Tools and Techniques for Establishing Trust in Virtual Therapy

MacBook Pro near white open book and coffee

Written by Kerem Okumus,

Now that virtual therapy seems to be becoming a common practice among therapists, there appears to be a question of establishing and maintaining a trusting relationship with patients.

It is much easier to establish trust and create a sense of intimacy during a face-to-face conversation than online. Nuances in body language, eye contact, and facial expressions can be easily missed or misinterpreted when communicating via a screen.

Moreover, you do not have the advantage of creating the right environment for sharing, e.g., using nice lighting, candles, or cushions for comfortable sitting.

It is much harder to create a comfortable environment when providing online therapy, but there are ways to do it successfully.

In this article, you will find some tips and tools that may help you create a peaceful atmosphere and develop trusting relationships with your patients. Hopefully, our guidelines will help you provide effective online counseling!

Creating a Truly Confidential Online Environment

Confidentiality is essential for the creation of a therapeutic alliance. Therefore, to establish trust, you should pay special attention to creating a safe environment in which the client knows that their privacy will be protected.

Platform Choice and End-to-End Encryption

The first thing to consider when choosing the platform for providing online therapy is the issue of the platform’s compliance with HIPAA.

Luckily, today there are many HIPAA-compliant teletherapy platforms that can help you with the provision of online therapy. Such platforms as Doxy.me, Zoom for Healthcare, and SimplePractice use end-to-end encryption that provides security.

Discussing the platform and its advantages and features can help you to create a safe environment.

Authenticated Access

Two-factor authentication (2FA) for the teletherapy account may be a very useful tool for improving the privacy of online therapy.

This method requires the user to complete an additional step of authorization (e.g., entering a verification code). Thus, even if the password was somehow stolen, the account will not be available to any third parties.

Privacy Tools to Protect Client Data

Along with the usage of a HIPAA-compliant platform, one more step that you may take to protect client data and create a confidential environment is the use of additional privacy tools.

If you conduct online therapy or receive any sensitive information on the computer, using a VPN service for PC can be helpful for protecting your internet connection from any interceptions.

Using general privacy tools can be an additional measure that will help you to create a more protected online environment.

Therapeutic Alliance: Tips for Creating Rapport Online

The success of therapy is often dependent on the therapeutic alliance that a therapist creates with his or her patient. Moreover, in order to create such an alliance, therapists spend a lot of time.

In the era of virtual therapy, when more than half of sessions are conducted remotely (either online or over the phone), creating a rapport without meeting patients face-to-face takes even more effort.

So, what may be helpful in such cases?

Being Verbal and Listening Actively

Every therapist knows that active listening is essential for the process of therapy. However, in-person interaction gives us the opportunity to read the client’s nonverbal signs and react to them. In the case of virtual therapy, these nuances can be missed.

Thus, being verbal and listening actively becomes more important in the case of virtual therapy. Tone, pauses, and choice of words become more significant in the process of communication. The demonstration of your engagement also becomes more important.

The repetition of the client’s words or the summarization of what he or she said can be very helpful in demonstrating that you are really paying attention to him or her.

Such words as “I hear you” or “that makes sense” can also be very useful in the case of virtual therapy to help the client realize that he or she is understood.

Nonverbal Communication

Establishing eye contact is another important thing to build trust with the client, but it becomes harder in the case of virtual therapy. Nevertheless, there are some things you can try.

For instance, positioning your camera at eye level can help you in the process of communication, as well as being visually present and engaging.

Not every client can feel comfortable being on camera, and it should be respected, but, nevertheless, video and audio can help in the process of creating rapport.

Some platforms, such as Zoom, have the “hide self view” option so that the client does not see himself or herself but still sees you. At the same time, you can still see him or her.

In the case of virtual therapy, the more expressive you are, the better. Some subtle cues cannot be easily understood by clients during the process of virtual therapy; thus, being more engaged and expressive, and using some nonverbal cues such as hand gestures can be very useful.

Setting Expectations and Boundaries

Talking about boundaries, the duration of the session, and the expected response time can be helpful in creating the right environment. In addition, it is important to discuss the confidentiality of the communication and protection of the client’s personal data.

It may also be helpful to have a simple backup plan so that you both know what to do in case of any problems with the connection or platform.

Conclusion

Providing therapy online definitely changes the way of building trust but makes it no less possible. It is just necessary to be more thoughtful and purposeful in the way you are communicating and creating a safe environment for your client.

Even small things become more important in the virtual environment. How you listen, how you react, how present you look, and how clearly you handle the issue of confidentiality all influence the feeling of your client about the safety of the environment.

About the author

Kerem Okumus is an Outreach Executive at Intseo Media, where he focuses on SEO outreach, publisher communication, and digital content partnerships. He has experience working with content covering technology, online privacy, cybersecurity, and other digital topics. 

 

 

 

Please also review AIHCP’s Grief Counselor Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

How to Specialize in Grief Counseling for Life-Altering Injuries 

Sad woman in a wheelchair suffering with grief. Written by Deepika,

Grief is a complex process, one that involves some type of loss in most cases. Not everyone possesses the internal resources needed to deal with overwhelming or crippling grief. While this emphasizes the demand for grief counselors, it’s important to understand that their role is not confined to a box. 

Many people only think of bereavement when a major loss is discussed. What about a life-altering injury that can leave someone grieving abilities they once had, a career they valued, or a future they had dreamt of? These losses can be just as important to address as the physical effects of the injury. 

Healthcare professionals interested in this area can specialize in grief counseling to support patients through a part of recovery that medical treatment may not suffice for. This article explains how to prepare for a specialization in grief counseling to support people after catastrophic injuries. 

Understand How Grief Works When Life is Forever Changed by Injury 

The first thing about injury that every healthcare professional must understand is that it is not always the same. As the Loewy Law Firm notes, a catastrophic injury causes permanent damage to the body and makes the victim unable to return to their former life or work. 

What differentiates a catastrophic injury from other kinds is the duration and the intensity of medical care required. Here, instead of losing another person, the individual may be coming to terms with changes in their body, abilities, independence, or the future. Such losses can continue to affect them long after the initial injury and medical treatment. 

At the heart of it, a patient may be grieving several changes at the same time, including:

  • The loss of mobility, strength, coordination, and other physical abilities
  • The need to seek help with activities that were previously normal or private 
  • Being unable to return to a former career or support themselves in the same way 
  • An unexpected change in responsibilities and relationships because of the injury 
  • The internal struggle with changes in appearance or the roles that once shaped their sense of self 
  • Having to reconsider plans or goals that once seemed achievable 

The reason such injuries are called life-altering is that their physical and emotional effects are severe. A 2025 study of people with moderate-to-serious brain injuries found that almost half of the participants continued to experience symptoms of anxiety/depression eight years after their injury. 

Moreover, difficulty dealing with the effects of the injury was also associated with higher emotional distress and poorer quality of life. Family and friends can provide valuable support, but they may not know how to deal with the situation. Motivating a patient to ‘stay positive’ or focus only on physical health leaves no room to process their loss. 

For healthcare professionals counseling victims of catastrophic injuries, this means looking beyond the immediate physical consequences of the injury. A counselor also needs to help clients express difficult emotions, work through changes in identity, and understand how their losses are affecting their relationships/future. 

 

Build the Skills to Guide Others Through Grief 

A general understanding of grief is not enough to counsel someone after a life-altering injury. There are several things patients often deal with at once, including physical disabilities, family responsibilities, changes in work, and plans for the future. 

A counselor must be able to understand such different concerns without assuming that every patient experiences them in the same way. So, what are some important skills professionals interested in becoming a grief counselor for catastrophic injuries must develop? They include the following:

  • Active listening, as patients require time and room to open up about their difficult experiences and emotions 
  • Empathy without reservations, as two people with similar injuries may grieve very differently 
  • Trauma-aware communication, where calm, respectful language is used without any pressure on patients to discuss their painful experiences 
  • Respect for independence, as patients need opportunities to make choices wherever possible to retain a sense of control 
  • Awareness of serious emotional concerns, since counselors must recognize when grief may occur alongside major depression, anxiety, or thoughts of self-harm 

A 2026 CBS News report showed how recovery can continue long after the initial injury. It shared the story of Hannah Strom, who survived a 2020 crash that injured 10 students and their coach. The incident left her with a broken leg and pelvis, a collapsed lung, and a traumatic brain injury (TBI). Over six years later, she was working as a rehabilitation aide at the same hospital where she had recovered. 

The report also highlighted the importance of looking beyond the immediate treatment of a serious injury. From the outside-in, a bird’s-eye view would suggest the need to prevent such injuries in the first place. 

Joseph Nugent, a fourth-year resident neurosurgeon at Oregon Health and Science University and a former paramedic, said, “When I was a paramedic, I brought countless patients to the hospital with traumatic brain injuries.”

