On the internet, anyone can be a grief therapist now

This story was reported and originally published by MindSite News, a nonprofit digital news site focused on mental health. Republished with permission.

On a Sunday afternoon in February of 2022, a daunting task loomed before me. I had to document my competency for a certificate in grief therapy, although I had no background in mental health. I logged into a continuing education company’s website and launched the six-hour pre-recorded workshop. 

Then I pressed the mute button and went about my day. I baked garlic bread, caught up with some friends, binged a Netflix show and took a nap.

Six hours later and $239.50 lighter, I took the final test. My grade was 35 out of 38; I passed with flying colors. I proudly downloaded my “certificate of successful completion” from a continuing education provider called PESI, although I had no intention of actually hanging out a shingle as a certified bereavement practitioner.

Why would I do such a thing? I’m an investigative reporter, and I wanted to see how hard it would be to game the system and pass the test without taking the course. As it turned out, it was ridiculously easy: The answers to the final quiz are summarized on the handouts shared prior to the test. 

Like several other online education organizations, PESI provided certifications in grief counseling for non-professionals and professionals alike. I applied for my Grief Informed Professional certification offered by Evergreen Certifications, a company owned by PESI. But Evergreen rejected my application, informing me that I needed to  demonstrate a background in mental health. 

However, the grief therapy industry was buzzing with other options, and I turned to an online education outfit called Udemy, signing up for its “Grief and Bereavement Counselling ACCREDITED CERTIFICATE”  – advertised for just $9.99, reduced from $94.99. The course was described as a “first step towards a professional career as a ‘bereavement counsellor.’” This turned out to be an even speedier ride than PESI. I bought the course at 1:37 am and received my certificate of completion at 1:39 am.

Wait, what?! Here’s a breakdown of the blitzkrieg: The course was divided into 24 lectures; I clicked the checkbox next to each of them to confirm my attendance and moved on to the 10-question quiz, which was the last requirement to obtain my certificate. Then, as I was answering the second question, my certificate arrived by email. Call me a teacher’s pet but I felt that I should finish the test anyway. I did, earning a 100% score without opening any of the lectures or studying the material.

A Udemy representative who responded to my interview request declined to talk about the certificate because, she said, she was “not a certified mental health professional.” 

“When we get to the area of certifications, it’s the Wild West,” said Jason Washburn, a board-certified clinical psychologist, professor and chief of the psychology division in the Department of Psychiatry and Behavioral Sciences at Northwestern University. “There’s absolutely no governance…because it’s not regulated by the state or by the [U.S.] Department of Education.”

Why grief counseling has boomed

With COVID-19 deaths well past 1 million in the U.S. and 6.5 million worldwide, the demand for grief counseling has exploded. Every death has a profound impact on approximately nine people, according to the University of Cambridge. Two years into the pandemic, a report showed that the percentage of Americans suffering from anxiety and depression has tripled, and drug overdoses and alcohol-related liver disease have risen as well. For some, the experience of bereavement can morph into something much deeper – an unshakable sadness that psychologists call prolonged grief disorder and is often misdiagnosed as depression.

Grief counseling is also in demand in the criminal justice system: Grief counselors have worked with bereaved prison inmates and are sought after for families enmeshed in substance use disorder. Inspired by work from restorative justice advocates, courts in numerous states from California to Alabama have ordered grief counseling as part of mandated treatment  for people in criminal diversion programs – all changes that experts view as bellwethers of a less punitive future.

However, there’s a tremendous shortage of trained and licensed mental health professionals to meet the demand for therapy, creating a market opportunity for people even without clinical training and licenses to work as grief therapists. To do that, they need something that attests to their knowledge –  certification.

And that’s where things get confusing. Being certified in grief counseling doesn’t mean someone is a licensed counselor, but to the general public, it seems like the same thing: A certification can be easily mistaken for a professional license.

Colleges and universities provide education and training in disciplines such as social work, counseling or psychology, culminating in an advanced degree. State boards administer exams and issue licenses to these professionals, giving them the right to practice. Certifications are legal, but they are neither a degree nor a license.

Adding to the confusion, many clinical professionals do seek additional certifications for specialized training in narrower areas, ranging from counseling for pet loss to trainings in preventing and treating patients for adverse childhood experiences (ACEs) and toxic stress. Even for mental health professionals, specialization in working with bereaved people is an important need, because few have been trained in this work through their degree programs. 

“You can go through the entire graduate curriculum in psychology and social work, even, astonishingly, in chaplaincy or palliative care and nursing, and never hear the word grief,” said Robert A. Neimeyer, a psychology professor at the University of Memphis who also directs the Portland Institute for Loss and Transition, which offers training and certification in grief therapy.

