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.
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
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.
This video discusses the nature of the subconscious mind and the keys to successfully helping individuals find change in their daily lives. Please also review AIHCP’s Clinical Hypnotherapy Program
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.
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.
Many people who feel unloved deal with past traumas and losses that affect self image. Most cases are irrational thinking that lead to these feelings. Despite this, these feelings are sincere and real enough for the person. In this video, we look at what makes individuals feel unloved and how to feel loved and have a healthier self image.
You don’t think about it because that would make you paranoid and crazy, but that sidewalk outside your apartment building might be a lawsuit waiting to happen, and your workplace could end up injuring you even if you work in an office.
Most people assume that these types of places are safe because they should be. Hospitals should follow procedures, your landlord should fix the steps if they’re broken, etc. That should be the deal.
But these places aren’t exempt from serious injuries, and it’s rarely one giant disaster that causes them. It’s a series of little things that are problematic, like the handrail that’s been wobbly for years. Everyone knows about it, yet nobody’s fixing it.
Falls are the leading cause of all nonfatal injuries in the U.S. – Centers for Disease Control and Prevention (CDC)
Small things tend to pile up, and once they do, it can easily end with someone seriously injured and a lawyer getting involved in a situation.
How Small Issues Turn Into Big Problems
Injuries are a big deal, so when you think about how they happen, you naturally think of something dramatic, like someone running a red light.
This makes sense because the issue is simple and obvious, but for the most part, that’s not how real life works. Real-life injuries and everything involving them are messy, and the cause isn’t always as obvious as you’d expect it to be.
Each year, 44,000+ deaths and millions of injuries in the U.S. are caused by preventable incidents (e.g., falls). – Injury Facts
So while you’d think that one big bang caused the person to end up in a full-body cast, the reality is that it was a series of little issues nobody paid attention to that were responsible for the injury.
Miscommunication can be enough of a reason for an accident.
Communication failures are the leading root cause in 60+% of all serious medical errors. – Joint Commission International
A nurse tells something to the tech, but the tech is already stressed, so they can’t even hear the whole thing properly. They both go on about their day, thinking two different things while at the same time believing they’re in perfect agreement. The information simply got lost somewhere along the way, and they won’t have any idea of it until someone gets in trouble.
Then there’s the “it’s always been fine before” mentality, and this is a big one.
Let’s say you’re a warehouse manager and you skipped the monthly safety check because there’s simply not enough staff for it.
Nothing happens. Goodie!
Next month rolls around, so you decide to skip the safety check yet again. Things are still fine. Fast forward a few months, and you’ve skipped that safety check so many times that you don’t even remember to do it. And then one frayed cable reminds you why you shouldn’t have skipped the first one, let alone every other that followed.
Another big part of this is routine.
People are creatures of habit, and when you do the same thing 100 times, you stop really seeing it. Your brain goes on autopilot because that’s what’s efficient, but this is horrible for safety.
Habitual behaviors can reduce active attention and situational awareness. – Stanford University
You can’t catch small issues on autopilot, and if you’re under pressure already, then you can’t even pay attention properly. As a result, you take shortcuts over and over until they start to feel like normal work instead of shortcuts.
It’s important to note that nobody WANTS to hurt someone else; none of this is done intentionally.
But if nothing bad happens right away, then things seem to work the way they are, so why change them? This goes on for a while until the day when all hell breaks loose, and someone ends up in the ER. And that’s when it hits you that it wasn’t that teensy little detail that was the problem, but a bunch of missed steps coupled with stress that caused the disaster to happen.
And do you want to know the really scary part in all of this? It happens everywhere.
What These Situations Say About How Systems Really Work
When a person gets hurt, it’s only natural to look for who messed up.
One person, one mistake, it’d be great if it were that simple.
But the smarter thing would be to step back and look at the whole system because that’s when you can truly see the whole story. You’ll probably see the same issues repeating over and over, just in different places and involving different people.
That means that it’s not the individual who’s at fault here, but the way the system was built at its core.
Most errors result from flawed systems and processes rather than individual negligence – Agency for Healthcare Research and Quality
Here’s a quick example to illustrate:
Most businesses will have certain ‘safety measures’ in place to help prevent harm. And while they are effective, they’re written for ideal conditions. This means full staff, lots of time, no distractions, etc. But we all know that this isn’t how real life works. So what ends up happening is the rules sit on a shelf somewhere while people on the floor make do with what they have.
Training can also be part of the problem because most people learn how things go when everything is normal. But that means that they don’t get to learn how to spot the small warning signs before something goes awry.
