Narrative Therapy and Grief

Posted on by Mark Moran

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

 

 

Behavioral Health and Positive Psychology

Posted on by Mark Moran

Most psychotherapy schools look at removing pathology or what is wrong in the person.  Counselors look to extinguish the problem and help the person overcome it but this approach, while classical and still beneficial, approaches the problem from the perspective of deficit.   Positive Psychology looks to approach situations from a health perspective.  It looks to identity what is right and positive in an individual and how one can again feel healthy by maintaining a healthy system and focusing on healthy and positive views that prevent pathology itself.  It is an entirely different perspective of the classical analogy of the glass of water.  Is the glass half full or half empty?   Obviously, a positive mindset is a powerful thing and relaying on positive energy and resources can help a person find health.  Positive Psychology focuses less on pathology but more on positive characteristics and strengths of the individual (Tan, 2022). Without over relying on a toxic positivity and false positive spin, Positive Psychology looks to help individuals utilize positive aspects of self to find healing and stay healthy

Positive Psychology focuses on the strengths and resiliency of a person. Please also review AIHCP’s Behavioral Health Certifications

Please also review AIHCP’s behavioral health certifications and see if they meet your professional and academic goals.

Positive Psychology

Positive Psychology as developed by Tayyab Rashid and Martin Seligman (Tan, 2022).    It looks to build upon what is already strong and help clients and patients flourish through positive emotions, relationships, work and meaning (Tan, 2022).  It recognizes human nature as generally positive and pushes individuals to undertake and engage in positive interactions to maintain health.  Instead of seeing pathology as a cause in itself, it sees pathology as a lack of positive character, strength and virtues (Tan, 2022).   In regards to depression, instead of focusing on the depressed mood or negative feelings, Positive Psychology assesses why the lack of joy,, hope or delight (Tan, 2022).  In regards to stress and anxiety, Positive Psychology looks at a sense of congruence though the concept of Salutogenesis. Aaron Atonovsky.  Salutogenesis dictates that to remain healthy, one maintains and focuses on healthy life styles.  Instead of permitting stress to break oneself down, one exhibits “coherence” as a way to face stress from a healthy perspective.  Atonovsky pointed out that one needs to have comprehension of the situation, a manageability of it, and a strong understanding of purpose.  In this way, the unhealthy reactions to stress can be limited by positive outlooks and emphasis on strengths of the person.

Techniques of Positive Psychology

The therapeutic relationship between counselor and client is essential in Positive Psychology.  Seligman and Rashid pointed out that this relationship helps clients discover their own inner strengths and allows the client to grow and heal oneself through their innate strengths and character rather than focusing on the weaknesses of the client (Tan, 2022).   They also identified five key possible mechanisms to promote change in the client.  First, a re-education of self regarding positive experiences.  Second, positive appraisals when recalling negative memories.  Third, identifying character strengths and virtues.  Fourth, using strengths in a balanced way, and finally, fifth, exploring meaning and purpose (Tan, 2022).

Within the therapy and its session, Seligman and Rashid illustrated important phases.  Phase one included the creation of a gratitude journal which documented the daily blessings every night.  In addition, a detailed discussion about character strengths and signature strengths to dwell upon followed by a self development plan entitled “Better Version of Me” to help develop one’s strengths to achieve certain goals.  Session two includes readdressing past negative memories with better outlooks about it.  It also includes forgiveness, as well as gratitude letters and lists. In phase three, the client focuses on hope and optimism, posttraumatic growth, positive relationships, positive communication, altruism and finding meaning and purpose (Tan, 2022).  Through these phases and the numerous exercises, the client learns self efficacy, positive strengths and better self image to grow in authentic happiness and well being (Tan, 2022).

Strengths and Weaknesses of Positive Psychology

The particular views of Positive Psychology can be beneficial for some clients.  In many cases, finding the positive outlook and perspective can be a powerful tool. It can also help one become more resilient, confident and self relying.  It can help build up self image and teach one how to maintain a healthy mental outlook on life.  However, for some, over use of positivity can be toxic because there does exist true pathology, especially in trauma, that needs examined.  It is sometimes important to see the glass half empty at times when healing is required (Tan, 2022).   Still, the positive twist and look to help individuals grow stronger is a good perspective and if utilized and interwoven can be a powerful tool for some individuals.   Positive Psychology obviously looks for numerous subjective elements of the person’s inner strength.  From a secular view, this can be applicable, but for a spiritual view, concepts of God and grace may need integrated for believers who find happiness in God, not self.  Also, concepts of suffering and negative experiences have value in some religious traditions, so such therapy needs to take into account religious and spiritual beliefs and tie them together with health positive outlooks that do not dismiss these concepts.

Conclusion

Positive Psychology presents a fresh perspective that can be compelling and useful in some cases.  It supports an excellent concept of internal efficacy and strength to face problems and the importance of maintaining healthy systems instead of focusing on broken down systems.  It is beneficial for some, but not everyone.  Sometimes, it can be integrated when needed in therapy with many of its concepts and tools in finding inner strength.  For some who are religious, concepts of happiness may need tied to religious beliefs on God and suffering.

Please also review AIHCP’s Behavioral Health Certifications, especially in Grief Counseling, Stress Management, Trauma Informed Care, and Spiritual Counseling Programs.

AIHCP Blogs

Stress Management and Salutogenesis- Access here

Behavioral Change- Access here

Other Resources

“Salutogenesis”.  Wikiepedia.  Access here

Joseph, J. & Sagy, F. (2022).  Positive Psychology and Its Relation to Salutogenesis. The Handbook of Salutogenesis [Internet]. 2nd edition.  Access here

Sabater. V. (2018). Martin Seligman and Positive Psychology.  Access here

Reference

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

How Clinicians Help Families Weigh Home Care Options

Posted on by Joseph Gerard

Please also review AIHCP's Healthcare Case Management Training Program and see if it matches your academic and professional goals

Written by Sofia Vallasciani,

“Is home really the best place?” It’s a question that triggers anxiety for both families and clinicians when care needs intensify. As a loved one ages, you and your whole family may find yourself sorting through a tangle of home care, residential care, and hybrid options. The stakes are high: quality of life, finances, and future well-being may all depend on your choice.

However, in the decision-making process, there is one ally to not overlook: your clinician. Clinicians often know your family and concerns, and may have followed your loved one through their care needs. Consulting them helps you get practical strategies for conversations and step-by-step tools for needs assessment, risk review, and budgeting. All of this can make it easier to navigate what’s ahead with more confidence, less stress, and peace of mind. 

Mapping the Conversation: Start With a Strong Foundation

Noticing that a loved one needs more help than he or she usually requires can be tough for family and friends. You may not be sure where to begin, what options are available, or what level of care may be needed at each stage. Here, clinicians can play a significant role in helping to guide the discussion with clarity and balance.

They will usually start by opening up the conversations and get a better feel of the situation with questions such as, “What matters most to you and your loved one right now?” Answering honestly and openly can help you and your family address immediate concerns and longer-term worries.

During a conversation regarding your loved one’s care, a clinician may use some strategies, including:

  • Clear, jargon-free explanations of home versus facility versus hybrid care.
  • Early identification of priorities (safety, independence, cost, access to medical care).
  • Emotional acknowledgment. They know that families will feel vulnerable, and they will work to normalize those emotions.

It may take patience, but recognizing family emotions upfront is essential to set the foundations of honest dialog later. 

Needs Assessment: Sorting Wants, Needs, and What’s Realistic

A structured needs assessment is the first step, which will support the entire decision-making process, grounding your decisions in facts rather than fear or wishful thinking. Clinicians can guide families through core questions, including:

  • What physical, cognitive, and emotional support does the person need on a daily basis?
  • Which tasks are truly challenging? These may include changes that you have noticed regarding everyday activities or aspects such as medication, bathing, transportation, and meal prep.
  • How available and willing are family members to pitch in, and for how long?

It is important to answer these questions honestly, allowing your clinician to have a full picture of the situation. For a fairer assessment, clinicians may also recommend using checklists, like those provided by AARP Needs Assessment, to clarify and quantify these details. 

Clinicians may also review your loved one’s medical history to identify health issues that may be manageable now but require more intensive care in the future. This way, you can have a clear idea of the steps ahead and what to expect as your loved one ages or their disease progresses. 

