How Can Healthcare Counselors Effectively Navigate Ethical Dilemmas Related To Dual Relationships, Informed Consent, And Client Autonomy?

Written by By Isaac Smith

Healthcare counselors must balance professional duties and client welfare to make ethical decisions. Avoiding harm and respecting client rights are emphasized in ACA, APA, and NAADAC ethical codes. This means avoiding inappropriate dual relationships, obtaining and documenting informed consent, and promoting client autonomy and self-determination. When faced with dilemmas, counselors must consult codes and supervisors, weigh risks and benefits, and prioritize client interests. We discuss each area below, using real cases to demonstrate challenges, best practices, and consequences for mistakes.

 

Dual Relationships: Boundaries and Risks

Dual relationships occur when a counselor has a significant professional or personal relationship with a client outside of therapy. The ethical code discourages dual roles whenever possible. The ACA and NAADAC Codes state that “counselors should take all possible steps to avoid engaging in dual-client relationships” because they “can undermine the fiduciary responsibility” to clients.

APA guidelines advise counselors and psychologists to avoid multiple relationships that could compromise objectivity, competence, or effectiveness or risk client exploitation. Any dual role can bias the counselor’s judgment, confuse roles, erode trust, or exploit.

In small or rural communities, dual relationships may be unavoidable. Counselors must assess risks and prevent harm or exploitation in such cases. Setting and communicating clear boundaries, getting the client’s informed consent to role changes, seeking supervision or consultation, and documenting the decision process are key. Extension of any professional boundary (e.g., buying a service from a client or attending a personal event) requires informed consent, supervision, and careful documentation to “ensure that judgment is not impaired and no exploitation occurs” (ACA Code Section A.6). In conclusion, counselors should ask “Is it truly necessary, and can I remain objective?” before taking on any secondary role and regularly assess the client’s impact.

Modern tools like a Random Word Generator can even play a subtle role in ethical reflection and training exercises. During professional workshops or counseling education programs, instructors sometimes use random verb generators to prompt spontaneous discussion about ethics, boundary management, or decision-making. For example, if the generator produces words like “trust,” “boundaries,” or “objectivity,” these can spark meaningful reflection on how counselors apply these principles in complex cases.

 

Best practices:

When possible, counselors should avoid multiple relationships. They should (1) assess and document risks vs. benefits, (2) set clear boundaries from the start, (3) obtain and revisit the client’s informed consent to any boundary extension, (4) seek regular consultation/supervision, and (5) thoroughly document each decision and client communication if a dual role is unavoidable Counselors should obtain explicit consent and consult colleagues before attending client graduations or business arrangements (ACA A.6.b and NAADAC I-11). All ethical codes prohibit them from having sexual or romantic relationships with current clients (and possibly former clients for years).

 

Consequences of missteps:

These standards can be violated with dire consequences. Counselors risk disbarment and legal liability in addition to harming clients. For boundary violations, state boards have placed counselors on probation or suspended their licenses. Malpractice suits and ethics complaints can cost counselors tens or hundreds of thousands of dollars in defense or settlement. Inappropriate dual relationships can ruin a counselor’s career and public trust.

 

Informed Consent: Transparency and Understanding

Informed consent educates clients about counseling so they can make voluntary, informed decisions. Ethical codes require this. ACA Code (2014) states: “Counselors must review in writing and verbally with clients the rights and responsibilities of both counselors and clients. Informed consent is documented throughout counseling. APA Code Standard 3.10 requires psychologists (including counselors) to obtain informed consent in client-friendly language. NAADAC’s code also requires providers to communicate consent clearly using culturally and developmentally appropriate language and noting comprehension issues.

Counselors should discuss therapy’s purpose and goals, techniques and interventions, potential risks or side effects, fees/insurance, confidentiality limits, and alternative resources at intake and throughout counseling. This should be explained verbally and in writing (consent form or brochure). Clients should ask questions and give meaningful consent. Counselors must get assent and guardian permission from minors and disabled adults as well as involve them in decisions. Counselors must disclose mandated treatment (e.g., court-ordered counseling) and confidentiality limits at the outset.

 

Best practices:

Adapting to clients’ developmental and cultural contexts, counselors should explain counseling in plain language. They should explicitly cover service refusal and its consequences. Consent should be documented (signed forms, progress notes referencing discussions) and reviewed if treatment changes. Visuals, translators, and simplified summaries help clients with different language or literacy levels understand. Have clients paraphrase their understanding. Counselors should disclose risks (e.g., mandated treatment) to others (ACA B.1.a and NAADAC II-7).