So when a problem does arise, it’s not unusual to see lawyers getting involved, especially law firms that specialize in these types of accidents/cases, such as Slip and Fall Injury Lawyers.
Where Things Usually Start to Go Wrong
Injuries don’t appear out of thin air, and if you take the time to trace them back, you’ll see that things start to go wrong days (or even weeks!) before.
But nobody noticed at the time, so here you are.
Communication Slips
We’ve all been there. You tell someone something, you assume they understood, but they heard something completely different, and you found out about that too late. This happens all the time, especially in workplaces.
For instance, a supervisor might ask you to check the back stairwell, but they’ll forget to mention that the tenant complained about the railing being loose, and now you’re in a cast and on painkillers.
And before you ask about maintenance, the guy didn’t see that anything was off, so he figured there was nothing to fix.
The Space Itself Is Risky
Sometimes, the problem is the way people behave.
Other times, the problem is a dumb setup, like a parking lot that has no lights in the corner or a staircase that looks like a joke with all the mismatched step heights. You probably don’t look at any of that and think it’s dangerous, but it is because those spaces have an impact on what you do.
If the entrance has no mat, people track water inside, and the floor stays wet the entire day. When there’s clutter in the hallway, people step around in all kinds of ways to get through.
You might not notice it, but your surroundings almost force you to behave in a risky way, and you have no idea about it.
People Not Following the Process Exactly
Sane people don’t plan on doing their jobs wrong, but processes change little by little.
So you skip a step because you have no time for it, and nothing bad happens. You figure, why not skip it again? Less work for you, and everything stays okay. But then skipping steps just becomes the way you work, not because you’re lazy, but because that seems more efficient.
Let’s say you work at a store where the rule is to rope off spills right away.
But you’ve done that 10 times already for tiny spills that get cleaned up in 2 minutes, and it feels like overkill. Next thing you know, you’re not using the rope anymore, and it works until the one time when you get distracted, and someone walks right through it.
People Get Overloaded
There’s only so much you can pay attention to; that’s just the reality of being human.
When there’s not enough staff or you’re behind schedule, the only thing that seems to help is doing more than 2 or 3 things at once. But if you go down this road, you’re bound to forget something here and there. You forget to lock the gate, you miss the wet floor sign, you tell yourself the loose tile can wait until later, etc.
And then later never comes because your brain literally can’t keep track of everything when you’re stretched that thin.
No One Is Responsible for the Problem
This one’s everywhere because who’s responsible for the crack in the sidewalk in front of the office building or for the leaky ceiling in the entryway? Everyone knows about these problems, and you think someone even mentioned it way back when, but whose job is it to fix these?
Nobody’s, it would seem. So it all stays there, week after week.
Conclusion
The most concerning thing about these injuries is that most of them happen because people haven’t been paying attention to everything that isn’t working.
The truth is, all those inconveniences like cluttered halls and dark corners are accidents waiting to happen. And you can’t say it’s hiding in plain sight because it isn’t actually hiding. It’s all there; everyone can see it.
The fix isn’t rocket science, and it doesn’t need a huge budget.
Just build systems that match how people work, not how you wish they worked. That’s really all there is to it.
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 Legal Nurse Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
The secular world voices concerns over many types of planning. Financial planning dominates most venues as critical to one’s security and future retirement. Commercials flood the television with various firms that can assure oneself and one’s family’s future through the guidance of financial advisors. One also sees the shift of importance to health and dieting, as well as intense workout plans. Life coaches, personal trainers all help create unique physical and dietary plans to the needs of one’s personal goals and health number parameters. Such concern over health and financial security is important and should be on the top of everyone’s list but in the secular world, seldom does one hear of spiritual planning. If one’s bodily health, or financial security or stability of one’s retirement in the temporal realm is important, where is the more pressing concern of one’s spiritual health, spiritual security or heavenly retirement? In the secular world, as St Teresa of Avila points out, so many exist outside the interior castle of the soul and its inner monologue and relationship with God. The soul is so blinded by the needs of the body that it forgets itself. Instead it ONLY sees the needs of the body, its health, its security and its future at the expense of the soul’s eternal salvation. When imbalance of such exists, then these physical goals and planning become illusions and false idols that detract from one’s final end. This is a very perilous life style.
Spiritual planning based upon God’s will is key. Spiritual planning should be as primary a concern as any financial planning. Please also review AIHCP’s Christian Counseling Program
In this blog, we will look at Spiritual Planning and how to implement some the most basic elements of it to provide spiritual growth and stability and a closer relationship with God. In this blog, our financial planning is interest in grace not money, growth in virtue not assets, security in God not bonds, and retirement in heaven not Florida. This blog in itself could be a long manuscript on such a broad subject, but will attempt to keep the subject as compact as possible with also consideration to other blogs and concepts, as well as texts, within AIHCP Christian Counseling as well as Spiritual Direction resources that have already touched on similar concepts found in this blog.