Weighing the Costs: Budgets, Value, and What’s Achievable

Cost is usually a key point in care discussions, and families often underestimate both the price and value of in-home support. However, it is important to understand that there are different levels of care, which are differently priced, and financial support options for eligible families. 

Here’s where consulting a healthcare provider can truly pay off. They understand the options available and the strategies you can use to reduce your out-of-pocket costs. During a thorough conversation, they will be able to take you through important aspects, such as:

  • Common home care services (personal care, homemaker assistance, nursing).
  • Typical price ranges by region.
  • What is and isn’t covered by Medicare, Medicaid, or private insurance.

They can help you better understand what are the senior care costs and benefits to expect, providing you with a realistic price forecast and an overview of the services that are typically included.

Managing Your Emotions During Money Conversations

Discussing detailed costs also helps reduce tension over what’s affordable by identifying which options fit within the family’s budget. When everyone sees a clear comparison of services and their prices, it becomes easier to remove emotion from the decision and select practical solutions that don’t cause resentment later. If the budget remains a sticking point, a provider can help the family separate true needs from extras, ensuring the essentials remain non-negotiable. 

As much as it feels cold to assign a value to a loved one’s care, understanding costs is critical for planning support that’s sustainable. If families overextend and run out of resources, gaps in both care and health outcomes can develop. Simply, making careful, well-informed budgeting decisions is an act of love as much as duty.

Assessing Risk: Safety, Function, and Setting

Risk conversations are rarely comfortable. No one wants to discuss the day-to-day needs of a loved one or how their health and care needs may change over time. However, discussing this aspect is vital for family peace of mind. They are also essential for meeting legal and ethical standards, ensuring your loved one is cared for in an efficient, compliant, and dignified way. 

A clinician may use open questions to guide families:

  • “What specific risks worry you most about home care? Are falls, wandering, or emergencies the main concern?”
  • “How likely is a sudden decline, and what backup plan feels realistic?”
  • “Which care setting offers the right level of supervision and structure?”

Assigning risk “tiers” (low, moderate, high) with clear examples can help families remove bias and correctly identify the level of care needed. 

A clinician might say, “If your father only needs help with occasional meal preparation but manages all medications safely, he’s at low risk and could thrive with part-time in-home support.” Or, “If your mother experiences frequent falls and sometimes forgets to turn off the stove, that places her in the high-risk category. In this case, 24-hour supervision at home may be safest.”

Using these kinds of specific scenarios frames the discussion around facts instead of fear, helping families see where their loved one truly fits on the risk spectrum. 

Navigating Family Conflict and Bias

Even with the best prep, conflict can erupt when siblings, spouses, or multiple generations get involved. Clinicians will expect, not fear, strong opinions. They understand that conflicts often start when some family members fixate on worst-case outcomes, issues relating to finances or level of responsibility, or when past grievances resurface as objections about care.

To keep things productive a clinician may:

  • Use scripts: “I can see this is stressful for everyone. Can we focus on what matters most to your loved one?”
  • Encourage the “wisdom of the table” by giving each participant a chance to state their concerns, without interruption.
  • Normalize disagreement as a natural phase of family decision-making.
  • Taking short breaks or moving the conversation to neutral territory (a coffee shop, park, or video call). 

The point isn’t to force agreement: it’s to ensure every family voice is weighed with dignity.

Documentation and Scripts: Tools for Clear, Unbiased Decisions

Accurate documentation supports better care, reduces revisiting old arguments, and ensures wishes are taken into account during the decision-making process. Clinicians can prepare take-home worksheets that include:

  • Date and participants in each meeting.
  • Main concerns and care goals discussed.
  • A brief summary of options, ruled-in and ruled-out.

Sample scripts to aid decisions might use phrasing like:

“Based on what we’ve discussed, here are the options we’ve agreed to consider… Our next step is to revisit these choices in two weeks, unless there’s a significant change in health.”

Sharing copies for everyone (yes, even via group email) avoids miscommunication and showcases that the process is transparent, which may help avoid conflict down the line.

Exploring Hybrids: When Neither Home Nor Facility Feels “Right”

Sometimes the best option isn’t either-or, it’s both. Hybrids, such as adult day services plus in-home help, can bridge gaps for families not ready to commit fully to residential care.

Your clinician may discuss hybrid options, which are often customized around your loved one’s needs. During this conversation, your healthcare provider can bring together support from different providers, providing information such as:

  • What services operate at home, in the community, or virtually.
  • A sample week’s support (e.g., in-home care three mornings, adult day care twice a week).
  • Reviewing transportation, supervision, and transition plans if needs change.

Clinicians may also encourage families to trial a hybrid model for 30–60 days, adjusting as needed, rather than making irreversible decisions after a single stressful meeting. During this time, you may be able to review and assess the level and quality of care, find out what works and what needs improvement, and discuss your thoughts with other family members. This can help you make a more informed decision when the time comes. 

Final Thoughts: Continuing the Family Care Conversation

Choosing between home, facility, or combination care isn’t a one-time event. Needs evolve, finances shift, and family dynamics change. Clinicians can help approach these conversations with humility, transparency, and expert tools that can help families choose with confidence.

For more practical frameworks, scripts, and case studies on family-centered care planning, The American Institute of Health Care Professionals’ internal blog archives offer a wealth of clinician-tested insights. Explore resources for continuing education, downloadable worksheets, and clinician support networks to deepen your understanding and enhance your next care conversation.

 

Writer Bio

Sofia Vallasciani is a health and wellness writer with over five years of experience creating clear, accurate, and accessible medical content. She specializes in translating complex health topics into reader-friendly material, with particular expertise in regenerative medicine, integrative health, and lifestyle medicine. Her work focuses on educating readers and supporting informed health decisions through evidence-based writing.

 

Please also review AIHCP’s Case Management Certification program and Case Management 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

Healthcare Facility Security: Why It Matters

Posted on by Joseph Gerard

A stethoscope over computer keyboard Written by Marchelle Abrahams,

One of the biggest challenges facing healthcare facilities these days is the rising number of security threats. Hospitals all over the world deal with physical threats, the risk of cyberattacks, and even problems with internal safety daily. In fact, the healthcare sector has quietly become one of the most targeted in the world.

The numbers tell the story. In 2024 alone, more than 250 million Americans had their health records compromised. As if that wasn’t bad enough, many nurses have said that they have experienced at least one incident of workplace violence in the past few months.

The message couldn’t be clearer: security is no longer a nice-to-have for healthcare facilities. It’s fundamental. If your facility isn’t protected, everything else is at risk. Patient trust. Staff morale. Daily operations. All of it.

So what does healthcare facility security look like in real life, and more importantly, how can you get it right? Let’s discuss.

What Security Means in Healthcare

When you hear “healthcare security”, you probably picture a guard at the front desk checking IDs. That’s a part of it, but it’s not all there is to it.

True healthcare facility security is multi-layered. As you already know, there will be a physical security guard at the front desk checking for IDs and watching out for trouble. You also have cameras, badge readers, and other forms of biometric security so that only authorized people can access certain areas. 

Then there’s occupational health and safety. This involves providing healthcare personnel with PPE, ventilation systems, as well as your protocols for handling biohazards.

Facilities also need safeguards for patient records, billing systems, and even medical devices. Why? Because a successful breach can cost facilities up to $7.42 million, according to the HIPAA Journal. Healthcare cybersecurity is non-negotiable.

If your facility is located in a rough neighborhood, healthcare safety means having the right legal safeguards and response plans in place.

Bottom line? Healthcare security isn’t just stopping threats. It’s keeping the entire system stable, safe, and running without a hitch.

Key Areas of Protection in Healthcare Facilities

So, what are the key security or protective measures that should be put in place? We already mentioned them briefly earlier. Let’s now go in-depth.

Physical Security

It starts with the physical security. This covers trained security personnel who check IDs and do bag checks. It also involves access control systems and CCTV surveillance that covers high-risk areas like ICUs, operating rooms, and drug storage facilities. 

The idea is that not everyone can go everywhere within the facility. But facilities are also moving beyond traditional bag checks and manual screening. 

Hospitals are now installing metal detectors like those used in airports. This trend has become even more popular since the Carilion Roanoke Memorial Hospital attack. On Christmas Day 2024, a man walked into the hospital’s trauma center with a hatchet and attacked a physician. 