 

Consequences of missteps:

Failure to obtain and document consent can violate clients’ legal and ethical rights. If clients discover unsaid limits of confidentiality or costs, they may feel confused, betrayed, or coerced. Formal complaints or malpractice claims can result from informed consent violations. Courts and licensing boards often side with clients who were not fully informed about the counseling relationship or risks. Counselors without informed consent may be fined or suspended in extreme cases.

 

Client Autonomy: Respect and Self-Determination

Respecting client autonomy means letting them make life and treatment decisions. It underpins counseling and healthcare ethics. The APA’s General Principles require psychologists and counselors to respect “the rights of individuals to privacy, confidentiality, and self-determination.” Likewise, the ACA Code emphasizes that clients’ freedom of choice should be respected in counseling plans. Even if clients refuse treatment in mandated settings, counselors must explain the consequences “while respecting the client’s rights to autonomy and self-determination” (NAADAC code).

Promoting autonomy means fully involving clients in decision-making. Counselors explain all reasonable options, discuss pros and cons, and ask about client values and preferences. Clients can choose alternative therapies, set goals, or decline interventions. Safe choices should be supported by counselors. Counselors respect informed client choices, such as refusing medication or ending therapy. Counselors must also recognize that some cultures value family or community decision-making over autonomy. Instead of imposing their values, ethical counselors must assess and respect a client’s background and autonomy.

 

Best practices:

Through collaborative methods like motivational interviewing, counselors help clients set goals and take charge of change. They should emphasize that the client makes decisions (e.g., treatment goals, session agenda, and therapy termination).

It clarifies that clients can refuse any service or modality and discusses consequences openly as required by ACA A.2.b. Counseling should be optional, not required. Counselors solicit and value client feedback throughout treatment. Counselors must not impose their values or judgments on clients; ACA Code (Section A.4.b) prohibits this.

 

Consequences of missteps:

Overriding client autonomy can cause trust issues or crises. A client may drop out or feel traumatized if a counselor coerces or ignores their choices. Ignoring autonomy is unethical. ACA’s principle of client welfare and dignity is violated if a counselor fails to respect a client’s legally-supported decision, such as an adult refusing treatment. Violating autonomy can lead to malpractice claims or disciplinary action, especially if the client is harmed by inadequate decision-making.

 

Best Practices and Risk Management

Counselors should use ethical decision-making and risk-management to handle these situations. Strategies include:

 

Boundary management:

Set boundaries and roles from the start of therapy. Record outside contacts and availability. During intake, set communication boundaries (e.g., no texts after hours) and roles (e.g., individual therapy only). Document clients’ social or business invitations and the counselor’s response. Some codes, like ACA A.5.c, restrict social/romantic contact for years after termination.

 

Informed consent clarity:

Continuously solicit client consent. Written forms and discussions should cover treatment nature, alternatives, risks, confidentiality, and rights (including autonomy). Update consent when treatment or roles change. Client participation in goal-setting and treatment plans (NAADAC I-17) promotes understanding and self-determination.

 

Consultation and supervision:

Ask for help with gray-area or boundary issues. Dual relationships, consent, and cultural issues should be discussed with peers or supervisors, per ethical codes. Note consults in records. This improves care and documents ethical decisions for later reference.

 

Documentation:

Take notes on informed consent, boundary agreements, and major decisions. Risks, benefits, client consent, and ongoing monitoring should be documented for dual roles. Counselors can prove their good faith in audits and complaints with thorough notes.

Continual education:

Maintain ethical standards and receive training on new issues like telehealth confidentiality and social media boundaries. Codes (ACA) and case law change periodically, affecting practice. As advised, review the ACA, APA, and NAADAC codes annually and attend ethics seminars. By proactively managing these areas, counselors protect clients and maintain professional integrity.

 

Conclusion

Ethics in counseling requires constant vigilance. Informed consent, dual relationships, and client autonomy are central to client welfare. ACA, APA, and NAADAC recommend avoiding problematic multiple relationships, ensuring informed and ongoing consent, and empowering client self-determination. Real-world cases show that counselors who blur boundaries or ignore consent and autonomy risk harming clients and themselves.