It is imperative for Christians to remember that salvation is not an accounting book of one’s own good deeds versus bad deeds. One cannot live a sinless life. The fall of Adam has prevented such endeavors and as broken human beings, we need the grace of God, earned through His Son on Calvary for salvation. One’s faith in Christ is essential for salvation, for one cannot find salvation in one’s own works. Pelagius, an early Church heretic, attempted to heretically teach that one’s human nature was not completely corrupted and that one, albeit rare, could imitate Christ and possibly live a sinless life. Pelagius believed works could save oneself. This was condemned by the Church at the Council of Carthage, and equally rebuked by the great saint, St. Augustine. St Paul indeed teaches that it is through Christ and His death and one’s faith in Christ that souls are saved, but it is important to understand that faith is more than a formal assent, but is a cooperation with the graces earned by Christ at Calvary. Christians are not saved by faith “alone” which was never included in the original translation but through faith which encompasses a working nature. Scripture emphasizes a working faith in Christ that balances the assent of faith with its fruits and works, for St James emphasizes the balance of spiritual works in faith. Christ, Himself, commands His followers to keep His commandments.
Hence as Christians believe that one cannot earn heaven by oneself, as if balancing a ledger, but one must completely rely on the grace earned by Christ, at such a high cost for each of us, for one’s salvation. The fruits of the working faith, the cooperation with the grace earned by Christ for one’s salvation, does not belong to oneself but a when connected to Christ, and under the grace of the Holy Spirit, become salvific. Spiritual Directors, as well as Christians who attempt to better themselves in spiritual life, must first come to this ultimate surrender that their salvation is not their own but a gift from Christ and applied through the Holy Spirit. The Blood of Christ cleanses one of sin and pays the price for that Original Sin of Adam as well as the actual sins committed by oneself. Alone, no matter what one does, like the past sacrifices of patriarchs, are insufficient, but when aligned with Christ and His death, where one’s cross becomes tied to Christ’s cross, then they become pleasing to God. Christians are not activators of their salvation, nor are they passive recipients of it, but are cooperators with what was earned at the cross, motivated by grace to the gift of salvation.
The Spiritual Planning strategies in this blog do not replace Christ’s gift of salvation, but are grace motivated gifts of the Holy Spirit to participate in that redemption at a more efficient way. While the soul participates, it is the grace of the Holy Spirit that encourages it, strengthens it and molds it. Unlike physical fitness and planning, where one plays a key role in physical transformation-albeit guided and trained by another, the spiritual transformation of a soul is the work and grace of the Holy Spirit.
It is important then to find humility upon any spiritual transformation-for all virtue and grace come from the Holy Spirit that was earned by Christ at the cross. One must come and apply the Blood of Christ and Grace of the Holy Spirit, but it is not one’s own deeds and actions but the work of God existing within one’s faith that permits such a cooperation. So, like all endeavors, one must be mindful of pride. Like financial planning, or physical training, pride can easily corrupt a healthy self image with vanity. Likewise, in spiritual transformation, pride can create the illusion that one has made oneself holy and that one is more holy than other people. Like the Pharisees, one can have one’s own spirituality become a weapon and tool for one’s own damnation. It is so important as one enters into a deeper relationship with God to be mindful of spiritual pride and to pray daily for continued spiritual humility and complete reliance on the grace of God. Salvation and faith is a gift from God and something earned by Christ. We are merely partakers of this gift and must always give honor and glory to God for any spiritual gifts or insights. With this understanding, the remainder of this blog will look at some helpful techniques in spiritual planning and growth.