He continued, “Skilled neurosurgeons can accomplish a lot, but my fire department and public health mentors showed me the best way to optimize outcomes for trauma is to direct efforts toward preventing the injury in the first place.” Indeed, prevention and grief counseling address different parts of the recovery process, but the crux is to extend care beyond the immediate injury. 

Finally, one cannot neglect the limits of grief counseling. Some patients may require assessment or treatment from another qualified mental health professional, especially when emotional challenges become severe. Even then, knowing when to involve others from the care team is an important part of preparing for this specialization. 

 

Lay the Groundwork for a Counseling Specialization 

Once you know your interest is in the area of grief counseling for life-altering injuries, it’s time to materialize that interest. What this means is that professionals need a strong foundation in grief, counseling, trauma, and the way serious injuries affect a person’s daily life and sense of self. 

The right preparation will depend on your existing healthcare background and professional goals. For instance American Institute of Health Care Professionals (AIHCP) has been offering grief counseling certification and CE courses in grief/bereavement for over 25 years. Receiving specialized continuing education and certification is a great way to increase your knowledge and lay the groundwork for your own grief practice. 

Be mindful that even college level healthcare training may not always give you the extensive knowledge/experience you need for dealing with grief. A 2026 exploratory survey of US medical schools found that, among the 10 schools that responded, 60% devoted fewer than five hours to teaching students how to cope with grief. Where as a certification with AIHCP is worth 100 continuing education hours.  

What’s more, 60% did not formally include physician grieving or coping in their curriculum. Only 20% reported offering specific clinical experiences involving end-of-life care during the preclinical years. Now, the survey had a low response rate, so it cannot be treated as representative of every US medical school. 

However, the findings make it clear that general healthcare experience does not always provide all the specialized knowledge needed to support people through a major loss. Deliberation on your part is a must. Therefore, consider preparing in the following ways:

  • Familiarize yourself with how people cope with different forms of loss. 
  • Strengthen your ability to listen attentively, ask useful questions, and communicate with empathy. 
  • Learn how traumatic experiences can affect emotions, behavior, relationships, and a person’s ability to recover after an injury. 
  • Understand the different types of complex grief responses. 
  • Develop a clear understanding of confidentiality, informed consent, and professional boundaries. 
  • Look into the emotional demands of working with people experiencing grief and how they may affect your ability to provide care. 

It is equally helpful to connect your grief counseling education with the type of injuries you may encounter. For example, someone working with people who have traumatic brain injuries may benefit from learning more about cognitive and behavioral changes. Similarly, those likely to work with people experiencing spinal cord injuries may require a deep understanding of changes in mobility and daily living. 

Gain relevant practical experience by exposing yourself to rehabilitation settings, hospitals, support groups, and community services. No matter the course you choose, do not forget to earn a proper license, especially when your role demands it. 

 

Join Hands With the Patient’s Wider Circle of Care 

The process of recovering from any sort of trauma is so complex that it cannot happen in a vacuum. Patients often have to work with physical therapists, social workers, rehabilitation specialists, and other healthcare professionals. If you plan to specialize in this area, it’s vital to understand how a host of professionals contribute to recovery. 

That’s the key to knowing where grief counseling fits into the big picture. Let’s consider a 2025 study that analyzed data from 79,604 people with moderate-to-severe traumatic brain injuries in the US Traumatic Brain Injury Model Systems database. Researchers compared 4,620 people who began rehabilitation early with 2,722 who joined much later. 

Earlier rehabilitation was found to be associated with improvements in productivity and life satisfaction. The latter included aspects like regaining independence, rebuilding relationships, and participating in daily activities. As you prepare for the specialization of grief counseling, learn to understand where your role stands amid the work of other professionals. 

Here’s an example: A patient who gets frustrated with rehabilitation may need a physical therapist to address a functional problem. At the same time, a counselor can help the patient work through the grief and frustration surrounding that limitation. Once you develop an understanding of how everything is interconnected, it will help you in the following ways:

  • You will know the role and contribution of each healthcare provider in the patient’s recovery. 
  • It becomes easier to understand the patient’s goals, such as what they wish to accomplish for themselves. 
  • Communication becomes smoother as you learn to share information between team members while preserving patient privacy. 
  • The changing needs of the patient are easier to spot, which may shift from surviving the injury to dealing with relationships or their future expectations. 

 

FAQs 

What does a grief counselor do for someone with a life-altering injury? 

A grief counselor helps patients process losses related to independence, abilities, relationships, work, identity, and future plans. They provide emotional support, help patients understand their changing circumstances, and recognize when additional mental health care or support may be needed. 

What skills are required to counsel people after catastrophic injuries? 

Important skills include active listening, empathy, respect for patient independence, trauma-aware communication, and asking thoughtful questions. Professionals should also understand grief, trauma, professional boundaries, and how emotional challenges affect recovery. 

What preparation is needed to work with patients experiencing injury-related grief? 

Preparation to work with patients experiencing injury-related grief may include education in grief and counseling, trauma awareness, relevant healthcare knowledge, practical experience, and ongoing professional development. Professionals must also understand their licensing requirements and learn how to work with a multidisciplinary care team. 

 

Key Data Points to Consider 

2025 study of people with moderate-to-severe acquired brain injuries  Almost half of the participants continued to experience symptoms of anxiety/depression eight years after their injury. 
2026 exploratory survey of US medical schools 
  • 60% devoted fewer than five hours to teaching students how to cope with grief. 
  • 60% did not formally include physician grieving or coping in their curriculum. 
  • Only 20% reported offering specific clinical experiences involving end-of-life care during preclinical years. 
2025 analysis examining 65 studies for group-based psychosocial interventions for adults with acquired brain injury The meta-analysis of 48 studies involving 2,653 participants found a small but statistically significant improvement in psychosocial outcomes. The outcomes considered were anxiety, depression, emotional distress, quality of life, and social support. 

Healthcare professionals cannot afford to rip apart the emotional and social aspects of recovery after a catastrophic injury. A 2025 analysis examined 65 studies for group-based psychosocial interventions for adults with acquired brain injury. In the meta-analysis, 48 studies involving 2,653 participants were included. 

The review discovered a small but statistically significant improvement in psychosocial outcomes. The outcomes that were examined included anxiety, depression, emotional distress, quality of life, and social support. Now, this does not mean that a single counseling approach will work for every patient. 

However, it does bring our original exploration full circle: recovery has to do with more than the immediate injury. So, your goal is not just to help someone feel better about what happened. It is to support them in working through the losses and discovering new ways to participate in family life, work, relationships, and the community. 

References 

  1. Lgoe Anna et al. 2025. Psychological outcomes following moderate-to-severe acquired brain injury: A longitudinal study. PubMed

https://pubmed.ncbi.nlm.nih.gov/40521926/

  1. Robinson, Erik. August 2026. Causes of traumatic brain injury vary widely worldwide, study finds. Oregon Health and Science University. 

https://news.ohsu.edu/2026/08/19/causes-of-traumatic-brain-injury-vary-widely-worldwide-study-finds

  1. Vishwanath Vineet, Plummer M Maria, et al. March 2026. Grief and coping education in US preclinical medical curricula. Findings from an exploratory survey. PubMed Central

https://pmc.ncbi.nlm.nih.gov/articles/PMC13039567/

  1. Thomson Kate, Haslam Catherine, et al. August 2025. Group Psychosocial Interventions Following Acquired Brain Injury: A Systematic Review and Meta-analysis of Group Process and Outcomes. Springer Nature Link. 

https://link.springer.com/article/10.1007/s11065-025-09670-w

Author Bio

Deepika has over six years of experience as a writer and editor. Passionate about words and learning, she takes an interest in a variety of niches. Her knack for turning complex ideas into relatable narratives allows her to resonate with the reader. When her pen falls silent, you can find her engrossed in a novel or getting her hands messy with fine arts. Through these, Deepika is committed to keeping her curiosity and creativity alive. 

 

 

Please also review AIHCP’s Grief Counselor Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Why Feeling Better Doesn’t Always Mean You’ve Recovered

Is your teen depressed? Please also review AIHCP's Child and Adolescent Grief Counseling Certification

Written by Marko,

After a long time, you’ve slept through the night and, when your friend made a joke, you actually laughed at it. You have plans for the weekend and, for the first time in forever, you’re looking forward to it instead of thinking about how to get out of it. 

It seems like you’re back to being yourself. It was a long way to go, but you did it. You’re okay.

Then… Well, then you realize you won’t make the deadline at work and the same thing happens again. And this is unfortunately something that (likely) resonates with a lot of people.

You feel this knot in your stomach, and you get overwhelmed by panic. It all rushes right back, as if it never left. As if you never made any progress whatsoever. As if you haven’t recovered.