He was able to carry out the attack because there was no system in place to detect the weapon. That’s changing. Systems like the CEIA OPENGATE detector allow people to walk through without stopping or removing personal items, while still detecting weapons like knives or firearms. 

According to GXC Inc., these detectors are fast, reliable, and less intrusive. And honestly, more practical in high-traffic environments.

Occupational Health and Safety

Your staff faces risks that go beyond angry patients. They also deal with exposure to biological hazards, chemicals, and infectious diseases. The COVID-19 pandemic was a real eye-opener. It showed just how vulnerable healthcare workers can be in these environments. 

That’s why healthcare security should also cover protection against these threats.

Let’s also not forget physical injuries from patient handling, as well as ergonomic strain from repetitive tasks. Hospital nurses are the most affected, with one source reporting that up to 83.9% of nurses experience symptoms of musculoskeletal disorders.

As a hospital admin, it’s on you to put clear policies in place. Not just on paper, but in practice. Proper lifting techniques, better equipment, and realistic shift structures can go a long way in reducing these risks.

Data and Asset Protection

We’ve already touched on the cost of healthcare data breaches. But honestly, the financial loss is just one part of the story. Think about the loss of reputation, as well as the legal consequences that will follow when patients’ personal information is stolen. And worse, sold on the black market.

This is a real and growing threat, and healthcare facilities need to take it seriously. At the very least, this means strong EHR security, firewalls, and encryption, and providing regular staff training on cybersecurity. These are non-negotiable basics. 

You may also want to consider taking on a cybersecurity expert. That could be an in-house role or an outsourced partner, depending on what makes sense for your setup. 

The goal is to ensure that patients’ information is safe within your system.

Protection in Conflict Zones

For facilities operating in rough neighborhoods or conflict zones, the stakes are even higher. 

In conflict zones, hospitals and medical facilities might have some leverage, but only just. And that wiggle room can be found in the Geneva Convention, which states that healthcare facilities are not to be attacked as long as they are fulfilling a medical function. 

But the truth is a lot different.

There are always attacks on healthcare facilities in these areas. In fact, health facility attacks intensified in the past couple of years, with more than 900 health workers killed in 2024 alone. 2025 was even worse.

Knowing that there’s a law somewhere protecting your facility is one thing, and it may not be enough. You need to have an actual security plan that reflects the risk to your facility.

The same thing applies if your facility is located in a rough neighborhood.

Why Security Is Critical in Healthcare

Maybe your healthcare facility has been enjoying people and tranquility, and now you’re wondering, “Why bother?” Here are three reasons to care.

  1. Patient and Staff Safety. First, it keeps people alive. Your patients and your staff. A secure facility has fewer injuries, fewer infections, and fewer incidents. People trust you more when they feel safe.
  2. Operational Continuity. Next, it keeps your doors open. A data breach can shut down your facility for weeks. A violent incident? It can also shut you down for weeks while the authorities investigate. Bottom line? Security failures cost money.
  3. Financial and Legal Exposure. According to the American Hospital Association, violence can cost healthcare facilities an estimated $18.27 billion. It might not be that much for your facility, but you get the picture. Without a proper security posture, you’re exposed both financially and legally.
  4. Reputation. Finally, it protects your reputation. It takes little to damage the reputation you’ve spent years building. One bad breach. One viral video of a fight in your waiting room. Suddenly, nobody trusts you anymore. Hospitals run on credibility. Lose that, and you lose everything.

Is Your Healthcare Facility Secure Enough?

Now that you know why security is important in healthcare facilities, ask yourself, is your security system secure enough?

The truth is that when your doctors and nurses feel safe, they provide better care. When patients feel secure, they heal faster. And of course, better patient outcomes speak well for your hospital.

So, investing in hospital security isn’t just an item in your budget. It’s an investment in your people, your patients, and your community.

Just like you wouldn’t run a hospital without electricity, don’t run one without real protection either.

Author Bio:
Marchelle Abrahams

Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks

 

 

Please also review AIHCP’s Health Care Leadership 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

What Makes Traumatic Grief Different?

Posted on by Joseph Gerard

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.

Iatrogenic Addiction: When Treatment Becomes the Trigger

Posted on by Joseph Gerard

Medication management is a critical element of case management and patient recovery and overall health

Written by Stephanie Garner

Reduce suffering. That is the goal most clinicians carry into practice. But sometimes the treatment itself turns into the problem — a patient walks into a clinic with a fracture and walks out, weeks later, unable to stop taking the opioid prescribed for post-surgical pain. Iatrogenic addiction is the clinical term for substance dependence or compulsive behavior that originates directly from medical treatment. Vowles et al. (2015) found wide variation in rates of problematic opioid use in chronic pain studies, largely because studies used different definitions of misuse, abuse, and addiction. Their weighted estimates placed addiction in the 8% to 12% range. Even the lower estimates remain clinically significant because they affect a large number of patients exposed to long-term opioid therapy.

What makes it worse? Many of these cases begin with textbook prescribing. A five-day course of hydrocodone after knee surgery. Lorazepam for acute panic attacks. Nothing reckless. The slide from therapeutic use into dependence happens quietly, and clinicians are often the last ones to notice — partly because medical training has long treated addiction as something that happens to other people’s patients.

The Broader Addiction Spectrum

Treatment-induced dependence does not develop in a vacuum. Genetic factors play a role. So do environmental stressors and psychiatric comorbidity. All of it feeds into whether a given patient crosses the line from use into disorder. The addictions most often seen in people today can be triggered by a variety of factors. A clinician trying to understand where iatrogenic cases fit has to look at the full picture — the most common types of addiction seen in clinical practice range from alcohol and opioid use disorders to behavioral patterns such as gambling and disordered eating.

Here is why that range matters: if you only screen for prior substance misuse, you will miss the patient who has never used recreationally but happens to carry an OPRM1 polymorphism. Variants in genes such as OPRM1 may influence opioid response and addiction vulnerability, but they are not reliable stand-alone predictors of who will develop opioid use disorder (Mistry et al., 2014).

On paper, that patient looks low-risk. In reality, biological vulnerability can complicate that picture. There is also a classification issue. The DSM-5 collapsed “abuse” and “dependence” into one spectrum — substance use disorder, mild through severe. Iatrogenic cases sit awkwardly inside that framework. The patient may meet DSM-5 criteria for substance use disorder, but the origin of that disorder is medical. It matters for treatment planning, for prognosis, and for how the patient sitting across from you processes what went wrong.

High-Risk Medication Classes

Some prescriptions carry far more risk of iatrogenic addiction than others. Knowing which ones is not optional — it is the baseline.

Opioid analgesics are the most studied example. The CDC’s 2022 guideline advises prescribing opioids at the lowest effective dose and for no longer than needed, with a tapering plan when opioids are used around the clock for more than a few days. Many post-surgical patients in some settings go home with enough pills for two weeks because the discharge paperwork was written before anyone stopped to ask whether acetaminophen and a nerve block might have been enough. Hospitals know alternatives exist. Actually rewriting the default order sets is a different story.

Benzodiazepines come next. Alprazolam, lorazepam, diazepam — effective for acute anxiety, but tolerance and physiologic dependence can develop with ongoing use. Withdrawal after prolonged use can mimic the original symptoms, trapping patients in a dose-escalation cycle they didn’t ask for. Some patients do not realize they are dependent until they try to stop.

And then there are gabapentinoids — pregabalin, gabapentin — which got positioned as the safer alternative to opioids around 2015 and never lost that reputation. Prescriptions went through the roof. Emerging data challenges that assumption (Evoy et al., 2021). Z-drugs and stimulants carry their own dependence curves. The common denominator? Neuroadaptation. The brain adjusts, and adjustment is where dependence starts.

Risk Factors and Vulnerable Populations

It would be convenient if prior substance use history were the only red flag. It is not. Not even close.

Depression, PTSD, and generalized anxiety — each one raises the risk substantially. Chronic pain also increases risk, even before prescribing patterns are considered. Imagine a scenario where two people walk out of the same pharmacy holding the same bottle of oxycodone 5 mg. One had an appendectomy last week — healthy, stable, good support at home. The other? Fibromyalgia for eight years. Depression that nobody has treated. No therapist, no psychiatrist, no safety net. Same prescription. Wildly different risk profiles.