In conclusion, counselors should set boundaries, inform clients, and respect their choices. In uncertain situations, consult ethical codes, consult colleagues, and document carefully. Counselors can handle dilemmas responsibly by using these best practices and reflecting on their values and biases. Ethics training, supervision, and self-reflection are crucial. The ACA, APA, and NAADAC’s commitment to clients’ welfare, dignity, and rights will guide counselors through even the most difficult situations.

 

Written by By Isaac Smith, Editorial Director Billing/coding/reimbursement specialist, CureCloudMD

 

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

Optimizing Digital Presence to Enhance Patient Trust and Professional Credibility

Managing sugar is a life style choice. Holistic Nurses and other healthcare professionals can help guide you through the process for better health with sugar related issues

Written by Harry Wolf,

For healthcare professionals who are aiming to build trust and credibility with patients (which is, surely, all healthcare professionals), a strong digital presence is of the utmost importance.

Thoughtful online strategies will help you stand out – and showcase your expertise and professionalism. 

Keep Your Online Bio Accurate – and Up-to-Date

To decide if a healthcare provider is trustworthy, patients often rely on reviewing online bios. An outdated bio creates doubts. It signals a lack of attention or professionalism. Conversely, keeping your information current reflects your commitment to accuracy and builds immediate trust.

Review your bio often. Are all roles, credentials, and affiliations updated? Remove any irrelevant details that clutter the narrative. And use concise language focused on the qualifications that patients care about most.

To strengthen your credibility:

  • Include recent certifications.
  • Highlight clinical specialties that are relevant to patient needs.
  • Add professional memberships or recognitions where appropriate.

A well-maintained bio reassures patients they are choosing someone who is actively engaged in their profession. It helps them feel confident that you bring expertise shaped by ongoing experience. This small effort goes far in fostering trust from the offset.

Showcase Relevant Certifications – and Continuing Education

Following on from the last section, certifications and ongoing education demonstrate your commitment to staying informed about advancements in the industry of healthcare. Patients want assurance that their provider remains current with the latest practices. 

Highlighting these qualifications online solidifies trust in your expertise. Display certifications prominently on professional platforms, practice websites, or directories where patients may search for providers. Make sure the information is easy to verify if necessary—list accrediting organizations or institutions by name, for instance.

To maximize impact:

  • Update certifications as they are renewed or newly earned.
  • Include any specialized training.
  • Mention conferences/workshops/continuing education programs you have attended recently.

When patients see evidence of recent learning efforts, it’ll signal that you take their care seriously enough to invest time in improving your skills.  This transparency makes them feel confident that they are receiving advice backed by up-to-date expertise.

Highlight Patient Outcomes with Measurable Results

Patients trust providers who demonstrate real/tangible results. Hence, highlighting patient outcomes helps prospective patients to understand the quality of care that you deliver – and sets realistic expectations. This strategy can significantly enhance your credibility – when done ethically and thoughtfully, that is. Focus on presenting measurable outcomes that align with your specialty or expertise. And avoid vague claims.

Here are some examples of what to share:

  • Post-surgery recovery rates (if applicable) or success stories (with consent).
  • Statistics showing improved patient health under your care.
  • Positive feedback reflecting specific areas of excellence in treatment.

Present these insights visually – if possible. Charts or simple graphics are easy to digest. 

By showcasing proven successes, you will reassure potential patients that they’ll benefit from evidence-based practices.

Create a Consistent Professional Image Across Platforms

An inconsistent or unprofessional image can create confusion. In turn, it can reduce trust.  A cohesive digital presence signals: reliability and attention to detail. Use professional photos and ensure your profile details align on all platforms – whether it’s your practice website, LinkedIn, or medical directories.  Inconsistent titles, incomplete bios, or mismatched imagery may raise red flags for patients who are seeking trustworthy care (which is, of course, every patient!).

To maintain consistency:

  • Use the same professionally taken headshot across profiles.
  • Ensure your credentials are listed identically on all platforms.
  • Align the tone and language with your targeted audience.

This uniformity reflects not just who you are but also how seriously you take patient relationships. 

A seamless online identity creates an impression of dependability – before patients even set foot in your office.

Use Testimonials and Reviews – to Build Credibility

Don’t overlook the immense power of testimonials. According to 2025 data published by WiserReview, 72% of customers trust businesses more after reading positive testimonials and reviews. And around 92% of consumers read testimonials and reviews before making purchases.