By triggering the HPA axis and increasing your cortisol levels, stress can reactivate previously reduced symptoms. – Harvard Health, Stress Response and Mental Health

That whiplash can be terrible in more ways than one, but it certainly doesn’t mean that you haven’t made serious progress. This is a normal part of the process, so it’s weird that it’s not talked about more. What feels like recovery doesn’t have to mean actual recovery, and what feels like a failure isn’t failure in the vast majority of cases.

Strange, isn’t it?

Let’s see why this happens.

Feeling Better and Being Recovered Aren’t the Same Thing

You no longer feel heavy, and the dark thoughts seem to be gone. 

And while this definitely is a good thing, this is still not what we consider ‘recovered’; it’s only progress towards this goal.

Clinical mental health recovery requires two things: symptom remission and restoration of functioning (work, social, cognitive). – National Institute of Mental Health (NIMH), Mental Illness & Recovery

Maybe you don’t feel that paralyzing panic anymore, but you can’t focus on the book you’re reading for more than 2 minutes. Sure, our mood might be better, which is great, but you still don’t feel motivated enough to shower or run errands you should’ve completed days/weeks ago; you’re procrastinating. 

It’s great that you feel less emotional pain, but that doesn’t necessarily mean that you can function normally again, which is why people tend to get stuck at this stage. It’s also the reason why feeling awesome for a few days can be so deceptive.

Recovery is complicated. Well, that goes without saying, really. 

But what makes it complicated?

People are different, and it comes as no surprise that the recovery process isn’t equal for everyone. There are some things that everyone does share – that’s the fact that there’s no moment where you instantly go from zero to hero. 

There’s no switch.

Mental health recovery is non-linear, meaning it has periods of improvement, periods of relapse, and periods of stabilization. – Substance Abuse and Mental Health Services Administration (SAMHSA)

Recovery is (usually) slow and messy, with a decent amount of back and forth, where you feel like you’re okay one day, and then the next, you feel like everything you did is wrong and all the work was for nothing. 

So, once you get that string of good days, it’s tempting to just declare you’ve recovered and move on with your life.

Relapse rates for mental health conditions (e.g., depression, anxiety) have recurred in 50-80% of people. – National Institute of Mental Health (NIMH), Depression Recurrence Studies

But no mental health professional would agree with you. 

They’ll pat you on the back for having a few good days, but they’ll also want to see if those days become months, especially when something stresses you out. They’ll want to see that you’re still stable even under pressure because, if you are, then you’re truly okay.

This is also why treatment can change at this point. 

Once the worst is over, the focus goes to building something that lasts.

These early improvements can be quite misleading because people start feeling relief, which is both real and welcome, to the point that they assume they’re healed (or at least mostly healed), while in reality, they’re nowhere near full recovery.

One good thing to remember is that you can always ask for help – in fact, it’s encouraged. 

Being among people who know how to help and people who’ve been where you are right now can be the difference between success and failure. This is why hospitalization institutions come in handy. You can find partial hospitalization in Delaware, Ohio, Texas, Maryland, etc. – all over the country. These types of institutions were designed to make your recovery process as efficient and as easy as possible. 

If you’re struggling, then professional help is the answer.

Recovery Happens in More Than One Area

There’s a lot of misinformation out there about recovery, so it’s really no wonder that many people assume it’s this big moment where you wake up one day, and you’re suddenly great. 

But that’s not how recovery works.

Emotional Relief Doesn’t Mean You Can Function Normally

On the one hand, you feel calm. Or at least calmer than you’ve been recently. 

But on the other hand, you find yourself staring at a computer screen for an hour without doing anything. This happens a lot – panic and sadness ease up, but concentration and motivation are nowhere to be found. This is normal. 

Your brain has been running on empty for so long, it makes sense that it needs a while to rebuild cognitive muscles.

You Have to Rebuild Healthy Routines

Behavioral activation is one of the most effective evidence-based methods for sustaining mental/emotional recovery. – American Psychological Association

When things start to go downhill, the first thing people forget about are routines. And it makes sense, because who wants to go to the gym when you feel like your life is falling apart? 

You no longer sleep well, you don’t eat on time, and when you do, it’s not anything healthy because you don’t feel like cooking.

Once your mood picks up, none of this will be magically fixed. 

What you’ll need to do is force yourself to exercise again, to cook, to run errands on time, to go to bed at a certain hour, and so on. 

It won’t feel too good, and you might still end up doomscrolling on TikTok until 3 A.M., but if you keep at it, all of this will become normal again.

Relationships Recover at Their Own Pace

Just because you no longer feel depressed 24/7 doesn’t mean you want to reach out to your friends and family. It’s been so long since you stuck to a plan without flaking or since you were in the company of other people without feeling irritated, so it’s no wonder this feels awkward.

This will take time, probably more than you think.

Get ready to have some awkward conversations with the people around you because they don’t know what to expect of you or even how to act around you. 

Just be honest and let time do its thing. There’s really nothing else to be done here.

Confidence Gets Back Little By Little

Repeated successes increase self-efficacy, which is linked to sustained long-term mental health recovery. – American Psychological Association

If you feel better, that’s a great sign. But the question is, “How are you doing mentally REALLY?” Do you believe in yourself again? Do you feel good about yourself?

Once you’ve managed to tackle these heavy emotions, that doesn’t automatically mean that confidence is back. 

The way you get back your confidence is by being consistent and steady. 

Keep giving yourself small and achievaeable/realistic goals. 

The more you complete them, the better you’ll feel because this will train your mind that progress is REAL. It’s not some abstract concept. Once you realize that your actions can make a difference, your confidence will (slowly) return.

What Actual Recovery Looks Like

As you may have figured out by now, recovery doesn’t look perfect. It actually looks kind of basic, with a little bit of chaos here and there. 

True/proper recovery you’ll find in the form of consistency.

One bad day is just that – a bad day. It doesn’t unravel into something that lasts for weeks, so one bad day is actually progress.

If you want to know about the biggest sign of recovery, it’s simple. 

It’s in how someone handles stress once it shows up. The important thing here is that they’ll deal with it instead of running away. They’ll sit with the discomfort they feel because they’re strong and don’t have to hide from the bad stuff anymore.

Another thing that happens once a person starts to recover is that they notice more meaningful stuff in their life. 

Like their job, for example. 

It no longer feels soul-sucking but worthwhile. 

All these relationships start becoming a source of comfort and connection instead of something that constantly drains you and makes you feel uncomfortable. Stress and the struggle won’t disappear. Everyone gets stressed out, and everyone struggles at one point or another. It’s how we face those things that change (for the better).

Conclusion

Someone who now sleeps better and laughs at jokes is winning life.

Don’t take feeling good for granted. This doesn’t mean that you don’t deserve feeling good – you do. But keep in mind that it takes a lot of work (whether you realize it or not) to keep feeling good and staying positive even though the odds might be against us.

We can do it, of course. 

But once we start feeling a bit too comfortable; once we start getting lazy, all those bad things in life will again start knocking harder at our doors.

The main takeaway here is that you now KNOW that it’s possible; and it’s not THAT difficult once you know what to do and how to do it. You just have to be aware at all times, and you have to train yourself.

2 Interlinking Opportunities:

From https://aihcp.net/2025/10/22/emotional-healing-process-in-counseling/ with anchor approach to emotional recovery

From https://aihcp.net/2024/11/21/psychological-recovery-after-crisis/ with anchor limitations of recovery

Author Bio 

Marko is an adamant and eager content writer with a decade of experience in various niches,  with healthcare being one of them. With his way of implementing storytelling, comparisons, and examples into hard-to-grasp topics, Marko’s able to make complex things sound interesting and relatable – key ingredients to make something understandable. As a hobby, Marko enjoys offroading, board games, and spending time with his family and his dog Cezar.

 

 

Please also review AIHCP’s Grief Counselor Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

The Clinical Side of ‘Loneliness’ That Needs to Be Discussed 

A person alone in the dark.

Written by Deepika

Someone is sitting alone in a room with no companions in sight. Another individual is a part of a crowded room, but emotionally disconnected due to a difficult phase in their life. Both these scenarios may or may not describe a person dealing with the issue of loneliness. 

Such a problem is often treated as a personal or an emotional one. Mostly, nobody stops to even consider the health implications of loneliness. The World Health Organization (WHO) has shared that one in six people worldwide suffers from loneliness. It also states that social connections can improve health and reduce the chances of an early death. 

As social beings, humans cannot afford to neglect loneliness; even one lonely person is one too many. As for healthcare, patients with this problem may enter a facility with complaints of chronic pain, fatigue, or sleeplessness. 

Now is the time to put aside the stigma and discomfort surrounding complex emotional needs. This article presents the case for exploring the clinical side of loneliness. We will see how emotional isolation manifests itself through physical and behavioral symptoms, and what healthcare can do to respond in a holistic way. 