Spiritual Planning
Supplied with the grace of the Holy Spirit to transform purely human thoughts and deeds into something more, one can work with those graces to better obey the commandments, submit to God’s will, grow in virtue, and enter into a deeper and more healthy relationship with God. This direction and progression towards God is a life long process with pitfalls, crosses, joys, successes, failures and losses. However, what it needs to be is a progression and a perfecting of oneself in virtue to have a deeper relationship that translates into the next life with God. Padre Pio points out that progression is key. A soul, even one that has sustained growth, that fails to continue in growth or progression becomes stagnant. The soul, like a plant seeking light, must continue to grow in the direction of that light, guided by the light and nurtured through it. The moment the soul stops seeking that light, it ceases to grow in communion with God. One can consider the temporal analogy of financial growth. If one has grown in wealth and has seen continual growth in the one’s accounts with a health market, then suddenly notices a stagnant level of return, there would be great concern. Why not for the soul? If growth has suddenly stopped or become stagnant with relationship with God, this should be a serious concern. For instance, a soul that regularly attends service in Protestant churches or Mass in Catholic churches, but has no spiritual connection despite obligatory attendance has entered into a state of concern. This is why Padre Pio reflected the vital importance of continual growth, despite setbacks, but continued renewal. If a soul falls, does it immediately seek God’s forgiveness? If one fails, does one immediately identify the issue and rectify it? As sinners, we all fail, but what is critical in spiritual planning, is not only the “attempt” to limit failure, but one’s quickness to rectify it. This again stems to one’s insight on humility and pride. If one understands one’s nature as broken, then one who falls, falls in humility but also seeks forgiveness in humility. One in pride who falls, has a far harder time seeking forgiveness.
All spiritual planning requires grace for we cannot earn our salvation. Spiritual planning is participating in that grace
Spiritual planning must acknowledge the reality of failure, but it almost acknowledge the life long nature of the journey. In life, some look for quick investments without securing a solid foundation. Others in physical training, desire a physique but lack the discipline to attain it. Some who diet, see a diet as a temporary status to attain a particular weight to fit in that dress, instead of a life long purpose of dietary health. Spiritual growth is not fast, it is not temporary, but it is a life style. It not likened to a New Years resolution, or a Lenten journey. Lent, for many Christians, is a spiritual diet. It lasts 40 days and then is suspended after Easter. The spiritual disciplines of Lent should be intensified in unison with the Church and in memory of Christ’s passion, but it should not be a spiritual diet for 40 days. The experience of more prayer, Scripture, introspection, fasting, denial, sacramental experience and spiritual growth in virtue should not be a 40 day experience but should represent the base line of all Christian life. This is not to demean the naive view of Lent by some Christians, for it is far better to sense some need than none at all, but, as Avila points out, these souls represent the utmost basic relationship with God and His grace. They, like a first level mansion, walk in, walk out, may peek inside its windows, but fail to grasp the greater beauty further inside the interior mansions of relationship with God. They become distracted by the lures of the world and progression spirituality ends abruptly until a later existential emergency or spiritual feast day.
Spiritual Planning is a life long journey that is about constant growth, humility in that growth, acknowledgement of failures, and complete trust in the grace of God to allow one’s working faith to manifest fruits and a closer relationship with God; A relationship that manifests in its finality in Heaven with God.
Spiritual Planning Ideas
Counseling strategies, life coaching, and physical training plans are quite similar to spiritual training. As Mark Walberg commonly states, “Are you prayed up”. Spiritual Directors are Spiritual Trainers in this sense. They are not just spiritual but also should have a core understanding of counseling techniques based in goal setting and facilitating change. In previous blogs, we discuss the psychology of change and habit. We discuss neuro-pathways and how habit takes time to form. One does not suddenly become a a horrible sinner by one trip nor a great saint by one wonderful moment, but it is a character and progress of that character that defines both virtue and vice. As the ancient philosophers noted, character is a continual presence of a particular excellence in action that is unhindered but natural to the nature. This is natural habit is not something easily gained, or lost. One merely can look at the horrible nature of sin and its addiction itself. One who works to rid oneself of vice must work with the grace of the Holy Spirit to heal, change and transform. God can miraculously change and convert a person, but in most cases, the journey is one of a cross, one where one’s nature learns of the love of God and His continual mercy as change is undertaken and achieved. So, suffice to say, the process of change involves counseling. It involves goal setting. Just like certain financial goals are discussed, set and hoped for, so certain goals spiritually must be discussed and planned. Like exercise, the goals of a certain weight, or certain amount of reps in a particular weight training, concur with a particular habit or virtue that one aspires for. As meticulous journals keep weight training numbers, so one may need to keep track of one’s modified behavior in recollection and examination of conscience. How many times, did I sin today? How many times, did I accept the grace of God and overcome temptation? St Ignatius Loyola in his spiritual exercises in week one, challenges the person to almost scrupulously monitor and track one’s failings. As if tracking calories, St Ignatius asks us to track sin and vice! A working faith demands such accountability to a God who has paid such a high price for us and has made such graces available to the soul for its salvation.