When choosing a healthcare provider, patients trust the experiences of others. Testimonials and reviews act as social proof – offering reassurance about your:

  • Professionalism.
  • Expertise.
  • Ability to deliver positive outcomes.

So, request feedback from satisfied patients (as long as they feel comfortable sharing their stories, that is). Make sure those testimonials highlight specific aspects of your care that resonate with prospective patients.

Best practices for leveraging reviews? They are as follows:

  • Display verified patient testimonials on your website prominently.
  • Respond professionally to online reviews.
  • Highlight patterns in feedback that showcase your strengths.

When done thoughtfully and ethically, using real voices amplifies trust in ways no self-written description can achieve. 

Prospective patients will gain confidence by knowing others in your care had meaningful success.

Maintain Active Engagement on Professional Networks 

Professional networks are valuable for showcasing your expertise and building trust with both patients and colleagues. An inactive or sparse profile can appear uninvested. But consistent activity highlights your dedication to staying engaged in the healthcare field.

Use platforms like LinkedIn to:

  • Share updates about your work.
  • Comment on industry news.
  • Celebrate those all-important milestones of yours. 

This visibility helps patients see you as an informed professional who is committed to advancing in your specialty.

Key actions for active engagement? They include these:

  • Share articles or research that reflect current trends in healthcare.
  • Post thoughtful insights from conferences you attend.
  • Engage with other professionals.

By maintaining a strong presence online, you will show potential patients that you are not just practicing – but actively participating in improving the field of medicine. This reinforces credibility and creates opportunities.

Publish Informative Content – That Reflects Your Expertise

To establish yourself as a trusted authority in your field, create and share informative content.

Providing this shows you’re:

  • Knowledgeable.
  • Approachable.
  • Committed to educating others.

Write articles or blog posts on topics that align with patient interests. 

You could also share educational videos or infographics – for a more engaging approach. Infographics are a particularly effective way for prospective clients to consume content, due to their visual appeal and their ability to make complex information easy to digest. However, as a Forbes article points out: “(An infographic is only) effective if its content and context are aligned to reach the target audience and deliver the knowledge they need and want.”

To craft impactful content (in general):

  • Focus on relevant subjects like managing chronic conditions or explaining treatment options.
  • Use simple language – but avoid oversimplification of complex medical ideas.
  • Ensure all information is accurate/well-researched/cited.

This strategy not only builds trust – but also keeps patients coming back to your platforms for guidance. 

It demonstrates that you are invested in improving understanding around healthcare issues.

Adopt Transparent Communication Practices – on Your Website and Social Media Channels

Clear and honest communication builds trust. Patients want to feel informed about their provider’s approach/services/values before they make decisions. By being transparent online, you eliminate uncertainties that could cause hesitation. Use your website or social media platforms to outline key aspects of your practice. Be upfront about the services offered, pricing (where applicable), or what patients can expect during visits.

Here are some ways to improve transparency:

  • Share step-by-step explanations of procedures or treatment processes.
  • Include FAQs.
  • Use plain language (rather than medical jargon, that is).

Transparency reassures patients. And it prioritizes open relationships right from the beginning. When individuals see clear answers upfront, it instills confidence in your professionalism and reduces potential barriers to reaching out for care.

Focus on Building Trust Through Privacy Assurance Measures Online

Patients need to trust that their information is safe. Demonstrating strong privacy practices online reassures your patients that you take data security seriously. Clearly communicate your commitment to protecting patient confidentiality. Highlight compliance with regulations like HIPAA (in the U.S.) or similar laws elsewhere, as this showcases professionalism and reliability. Steps for ensuring privacy assurance? 

  • Display clear privacy policies on your website.
  • Use secure contact forms – for appointment requests or inquiries.
  • Avoid sharing any identifiable patient stories or images without explicit consent.

By prioritizing transparency around how sensitive information is managed, you show respect for patients’ rights and their concerns about digital safety—further solidifying trust in your care delivery approach before they even meet you in person.

A row of medical doctors and nurses

Invest in High-Quality, Professionally-taken Photographs

A professional photo is of crucial importance – for establishing trust and credibility, that is. Patients connect better when they see a provider who looks:

  • Confident.
  • Approachable.
  • Professional. 