 

The Unmistakable Imprint of Loneliness on Physical and Behavioral Health 

Healthcare professionals seldom find someone entering the gates of their facility exclusively with the problem of loneliness. This is especially true in the case of those whose primary complaints are physical, like aches and discomfort. 

This makes it difficult to identify the root cause, although loneliness is becoming an increasingly important factor. Arthur C. Evans, the CEO of the American Psychological Association (APA), noted that “Research tells us that a sense of isolation and social fragmentation can have real consequences for our ability to manage stress and stay healthy.” 

So, does loneliness and its side effects show up in one’s physical and behavioral health? Absolutely, but the appearance is so indirect that it is easy to miss the symptoms. As a result, patients are stuck in a vicious cycle of repeated consultations, diagnostic ambiguity, and fragmented care. 

Unless the emotional component is identified and given its due diligence, the issue can be temporarily stalled, but not eradicated. The following are some common physical and behavioral indicators associated with loneliness:

  • Constant complaints of fatigue or low energy without a clear medical cause 
  • Sleep disturbances, including irregular sleep cycles or insomnia 
  • Headaches, body pain, or other somatic issues 
  • High levels of anxiety, irritability, and emotional instability 
  • Reduced motivation for self-care or poor adherence to treatment 
  • Minimal engagement during consultations 
  • Frequent healthcare visits for recurring or unexplained symptoms 

From a clinical perspective, such presentations confirm the importance of interpreting patient symptoms with a framework that extends beyond visible complaints. Such an approach is a part of modern nursing education, including the Accelerated Bachelor of Science in Nursing or ABSN. This model is designed to prepare students without a prior nursing degree for professional nursing practice. 

On that note, programs such as the Elmhurst University ABSN program place emphasis on principles for adult populations experiencing common health problems within different care settings. So, the focus is not only on clinical competencies, but also on holistic patient assessment and psychosocial factors that influence health outcomes. 

It is the need of the hour to approach adult patient care through an emotional and social lens. That is exactly how holistic and accurate patient care becomes possible. 

 

Why Modern Healthcare Cannot Treat Loneliness as a Secondary Concern 

Is it not sad to think that despite many patients suffering from physical concerns that have emotional roots, healthcare doesn’t seem to get it? Perhaps the challenge has to do with how loneliness doesn’t display itself in obvious ways. Let’s understand closely why it’s time to pull down the walls and treat loneliness as a primary concern. 

More Than Emotional Well-Being Is at Stake 

Some of the main problems associated with loneliness are feelings of sadness and disconnection with one’s surroundings. It’s only a matter of time before the symptoms show up in the form of headaches, sleep disturbances, or digestive problems. 

In a 2024 study involving 66 young adults (18-35 years), it was found that loneliness was a risk factor for cardiovascular disease development. Since the issue will become physical at one point or another, why not tackle it at its root from the beginning?

Patients Are Often Oblivious to Their Loneliness Issue 

As hinted before, many patients with chronic loneliness enter the clinic gates with concerns like sleep disorders or unexplained tiredness. For some, loneliness develops gradually through grief, retirement, or social withdrawal. Since such experiences either seem trivial or normalized, they never come to the surface. 

Matters only get worse due to fast-paced lifestyles facilitated by digital communications and work expectations. As revealed in a 2025 study involving individuals with chronic disease and loneliness, the stigma surrounding the latter often discourages people from acknowledging the isolation despite health effects. Perhaps healthcare providers need to bridge this gap, right?

The Irony of Modernism Only Makes Things Worse 

Technology came with the promise of connecting the world like never before. We may be a global village now, but we are more disconnected from genuine human connections than ever. When life gets fast-tracked, and connections become virtual, there is hardly any room for deeper interpersonal relationships. 

A 2024 poll discovered that 30% of adults reported feeling lonely at least once every week. This issue was higher among younger adults despite being the most digitally connected population. That explains why healthcare finds loneliness to be most pressing among those with an ‘apparently’ active social life. 

 

What Healthcare Must Do as Loneliness Becomes a Clinical Reality 

Acknowledging the problem of loneliness is just one half of the equation. Healthcare must now recognize emotional isolation in terms of long-term health outcomes. Here’s what can be done in light of the growing clinical reality of loneliness. 

Being Aware of the Less Obvious Signs of Loneliness 

Since loneliness likes to be sneaky, healthcare providers need to know what that implies. From vague physical complaints to subtle changes in behavior, nothing should be ruled out. Certain probing questions regarding the patient’s social life will provide the rest of the answer. 

A 2024 study was conducted precisely to examine whether loneliness was related to increased healthcare utilization among older adults. After analyzing 932 medical records, it was found that patients experiencing loneliness were more likely to use healthcare resources than their peers. Is it still safe to believe that healthcare can afford to neglect even the less obvious signs of loneliness?

Making Therapeutic Communication a Part of Patient Care 

A part of the challenge involved in treating patients with loneliness-induced physical issues is that they might resist the idea initially. Unless therapeutic communication drives the doctor-patient interactions, the latter is less likely to discuss their struggles or story. 

This type of communication includes listening patiently, responding empathetically, and providing emotional validation. Studies have shown that the sensitivity of doctors towards patients’ communication signals can go a long way in improving patient satisfaction. So, this step cannot be an optional one. 

Integrating Emotional Well-being Into Holistic Healthcare 

Now, this one may seem shocking since emotional well-being is already a part of holistic healthcare, right? Yes, in theory at least. As for clinical screening, it is often left unaddressed due to time constraints or documented as less severe. Some healthcare institutions keep emotional well-being separate from medical treatments. 

Continuity of care is only possible when emotional well-being is integrated, along with interdisciplinary care. In a 2025 cohort study, 7,484 adults with atherosclerotic cardiovascular disease were examined. Those with loneliness had a 33% higher risk of mortality compared to those with a healthy social life. Even hospitalization rates were higher among the lonely folks, so why keep emotional well-being separate? 

 

FAQs 

Can loneliness affect physical health, or is it just an emotional issue?

Yes, loneliness is more than an emotional experience. It can contribute to physical health problems such as fatigue, sleep disturbances, and a weakened immune system. From a clinical perspective, loneliness often has a say in how symptoms appear and the way patients respond to treatment.

Why are so many patients with loneliness oblivious to it?

Many patients fail to identify loneliness as the root cause of their physical ailments because it develops gradually and has an indirect effect. Additionally, social withdrawal and emotional disconnection tend to get normalized over time. As a result, individuals may seek medical support for physical symptoms without realizing that the factor driving the problem is loneliness. 

How can healthcare professionals identify and manage loneliness in clinical settings?

To identify loneliness, it is important to observe subtle physical and behavioral signs, including unexplained symptoms, low engagement during consultations, and frequent healthcare visits. As for the management, it involves regular screenings, strong therapeutic communication, and interdisciplinary care. 

 

Recent Data on Loneliness and Its Impact 

Number of people who suffer from loneliness worldwide, as per the World Health Organization  One in six people 
2024 study on 66 young adults aged 18 to 35 years Loneliness was found to be a risk factor for cardiovascular disease 
2025 study involving individuals with chronic disease and loneliness  The stigma surrounding the latter made it difficult to acknowledge emotional isolation despite the health effects 
Adults who reported feeling lonely at least once every week in a 2024 APA poll  30% of those surveyed 
2024 analysis of 932 medical records on the relation between loneliness and increased healthcare utilization  Directly proportional 
Studies on physician sensitivity to patients’ communication signals and patient satisfaction  Direct correlation 
2025 cohort study involving 7,484 adults with atherosclerotic cardiovascular disease  Those with loneliness had a 33% higher risk of mortality 

Loneliness is in no way new because it has impacted people across all generations. Earlier, there weren’t many ways to measure or record this problem. However, it stands true that loneliness is more pronounced now, especially since community living is scarce. 

Moreover, everyone seems to be too busy with their own lives, right? The human heart craves meaningful connections, or else it does not care. From a healthcare viewpoint, this means that addressing only visible complaints does not suffice. 

The next time your team conducts its routine assessments, let every member be trained and aware of the clinical side of loneliness. No matter how advanced healthcare becomes, if the elephant in the room stays hidden in plain sight, then is that true progress? 