Age complicates things further. Benzodiazepine clearance slows down as patients get older — a 78-year-old on lorazepam is not going to process it the way a 45-year-old does, and the sedation piles up in ways that increase fall risk significantly. Teenagers are a different problem entirely. Adolescents prescribed stimulants need careful monitoring because these medications are Schedule II and have misuse potential, but appropriate ADHD treatment does not clearly increase later substance use disorder risk.

And across every demographic, fragmented care makes things worse. Three specialists, no shared chart, nobody coordinating. The orthopedist writes hydrocodone, the psychiatrist writes clonazepam, and the two of them have never spoken. Meanwhile, the patient’s medicine cabinet holds a combination that any pharmacist would flag — if anyone thought to ask.

Screening and Early Detection

Catching iatrogenic addiction early is possible. The tools exist. They are just underused. Tools such as SOAPP-R and CAGE-AID can support screening, but they measure different kinds of risk and should be used as part of a broader clinical assessment. These tools are brief and practical enough for routine clinical use. Yet both get skipped constantly.

Ongoing monitoring matters just as much. Prescription Drug Monitoring Programs operate in all 50 states now, but a 2023 study out of Minnesota found that four in ten opioid prescribers never checked the PDMP before writing a prescription (Sacarny et al., 2023). Four in ten. That is not an individual failing — it’s a systems problem.

The early warning signs are often subtle. A patient asks for a dose increase ahead of schedule, becomes anxious around refill dates, or shows pushback when tapering is discussed. These shifts deserve attention before anyone meets formal diagnostic criteria. Once someone is doctor-shopping or repeatedly presenting to the ED, the best window for early intervention may already have passed.

Prevention and Ethical Prescribing

The conversation about dependence risk needs to happen before the first pill is dispensed. Not in a consent form buried under six other documents — out loud, in plain language. Most patients do not get this conversation. They should.

When you spread pain management across multiple modalities, no single drug carries the full load. Chronic low back pain might respond better to a low-dose NSAID, physical therapy, and nerve blocks than to oxycodone alone. Same logic for anxiety — an SSRI plus psychotherapy is a different risk equation than a benzodiazepine and a six-week follow-up. None of this is new. It is just underutilized — reimbursement still favors pills over sessions.

Tapering deserves its own mention. Abrupt discontinuation of opioids or benzodiazepines can cause significant withdrawal symptoms, and with benzodiazepines in particular, sudden cessation can trigger seizures. Evidence-based deprescribing guidelines outline gradual dose-reduction strategies that are safer and more practical in clinical care (Pottie et al., 2018). Some of this work also has to happen at the institutional level. Systems that require PDMP review when opioids are prescribed, and that audit whether those checks occur, are more likely to catch high-risk prescribing patterns that individual clinicians may miss.

Implications for Healthcare Education

This is where medicine has genuine catching up to do. A scoping review found very limited coverage of opioid use disorder within the broader literature on substance use disorder education in medical schools. Medical schools have often devoted limited curricular time to addiction education, and that gap shows in clinical practice. Students graduate knowing oxycodone’s pharmacokinetics but not how to recognize when a patient is sliding toward dependence on it.

Continuing education has to pick up the slack. Nurses, counselors, case managers, pharmacists — these professionals encounter iatrogenic addiction regularly, sometimes before the prescribing physician does. Certification bodies need to make addiction-risk literacy a requirement. The LCME still does not mandate specific SUD education hours, so each school decides for itself. A handful — Virginia Commonwealth among them — have embedded addiction rotations into clerkships. Most have not.

I realize “add more training” sounds like a platitude at this point. But the ask here is specific: if you can prescribe a Schedule II controlled substance, you should be able to explain — in clinical terms — how that substance produces dependence. If you can’t, the training failed you somewhere.

Conclusion

First, do no harm. Everyone learns that phrase. Iatrogenic addiction is what it looks like when we fail at it — not because anyone acted with bad intent, but because the screening wasn’t done, the training wasn’t there, or the system made it too easy to keep refilling a prescription nobody was monitoring. The prescriber has to look at their own patterns honestly. The institution has to fund PDMP integration and real addiction coursework, not a single noon lecture during orientation week.

The patients who developed dependence through medical treatment did nothing wrong. They followed instructions. They trusted the system. Earning that trust back means doing the structural work — and then doing the harder thing, which is admitting out loud where we got it wrong.

References

Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recommendations and Reports, 71(3), 1–95. https://doi.org/10.15585/mmwr.rr7103a1

Evoy, K. E., Sadrameli, S., Engel, J., Covvey, J. R., Peckham, A. M., & Morrison, M. D. (2021). Abuse and misuse of pregabalin and gabapentin: A systematic review update. Drugs, 81(1), 125–156. https://doi.org/10.1007/s40265-020-01432-7

Mistry, C. J., Bawor, M., Desai, D., Marsh, D. C., & Samaan, Z. (2014). Genetics of opioid dependence: A review of the genetic contribution to opioid dependence. Current Psychiatry Reviews, 10(2), 156–167. https://doi.org/10.2174/1573400510666140320000928

Muzyk, A., Smothers, Z. P. W., Akrobetu, D., Ruiz Veve, J., MacEachern, M., Tetrault, J. M., & Gruppen, L. (2019). Substance use disorder education in medical schools: A scoping review. Academic Medicine, 94(11), 1825–1834. https://doi.org/10.1097/ACM.0000000000002883

Pottie, K., Thompson, W., Davies, S., Grenier, J., Sadowski, C. A., Welch, V., Holbrook, A., Boyd, C., Swenson, R., Ma, A., & Farrell, B. (2018). Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline. Canadian Family Physician, 64(5), 339–351. https://pmc.ncbi.nlm.nih.gov/articles/PMC5951648/

Sacarny, A., Williamson, I., Merrick, W., Avilova, T., & Jacobson, M. (2023). Prescription drug monitoring program use by opioid prescribers: A cross-sectional study. Health Affairs Scholar, 1(6), qxad067. https://doi.org/10.1093/haschl/qxad067

Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., Ney, J. P., & van der Goes, D. N. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain, 156(4), 569–576. https://doi.org/10.1097/01.j.pain.0000460357.01998.f1

 

Author bio: Stephanie Garner, MS, is the Chief Executive Officer of ARVAC Incorporated in Dardanelle, Arkansas, where she has served since 2013. She holds a Master of Science in College Student Personnel from Arkansas Tech University and a Bachelor of Science in Political Science from the University of the Ozarks.

 

The Importance of Pre-Authorization in Preventing Denials

Posted on by Joseph Gerard

Medical Coding Bill And Billing Codes SpreadsheetsWritten by James Eric

Healthcare revenue is not only dependent on the quality of care delivered to the patients. It also relies on how well your billing process supports that care. One weak link in the medical billing process can disrupt the entire cycle. One of those critical links within the medical billing workflow is the prior authorization, a step that providers manage internally or with the support of a medical billing company to ensure accuracy, compliance and timely approvals. While many providers still treat it as a routine task, in reality, it plays a strategic role in denial prevention. When handled well, you can spot the importance of pre-authorization becoming fruitful for your revenue outcomes. It protects your revenue and builds payer trust. When ignored, it leads to denials and revenue delays, losses that could have been easily avoided.

Let’s break down the real role of pre-authorization and how it shapes a stronger billing workflow.

Prior Authorization in the Medical Billing Process

The prior authorization in medical billing is executed before the healthcare service is delivered. It is the step that makes sure that the insurance provider agrees to the coverage in the patient’s plan. This approval is the key that aligns all the stakeholders: the patient, the practice, and the insurance company, on the medical coverage.

The Right Prior Authorization Workflow

The prior authorization process is the step conducted between patient scheduling and service delivery. It acts as a checkpoint before costs are incurred. A typical workflow for the execution of the pre-authorization includes:

  • Eligibility verification
    The team checks if the patient’s insurance is active and valid.
  • Clinical documentation submission
    Providers send medical records, diagnosis codes, and treatment given.
  • Payer review and approval
    The insurance company evaluates medical necessity.
  • Authorization tracking
    Staff track approval status and ensure validity dates align with service delivery.
  • Final confirmation before service
    The provider proceeds only after approval.

Each step demands accuracy and timing. Even a small gap can lead to denial.