Conversely, poor-quality images – or inconsistent visuals – can unintentionally send the wrong message. Professionally taken photos—such as doctor headshots—can set you apart online. They show that you care about details and take your role seriously.  These images should align with the tone of your practice – whilst making patients feel at ease.

Here are some helpful tips for effective headshots:

  • Dress professionally in attire that reflects your role (but without being overly formal!).
  • Use well-lit settings with simple backgrounds.
  • Ensure consistency – by using the same image across all platforms.

Investing in this step builds immediate trustworthiness!

The Takeaway

By presenting yourself authentically, transparently, and consistently, you will create lasting connections that strengthen both your practice and patient relationships.

Author bio: Harry Wolf is a freelance writer. For almost a decade, he has written on topics ranging from healthcare to business leadership for multiple high-profile websites and online magazines.

 

References:

Meier, Michelle. Grow your practice with a great healthcare professional bio (with example). The Intake, Tebra. https://www.tebra.com/theintake/practice-growth/get-new-patients/grow-practice-healthcare-professional-bio

Unauthored. The Importance of Continuing Education in the Healthcare Industry. Portobello Institute.

https://blog.portobelloinstitute.com/the-importance-of-continuing-education-in-the-healthcare-industry

Fernandez, Amandine. The cost of an inconsistent visual identity. Letsignit. https://letsignit.com/blog/cost-of-an-inconsistent-visual-identity

Vaghasiya, Krunal. 12 Must-know testimonial statistics (2025 Data). WiserReview. https://wiserreview.com/blog/testimonial-statistics/

Forbes Councils Member, Expert Panel®. 12 Effective Ways To Use Infographics For Marketing. Forbes. https://www.forbes.com/councils/forbesagencycouncil/2021/01/25/12-effective-ways-to-use-infographics-for-marketing/

 

Neurobiology and Trauma

When a person is confronted with a life and death situation, the body responds with a fight, flight, or freeze response.  Other responses can include fawning, or complete total shutdown of the body.  These behavioral responses to stressors, life altering events, or trauma in forms of abuse or loss correlate with inner workings of the sympathetic nervous system which activates the body to respond.  While in the acute phase of reaction to threats, this evolutionary reaction system is good and beneficial but when trauma becomes stuck and unresolved resulting in constant hyperarousal or hypoarousal manifested in PTSD, then it can become pathological and require intense therapy to resolve the unresolved trauma.  This article will review the inner workings of trauma response within the brain and why unresolved trauma becomes an issue for some individuals.

The limbic system plays a key role in the brain in accessing threats and dealing with trauma, Please also review AIHCP’s Trauma Informed Care Program

Please also review AIHCP’s Healthcare Certifications, especially in Trauma Informed Care, Grief Counseling and Crisis Intervention

The Brain and Threat Reaction

All reactions within the body are due to stressors.  When something is perceived as a threat, the body responds.  This fear circuitry promotes safety and survival (Evans, 2014, p. 20).   The old part of the brain is the emotional part and possesses the feelings while the newer more evolved part of the brain processes the feelings from an intellectual perspective.  Both these processes interact in stress response over riding each other.  The primary reactions to stress include the autonomic nervous system which activates the sympathetic for fight or flight, the hypothalamic-pituitary-adrenal axis which releases hormones and cortisol for stress response and the limbic system of the brain which processes threats and emotions during a threat.

Evans notes that the fear response to threats is a crucial part of human survival and the process in which human beings react to fear in the brain is essential (2014, p. 21).  Unfortunately, some events are not processed properly in the moment due to extreme emotional imprinting and this leads to unresolved issues.

In any fear, terror, or stress moment, the brain analyzes the threat.   Within seconds, the sympathetic nervous system is activated to the perceived threat.  The body releases norepinephrine and epinephrine , also known as noradrenaline and adrenaline into the body.  The hypothalamus and pituitary gland also then releases cortisol into the body.  This increases blood flow and heart rate, tightens muscles and prepares the body for fight or flight.  In turn the amygdala processes these emotions and stores them.  While the amygdala is operating, the prefrontal cortex or thinking part of the brain is less active.  Once the threat is distinguished, the body is supposed to return to a base line state.  Evans refers to this process as fear extinction (2014, p., 21).  Individuals who continue to experience heightened fear responses when the threat is no longer an issue exist in a state of dysfunction with unresolved trauma since the brain cannot tell the difference between the memory and current non-threatening state.