Goal Planning
Goal planning is part of the counseling paradigm. This is especially seen in behavioral therapies where behavioral change is based on how one thinks. Behavior is greatly modified and altered by how one thinks. Cognitive Behavioral Therapy helps individuals think differently so as to feel differently and finally behave differently. Within the behavioral model, desired changes take time but they are planned changes in behavior starting in how we think about things. Spiritual Directors can help individuals think differently about life through the prism of grace, God, and virtue. In doing so, desired behavioral modifications as well as targeted virtual habit can be set in goals.
Like all behavioral modification, spiritual change shares common counseling goal setting strategies
Again, though, before any planning can be undertaken, unlike temporal planning which relies on the strengths and powers of oneself, spiritual planning must be placed entirely into the grace of God. Goals and noble desires are attained through grace and normal actions are spiritualized and made perfect when united with Christ. Hence no spiritual plan can have any value if placed in pride and self or the belief that one’s own works and deeds have value without the guidance and grace of God. Without God, these works, dreams and aspirations are utterly worthless. This is why any plan, before undertaken, must be placed within the guidance and protection of God. Daily prayer, devotion, and commitment to God’s will is essential. When one rises, all plans, all duties, all vocational assignments, all crosses, and all joys must be given to God. The morning offering gives to God everything one does in a day before the day starts and unites everything to Christ to be offered to the Father as a perfect sacrifice to be guided by the grace of the Holy Spirit. One must then relinquish control and unite one’s will with God. One must acknowledge one’s utter dependence on God and again unite one’s will to Him for transformation. Placing one’s plan under the guidance of God and allowing it to fall under His will is a big differing point between temporal planning and spiritual planning, but for the Christian, why not submit all plans-even temporal- to God’s will!
In counseling, especially behavioral therapies, plans need to be discussed and identified. The goal need identified but also how to attain the particular goal, the challenges to that goal, possible setbacks and time frames. Because of the human nature, the counselor needs to curb enthusiasm so as to prevent burnout when goals become difficult. Great zeal can quickly turn to great despair. The counselor is trained to set intermediate goals for a person. Little goals that track progress can help build confidence and lessen despair upon failure. This can be seen in financial expectations, as well as weight loss expectations, or even behavioral modifications to stop smoking or drinking. An individual with a spiritual plan to evict a vice from one’s habitual orbit, may find despair if one fails on a particular day. Like a person who succumbs to a cigarette or donut late at night, one can succumb to a vice. A good spiritual director can calm the person and identify why and how it occurred but also to remind one that habits take time and goals take time to achieve. One needs to find mercy in God when one fails and not find complete pride or joy in one’s own accomplishments but to reflect all in God.
Pitfalls are part of all plans. Individuals attempted to escape habits, fall, but what God cherishes is the choice to change and the direction. This is why spiritual directors should encourage the soul and point out the importance of gradual change in severity and frequency and the mercy and grace of God. Intermediate goals do not demand perfection but gradual growth. Once intermediate goals are met, one can move forward to the next step. Like weight training, once a certain number of reps are met, or a certain weight is attained, one is able to advance. Like so in spiritual life.
Like all planning, it is crucial to keep the person focused but also humble and also remind one of one’s nature. Many times during change, individuals become obsessed more so with the numbers than the journey and end goal. One can become scrupulous and focus more on avoiding or worry or fretting over the smallest of actions to the point it causes extreme distress, despair and guilt. The devil can be very subtle in derailing a soul working towards God. So it is important that whichever habit, or spiritual goal one has, to not mistaken the goal or new habit as the ultimate end. Unlike the view of the ancient philosophers, virtue itself is not the end goal of our worship. Virtue is a vehicle and intermediate step to the ultimate goal which should be relationship with God. So when one focusses more on numbers, one begins to focus more on self than God. God is the ultimate goal in the entire endeavor of spiritual planning. Unlike physical training, when one only looks at the body and its change, but not the overall health, then derailment can occur to various maladies. Likewise, when virtue is sought for the sake of virtue, instead of its purpose as a vehicle to God, then it can be turned against oneself. In this, one needs to see things that are means as means, and clearly in planning contrast it with one’s end. Counselors help individuals navigate this, as well as spiritual directors.
Spiritual Strategies
With a stronger understanding of the nature of planning, as well as setting goals, and understanding the difference between means and ends, we will quickly review some types of spiritual plans. In my daily life, I believe in planning. Calendars are essential but also journals as well as notes to self, as well as self talk to keep one on track. Life is comprised of professional, academic, family, self, physical and spiritual aspects and we need to balance these in accordance. We need to structure these vocational duties that we owe to God, self and neighbor. First and foremost, they must be prioritized. Certain things on lists are non-negotiable. They are priorities that must be met before others. Obviously physically, diet, grooming, and sleep are among those. Spiritually, prayer, worship and communion with God should top that list. However, in any planning, there are events, assignments, or obligations that are secondary to primary ones. Some may be flexible and able to be moved, while others may be optional. It is important to define these when planning.