 

References:

  1. World Health Organization. 2025. Social connection linked to improved health and reduced risk of early death. 

https://www.who.int/news/item/30-06-2025-social-connection-linked-to-improved-heath-and-reduced-risk-of-early-death

  1. American Psychological Association. 2025. APA poll reveals a nation suffering from stress of societal division, loneliness. 

https://www.apa.org/news/press/releases/2025/11/nation-suffering-division-loneliness

  1. Vasan Shraddha, Lambert Elisabeth, et al. Investing the relationship between early cardiovascular disease markers and loneliness in young adults. 2024. Scientific Reports. 14221.

https://www.nature.com/articles/s41598-024-65039-8

  1. Fan Zhiguang, Wen Hongjuan, et al. The Chinese version of the stigma of loneliness scale in people with chronic diseases: an assessment of psychometric characteristics. 2026. Springer Nature Link. Volume 25, 1619. 

https://link.springer.com/article/10.1186/s12889-025-22743-y/metrics

  1. American Psychiatric Association. 2024. New APA poll: one in three AmericansAmericans feels lonely every week. 

https://www.psychiatry.org/news-room/news-releases/new-apa-poll-one-in-three-americans-feels-lonely-e

  1. J.J. Mira, D. Torres, et al. Loneliness impact on healthcare utilization in primary care: a retrospective study. 2024. Journal of Healthcare Quality Research. Volume 39, Issue 4. 

https://www.sciencedirect.com/science/article/abs/pii/S2603647924000277

  1. Confort Frederico Carlos. Physicians’ attention to patients’ communication cues can improve patient satisfaction with care and perception of physicians’ empathy. 2024. PubMed

https://pubmed.ncbi.nlm.nih.gov/38703716/

  1. Galper Kathleen, et al. Routine loneliness screening in adults with atherosclerotic cardiovascular disease in a large national health plan: a retrospective cohort study. 2025. PubMed

https://pubmed.ncbi.nlm.nih.gov/41043827/

 

Author Bio

Deepika has over six years of experience as a writer and editor. Passionate about words and learning, she takes an interest in a variety of niches. Her knack for turning complex ideas into relatable narratives allows her to resonate with the reader. 

When her pen falls silent, you can find her engrossed in a novel or getting her hands messy with fine arts. By these, Deepika is committed to keeping her curiosity and creativity alive. 

 

 

Please also review AIHCP’s Grief Counselor Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

The Unspoken Nursing Skills of End-of-Life Conversations 

health care worker comforting a patientWritten by Marchelle Abrahams.

Some conversations are hard to have. And nothing can prepare you. Not a textbook. Not an online tutorial. Not a deep breath before delivering the bad news.

Once you have taken the Nurses’ Pledge of Service, talking to a patient about the end of their life is part of the package. Maybe you were warned how difficult it would be. Maybe you thought you’d cross that bridge when you got there.

The truth is that it doesn’t get easier. Sometimes the opposite. As long as you treat your patient and their family with dignity, the right words will form. Also, there are certain skills nobody has taught you until now.

Words Have Gravity

To you, words are something you speak to share information. An individual who doesn’t have the luxury of time can find comfort or hurt in them.

The journal Federal Practitioner published a paper titled The Meaning of Words and Why They Matter During End-of-Life Conversations several years ago. The advice still holds.

Author Grace Cullen goes into extensive detail on how essential effective communication is in healthcare delivery. However, misinterpretation can influence the quality of the care. 

The former palliative care nurse practitioner (NP) says that discussions must be handled with accuracy and precision. They must be conducted in a timely fashion and require skills that take practice to sharpen.

So, what are those skills?

With her years of experience, Cullen has learned that nurses don’t control how the conversation flows. 

“We approach patients with a blank canvas, open to receive messages that will be shared and reacted to accordingly.” – Grace Cullen, DNP, FNP-BC, ACHPN, AOCNP, RN-BC.

That’s why end-of-life (EOL) talks require compassion, an inherent human trait that isn’t taught in textbooks. Instead, it’s cultivated with training and application, advises Cullen.

Suggested Communication Phrases

Do not use medical terms. Talk in simple language and repeat the information. The truth should be gradually introduced to the patient.

Don’t leave families to their own devices. Offer administrative help, such as suggestions for hospice or palliative care. (Flugelman MY. How to talk with the family of a dying patient. BMJ Supportive & Palliative Care 2021;11:418-421.)

When speaking about advanced planning, Healthier Washington Collaboration Portal suggests the following:

  • What’s your understanding of your current situation?
  • If there ever came a time when you couldn’t make decisions for yourself, who would you trust to do that for you?
  • When you think about dying, have you thought about what the end would be like or how you would like it to be? 

Look to Mentors for Advice

You’ll probably get the best advice from your mentors. And yet, they’ll admit that no matter how many times you have the conversation, it still stings.

That’s why it’s important when finding a preceptor for a nurse practitioner to latch onto someone with years of experience in the EOL field. They can guide you on the best practices and share their wisdom on what works and what doesn’t.

In most cases, a nurse practitioner (NP) preceptor is a proficient clinician. They bridge the gap between classroom theory and real-world practice. In other words, you’re in good company.

ClickClinicals advises using professional NP preceptor matching services to ensure you’re matched with a preceptor aligned with your goals. They’re a sound option for nurse practitioner clinical placement help, and they’ll find you an NP preceptor fast.

Missed Opportunities for EOL Care Discussions

Timing is everything. Having the conversation too late can do more harm than good. A qualitative study published in the JAMA Network revealed a few insights. 

About 140 oncology patients were surveyed. Only 21 (5%) of encounters included EOL discussions. The study found that early EOL care preferences improve clinical outcomes. Unfortunately, most talks occur a month before death, despite most patients wanting information earlier.

Discussions about end-of-life care shouldn’t wait until a patient needs hospice, psychiatrist Natalie Jacobowski tells the Cleveland Clinic. She views it as counterintuitive.

Ask for permission to speak about the “what ifs” when starting treatment to prolong a patient’s life, advises Dr Jacobowski.

Create a Safe Space

Talking about someone’s imminent death is taboo, to say the least. It’s also uncomfortable and morbid.

A patient might not want to broach the topic, as it may appear weak or negative. Dr Jacobowski suggests taking your cue from them. Watch their body language. Acknowledge their fears. 

Take this as a step in the right direction. 

Frame the conversation as: “I imagine there are a lot of thoughts and worries. Is there anything that’s standing out to you that’s worrying you the most?”

That way, the patient will know you’ve created a safe space for them to voice their concerns.

Validate and Respond

Not every conversation goes according to script. Emotions are fraught. Anger. Sadness. Frustration. Grief. Patients are feeling them all at once.

Don’t gloss over their response and carry on like normal. Recognize their emotion and name it. For example: “I can see that this is incredibly difficult and upsetting to hear.”

Always lead the conversation, but also prioritize open-ended questions, because they’ll have many.

Validate their feelings. No judgment needed. Allow for silence. Remember, they’re only just processing the news. It takes time.

 

FAQs: End-of-Life Conversations in Clinical Practice 

  1. Why are end-of-life conversations delayed in healthcare settings?
    Many clinicians hesitate due to discomfort, fear of removing hope, or uncertainty about timing. 
  2. What is the most important communication skill during end-of-life discussions?
    Clarity paired with compassion. Using simple, non-medical language helps patients and families better understand and process the situation.
  3. How can clinicians create a safe space for these conversations?
    By asking open-ended questions, observing body language, and validating emotions without judgment.
  4. How do preceptors help nurse practitioners improve in end-of-life care?
    Experienced preceptors provide real-world exposure, model difficult conversations, and offer feedback that helps refine communication skills.

Key Statistics at a Glance 

Topic Finding Insight
EOL Discussions in Oncology Encounters  5% (21 out of 140 patients)  Very few clinical encounters include EOL discussions.
Timing of EOL Conversations  Often, within one month before death  Conversations are happening too late, limiting patient autonomy and preparedness. 
Patient Preferences  The majority prefer earlier discussions  Patients want transparency sooner, not at critical decline stages. 
Communication Risks  Misinterpretation affects care quality  Poor wording or unclear messaging can negatively influence patient understanding and care decisions. 

 

Parting Words

You chose to become an NP for a reason. And that reason is to care for and help people heal. Keep that in mind whenever sensitive patient discussions arise.

Lectures and textbooks can only teach so much. The rest is up to you. 

Whether you’re at the start or in the middle of this big, bold, beautiful journey called nursing, never forget why you are here.

References:

 

Author bio

Marchelle Abrahams is an award-winning writer (RDMA Awards 2019) who found her voice after carving a niche as a features writer for Independent Media. Currently, she freelances for various print and online publications, while ghost-writing blogs for several clients. 

 

 

Please also review AIHCP’s Grief Counseling Certification, as well as its Child and Adolescent Grief Counseling Program, Pet Loss Grief Counseling Program, Christian Grief Counseling Program, Grief Diversity Counseling Program, Grief Perinatal Program, Grief Practitioner Program and finally its Grief Support Group Leader Program.

Grief Counseling: Death of an Estranged Loved One Video Blog

Unfortunately, when someone dies it does not always occur under the best family conditions.  Some families may be divided, estranged, or not speaking.  In some cases, the estrangement between the deceased and the living family member.  These situations add complications to already a sad and grieving situation.  This video reviews some of the complexities associated with death of a estranged loved one.