Key to stress response are three key parts of the brain.  This includes the hippocampus, the amygdala and the prefrontal cortex which make up the limbic system.  These three interplay with each other and are key to fear extinction, emotional regulation and cognitive reasoning (Evans, 2014, p. 22).  They also play a key role in storing memories from short term to long term storage and differentiating between past and present threats.  The hippocampus deals with memory and context.  It plays a key role in processing and storing memories and when the hippocampus is in dysfunction this can negatively effect trauma resolution. The amygdala during the stress response also becomes activated.   The amydala is the alarm system of the brain.  Those with PTSD are said to have a hyperactive amygdala due to unresolved trauma which prevents fear extinction (Evans, 2014, p.24).   The pre-frontal cortex which manages cognitive thought, emotional regulation and decision making.  It can also become impaired during trauma.  When not working, it can lead to subjective fears and lack of emotional regulation and loss of rationale.  Under normal circumstances, fear is extinguished and the body returns to a normal state via the hippocampus processing the context of here and then, the prefrontal cortex processing the event, and the amygdala activation decreasing.  In cases when trauma is unresolved, the hippocampus is unable to process the here and now, while the amygdala remains hyperactivated, preventing the prefrontal cortex from processing the event.  This hinders the ability of the hippocampus to store the memory properly in the past and the hyperactivation of the amygdala inhibits the prefrontal cortex from problem solving (Evans, 2014, p. 31-32).

Unresolved Trauma and PTSD

Individuals exposed to extreme cases of pain, loss, abuse, war, or inhumane treatment have the potential for PTSD.   Post Traumatic Stress Disorder or PTSD is one of the most common forms of unresolved trauma disorders that individuals face.  Once considered only a war time disorder, it now can effect any trauma survivor of abuse, rape, or natural disaster.  Yet it is important to note that the same horrific event may be processed by some and not others. Most can process the traumatic event within 3 months, while others may experience prolonged trauma (Evans, 2014, p. 29).  Numerous subjective variables about the person’s genetics, brain structure, past trauma, resilient traits and social support all play roles why some persons process trauma without dysfunction and others do.  It is not a sign of weakness but merely an inability for a particular case and reason that the brain is unable to properly process the situation.  As seen above, this sometimes has much to do with the amygdala and the inability to  extinguish the fear.

While many only correlate PTSD with veterans it can also affect survivors of abuse or other traumatic experiences

Due to these issues, hyperarousal or hypoarousal can occur in those with PTSD.  This leads to re-experiencing symptoms, avoidance, as well as hyperarousal which can lead to hypervigilance (Evans, 2014.. p. 29). Those with PTSD are unable to regulate emotions when hyperarousal or hypoarousal occur.  To learn more about hyperarousal or hypoarousal and emotional regulation, please click here.  Whether hypoarousal and its symptoms of numbing, withdraw and dissociation, or hyperarousal and its symptoms of anxiety and hypervigilance, the brain is unable to differentiate the past trauma with current triggers.  This can cause flashbacks where the person loses contact with time, or location.  Only until the person learns grounding techniques and ways to regulate emotion can he/she find a window of tolerance to experience the event, process it, recreate new neuropathways associated with the memory, and store it long term without unresolved trauma symptoms.

Many counselors utilize exposure therapies such as EMDR, or cognitive therapies such as CBT to help clients and victims revisit and reframe the event in a healthy fashion and learn to process it as well as manage and regulate emotions that can be triggered due to the event.

Conclusion

The purpose of this short article was more so to understand the parts of the brain associated with the stress response and how the brain normally operates to better understand why when it does not operate correctly, one experiences unresolved trauma and PTSD.  An overactive amygdala and underactive prefrontal cortex play off each other and cause the inability for the body to continue the process of fear extinction.  This causes an inability of the hippocampus and prefrontal cortex to properly process, understand and store the memory.  While most resolve traumatic experiences within 3 months, some do not.  There are many subjective variables as to why one person and not another may experience unresolved trauma.  Trauma Informed Care specialists understand the neuroscience behind PTSD and help the client or victim find windows of tolerance and teach them emotional regulation and grounding techniques to heal from cope as well as heal from past trauma.

Please also review AIHCP’s many healthcare certification programs and see if they meet your academic and professional goals

Please also review AIHCP’s Trauma Informed Care Program as well as its many healthcare certification programs.

Reference

Evans, A. & Coccoma, P. (2014).”Trauma Informed Care: How Neuroscience Influences Practice”. Routledge.