Why It Matters Early

Pre-authorization sets the tone for the entire revenue cycle. It reduces uncertainty before care begins, ensuring that the medical necessity of the services is recognized by the payer. Without the timely pre-authorization, the practice will transition into a reactive approach. The time and resources wasted on the denial handling hit back at your revenue.

Medical Billing and The Importance of Pre-Authorization

The importance of pre-authorization becomes clear when you look at denial patterns. A large portion of denials comes from missing or incorrect authorizations.

Direct Impact on Claim Approval

Insurance payers expect strict compliance with authorization rules. If a service requires approval and the provider skips it, the claim faces high denial risk. It is a mandatory step, and the absence of it could directly lead to the claim denial. Due to the unverified medical necessity, the payer is unable to approve the payment.

Streamlined Cash Flow

Denied claims delay the rightful payments for a practice while also increasing the need for rework by the billing teams. Pre-authorization reduces this friction. With a strong prior authorization management system, providers:

  • Improve first-pass claim acceptance
  • Reduce accounts receivable days
  • Lower administrative overhead

This way, the practices can target improved revenue outcomes and a faster payment release.

Billing Transparency and Patient Satisfaction

The common belief among the patients is that their insurance will cover their healthcare. When authorization fails, they receive unexpected bills. Pre-authorization helps avoid these situations. It gives patients clarity about coverage before treatment. This builds trust and reduces disputes.

Regulatory Risks and Compliance

Payers conduct audits to check for compliance. In the case of a lack of authorization, it can lead to an audit or a penalty. A prior authorization workflow has several advantages, including the assurance that there is adequate documentation to protect revenue as well as reputation.

Results of Inefficient Pre-Authorization Management

When a healthcare reorganization lacks the proper management of the prior authorization requirements, it drastically affects its revenue. It decreases the staff’s efficiency, the billing workload increases, and the patient satisfaction goes down the drain.

Higher Denial Rates

The most immediate effect of inefficient prior authorization in medical billing will be a rise in denial rates. This will be due to a lack of approval, authorizations that have expired, and incorrect codes being used. Your billing team will be required to rework a claim from denial to an accurate one and then send it out for submission. It slows down the entire revenue cycle.

A Draining Revenue Cycle

Not all denied claims are eligible to be recovered. Some will be lost in the system due to a lack of time or resources. This will lead to a leakage in revenue. This leakage adds up to a huge revenue loss when calculated annually.

Administrative Workload

Manual processes are often inefficient. They require a lot of time to monitor approvals, make phone calls to payers, and correct mistakes. This leads to low productivity and high employee burnout. Manual processes also increase operational costs.

Delayed Patient Care

If authorizations are not obtained in a timely fashion, this will lead to delays in patient care. This delay affects patient satisfaction, and with the rescheduling required, it drains their trust in your practice.

Poor Data Tracking

However, without a proper prior authorization processing in place, it becomes challenging to track and monitor this process. It becomes harder to check into the approved, pending, and denied claims, optimize the revenue, and identify trends.

Target Improvements with Prior Authorization Best Practices

Improving pre-authorization does not have to be a transition for the whole process to have a significant impact. Best practices for a well-implemented prior authorization workflow include accuracy, speed, and accountability.

1. Standardize the Process

Practicing the process as a prerequisite develops consistency. Standardize the processing protocols for each step of the prior authorization workflow.

  • Define the required documents for each service
  • Use checklists to avoid missing details
  • Align coding with payer requirements

Standardization ensures every request meets payer expectations.

2. Integrate Technology for Automation

Manual operations delay the billing execution, while automated processing improves speed and accuracy. Use tools that:

  • Verify eligibility in real time
  • Auto-populate patient and provider data
  • Track authorization status

Utilizing advanced technology ensures prior authorization improvement while reducing errors and speeding up execution.

3. Staff Training for Compliance Standards

Each payer has different requirements. Staff must understand these variations.

Regular training helps teams:

  • Submit accurate requests
  • Avoid common denial triggers
  • Handle complex cases with confidence

Knowledge-driven teams perform better and reduce rework.

4. Improve Inter-Departmental Communication

The prior authorization execution involves different parties, including the front desk staff, the physicians, and the billing team. A minor error from one of these and the claim becomes erroneous. Create a connected workflow where:

  • Scheduling teams flag authorization needs early
  • Clinicians provide complete documentation
  • Billing teams verify approvals before claim submission

This alignment improves the entire prior authorization in revenue cycle management for your practice.

5. Monitor Key Performance Metrics

Tracking performance helps identify gaps. Focus on metrics such as:

  • Authorization turnaround time
  • Approval rates
  • Denials linked to authorization issues

Regular monitoring supports continuous improvement.

6. Authorize Ahead of the Patient’s Appointment

Waiting till the last moment to get the pre-authorization is not a wise idea. Make sure that you attain the authorization as soon as the patient sets the appointment. A proactive timing helps through:

  • Reduced delays
  • Improved approval rates
  • Ensured smoother patient flow

This approach reflects strong prior authorization best practices.

7. Highest Documentation Accuracy

Inaccurate or incomplete documentation has the highest ratio of causing claim denials. To combat this, ensure that your clinical documentation is practiced with the greatest accuracy levels. Clear documentation increases your first-pass claims rate. Verify the accuracy standards by checking for certain details in the documentation:

  • Accurate Diagnosis codes
  • The treatment plan
  • Physician’s notes

8. Dedicated Prior Authorization Team

A specialized team plays a key role in improving billing efficiency. A focused team handles authorization tasks with greater accuracy with the help of their regulatory understanding and expertise. An improved pre-authorization reduces delays in the payment and improves the billing outcomes.

9. Real-Time Claim Status Tracking

Not knowing the claim status may cause delayed reactions from your billing team. With the help of timely tracking and follow-up for the submitted claims helps:

  • Identify pending requests
  • Follow up with payers
  • Avoid expired approvals

An optimized medical billing process delivers a progressive revenue cycle to your practice.

10. Regular Audits for Targeted Improvement

A healthcare billing system can never be consistent. To keep it on track and streamlined, regular revenue cycle audits help quite a lot. They help review:

  • Denial patterns
  • Process delays
  • Processing Loopholes
  • Recurring Errors
  • Staff performance

Use insights to refine your prior authorization management strategy.

Conclusion

Pre-authorization is not just a compliance step. It is a strategic tool for denial prevention and revenue protection. The importance of pre-authorization becomes clear when you connect it to financial outcomes and patient experience. A strong prior authorization in the medical billing framework ensures that services align with payer expectations before they are delivered. This minimizes the risks, increases claim acceptance, and facilitates smooth cash flow. On the other hand, poor management of prior authorization processes causes unnecessary claim denials, delays, and lost revenues. It also increases the workload and compromises patient trust.

The way ahead is quite clear. You should focus on structured workflows, documentation, and the effective use of technology. You should implement tried and tested prior authorization best practices. If done well, the pre-authorization process transforms your revenue cycle from reactive to proactive. It provides your healthcare business with control, clarity, and confidence in all your claims.

 

 

Author Bio:

James Eric is a seasoned healthcare professional with over 10 years of experience in medical billing, coding, and compliance. Throughout his career, he has helped practices optimize revenue cycles, ensure regulatory compliance, and streamline documentation processes. His in-depth knowledge of payer guidelines and coding standards makes him a trusted resource in the industry. Currently, James is bringing his expertise to Physicians Revenue Group, where he contributes to delivering high-quality, efficient billing solutions tailored to healthcare providers’ needs.

 

 

Behavioral Health and Psychotherapy

Posted on by Mark Moran

Mental health is usually the most neglected part of one’s overall being.  Even in the United States where so many eat unhealthy, ignore annual testing, and critical bloodwork and basic health, mental health even lags farther behind in concern.   However, when physical symptoms of malady occur, quick and urgent solutions are sought through a physician.  If one becomes acutely ill, one is encouraged to visit the doctor and find remedy, but when one manifests emotional or mental symptoms, far too many times, the symptoms are masked, ignored, or dismissed as “crazy” or as if only in one’s mind.  While individuals are not labeled or stigmatized for high cholesterol or diabetes, individuals with anxiety, or depression are many times made to feel less or insane or mentally weak.