Please also review AIHCP’s Grief Counseling Certification Program

The Creative Grief Cycle: Stage 1 – Creation

Where Grief First Finds Language

Written by Daniel Stern

A Conceptual Model Emerging from Lived Experience

The Creative Grief Cycle is a conceptual framework that emerged from my own experience of grief and the process of writing through it. In the time following loss, I found that writing did not begin as expression or communication, but as something more immediate—an attempt to give form to experience before it could be fully understood. What I describe here reflects that process. It is not a formal clinical model, but an effort to articulate a pattern that became visible through lived experience, considered alongside existing research in expressive writing, narrative psychology, and grief theory.

In a previous article, I introduced what I call The Creative Grief Cycle—a way of understanding how grief moves through creative expression. In that earlier piece, I described how grief often begins in silence; this stage begins at the point where that silence first breaks into language. This article focuses on that transition: the moment when experience first enters language.

The cycle has three stages:

  • Creation — where grief first takes form in language
  • Communication — where that expression connects with others
  • Rediscovery — where the work can be revisited over time, allowing meaning to evolve

Here, I want to focus on the first stage: Creation.

Research in expressive writing and grief has shown that writing about emotional experience can improve psychological and physical well-being (Pennebaker & Chung, 2011). This aligns with work in expressive and therapeutic writing (Mazza, 2017; Stepakoff, 2009), and with research emphasizing the role of narrative in helping individuals organize and make sense of loss (Neimeyer, 2001; McAdams, 2001). What receives less explicit attention, though, is an earlier phase—the point before writing becomes expressive or communicative, when pre-verbal emotional experience first begins to take form in words. While elements of this transition appear across existing research, they are not typically isolated as a distinct phase in grief writing itself.

 

Writing Begins as Pressure

In my experience, grief did not begin in words. It began as something closer to pressure—diffuse, persistent, and not yet nameable.

This pressure did not feel like a thought or even a clearly defined emotion. It was more constant than that—something ambient, but insistent. It did not organize itself into sentences or ideas. It accumulated.

At times, it felt physical: a weight in the chest, a tightening, a sense of something pressing inward or outward without direction. At other times, it was harder to locate—an internal density, a sense of saturation, as though experience had nowhere to go.

Research in trauma and affective processing suggests that overwhelming emotional experience is often encoded in sensory, bodily, and affective forms before it becomes available to language (van der Kolk, 2014). Putting feelings into words can also change how those experiences are processed (Lieberman et al., 2007). In this sense, what I describe as pressure may reflect a stage where experience is present but not yet organized in language.

What defines this state is not just intensity, but a lack of structure. Something is there—persistently—but it cannot yet be articulated or fully understood.

It is this pressure, rather than intention, that seems to initiate writing.

Writing does not begin here as expression. It begins as a response. Something pushes toward language—not clearly or steadily, but in fragments that appear, recede, and return.

Words surface incompletely: a phrase, an image, a line that will not leave. There is often hesitation, even resistance. The act begins not because there is something clear to say, but because something can no longer remain entirely internal.

In practice, this early movement often appears in small, recurring fragments before anything fully forms. For example:

From “A Picture on the Wall”

A small square of pigment
leaned out of its silence
and took me by the collar.

Or:

From “Between Two Gravities”

Between what demands I shine
and the gravity that pulls me inward…

These lines do not yet explain, resolve, or interpret the experience—they simply hold it in place. What they do is more immediate: they allow something to remain present long enough to be encountered.

At this stage, what appears on the page is not meaning in the usual sense. It is better understood as what I call proto-meaning— the earliest linguistic shape of an experience before it has become explanation, insight, or story.

Experience begins to take shape in language, but it is not yet narrative, explanation, or reflection. What emerges instead are fragments—images, lines, repetitions—that allow experience to exist outside the self for the first time.

This shift is subtle but significant. What was previously diffuse and internal begins, however slightly, to cohere.

Seen this way, fragmented or image-based writing is not a failure of clarity, but the beginning of it.

At this point, writing is not oriented toward communication or interpretation. Its function is more basic. It brings experience into form—giving it just enough structure to be encountered rather than only endured.

This is the first movement of Creation: not clarity, but necessity.

 

When Language Creates Distance

Once experience begins to take form in words, something shifts.

Language introduces structure. Even a single line creates a boundary—this word instead of another, this image held long enough to be seen. What was previously diffuse begins, however slightly, to take shape.

This does not immediately produce understanding. The experience may still feel unclear. But something important changes: distance becomes possible.

Not detachment—but perspective.

The experience is no longer entirely internal. Some part of it now exists outside the self, where it can be returned to. The writer is no longer completely inside the feeling. Something has been set down, even if only partially.

Research on expressive writing shows that, over time, people begin to organize emotional experience into more structured language—connections, causality, and meaning (Pennebaker & Chung, 2011; McAdams, 2001). Before that happens, a more basic shift occurs: experience becomes something that can be held and revisited (Neimeyer, 2001).

Writing begins to do more than respond—it begins to shape.

That shaping is not linear. It circles. It revisits. It approaches the same experience from different angles. But even in fragments, something changes: what was uncontained is now being held, line by line.

 

Why Grief Turns to Metaphor

Even as writing begins to create structure, it rarely does so through direct explanation.

Grief often resists that kind of language. Statements like “I feel empty” or “I am overwhelmed” may be accurate, but they flatten the experience. They fail to capture its movement, its contradictions, and the way it shifts over time.

So the writing moves toward image.

This is not simply stylistic. In early grief writing, metaphor may become necessary because direct language can feel too limited.

In early drafts, grief often appears not as a statement, but as a force. The fragment returns, unchanged:

From “Between Two Gravities”

Between what demands I shine
and the gravity that pulls me inward…

Here, the experience is not named directly. It is approached through something else—gravity, pressure, distance. Not because these are more precise, but because they make the experience possible to hold.

This aligns with work in poetry therapy, which suggests that metaphor provides an accessible structure for experiences that resist direct articulation (Mazza, 2017; Stepakoff, 2009). Cognitive linguistics similarly proposes that metaphor acts as a bridge between emotional and conceptual experience (Lakoff & Johnson, 1980).

In early grief writing, metaphor functions less as ornament and more as a tool.

By mapping internal experience onto something more concrete, metaphor creates a structure capable of holding what would otherwise remain diffuse. It gives shape without requiring full understanding. It allows movement—an image can shift, return, and evolve in ways a direct statement cannot.

Through metaphor, writing does not simply express experience—it begins to uncover it.

 

Writing as Discovery: Aphelion

In my own experience, the first poem I wrote after loss—Aphelion—began without intention. It did not start as an effort to express or explain anything. Instead, it emerged in fragments: isolated lines, images that appeared without context, and a persistent sense of movement that I could not yet name.

The central metaphor developed gradually rather than by design. Aphelion—the point in an orbit where a body is farthest from the center it moves around—became a way of approaching an internal state that resisted direct articulation: a simultaneous sense of distance and attachment, of being pulled away while still held in relation.

An early passage reflects this movement:

Some slip the constellations we hope to trace,
following a hidden geometry,
their own unseen law.

And when they reach aphelion—
that farthest point
where distance feels eternal—
we feel their silence
more sharply than their light.

Early lines did not explain this. They circled it. Images of distance, gravity, and motion appeared before any clear conceptual link was made. The metaphor did not begin as meaning; it functioned first as a container—something stable enough to hold a shifting internal state.

As the poem developed over several weeks, that structure allowed movement. The metaphor could shift, return, and reconfigure in ways that direct language could not. What had been entirely internal began to exist externally—not as a coherent narrative, but as something visible and revisitable.

By the time the poem was complete, the experience itself had not resolved. But it had changed form. What had been diffuse became structured enough to be encountered.

This pattern is not unique to a single piece. Across early grief writing, metaphor often emerges not as stylistic choice, but as necessity—providing the first framework capable of holding experience before it can be interpreted.

At this stage, there is often:

  • no audience
  • no intention to explain
  • no clear endpoint

 

The process itself is the point. Writing is not expressing experience—it is creating the conditions under which experience can be known.

 

The Function of Creation

It is important to be clear about what writing in this stage does—and does not—do.

Writing does not resolve grief.
It does not produce immediate understanding.
It does not yet create stable meaning.

What it does is more foundational.

It transforms experience from something uncontained into something structured enough to be encountered. It brings experience into language—not as explanation, but as form.

What emerges at this stage is not fully developed meaning, but something closer to proto-meaning—the first structures capable of holding experience in language.

This can be understood as a process of linguistic emergence, in which pre-verbal emotional experience begins to take early linguistic form. Through this process, experience becomes something that can be returned to, engaged with, and gradually understood over time.