Additional Resources

“The Neurobiology of Trauma: Understanding the Brain’s Response to Adverse Experiences 2025”. Kaplan Therapy.  Access here

“How the Brain Reacts to Stress and Trauma” Science News Today.  Access here

Kubala, K. (2021). “The Science Behind PTSD Symptoms: How Trauma Changes the Brain”. PsychCentral.  Access here

“Trauma and the Brain: PTSD Brain Diagrams Explained” (2024). NeuroLaunch. Access here

 

 

 

Trauma Informed Care: Vicarious Trauma, Compassion Fatigue, Burnout and Regulating Self

It is only natural for many counselors to become sickened, disgusted, angered, or enraged when discussing trauma with a victim.  The stories of abuse against the innocent cry for justice.  As counselors, or safe guarders, in many ways, these emotions are important in helping the counselor or social worker become instilled with the desire to find justice of the victim and legal punishment for the perpetrator.  Hence, it is natural to feel.  Counselors are not robots and as human beings, they can become influenced and effected by the details of the stories of victims.  These effects can appear in forms of vicarious trauma, compassion burnout, or even loss of emotional control in a counseling session.  As healthcare professionals, it is imperative that counselors, social workers and pastoral caregivers are able to monitor themselves in order to be there for the client/victim.   In this article, we look at vicarious trauma, burnout and regulating self and how it is important to identify these things and utilize the skills of regulation in counseling, but also every day life.

Vicarious trauma is indirect trauma that affects the counselor or caregiver. Please also review AIHCP’s Trauma Informed Care program

Please also review AIHCP’s Healthcare Certifications as well as its Trauma Informed Care program, as well as AIHCP’s Grief Counseling and Crisis Intervention programs.

Absorption Vulnerability: What is Vicarious Trauma, Compassion Fatigue and Burnout?

It falls under the umbrella of vulnerability absorption.  Counselors can become affected by their clients and the stories told by them. Within these types of absorption, counselors can face compassion fatigue, vicarious trauma, or burnout.  Within compassion fatigue, the trauma and stories of the victim wear down the counselor emotionally.  It affects their ability to be empathetic and optimistic in the therapeutic relationship.. Vicarious trauma, on the hand has a different type of reaction to trauma.  Vicarious trauma is when a counselor or mental health professional is indirectly affected by the trauma of the client/victim (Compton, 2024, p. 236) but in this type of trauma, the counselor experiences types of post traumatic stress symptoms.  It goes beyond the emotional wear of compassion fatigue but also affects the beliefs and behavior of the counselor.  Burnout on the other hand does not include the trauma of the victim, but has more to do with large caseload, working long hours and inter stress dynamics at work (Compton, 2024, p. 236).  All symptoms of burnout as well as vicarious trauma and compassion fatigue are detrimental to the therapeutic relationship because it weakens the counselor’s ability to actively listen, employ empathy, help the client heal and remain regulated. Some may overlap and also play on each other.

Compton points out that counselors who are more susceptible to vicarious trauma and absorption vulnerability usually have past trauma that is triggered in counseling through the indirect trauma of the client (2024, p. 238).  Hence indirect exposure to horrible stories of abuse, one’s own past trauma history and the triggers associated with it can engage within the counselor various trauma responses.  Like the client, the counselor can experiences challenges to one’s own beliefs and world views and also cause an existential crisis of faith (Compton, 2024, p. 237).  This can later filter into the counselor’s home life causing counselors to either avoid those in need, or to overcompensate with becoming to involved.  Overinvolvement and lack of professional boundary can lead the counselor into seeing the client as oneself and lead to clouded vision as well as trying to do too much beyond one’s skill level in some cases.

Regulating One’s Emotions

When hearing horrific stories of abuse, it can be difficult during a session for a counselor to be able to maintain the needed co-regulation for a client.  A counselor, like a trauma survivor, can enter into states of hyperarousal or hypoarousal.  In other articles, we discussed the nature of hyper and hypoarousal states of the client, but these same states can also affect the counselor in negative ways.  In regards to hyperarousal, a counselor may become more irritated, anxious, or upset, while also feeling an increased heart rate as the sympathetic nervous system is activated.  Likewise, a counselor may become dissociated, numb or lost due to the reaction of the parasympathetic system.  In both cases, the counselor is losing the ability to regulate.