Most professionals have to take continuing education (CE) credits to maintain their licenses and certifications. Taking CE courses is critical, said Gerald Koocher, an attending psychologist at Boston Children’s Hospital and  senior lecturer in psychiatry at Harvard Medical School. “Within about seven or eight years after you graduate…half of what you learned is obsolete,” he said.

And while state licensing boards appear to do an adequate job of screening CE credits, certification providers may not. Perhaps the biggest reason: The terms “Continuing Education Credit” or “Continuing Education Unit” are not legally protected – meaning no organized body controls them – and are thus available to any education provider that wants to issue them. And if patients looking at their grief counselors’ certificates on the wall cannot tell the difference, what then?

In 2020, Washburn of Northwestern University co-authored a study on specialty mental health certifications with two colleagues, including Gerald Rosen, a psychologist and clinical professor emeritus in the department of psychology at the University of Washington in Seattle  They gave a “Certified Clinical Trauma Professional” certification test and materials to a 14-year-old, the daughter of an author’s friend. She answered all 50 questions correctly thanks to matching sentences in the study guide. 

In a caustic abstract, the authors wrote: “We demonstrate that an 8th grader with no prior mental health education or training can pass a test intended to assess expert levels of knowledge obtained from a workshop.” 

Rosen, in fact, remembers when qualifications were even more lenient. “In the 1970s, you didn’t even need to have a high school degree,” he said. “It was unbelievable. Anyone could call themselves a counselor.”

Credentialing: Not the cat’s meow

But the three professors weren’t the first ones to go after the certification industry.

Two decades ago, Steve Eichel, a psychologist known for his research on destructive cults and mind control, grew increasingly exasperated and dubious of credentials in his profession. He decided to credential his cat – yes, you read that right – to showcase the lack of checks and balances in the industry. “This was a surprisingly easy thing to do,” he wrote in an article published on his website.

Eichel was compelled to explain himself after a reporter wrote to him in 2002 asking how to reach Dr. Zoe D. Katze. “The cat is out of the bag,” he wrote. “Dr. Zoe D. Katze, Ph.D., C.Ht. is a cat. In fact, she is my cat. Those familiar with basic German have probably already enjoyed a laugh. ‘Zoe Die Katze’ literally translates to ‘Zoe the cat.’”

He reported that his cat’s credentials looked impressive and that she had been certified by three major hypnotherapy associations, “having met their ‘strict training requirements’ and having had her background thoroughly reviewed.”

The psychologist was driven to certify his cat, he wrote, after hearing too many prospective clients complain that they had found someone else “with all these certifications and diplomas and he/she charges half of what you psychologists charge.” His breaking point came when he discovered another colleague online who had a PhD from “a notorious diploma mill” and listed “a veritable alphabet soup” of certifications and diplomas after his name. 

After Eichel added Zoe as an “authorized user” on his credit card, everything fell into place. “In the nefarious world of quasi-credentialing and diploma scams, money talks. Or at least it meows,” he wrote. After Dr. Katze received one credential, other associations that had reciprocity agreements awarded more. “Not bad for a cat that’s not even a purebred,” he wrote.

Eichel noted that a banker asked for Zoe’s social security number, but “cheerfully relented when I told him it would take me some time to search for it.” The certification industry isn’t responsible for the banker’s lack of rigor, of course, but Eichel’s point still holds: It’s far too easy to pass these tests and get certified.

Eichel turned more serious when he discussed the meaning of his cat’s credentials. He dismissed the idea of stricter laws on credentialing, which he thinks would do more harm than good, since what constitutes “good” therapy is hard to define. However, he called on readers to help monitor themselves, “to examine our own motivations for obtaining credentials (both legitimate and dubious), to police ourselves and our own professions, and to do our best to educate the public.” 

The tale of Dr. Zoe D. Katze, Ph.D., C.Ht, made a lasting impression on the experts I spoke with. Twenty years later, not once did a source fail to mention the story to me. Because 20 years later, it seems like almost no progress has been made.

Online grief courses abound

For consumers, certifications are supposed to signify a set of minimum competencies. But in a competitive market, credentials have also become an avenue to distinguish yourself. Quite naturally, some professionals are attracted by less expensive and less time-consuming courses that offer a quick way to get visibility or access to a network of prospective clients.

I looked into six grief recovery and/or counseling certification courses for this story. Four of them – offered by the Grief Recovery Institute, the Global Grief Institute, PESI and Udemy – are among the first to come up in an internet search for grief therapy certification. Two others are offered by professional associations. I found that the rigor, the work required and the education prerequisites to seek certification varied widely.