From this point, the later stages of the Creative Grief Cycle become possible:

  • Communication, where expression becomes relational
  • Rediscovery, where meaning evolves across time

But neither occurs without this first shift.

Before grief can be shared or understood, it must first take form in language.

 

Author’s Bio:

Daniel Stern is a retired engineer turned astronomer and astrophotographer whose poetry explores grief, silence, memory, and renewal. His work lives at the intersection of science and emotion, where observation becomes reflection and language reaches for what cannot be measured. He is the author of Aphelion, his debut book of poetry, and the chapbook The Roar of Silence, a collection born from personal loss and the search for meaning in its wake. In his work as an astronomer, his astrophotography has been recognized numerous times by NASA (APOD). He has discovered deep-sky objects and, in collaboration with others, has been published in peer-reviewed astrophysics journals. Stern lives in Delray Beach, Florida, with his wife, Randie.

Website:           Http://www.theroarofsilence.com

Email:                dstern@mea-obs.com

 

 

 

References

Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338–346.

Lakoff, G., & Johnson, M. (1980). Metaphors we live by. University of Chicago Press.

Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421–428. https://journals.sagepub.com/doi/10.1111/j.1467-9280.2007.01916.x

Mazza, N. (2017). Poetry therapy: Theory and practice (2nd ed.). Routledge.

McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5(2), 100–122. https://journals.sagepub.com/doi/10.1037/1089-2680.5.2.100

Neimeyer, R. A. (2001). Meaning reconstruction and the experience of loss. American Psychological Association.

Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing: Connections to physical and mental health. In H. S. Friedman (Ed.), The Oxford handbook of health psychology (pp. 417–437). Oxford University Press.

Stepakoff, S. (2009). From destruction to creation, from silence to speech: Poetry therapy principles and practices for working with suicide grief. The Arts in Psychotherapy, 36(2), 105–113. https://doi.org/10.1016/j.aip.2009.01.007

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

 

 

 

Please also review AIHCP’s Grief Counseling Certification, as well as its Child and Adolescent Grief Counseling Program, Pet Loss Grief Counseling Program, Christian Grief Counseling Program, Grief Diversity Counseling Program, Grief Perinatal Program, Grief Practitioner Program and finally its Grief Support Group Leader Program.

Narrative Therapy and Grief

There are numerous modalities and therapies to help individuals face grief and loss in a healthy way.  Most psychotherapies share equal positive results in helping individuals deal with anxiety, grief, or other mental problems.  In the case of depression, as well as prolonged grief disorders, they also share in efficacy but many counselors prefer integrated approaches sharing from one discipline and incorporated another.  One type of therapy that many grief counselors find effective for grief and loss is Narrative Therapy.  While Narrative Therapy may not be for everyone, nor the sole answer, it can play a part in helping individuals understand their loss in a more constructive and adaptive way.

Narrative Therapy helps the client find new meaning in the loss. Please also review AIHCP’s Grief Counseling Certification

Please also review AIHCP’s Grief Counseling Certification Program and see if it meets your academic and professional goals.

What is Narrative Therapy?

Narrative Therapy is a type of constructivist therapy with postmodern philosophies developed by Michael Kingsley White and David Epston (Tan, 2022).  According to Tan, postmodernism is a world view that truth is not objective or tied to merely observation or within the systems of language in which is described and hence is open to subjective experience (2022). Social Constructionism applies this principle that the client is the expert on what one  experiences and understands one’s own subjective truth best without judgement of others (Tan, 2022).  Narrative Therapy falls under this type of philosophy, albeit, many of its techniques can be applied outside its rigid definitions.

Narrative Therapy is closely tied to meaning making and in that regards in some ways to Existentialist Therapy and the importance of finding subjective meaning to one’s issues.  Meaning is then created through social relationships, especially in one’s use of language in stories or narratives one shares.  Due to this, meaning and subjective reality can be rewritten or reframe or re-understood by the client through Narrative Therapy (Tan, 2022).  Narrative Therapy views human nature as basically positive and able to form new and better constructive directions through formulating healthier meanings about the past and present.  This is especially true regarding grief, trauma and loss.  Narrative Therapy opens the door for others to rewrite the story and replace past narratives that are saturated in negative and oppressive overtones.

Narrative Therapy finds many of its uses in David Neimeyer and his work utilizing meaning making and meaning reconstruction in grief counseling and loss.

Narrative Therapy at Work

A strong therapeutic relationship between client and counselor is required in Narrative Therapy.  It borrows this from many Rogerian concepts that utilize empathy and understanding and a true connection.  This type of connection is key in any type of grief counseling regardless of therapy and should be a fundamental concept for any one hoping to console the bereaved.    Due to the fluid nature of grief, Narrative Therapy does not propose a guide book of handling grief or emphasizing one technique over another.  It instead teaches that there is no true right or wrong way to conduct the therapy again applying to Rogerian person centered theories, as well as its social constructivist ideals (Tan, 2022).

Still, there are tools that are generally applied to individuals to help them move beyond their oppressive past narratives.  The attempt is to better understand the past or loss or whatever narrative, reframe it with new meaning, and incorporate it into the overall life of the person.  Much like any meaning reconstruction, where a person’s life is a likened to a book with various chapters, some good, some bad, but all delivering a theme and message of the wholeness of the person.

Journaling and reconstructing oppressive past narratives is key in Narrative Therapy and critical in Grief Couneling

First, question is key in Narrative Therapy.  The therapist or grief counselor will ask a variety of questions to help assist the person in understanding oneself.  The attempt is to help identify past oppressive narratives and to help the person become unstuck from those perceptions.  The second tool is externalization and deconstruction.  In this, the therapist hopes to help the person realize that he or she is not the problem, but the problem is the problem (Tan, 2022).    The problem or attribute is detached from the individual and seen as an independent and external parasite in itself.  This externalization serves as the starting point in facilitating deconstruction from the oppressive narrative (Tan, 2022).   Narrative Therapy will help the client map the problem and its influence on one’s life and how profoundly or deeply it has negatively altered one’s life.  Many times when  mapping, the counselor will look to label the problem and again externalize it from the person during the deconstruction phase.  A third tool is searching for unique outcomes.  This is more solution based and the therapist helps the client identify times the client dealt successfully with the issue and how this can be incorporated again and at a more efficacious result. Fourth, therapists help clients reauthor their story and find different future outcomes from what they feel by the past oppressive narrative.  They are also aided in reframing that story and taking control of it and finding meaning in that story.  Finally, documenting the evidence of client’s progress is key.  Therapist will include letters that the client later re-read that reinforces and summarizes the therapy when they are feeling less or discouraged.

Highly involved also in healing is writing.  Clients are encouraged to journal, write letters to oneself or unsent letters to others, similar to Gestalt Therapy.  Journaling is key to identifying oppressive feelings and themes, as well as controlling the narrative through the power of the subjective reality of the person writing their story.  This is not to dismiss the event, or even to dismiss facts, but to reinterpret these events and meanings in a more conducive way to healing which sometimes means looking at the loss, event, or problem in a different light.

Ultimately the therapy looks to help clients to control their own narrative through cognitive processes and writing processes to form a new narrative.  The client names the problem, explores how the problem has adversely affected him/her and explores new ways to interpret the the issue or find different meanings.  In addition, the counselor helps the client identify times when he/she successfully dealt with said issues, as well providing the client with encouragement on imagining a sound and healthy future beyond the problem (Tan, 2022).

Conclusion

One can see the useful elements of Narrative Therapy and some of its independent tools in helping individuals, especially with grief.  Individuals suffering from loss, or in some cases, pathological and traumatic loss need a therapeutic relationship that is filled with patience and empathy but they also need ways to face the past loss.  They need to remove the negative narrative that haunts them regarding the loss and find new meaning about the loss and how to incorporate it into one’s life.  This type of Meaning Reconstruction is a key element in Narrative Therapy and helps the person not only understand the past and find new meaning and authority over it, but also how to cope and develop a meaningful future that respects the past loss but also adjusts to it in a healthy and secure way.

New narratives can help individuals move forward from loss in a healthy way. Please also review AIHCP’s Grief Counseling Certification Program

Grief Counselors who are clinically licensed can utilize this therapy for those suffering from prolonged grief disorder, while in some cases, elements of it can be used for those not suffering from pathological or complicated grief reactions.  Journaling is a healthy element of Narrative Therapy for any case in understanding a loss and finding meaning in it.

Please also review AIHCP’s Grief Counseling Certification Program which is applicable for both non-clinical professionals as well as clinical professionals.  Of course, only clinical professionals can utilize Narrative Therapy with those suffering from complicated, traumatic or prolonged grief disorders.

Reference

Tan, S-Y. (2022). Counseling and psychology: A Christian perspective (2nd Edition). Baker Academic.