Psychotherapy is a type of talk therapy with a variation of different approaches and schools of thought. Please also review AIHCP’s Healthcare Certifications

Mental health is health and it is important.  Mental health is not something that just exists in one’s mind but it tied to not merely social and behavioral issues but also tied to physiological and biological factors that at times require medication like any outward condition.  What exists in the mind is real and it is connected to physical health as well and if not treated can lead to other physical as well as social issues.   Psychotherapy serves as a crucial way to help individuals understand themselves, their conditions and to validate their emotions.  It grants to them a therapeutic relationship to find healing, as well as to find ways to cope and create better and safer ways of thinking and behaving.  This short blog will look at what psychotherapy is, its efficacy, and some schools of psychotherapy and their techniques in helping individuals find healing.

Please also review AIHCP’s Healthcare Certifications, as well as its Behavioral Healthcare Certifications which include grief counseling, crisis counseling, trauma informed care, stress management, anger management, meditation instructor, Christian and spiritual counseling and many more!

What is Psychotherapy?

Psychotherapy is considered a type of talk therapy to face individuals in psychological distress (Wampold, 2019).  It is considered to be an acceptable as well as beneficial healing practice with roughly 10 million Americans involved in some type of psychotherapy a year (Wampold, 2019).  The effectiveness of psychotherapy includes treatments for depression, anxiety, substance abuse, obsessive compulsion disorders, eating disorders, trauma, sexual and marital issues.  Despite the effectiveness, the stigma and dismissal of mental health leaves up to 40 percent of the people who would be considered by the Diagnostic and Statistical Manual of Mental Disorders or the DSM-5 as not receiving the mental help they require and need (Wampold, 2019).

Care for mental health is not something new that merely emerged onto the world stage upon the advent of modern science but has existed throughout the centuries through more humanistic and pastoral venues.  These modalities utilized empathy, caring and meaning making within religious contexts to help people find peace and security in times of depression and anxiety (Wampold, 2019).  However, at the turn of the 19th Century, the scientific method gained prominence in all fields of human inquiry and this eventually also effected the way individuals analyzed and studied mental health.  In the later part of the 19th Century and early 20th Century, Sigmund Freud would emerge as a leader in psychoanalytic theory which would primarily utilize talk therapy as a way to understand mental pathology through the lens of the conscious and unconscious mind.

Following Freud, in the Mid 20th Century, the school of Behaviorism would become a dominant force through pioneers such as Joseph Wolpe and later Cognitive Behavioral Theory through the thoughts and genius of Aaron Beck and Albert Ellis.   Later, more patient and modern concepts of Person Centered Therapies emerged through the concepts of Karl Rogers which emphasized the therapeutic relationship.  In the post modern era, there are numerous different schools as well that not only have different approaches but also consider various cultural and gender based aspects of mental health and care.

Schools of Psychotherapy

According to Tan, there are numerous schools of thoughts in psychotherapy with some being completely original, while others are offshoots and subdivisions of others.  More differing schools of thought can at times be at odds at core values and retain heated rivalries of thought, while other schools share similar core concepts and integrate previous concepts to evolving changes in modern treatment.  There to this day exist pure schools of one discipline that  a licensed professional can train within, as well as therapists who treat within that particular and only therapy, but many therapists and licensed counselors or social workers usually adhere to a blend of different methodologies borrowed from different schools to meet the needs of a client.  Among the numerous schools exist Psychoanalytic Therapy, Adlerian Therapy, Jungian Therapy, Existential Therapy, Person-Centered Therapy, Gestalt Therapy, Reality Therapy, Behavior Therapy, Cognitive Behavior Therapy, Mindfulness and Acceptance-Based Therapy, Constructivist Therapy, Integrative Therapy, Positive Psychology and Marital and Family Therapy (Tan, 2022).

Mental health is health. Psychotherapy is a proven and beneficial way to find healing and growth

We will examine only a few below to give a some understanding of the different modalities

Psychoanalytic Therapy

Psychoanalytic theory as proposed by Freud looks into the subconscious of a person to understand hysteria or pathology.  Freud understood the human mind to consist of the Id, Ego and Superego.  The Id represented humanity’s most basic instincts and drives.  The ego represented humanity’s personal desires and sense of self.  The Superego was the person’s superimposed cultural and religious ideals of right or wrong and morality.  When these were in conflict, anxiety resulted.  In addition, based upon one’s past progression throughout various sexual stages of life, one could become stunted or face pathology due to lack of development.  These issues could be found within the forgotten subconscious manifesting later in life as pathology.  Freud incorporated a variety of talk therapies to confront defense mechanisms that hid the problems of the mind, as well as dream analysis to help the person uncover the trauma or repressed event of the past.  Freud’s strict adherence to his theories led to divisions with Alfred Adler as well as Carl Jung (Wampold, 2019).

Behavior Therapy

Behavior Therapy is the most empirical and studied based of the therapies.  It stems from empirical observation and positivism of the early 20th Century and looked to understand mental health and behavior as something that stemmed from one’s environment.  Behavior Therapy finds its core and foundational base in both classical and operant conditioning.  Classical conditioning is based off Pavlov’s experiments with dogs and how they responded to various stimuli.  Pavlov discovered that an unconditional response to a natural stimuli such as salivating to the presence of food, could become conditioned via a conditioned stimuli associated with the unconditioned one to create the same salivation or now conditioned response.  For instance, the ringing of a bell associated with dinner time, over time could still elicit salivation when food was gradually removed from the sound.  This proved that one could be conditioned or counter-conditioned to respond and behave to certain introduced stimuli and possible reverse negative behaviors.  In addition to classical conditioning, Behavior Therapy also emphasizes the importance of operant conditioning which is based off basic child rearing of reward and punishment of certain behaviors.  Parents can reward certain acts for good behavior through positive reinforcement, or remove negative stimuli from the event via negative reinforcement to increase or maintain a certain behavior If the parent is not looking to increase or maintain a behavior through positive or negative reinforcement, the parent can look to remove or decrease a certain behavior via punishment (Tan, 2022).   These types of extinction approaches are how behavior can be modified through external stimuli via operant conditioning.   Behavior Therapists utilize a variety of methods to help change behavior through modeling, token economies, systematic desensitization, and relaxation strategies (Tan, 2022).

Cognitive Behavioral Therapy

Cognitive Behavior Therapy can be divided into Cognitive Therapy (CB) of Beck and Rational Emotive Behavior Therapy (REBT) of Ellis. There are multiple others based as well found within the CBT family tree including Stress Inoculation Training (SIT) as well as later developed mindful schools that include Dialectical Behavioral Therapy (DBT),  as well as Mindfulness Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) (Tan, 2022).

The primary branching of CBT from Behavior Therapy was the less deterministic view of conditioning and basing more human behavior on the response to mental representation of stimuli and hence the importance of understand pathology under the lens of a person’s cognition, attitude and perception of what is occurring (Wampold, 2019).  Beck believed that cognitive distortions were a key issue with many mental issues.  He introduced the idea of cognitive restructuring and helping the client restructure through coping strategies and problem solving therapies (Tan, 2022).   So CBT looks beyond the mere limitation of maladaptive habits being formed due to external conditioning, but more attributes them to maladaptive or irrational thinking that leads to maladaptive feelings and behaviors (Tan, 2022).   Beck listed a variety of cognitive distortions such as arbitrary inferences, selective abstractions, overgeneralizations, magnifying and minimizing, personalizing, and dichotomous thinking that lead to maladaptive behaviors (Tan, 2022).  Ellis added that mental constructs such as “must”, “should” or “got to” can also lead to human unhappiness, emotional problems or neurosis (Tan, 2022).

Beck introduced techniques and interventions that challenged the person to question and overthrow maladaptive thinking and cognitive processes.  He endorsred such talk therapies that included analyzing one’s own words that one uses to better understand one’s thinking (Idiosyncratic Meaning, as well as questioning the evidence of claims, reattribution or reevaluating other ways to interpret events, as well as as a host of other concepts such as decatastrophizing, fantasized consequences, labeling and scaling (Tan, 2022). Ellis also added such techniques and therapies as direct disputation or challenging of a belief, as well as his ABC model which included homework for the client to directly monitor and journal certain thoughts.  Ellis also utilized humor, as well as role playing as effective methods to counter certain cognitive maladaptive thoughts (Tan, 2022).