The Global Grief Institute, for example, which urges people to “get your piece of the $100 Billion dollar Coaching industry,” doesn’t require a college degree; in fact, it appears to discourage participants from getting one (see Facebook posting, left). It’s able to certify mental health newbies like myself because it markets its courses under the term “coach” – and coach isn’t a protected job title in the U.S.; neither is “professional” or “specialist.” Protected job titles such as psychologist or social worker require completion of specific training courses, usually a graduate degree in psychology or related fields. 

Interestingly, the designation “counselor” isn’t protected equally across the country, either: Most states require counselors to obtain a license to practice. But certain states allow unlicensed counselors to practice if they don’t advertise themselves as licensed.  

Since laws differ from state to state, the landscape is difficult to navigate for patients as well as professionals seeking to get certified. Of the four commercial certification outfits, one is being sued for deceptive pricing and has racked up hundreds of outraged consumer complaints. (See accompanying summary of other grief counseling training organizations and of two rigorous professional certification providers.)

APA stamp of approval?

The credentialed cat experiment – and most recently, my own experience – underscore that certification for grief practitioners needs improvement. The mental health field has always strived to become as credible and respected as regular health care, and the concept of certifications and credentials, in fact, comes from medicine. 

You can ask a surgeon for his track records of successful operations, or a gastroenterologist about his rate of successful colonoscopies. But how do you apply this level of rigor to a profession often characterized by subjectivity? How do you make sure counselors in general are skilled and reputable? 

Certification attempts to address these questions, and not all the training is questionable, of course. The American Board of Professional Psychology (ABPP), for example, issues well-regarded certifications that involve extensive work and prerequisites. 

Without an oversight agency, many look to the American Psychological Association as a gatekeeper. The APA has a section of its website called “Approved Sponsors of Continuing Education” – CE providers the association recognizes as trustworthy and professional. Udemy is not on it. Neither are the Global Grief Institute or the Grief Recovery Institute. But PESI is, and you can click through to its listing of classes and webinars.

APA’s list is theoretically only relevant for psychologists. However, the APA does approve sponsors of CE courses created by laypeople if they meet its lengthy standards and criteria for CE content. The APA’s seal is widely seen as a stamp of approval – and PESI, for example, advertises the APA seal on its own website.

Is there a gatekeeper in the house?

Perhaps it’s not necessary to have a professional background to be an effective grief coach or peer counselor.  Many people who want to enter the field mention that they have experienced grievous losses of their own that motivate them to help other people in their suffering.

There is also a growing movement of people with lived experience with mental illness and recovery who want to use their experiences to help others. Peer support specialists are even eligible to be paid for their work with funds from the federal Medicaid system – if they have completed training and certification programs sanctioned by each state. 

So what’s the harm in the lack of strict national standards in the grief counseling industry? To begin with, peers and others who want to work with people who are grieving deserve the best possible training. At present,  professionals and non-professionals alike may pay for continuing education that isn’t optimal or even scientifically valid.  More importantly, patients dealing with profound grief could find themselves working with people who have no real training – beyond an easily passed on-line course.

Jolene Formaini, a retired nurse who ran a bereavement program for a Pennsylvania hospice, recalls the story of a mother grieving over the death of her college-aged daughter. She sought help from a woman who billed herself as a “certified”  grief counselor but had no clinical training. When Mother’s Day came, her counselor sent her flowers and a card signed with her daughter’s name. 

“She was crushed,” says Formaini. For this mother, it felt like going back to square one in her grieving process. “There is no course in the world that would say that’s okay,” says Formaini. She believes marketing oneself as a certified grief counselor despite not completing any appropriate program is “dangerous.”

Licenses and board certifications, at least, give patients an avenue to complain. Psychologists certified by the ABPP can lose their certification if sanctioned by the licensing board or even have their license revoked. An unlicensed counselor, therapist, coach or professional who’s been handed bogus credentials isn’t held to a set of minimum standards.

“If somebody just calls themselves a grief counselor and they give you bad advice, there’s no profession for you to appeal to. No one regulates their behavior,” said Gregory Neimeyer, the APA’s associate executive director for professional development and continuing education. 

And gatekeepers are hard to find: Counseling and psychology have become increasingly specialized and universities don’t have the resources to provide hyper-specific training. States don’t want to halt innovation since they can’t keep up in creating specialized licenses for each new, potentially effective therapy. National boards and associations are shackled by lack of time and resources.