AIHCP Blogs

Honoring Endings-Access here

Grief Journaling- Access here

Additional Resources

Ackerman, C. (2026). “What Is Narrative Therapy? Techniques & Worksheets”. PositivePsychology.com.  Access here

Clark, J. (2025). “How Narrative Therapy Works”. VeryWellMind.  Access here

Guy-Evans, O. (2025). “Narrative Therapy: Definition, Techniques & Interventions”. Simple Psychology.  Access here

Narrative Therapy. Psychology Today.  Access here

 

 

What Makes Traumatic Grief Different?

Grief - human hands holding black silhouette wordWritten by Marko,

The idea of saying goodbye to someone you love forever is heartbreaking. 

But, as hard as it is, it’s a different kind of hurt when you compare it to losing someone out of the blue. It’s sad, but the truth is, being able to say goodbye is a privilege not everyone gets. 

You have time to sit with it, and to hold your loved one’s hand, even if it’s for the last time.

Then there’s the other way, when you’re just living your normal life. And someone knocks on your door and tells you your loved one is just… Gone. Just like that. No last conversations, no warnings. One minute they’re here, the next, they aren’t, and there’s nothing in between that. 

This kind of shock leaves your brain stuck, and that stuck place is called traumatic grief.

In this article, we’ll go over the differences between traumatic grief and what people call normal grief. And if you’re wondering why that difference is important, it’s because you can’t recover unless you know what you’re recovering from.

How Grief Usually Unfolds When Loss Is Expected

Grief always hurts. There’s no way around that. It doesn’t matter if loss is expected; nobody can prepare for it in a way that doesn’t hurt. 

But the hurt usually doesn’t come all at once. Instead, it follows a somewhat steady path. Imagine if a person has a family member who’s terminally ill. They know what’s coming, and the hard moments come little by little. The whole thing feels like this heavy burden they’re carrying around all the time, and when the time comes, and they finally lose their loved one, they already saw it coming.

This all gives the brain some time to prepare.

That doesn’t mean that there’s a way to be actually ready for what’s going to happen, but you can’t help but have a sort of mental rehearsal going on in your head. So, you might cry in your car every few days, or you might imagine what your life is going to look like once that person is no longer here. There’s time, which means there can be closure, and closure is the first step towards healing.

Time also means emotions can adjust. 

By no means does that mean it follows neat little stages that come one after the other. Grief is messy, and some days are better than others. Still, the little things like going to work and making dinner help in keeping you grounded.

And as time heals you, you’ll still have all the memories of the person who’s no longer with you, but it’ll stop hurting (as much, anyway).

If the loss comes without any warning, though, none of this can happen.

What Changes with a Sudden, Traumatic Loss

It’s very frowned upon to say that one kind of grief is harder than another because everyone deals with grief in their own way. 

You can’t know how someone else is feeling, and you can’t be sure that you have it better or worse than they do. With that being said, the grief that accompanies traumatic loss is very different from the grief that happens after an expected loss, and some might say it’s harder. 

And they wouldn’t be wrong.

The hardest part of traumatic grief is that you now have to deal with two things at once. 

Sudden or violent loss measurably increases risk of prolonged grief/trauma (e.g., PTSD-like reactions). – National Institute of Mental Health

You feel the emotional loss, which is heavy enough on its own. But along with that, you’re also in complete and utter shock. And shock and sadness are two different emotions. 

When you’re in shock, it’s basically your brain slamming the brakes even though there was no yield or stop sign in sight.

For the most part, people go numb right after they hear the tragic news. Not in a cold way like they don’t care, but just blank.

Acute stress reactions )e.g., numbness, confusion, dissociation, etc.) are common side-effects of experiencing traumatic events. – Substance Abuse and Mental Health Services Administration

So, they’ll stare at a wall for an hour, or they’ll answer the door and forget they did it a few seconds later. They’ll hire a wrongful death attorney for fatal car crashes in Chicago when they should have hired one in Joliet, where they live. From the outside, this seems absolutely ridiculous, but two things are happening here: one, the brain is trying to protect you. 

And two, that loss made no sense, so it’s pretty much impossible to accept what’s happening. 

The brain keeps searching and searching for a connection between one moment where life was normal, and the next when it fell apart.

On top of all this, there’s also the real-life stuff to handle because there’s no grace period. You have to sign the papers here, make the calls there, decide on funeral arrangements and finances, and yes, hire a lawyer if someone else is to blame for the tragedy. 

It’s not that hard to believe that, because of dealing with all this, a person would forget they opened the door or hired a lawyer in the wrong city, isn’t it?

How Traumatic Grief Feels Different in Daily Life

Normal grief is heavy, but traumatic grief? That’s both heavy and confusing at the same time. 

Here’s what the difference looks like in everyday life.

There’s No Time to Prepare Mentally

If the loss came out of nowhere, the brain didn’t get any of the warning signs. 

No hospital stays, no bad test results, no slow decline, no last conversations… Nothing. As a result of this, the mind will continue acting as if the person is still alive, regardless of the fact that reality is different.

A person who’s grieving could find themselves picking up a phone to call their deceased loved one, or setting an extra plate for dinner. You might say this is pure denial and nothing else, but that’s not the case here. The brain is having a hard time catching up with what’s actually happening because nothing makes sense. 

The worst part is that this can go on for months.

The Body Stays Stressed

Grief consumes both mental and physical health, and with traumatic grief in particular, the body acts as if the danger is still here. You stay in that terrible fight-or-flight mode for a long time. You might notice your heart starts to race at random times, or you’ll jump at small noises.

Your body can stay in a constant state of heightened stress after experiencing trauma; this can negatively affect sleep, heart rate, body regulation, etc. – National Institute of Mental Health

And sleep? Now, that’s a battle every single night. 

You’ll either sleep too much or too little, but either way, you’ll never truly rest.

As crazy as it sounds, all this is normal. This is basically your nervous system doing exactly what it’s designed to do. The problem here is that there’s no ‘real’ threat to handle. Your mind thinks there is a threat, so it reacts accordingly.

Thoughts Keep Going Back to The Dreadful Event

Normal/regular grief revolves around someone’s memories about the person that’s gone (for the most part). These are inside jokes, things you’ll miss (laugh, jokes, routines, etc.) – the good times.

Traumatic grief is different. This type of grief is stuck on death where your mind replays a few moments over and over again. And it’s difficult to get out of that loop.

Core features of trauma-related conditions  are intrusive (negative) memories and repeated mental replay of the trauma. – U.S. Department of Veteran Affairs

The phone call, the news, the moment you found out, rinse and repeat, over and over.

You don’t consciously choose to think this; it simply shows up. The hardest part about this is that the brain is so focused on that tragic event that you can’t hold onto the happy memories.

It’s not that they’ve disappeared, but they’re buried under that replay button that refuses to stop.

It’s Harder to Find Closure

Harder, and even impossible. 

Normal grief gives you an ending. It’s not a happy ending, but it’s an ending nevertheless, where you might even get to hold the person’s hand and tell them you love them. It all makes sense, as painful as it is.

But there’s no ending with traumatic grief, and nothing makes sense anymore. 

Because of the absence of anticipatory coping/closure after experiencing unexpected loss a person can experience prolonged grief. – Harvard Medical School

So, in order to make it all feel sensical, the ‘what ifs’ start to pop up. What if they left 5 minutes earlier? What if someone had been there? 

None of that helps, but it also can’t go away. You know it’s irrational to play those scenarios over and over, but without a proper goodbye, your mind can’t wrap around the fact that this tragedy happened, and it can’t move past it.

Conclusion

None of this has anything to do with how much you loved the person. 

The only thing that matters is how the tragedy happened: was it expected, or was it a shock? And you might say that neither is worse, but truthfully, traumatic grief hits on more levels. Aside from the deep sadness, there’s also shock and pressure, with no soft landing in sight. It’s like your life just attacked you all of a sudden.

Make no mistake; just because you understand the difference doesn’t mean you can fix anything. But it’s useful because it explains why recovery is slower, and why everything feels more unpredictable. 

At the end of the day, if all you can know is that you’re not going insane, that’s still something.

Author Bio 

Marko is an adamant and eager content writer with a decade of experience in various niches,  with healthcare being one of them. With his way of implementing storytelling, comparisons, and examples into hard-to-grasp topics, Marko’s able to make complex things sound interesting and relatable – key ingredients to make something understandable. As a hobby, Marko enjoys offroading, board games, and spending time with his family and his dog Cezar.

 

 

Please also review AIHCP’s Grief Counseling Certification, as well as its Child and Adolescent Grief Counseling Program, Pet Loss Grief Counseling Program, Christian Grief Counseling Program, Grief Diversity Counseling Program, Grief Perinatal Program, Grief Practitioner Program and finally its Grief Support Group Leader Program.