Spiritual strength involves not only God’s grace but also an active participation of developing spiritual habits. Please also review AIHCP’s Christian Counseling Program
Planning wise, like financial plans, I like to plan by the quarterly year. While I have daily duties, weekly duties, bi-weekly duties, and monthly duties, that lead to fulfillment of the quarter, I like to see set goals for that period. Some goals are primary, others may be flexible, but they are listed. The 3 month period serves as a reminder of what needs done in some cases, but also where I would like to be as a measuring stick. Obviously one can see where this can be applied financially, physically but also spiritually.
From a spiritual context, how has one’s daily, weekly and monthly habits gradually changed over the 3 month period? Daily journaling, weekly remarks and monthly checks can keep one on pace with possible goals. If one is stricken with the vice of drunkenness, one can review the number of drinks a week and its gradual reduction from week to month to quarterly period. If the goal is to reduce this habit, then one may discover a new trend that one can find solace in as recorded numbers show reduced intoxication as well drinks per week or month. One can then ascertain if one has met the quarterly goal or not and how to access the next quarter. Remember, this is a life style, it is a marathon, not a race, so gradual is better than nothing. This again takes one to the importance of daily and weekly monitoring, so that data and change of habit can be documented. During this examination of conscience, at the end of each day, or week, or month, or every one quarters, one can see the weaknesses, what one can do better, and most importantly remember on one’s complete reliance in God for any change. The spiritual director can encourage the soul in this progress and also help set new intermediate goals, or re-ascertain certain strategies or time tables to help maintain the confidence of the person in this change and ultimate better relationship with God.
The spiritual director also becomes a spiritual coach in this endeavor. Upon reflection of plans, one’s attainment, progress, or failures, a coach helps develop a person’s skills. This may consist in different prayers or penances, or fasting that help foster a particular virtue or habit. Particular spiritual readings of the saints and their writings, as well as Biblical books or chapters that correspond with one’s troubles can be utilized. Goals within a particular time table may include within a 3 month span to work in charity, or read a certain amount of books, or become more acquainted with a particular book of the Bible that will help one move forward. In may also include if Catholic, more frequent reception of the Eucharist, as well as confession. These things not able help the soul in despair, but also give the soul sources of grace to help transform over the spiritual planning time. Spiritual directors or confessors can become original in their ideas to share with individuals various particular deeds, or readings that meet a person’s needs and direction.
With all planning, one seeks change, and good change agents produce change. This involves within the spiritual planning, promoting healthier communications and removal of vice associated materials. These things that promote sin are referred to as occasions of sin. It can be a person, place or thing. Spiritual directors need to encourage souls to avoid places associated with particular sins. If bars are associated with drinking or lewd conduct, then these places should be removed from a person’s habitual visit. The same holds true for any addict of any vice. In regards to lust, avoiding imagery or situations that promote lust should be removed from one’s life. If a cell phone in close proximity calls one to pornographic imagery, turn off the phone or remove it from one’s reach. Many of the saints practiced far greater mortifications, beyond what I would recommend, but one must, if seeking change, remove the occasions of sin. Like a person a diet who removes donuts and cakes from the cabinet, one must remove occasions associated with the detrimental behavior.
Like wise positive change agents must be introduced into any spiritual plan promoting change. Like in a diet, one supplies their refrigerator with wholesome foods, so the soul must supply the daily routine with wholesome content. Good spiritual reading, better company, prayer, as well as support from other religious persons who share the same ends is crucial. A clean home promotes change, so does a clean spiritual environment. One needs to remove the spiritual filth for the soul to change. Like a dirty body that needs cleaned to become healthy, so does a dirty soul need cleaned to move forward. Christ’s blood and the grace of the Holy Spirit provides the solution. One must wash oneself in these things and provide oneself with healthy reminders of those things that promote new spiritual change within oneself. Healthy and positive change agents replace negative occasions of sin and replace maladaptive coping with healthy spiritual coping founded in prayer and faith in God.
Conclusion
Spiritual planning is a life style change that takes time and is a life change of progress towards God. One cannot earn this change but it is gift from God that we partake in. While the grace of God is a gift, one still must work with that grace. Spiritual change, like any change, or plan in life, is something that one must dedicate oneself to and purposely plan to achieve with commitment and guidance of the Holy Spirit. There are many ways to promote a better relationship with God and when we find time to plan prayer, worship and submission to Him, He will guide us in all our plans to find better communion with Him.