Person Centered Therapy and Existentialist Therapies

Karl Rogers was instrumental following the behavioral theory waves with incorporating a more person centered type therapy that focused more strongly than ever before on the counselor/client relationship.  Many of his counseling techniques and strategies are core elements of modern counseling.  Rogers emphasized empathy, genuineness and unconditional positive regard for the client.  Unlike past therapies, the counselor became a guide that helped the client uncover what is best for themselves.  This now type of therapy unfolded into a person discovering their own ability of self healing through a tender guide and counselor.

Rogers hoped to allow the person to actualize their potential through a empathetic relationship.  In valuing the experience itself, the counselor looks to help the client find personal growth through the person’s own actualization by discovering one’s true self and self worth.  Person Centered Therapy looks to not solve the problem but help the person find the ability to heal and grow through congruence, empathy, unconditional positive regard and genuineness (Tan, 2022).

Existential therapies find their origin in existentialist philosophy.  Individuals need to find meaning in their lives to find purpose and understanding of their human condition. One needs to embrace their inherent freedom to find meaning in their particular life.  Meaning and labeling can lead individuals from dark places, but when this meaning is lacking, then it becomes difficult to move forward.  Victor Frankl, a survivor of the Nazi concentration camps, wrote extensively on meaning making and Logotherapy as ways to find meaning and to control one’s life. (Tan, 2022). Within the core of all existentialist philosophy is understanding the nature of anxiety as a natural part of life, taking control of one’s life, accepting the realities of life and death, and moving forward with a sense of meaning to one’s own life and journey (Tan, 2022).

What Therapy is Best

No one school is better than another. What matters most is the counselor/client relationship and what best therapy the client responds to

Despite the numerous therapies listed, or discussed, no one therapy has a true monopoly over another.  Each have their own strengths and weaknesses and some even share in various common threads that tie them together.   For instance, if one looks at views on human nature alone, psychoanalytical portrays a pessimistic outlook, behavioral portrays a neutral one, while humanistic paints an optimistic view.  In regards to development, psychoanalytic sees human development as a series of psychosocial sexual stages tied to attachment theories, while behavioral views development from a learning and experiential standpoint.  From a health standpoint, psychoanalytic views health as balance with ego, id, and superego, as well as security and healthy attachments, while behavioral schools view mental health as healthy adaptations, cognitions and absence of dysfunction.  Humanistic schools would see health as congruence, awareness and acceptance of self.  In regards to goals and outcomes, psychoanalytic would hope for a personality change due to a resolution between the subconscious mind and one’s current state.  Behavioral schools would consider distress reduction and adaptive functioning as a final goal, while humanistic schools would for authenticity of self, self actualization and a meaningful existence as key (Wampold, 2019).

All of these outcomes seem healthy and each are achieved through different perceived roles of the therapist.  One as direct and distant observer in psychoanalytic, one as a guide in behavioral, and one as a facilitator in person centered (Wampold, 2019).   Ultimately the most important characteristic in any therapy is how well the therapist adheres to it and how well the client responds to it.  In fact, the counselor/client relationship remains one of the most important elements in psychotherapy (Wampold, 2019). This is ironic, since of the major three, Person Centered Therapy values this relationship the most within the therapeutic relationship as emphasized by Rogers.  Ultimately, the client makes it work (Wampold, 2019).

Regardless, even if Behavioral Therapy and CBT have the most empirical studies, no one therapy proves to stand out above another.  It ultimately depends on the needs of the client and how their own individual needs respond to it.  In this way, psychotherapy is more diverse and subjective than traditional physical medicine.  Most counselors do not adhere to merely one theory but hold to a hybrid approach which finds a totality of truth in all of them together.  They hence can cherry pick various techniques for certain clients and integrate as needed for the client (Wampold, 2019).

Psychotherapy, nonetheless, as a branch within itself, remains effective for mental health.

Conclusion

Psychotherapy is critical to mental health.  Many face stigma over mental health and unfortunately, many disregard it as not as crucial or important as physical health.  The reality is mental health is health and needs to be addressed through the variety of psychotherapies available.  Many of the schools are very diverse in thought, while others share common attributes, but despite their differences, studies show all to be equally effective.  Ultimately it comes down to the client and the abilities of the therapist.  In fact, many therapists share and integrate from different schools of thought to find the best outcome of the patient.

Please also review AIHCP’s numerous behavioral health and healthcare certification programs

Please also review AIHCP’s numerous healthcare certifications and see if they meet your academic and professional goals.  Please bear in mind, AIHCP’s certifications are not modalities of practice in themselves.  AIHCP does not certify a licensed counselor in a particular modality but in certain types of counseling that are not regulated at the state level, such as grief counseling, or crisis counseling.  Pathology and treatments discussed are reserved for licensed clinical counselors, social workers, psychologists and psychiatrists alone.  AIHCP behavioral health certifications are available to both clinical and non-clinical professionals and to be utilized within the scope of their professional and legal practice.

References

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

Wampold, B. (2019). The basics of psychotherapy: An introduction to theory and practice. APA.

Other AIHCP Blogs

CBT. Access here

Behavioral Therapies. Access here

Rogerian Therapy and Depression.  Access here

Freud and Defense Systems.  Access here

Additional Resources

Guy Evans. (2025). Psychotherapy: Definition, Types, Techniques, & Efficacy. Simply Psychology. Access here

Psychotherapy (2022). Cleveland Clinic.  Access here

Psychotherapy. Mayo Clinic.  Access here

 

 

 

Cognitive Behavioral Therapy (CBT)

Posted on by Mark Moran

CBT is one a tested and effected therapy for many basic mental issues that people face.  It is utilized by numerous counselors for numerous cases of depression, anxiety, and other impulse issue related disorders.  This blog continues from the behavioral therapy blog from AIHCP and focuses more on the cognitive element and second wave of behavioral therapy.  Please also review AIHCP’s numerous behavioral healthcare certifications in grief counseling, stress management, anger management and crisis intervention.

How we think affects how we feel and behave. Please also review AIHCP’s Healthcare Certifications

What is CBT?

Cognitive Behavioral Therapy or CBT is part of the second wave of behavioral therapy.  It retains  many of the core behavioral therapy characteristics that recognizes who we are due to behavioral formation but emphasizes the importance of cognitive aspects that reflect feelings and subsequent behaviors.   According to Tan, CBT remains faithful to behavioral therapies various modifications but incorporates the cognitive processes associated with it (2022).   The primary founds of cognitive behavioral approaches are Aaron Beck of CT, Albert Ellis of CBT and Donald Meichenbaum of stress inoculation trainding (SIT) (Tan, 2022).

According to Ellis, the root of most emotional problems stems from irrational beliefs and thinking.  The purpose of cognitive behavior therapy is to alter irrational beliefs to alter negative feelings and that produce negative outcomes and behaviors.  CBT has three primary phases of help for a client.  The first involves cognitive restructuring or changing maladaptive or dysfunctional thinking, secondly equipping the client with coping skills to handle stressful situations and finally help the client acquire problem solving skills to explore options and solutions to issues (Tan, 2022).

Unlike radical behavioral therapies that bind the person to their environment which produces behavior, CBT does not deny the free will of the person’s behavioral development but ties it more closely to the influence of thought on the mind (Tan, 2022).   Some of the key basic theoretical principles of CBT include a neutral human nature that is neither good or bad, much like BT, but also emphasizes that the human organism primarily responds to cognitive representations of one’s environment than to the environment itself.  In addition, CBT views the thoughts, feelings and behaviors of a person to be all causally interrelated and connected.  Due to this, attitudes, expectations and attributes and other cognitive activities are essential clues to understanding ones psychopathological behavior.  CBT therapies envelop testing and empirical verification to better assist the client in reliable strategies and healing modalities to overcome these pathologies.   Through this healing process, CBT recognizes the behavioral therapist as a educator and diagnostician who identifies the pathology within the client and helps the client design new experiences and thoughts to remove the dysfunctional cognition and abnormal behavioral reactions (Tan, 2022).

Cognitive Distortions

Cognitive distortions or how people think play a key role in how one feels and reacting poorly to life situations.  Many automatic thoughts in childhood create basic assumptions about life which lead to maladaptive schemas that lead to bad behaviors (Tan, 2022). Beck believed that many of these cognitive distortions created these issues.  Beck listed 6 types of cognitive distortions.

