protocol for Grief-Informed Clinical Supervision

The Integrative Conceptual Framework for Grief-Informed Clinical Supervision may be implemented through a structured and iterative supervisory process. Clinical supervisors should begin by initiating a conversation with their supervisees about grief and loss. Supervisors initiate focused dialogue exploring death-related and non-death-related losses, client deaths, and the perceived resolution status of these experiences, as well as their potential impact on current clinical work. This can be achieved through carefully crafted questions that encourage supervisees to reflect on their personal experiences with grief and how these experiences may affect their clinical work. Supervisors are encouraged to assess their supervisees’ grief experiences and whether those experiences are resolved or ongoing. This assessment can be done through self-report, observation, and/or discussions during supervision. Identifying whether grief is unresolved or reactivated is crucial, as it may influence supervisees’ ability to work with grieving clients effectively. Next, supervisors should assess the supervisees’ clinical decision-making, emotional regulation, and responsiveness to grieving clients. Next, supervisors should assess the supervisees’ formal and informal training in grief counseling, gauging their perceived competency in working with grieving clients. It is important to determine whether the supervisee feels adequately prepared to address grief and loss in their clients and to explore areas where additional training or support may be necessary. Competence is considered across the five grief counseling domains outlined in the framework: self-awareness, conceptual knowledge, assessment skills, treatment skills, and ethical decision-making. This step clarifies whether additional instruction, modeling, or targeted skill development is needed.

Once supervisors have an understanding of their supervisees’ grief experiences and training, they should assess their developmental stage and determine their dominant role within the supervision process. Based on these assessments, supervisors determine supervisees’ developmental functioning within grief counseling tasks and align their supervisory role accordingly. Depending on the supervisees’ needs, this role may shift, with supervisors acting as teachers, counselors, or consultants. When knowledge or skill deficits are primary, supervision may emphasize a teacher role; when unresolved personal grief influences clinical functioning, a counselor role may be prioritized to facilitate reflective processing; and when supervisees demonstrate advanced integration and autonomy, supervision may function more consultatively. In some situations, a blended role may be required. Supervisory roles remain flexible and responsive to supervisee development and clinical context.

Finally, based on these assessments, supervisors should work with their supervisees to set supervision goals focused on enhancing grief counseling competencies. These goals should be tailored to the supervisee’s developmental level and personal experiences with grief and loss, with a focus on improving self-awareness, conceptual skills and knowledge, assessment skills, treatment skills, and ethical skills. Goals may target strengthening theoretical understanding, refining grief assessment, enhancing intervention flexibility, improving management of countertransference, or clarifying ethical decision-making. These goals are revisited periodically, particularly following new loss experiences or shifts in caseload complexity, ensuring that supervision remains responsive and supportive of ongoing professional growth. Through this structured yet flexible process, the framework functions as an operational supervisory model that supports supervisees’ emotional well-being and competence in providing effective grief counseling.

Beyond its developmental structure, this framework should be understood as culturally situated rather than culturally neutral. Grief is shaped by sociocultural, religious, and communal meaning systems that influence beliefs about death, emotional expression, continuing bonds, and appropriate adaptation to loss (Rosenblatt, 2020). Accordingly, grief-informed clinical supervision must extend beyond skill development to include reflexive dialogue about cultural positioning, power dynamics, and the potential imposition of dominant grief norms. Integrating principles of cultural humility and social justice into supervisory practice strengthens the framework’s capacity to support supervisees working with clients from diverse and historically marginalized communities (Harris & Bordere, 2016; Rosenblatt, 2016). In this way, the framework not only organizes grief counseling competencies but also promotes culturally responsive and ethically grounded supervision practice.

Strengths and Limitations of the Integrative Conceptual Framework for Grief-Informed Clinical Supervision

As a conceptual framework, this work has not been empirically tested and is not intended to function as a prescriptive model of supervision. Rather, it is designed to organize existing scholarship on grief counseling competencies and clinical supervision, with particular attention to supervisees’ personal and professional loss experiences. Several additional limitations should be noted. Empirical research is needed to examine the framework’s applicability, utility, and relevance across diverse supervisory contexts. The framework also emphasizes individualized supervision processes, which may result in variability in implementation depending on supervisee needs, supervisory style, and institutional or training settings. Finally, the framework assumes baseline grief counseling competence among supervisors, consistent with ethical expectations that supervisors practice within the boundaries of their training and expertise. Future research should examine supervisors’ grief-related competencies and identify training pathways that support effective grief-informed supervision. Because the framework was developed primarily from counseling and psychology literature, its applicability across diverse sociocultural and religious contexts warrants empirical evaluation.

Conclusion

This paper proposed an integrative conceptual framework for grief-informed clinical supervision that synthesizes developmental supervision theories and grief counseling competency frameworks. By centering supervisees’ developmental processes, grief-related competencies, and personal and professional loss experiences, the framework offers a structured way to conceptualize grief within supervision practice. Future research is needed to examine grief-informed supervision processes and their implications for clinician development, well-being, and the quality of care provided to grieving clients.