We should plan ahead spiritually and work on our relationship with God as much as we do with other types of financial planning or health training. Please also review AIHCP’s Spiritual Direction Program
Spiritual planning in itself should be a big part of one’s life. It should take priority over everything else we do because our ultimate end is God. Spiritual planning acknowledges the necessity of Christ’s death and the grace for salvation and how to apply it to our lives so when we stand before God, we will know Him well, as we enter into paradise.
Creation, Communication, and Rediscovery in Grief Writing
Written by Daniel Stern
Grief disrupts the narrative of life. When a profound loss occurs, the future we imagined with that person vanishes, and the past becomes newly charged with memory and absence.
Yet paradoxically, grief is also one of the most powerful generators of creative expression. Poetry, painting, music, and storytelling have historically emerged from loss, giving shape to emotions that are difficult to express.
For many writers, including myself, poetry becomes the place where grief first learns to speak.
I’m not a clinician. What I’m describing comes from my own experience writing poetry about grief. I found that creative expression did more than document loss; it initiated a cycle of emotional processing. My experience aligns with research on expressive writing, poetry therapy, and meaning-making in grief—that creative expression can help people process loss and make sense of it.
From this intersection of lived experience and research, I began to notice a pattern in how grief can move through creative expression. I refer to this pattern as The Creative Grief Cycle.
Creation — the act of writing transforms grief into language
Communication — the work becomes a bridge between the grieving individual and others
Rediscovery — the creative work can be revisited repeatedly, allowing grief to evolve into reflection
Together these stages form a self-reinforcing cycle that moves grief from raw emotional experience toward shared understanding and lasting meaning.
Research on expressive writing, meaning reconstruction, and poetry therapy supports key elements of this cycle.
Stage One: Creation — Writing as Emotional Processing
The first stage of The Creative Grief Cycle is the act of creation itself.
When grief is written, it changes form. What was once diffuse emotional pain becomes structured language. Words, metaphors, and images impose order on an experience that initially feels chaotic.
Psychologist James W. Pennebaker, whose research pioneered the study of expressive writing, demonstrated that writing about emotional experiences improves psychological and physical well-being. His studies showed that expressive writing helps individuals organize traumatic memories into coherent narratives, supporting emotional processing that might otherwise remain unresolved (Pennebaker & Chung, 2011).
Scholars in poetry therapy also describe writing as a structured way of processing emotional experience (Mazza, 2017). Neimeyer (2012) has similarly emphasized that grief often involves reconstructing meaning after loss, frequently through narrative and creative expression.
Subsequent studies have found similar benefits. A comprehensive review in Advances in Psychiatric Treatment found that expressive writing can reduce stress, improve mood, and enhance coping with traumatic experiences (Baikie & Wilhelm, 2005).
In grief specifically, expressive writing has been associated with meaning reconstruction, a central process in bereavement. Neimeyer (2001) describes mourning as rebuilding meaning after a loss disrupts one’s life narrative.
These findings mirror my own experience writing poetry after the loss of my son. In one poem I wrote:
“A poem begins in blood.
My son is gone, yet I write—
each word a slice of myself.” The Price of a Poem
Writing did not remove grief. Instead, it transformed grief into something that could be examined and understood.
Researchers studying poetry therapy describe this process as the movement “from silence to speech.” Stepakoff (2009) explains that poetry allows individuals to represent traumatic grief symbolically, making it possible to approach experiences that initially feel unspeakable.
In The Creative Grief Cycle, creation is therefore the first step in transforming grief into meaning.
Stage Two: Communication — The Social Function of Grief Poetry
The second stage of The Creative Grief Cycle occurs when the work is shared with others.
Grief is inherently isolating. Individuals experiencing loss often feel that their emotions cannot be adequately explained to those who have not lived through similar experiences.
Poetry can bridge this gap.
Because poetry communicates through metaphor, rhythm, and imagery, it can convey emotional realities that ordinary explanation cannot. Readers encountering grief poetry can recognize aspects of their own experiences within the work, creating a moment of shared understanding.
Maybe creative expression can help individuals communicate their complex grief experience when traditional conversation is difficult.
Stroebe (2018) highlights that poetic language can complement scientific models by illustrating the lived experience of grief, bringing emotional depth to processes identified in research. Psychological frameworks describe processes of mourning, but poetry can capture the lived texture of grief—its contradictions, memories, and silences.
This communicative dimension is visible in many grief poems. In one of my own poems, I describe writing as a way to keep a voice present in the world:
“I write
because my voice still walks the earth
even when his footsteps do not.” Don’t Live Inside That Silence
The poem becomes more than a personal reflection; it becomes a message others can encounter.