That means people needing help with their grief may face unexpected hazards, experts say.

“We want to raise the awareness of the public that you should be careful when somebody says they’re certified, to make sure that they’re certified by something that’s bona fide within the profession,” said Washburn.

Kathy Richardson, a licensed counselor and assistant professor at Rosemont College, advises patients to ask grief practitioners about their educational background and training before committing: “Where were they trained? What’s their educational background? Did they just get a Black Friday deal or 50% off a workshop and they went ‘now I’m a world renowned grief specialist?’”

Down the rabbit hole

Richardson’s words were ringing in my ears as I opened a new tab. A quick internet search on “How to get a certification in grief counseling” displayed an attractive offering: a certification with “a minimum of 6 hours of continuing education in specific grief counseling topics.” I clicked on the link. It led me to Evergreen Certifications, a private company that provides certifications in behavioral health, healthcare, speech-language, physical therapy, occupational therapy and education. I emailed the company, identified myself as a journalist, requested an interview and got an automated acknowledgment – but no further reply or interview opportunity.

I continued my research. Of the four grief recovery courses approved by Evergreen, two were available through PESI, a leader in healthcare continuing education. PESI markets mostly to health care professionals, but it also allows non-professionals (in categories such as ‘parent/guardian’) to take various courses.

Unlike other continuing education providers, PESI doesn’t give out certifications. It provides the training and credits required to qualify for certifications from Evergreen and others. I thought PESI and Evergreen were separate entities, but court and tax records show that PESI actually owns Evergreen, which was founded in 2017. To my knowledge, this hasn’t been advertised by either organization. (For more on PESI’s internal financial workings, see here).

“We don’t hide the fact that [Evergreen is] part of PESI, but we don’t feel the need to also advertise it because it does sit as its own entity,” PESI’s deputy director Michael Olson said in an interview. “Evergreen standards will honor education from any provider that meets the standards.” The cost for PESI’s Grief Treatment Certification Training course was $219.99 for a $439.97 value, according to its website. 

I wasn’t especially lucky to get this deal since the online course has almost always been on sale. Since enrolling in PESI’s certification program a year ago, I have received 808 promotional emails for various courses, seminars and workshops – more than two a day on average. Anything is fertile ground for massive discounts: summer sales, Memorial Day sales, spring sales, St. Patrick’s Day sales, and Valentine’s Day sales.

The completion of PESI’s Grief Treatment Certification Training relied on self-monitored attendance records and a multiple-choice quiz. This was the test I was able to pass on that Sunday afternoon of bread-baking, with a certificate of completion available to download soon afterward.

But could I finally advertise myself as a certified grief and bereavement practitioner? This was still unclear. The documents I received from PESI and Udemy were indeed certificates, but they did not mention “certification.” This distinction is confusing but critical. 

My certificates – also called certificates of successful completion – are proof that I attended and completed a course. That paves the way for students to apply for certification, which allows you to add a multitude of letters after your name: CGP for instance (Certified Grief Professional). In fact, several of my fellow Udemy classmates had already posted various diploma-like certificates to the “Licenses and Certifications” section of their LinkedIn profiles. Some of them were mental health professionals; others were not.

I noticed a similar trend scrolling through the forum page of the PESI course I took. The drop-down list of professions upon signing up included non-professional occupations such as “teacher,” “school administration,” “physical therapist,” “audiologist,” “massage therapist,” “coder,” “attorney,” and even “HR professional.”

I was uncertain how to identify myself since the multiple-choice boxes included no category for journalist, so I initially checked the first one: “Counselor,” then changed to “parent/guardian” since that was the closest I could find to my situation. 

When  I called  Evergreen to find out why I had never been issued a certification,  a customer service representative explained that I had to be a licensed mental health professional.  That’s not what PESI’s director Michael Olson told me, however.  He said in an interview that the certification would be different than a mental health professional’s, but that non-professionals are eligible to get certified if they pass the test.

Either way, I had another option now. The Grief and Bereavement Counselling course offered by Udemy is accredited by the International Association of Therapists (IAOTH), an organization based in the U.K. I promptly signed up for a membership, adding both my Udemy certificate and the PESI one to the qualifications section. 

And today – voilà – here I am: listed on the association’s website and ostensibly available for hire.

– Rappler.com

Astrid Landon is an audio reporter, editor and producer working in Paris, Madrid and the United States. She is also an investigative journalist writing about healthcare and the mental health system in the United States and France. Her stories have appeared in the Guardian, France Televisions, Libération, AreWeEurope, Challenges, and other outlets.

This article has been republished from Coda Story with permission.