  • Arbitrary Inference-making a conclusion without significant evidence
  • Selective Abstraction-a conclusion based on details taken out of context while ignoring other relevant information
  • Overgeneralization- applying a general rule to all situations not necessarily related
  • Magnification or Minimization-perceiving an event as greater or less than it really is
  • Personalization-relating a causal event as correlated to oneself when the event is not related to oneself
  • Dichotomous thinking- viewing things in one or two extremes as complete success or complete failure

Tan lists various examples tied to these cognitive distortions.  When making a conclusion without evidence can be likened to a mother believing she is a horrible mother because dinner was not on time due to working a long job.  An example of selective abstraction would be a person who becomes jealous of a girl friend speaking to a man, but not knowing the man she is speaking to is her cousin.  Overgeneralizing can be likened to a man who is turned down by a woman and then believing that all women will turn him down.  In regards to magnifying or minimizing, a person who may believe if he or she fails this exam, the world will end and one’s life will be over.  Personalization examples include someone who feels slighted by another and not concluding that the other person may have not meant anything by it or not even noticed it.  Dichotomous thinking can be compared to someone thinking if they fail to get the position or job, then one is a complete and total failure as a person (Tan, 2022).

Ellis also added critical elements to understanding cognitive distortions.  General irrational beliefs about life itself can lead to irrational reactions.  Among the irrational beliefs that Ellis listed were (Tan, 2022)

  • The necessity of close to universal acceptance or love
  • The erroneous correlation of worth tied to competence and adequacy
  • Wicked people should always be punished
  • It is a terrible reality if things are not as a person wants them to be
  • A person cannot control one’s own happiness but is subject to the circumstances of life
  • Dangerous and fearsome things must constantly be thought about and avoided
  • Avoidance of uneasy difficulties as a life plan instead of facing them
  • A person should be dependent upon others
  • The past makes one who one is and there is no escaping that past
  • Other people’s problems should be a burden upon oneself
  • The correct solution to each problem must be discovered to avoid chao

In addition, Ellis hoped to remove the controlling thoughts that include the words “must”, “should”, or “have to” (Tan, 2022).  CBT, or also rational emotion behavioral therapy (REBT) goes farther than CB of Beck and more strongly challenges the beliefs of the client, as well as differentiating between negative healthy emotions such as sadness and frustration as compared to unhealthy negative emotions such as depression and hostility (Tan, 2022).

Cognitive Techniques

There are variety of techniques at play within the mental toolbox for cognitive therapists.

There are numerous cognitive techniques in CBT and CB to help individuals confront irrational beliefs and thoughts. Please also review AIHCP’s healthcare certifications

CB

Beck employed a variety of techniques within cognitive behavioral therapy.  Beck would utilize the technique of idiosyncratic meaning to ask clients to utilize words to describe their thoughts and feelings.   The counselor then analyzes the words and questions the client on why particular words are being used to describe oneself.  Reattribution is a technique which forces clients to think of other reasons why something occurred.  Commonly the counselor will ask one if there “is another way to look at this?”  The counselor can also use rational responding as a technique which analyzes the evidence for or against something, what is more reasonable an explanation, limiting the extreme response of the person, and finding better ways to cope with the problem.   Counselors or therapists can also utilize examining options and alternatives as a strategy to brainstorm other solutions.  The counselor can use decatastrophizing as  a way to illustrate how the client is blowing things out of proportion.  CB therapists also utilize fantasized consequences which examines the supposed consequences of a situation to expose the irrationality of it.   Closely related is the technique of exaggeration or paradox in which the client is asked to verbalize all fears and consequences to the utmost extreme.  Upon reaching this height, the counselor then carefully walks the client back down to a more reasonable conclusion.   Obviously, this type of therapy should be used with care for some clients with particular past traumas.  Counselors also can try the technique of scaling to reduce the all or nothing feelings of a person.  This involves numbering the issue on a scale of 1 to 100 to help the client truly understand the significance of something.  Self talk is an important skill and technique as well that helps the client internally speak to oneself when confronted with the particular issue of control.  An interior monologue of planned and self rehearsed responses to a given situation and then utilized. Thought stopping is yet another technique to help clients where the client is given control of maladaptive thoughts through the command of stop, or through distracting oneself from the thought itself.  In addition to disruptive thoughts, counselors can help clients learn labeling of distortions in which the client is taught to identify the irrational and properly label it for what it is.  Essential to this and many other techniques is the use of homework for clients.  Clients can journal or in some cases put themselves in certain situations and practice these skills (Tan, 2022).

CBT/REBT

Ellis also employed a variety of techniques building upon Beck’s ideas to help individuals manage and control irrational thoughts and behaviors.  Ellis helped clients learn the technique of disputing irrational beliefs as a way to face them. Ellis employed this foundational technique with the ABC model.  A stands for the activation of the event or situation encountered, B stood for the beliefs that are usually irrationally tied to the event, and C stood for the consequences of those beliefs.  Ellis would help individuals understand all three aspects of this to understand every step of the irritational episode and how to better dissect it (Tan, 2022).   Ellis  also utilized the concept of homework and applied it to the ABC model by asking clients to keep a journal at home in which the steps of ABC evolve also into DE, in which the client in journal form disputes the irrational belief of the day and to note the unhealthy effects.  Ellis also emphasized a changing in language.  He especially dismissed demanding language that involve “must”.  In addition, Ellis was a big believer in psychoeducation as a way for individuals to understand themselves, and to apply what they learned in teaching others.

Beyond cognitive tools, Ellis also employed a variety of emotional tools to help understand one’s irrational thoughts.  Emotionally, Ellis believed in the importance of unconditional self acceptance and the critical part the counselor played in conveying this to the client.  Although no way as dependent as person centered therapy and the therapeutic relationship, CB and CBT does recognize the important role a counselor plays in helping guide the client.  In such way, emotional support is important and various therapies can be utilized to help emotional healing.  Rational emotional therapy teaches clients how to use mental imagery to visualize certain behaviors and thinking.  Clients are encouraged to visualize negative emotional experiences and how to work through them.  Emotionally, Ellis also believed that poking fun through humor was important.  The use of humor technique utilizes humor as a tool to attack irrational thought.  With emotion, self talk is also taken to a higher level, where the person moves from quiet internal discourse to verbally loud raised voice to dismiss the irrational thought.  This is also accomplished in role playing between the counselor and client, where the counselor allows the client to rehearse something is emotionally upsetting (Tan, 2022).  Many behavioral techniques include also tested behavioral techniques that are tied to operant conditioning, modification strategies, social skill training, relaxation trainings, stress management, and system desensitization (Tan, 2022).

Conclusion

Cognitive Behavioral (CB, CBT, REBT) are all byproducts of behavioral therapy but extend within its second wave to a more cognitive based approach.  It is one of the most empirically based systems in psychology and is equally effective in treating numerous pathologies as most time tested strategies.  It does not focus as much on the past as psychoanalytic theories but more so on the present and finding solution within the present.  In addition, while it does stress more importance of the therapeutic relationship than psycho analytic, it does not go as far as person centered therapies.   In its essence it sees humanity as neutral while other religious views portray humanity as broken but overall good.

CBT is a successful therapy that identifies irrational thought, how to cope with it and how to finally implement changes. Please also review AIHCP’s behavioral health certification programs

Please also review AIHCP’s Healthcare Certifications and see if they meet one’s academic and professional goals.  AIHCP offers a variety of certifications in the behavioral fields.  It is critical to remember that CBT, as all therapies, are reserved for only licensed professional counselors, social workers, psychologists or psychiatrists that a certified in CBT.  AIHCP’s certifications can be utilized by clinical professionals as well as non-clinical professionals but AIHCP does not offer any certifications in CBT but these are reserved for various organizations with board approvals.  If interested in applying CBT to one’s practice, one needs to be first licensed and also certified within that field.  This does not mean certain tools and aspects of it cannot be utilized for non-pathological cases in the pastoral setting, but not as a therapy itself.

 

Additional AIHCP Blogs

Behavioral Therapy: Access here

Person Centered Counseling.  Access here

Existential Counseling.  Access here

Jungian Psychology.  Access here

Reference

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

Other Resources

Dr Aaron T Beck. CBT Institute.  Access here

Cherry, K. (2026). Albert Ellis Biography. VeryWellMind.  Access here

Cognitive Behavioral Therapy.  Mayo Clinic.  Access here

Mcleod, S. (2023). “Cognitive Behavioral Therapy (CBT)”. SimplyPsychology.  Access here