Communication also allows grief to move across generations. In another poem, written about telling stories to my granddaughter after her father’s death, I wrote:
“I give her my son
the only way I still can—
one story at a time.” Tell Me a Daddy Story
In this moment, poetry functions as inheritance. Memory travels through language into the future.
In The Creative Grief Cycle, this is when grief moves from private experience into shared understanding.
Stage Three: Rediscovery — Revisiting the Work
The third stage of The Creative Grief Cycle emerges and can evolve over time.
Unlike spoken conversation, creative works endure. A poem written during an intense period of grief can be reisited months or years later. This creates a powerful reflective process. When the writer returns to the poem, they revisit the emotional state that existed when it was written. The poem becomes a preserved record of grief at a particular moment in time.
Poetry can preserve the emotional complexity of grief in ways that allow both writers and readers to return to the experience with evolving perspectives.
In practical terms, a poem becomes an emotional time capsule. The writer who reads it years later is no longer the same person who wrote it. The grief may have softened, deepened, or transformed.
In one poem, I tried to capture how silence evolves over time:
“Silence becomes a cathedral,
vast and unforgiving,
its arches built of absence.” The Roar of Silence
This rediscovery stage allows grief to evolve from raw emotion into reflection.
In The Creative Grief Cycle, rediscovery completes the cycle by enabling the work to continue generating meaning over time.
The Creative Grief Cycle
Taken together, the three stages form a continuous cycle:
Creation → Communication → Rediscovery
Grief is transformed into language through writing.
The work communicates the experience to others.
The work can be revisited repeatedly, generating new insight.
Each stage reinforces the others. Writing enables communication. Communication deepens meaning. Rediscovery inspires further creative expression.
This cycle offers an explanation as to why creative work often continues long after the initial loss. Once grief has been expressed through art, the creative impulse frequently expands into other forms of expression.
In one poem reflecting on transformation through grief, I wrote:
“Grief softens us,
wonder reshapes,
creation strikes sparks
across even the softest anvil.” The Furnace Never Cools
Grief melts what once felt rigid. Creativity reshapes it.
Conclusion
Grief cannot be eliminated. Loss remains one of the defining experiences of human life. But creative expression changes how grief exists in the world.
Through The Creative Grief Cycle, grief moves through a process of creative transformation:
Writing transforms emotional experience into language
Communication connects that experience with others
Rediscovery allows the work to continue generating meaning over time
In this way, poetry does not simply document grief.
It allows grief to become something else: connection, reflection, and enduring voice. Loss may silence a person’s presence in the world. But through poetry, the conversation continues.
About the Author
Daniel Stern is a retired engineer turned astronomer and astrophotographer whose poetry explores grief, silence, memory, and renewal. His work lives at the intersection of science and emotion, where observation becomes reflection and language reaches for what cannot be measured. He recently published The Roar of Silence, a collection of 15 poems born from personal loss and the search for meaning in its wake. He also authored Aphelion, a book of poetry fused with his deep-sky astrophotography. In his work as an astronomer, his astrophotography has been recognized numerous times by NASA (APOD). He has discovered planetary nebulae and, in collaboration with others, has been published in peer-reviewed astrophysics journals. Stern lives in Delray Beach, Florida, with his wife, Randie.
Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338–346. https://doi.org/10.1192/apt.11.5.338
Mazza, N. (2017). Poetry therapy: Theory and practice (2nd ed.). Routledge.
Neimeyer, R. A. (2001). Meaning reconstruction and the experience of loss. American Psychological Association.
Neimeyer, R. A. (2012). Techniques of grief therapy: Creative practices for counseling the bereaved. Routledge.
Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing: Connections to physical and mental health. In H. S. Friedman (Ed.), The Oxford handbook of health psychology (pp. 417–437). Oxford University Press.
Stepakoff, S. (2009). From destruction to creation, from silence to speech: Poetry therapy principles and practices for working with suicide grief. The Arts in Psychotherapy, 36(2), 105–113. https://doi.org/10.1016/j.aip.2009.01.007
Stroebe, M. (2018). The poetry of grief: Beyond scientific portrayals of mourning. Omega: Journal of Death and Dying, 77(1), 3–16.
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.
Fear can play a strong role in grieving. Whether anticipatory and fearful of a future event, or fear that cripples one while grieving to express or reach out, or fear that becomes maladaptive with other types of losses, it needs addressed. This video looks at how fear can affect grieving. Please also review AIHCP’s Grief Counseling Certification
Written by James Eric
Written by Marko,