Settling oneself without upsetting the client is key.  In the hyperarousal state, the counselor needs to settle and ground oneself by calming the mind through breathing, grounding, or other cognitive exercises that relax the sympathetic nervous system, while in the hypoarousal state, a counselor needs to activate by stimulating the brain or creating movement.  Many times, it is encouraged in these activation or settling techniques to discreetly include the client who may well also be experiencing tension.  Hence any of deep breathing exercises or cognitive grounding techniques, as well as movement, stretching, or even a cold glass of water can help a counselor and client regain emotional regulation.  Many of these grounding techniques and how to utilize them are mentioned in other AIHCP articles.  Please click here to review grounding and containment strategies.

While counselors track clients emotional and physical reactions, counselors can also scan their own body for hyper or hypoarousal.  Compton recommends scanning one’s own body in intense moments to detect these emotional changes within the body.  In addition, Compton recommends evaluating ones subjective unit of distress on a scale of 1 to 10 via the SUDS scale (2024,. p. 249).  It is  important to understand not only the window of tolerance of one’s client but also oneself.  Again, the window of tolerance refers to the optimal time a person is able to discuss trauma in a rational and calm way without triggers activating a fight, flight or freeze response.   In charts, the window of tolerance is colored as a green zone, while hyperarousal is dictated a red zone, while hypoarousal is regarded as the gray zone.  When in the red zone of hyperarousal, a counselor needs to stop and engage in calming activities, while when in the grey zone of hypoarousal, a counselor needs to activate and arouse the mind and body (Compton, 2024, p. 248-249).

Intense emotions of clients can cause vulnerability absorption in counselors. Counselors need a others-orientated empathy to properly help clients heal

Key regulation, a counselor needs to identify triggers that can cause these reactions.  As human beings counselors too have triggers that can cause various reactions to a story or person.  Past trauma, one’s own biases,  and one’s own way of handling things can cause internal division with the client and it is important to identify these triggers.  These triggers can cause issues with providing unconditional positive regard and empathy to the client.  In displaying empathy, sometimes, according to Compton, can fall into two categories- self-orientated empathy and others-orientated empathy.  In regards to self-orientated empathy, one feels the pain of others but it affects the person directly and impacts their ability to help, while others-orientated empathy allows one to feel but gives the necessary space and distance to help others in suffering (2024, p. 254). To review AIHCP’s previous article on unconditional positive regard and empathy, please click here.

Counselors when they do feel emotions should not dismiss the feeling as bad or good.  Emotions, according to Compton, are not dangerous in themselves but a counselor simply needs to allow and notice them but constrain them for the benefit of the client (2024, p. 256-57).  In addition, certain stories may also lead rumination or the inability to shake a certain thought or memory that has invaded the mind during counseling.  Compton suggest focusing such worries and thoughts to goal solving thoughts (2024, p. 258).   Again, emotions and thoughts are natural, but as professionals, one needs to identify them and properly regulate them in counseling.

Self Care

Counselors, like any caregivers or safe guarders, experience many terrible thing through the stories they hear.  The ability to absorb but yet to effectively care is a thin line from falling victim to vicarious traumas.  Hence it is so important for counselors to be skilled in self-regulating, but also skilled in understanding professional and emotional boundaries.  Counselors need to ensure that their brain and body is able to find the necessary time to heal and rest.  Self care is in many ways stewardship of self.  It involves understanding that one is not the ultimate solver of all problems and understanding the value of time and how to utilize it for the greatest good.   Sometimes, it is the mind that needs the most rest.  Allowing the mind freedom from unnecessary trauma or images when away can allow one to find peace at home.  Instead images or stories or movies that may invoke triggers should be avoided. Hence according to Compton, it is important to be a steward of one’s mind, body, time and relationships with others.  This involves boundaries as well as enjoying the good in life.  It can be very difficult to avoid the fog and darkness of abuse and the counselor needs to have balance.  Spirituality, hobbies, time off, boundaries, as well as utilization of grounding techniques and the mastery of them is key.  Deep breathing, relaxation, meditation, and digesting good and wholesome content is important for counselors to be able to continue to give quality care to each hurt soul

Conclusion

Please also review AIHCP’s Trauma Informed Care program as well as its Healthcare certification programs

Counseling and safe guarding victims of trauma takes a toll on healthy minds.  Positive energy and coregulation of the counselor in the therapeutic relationship can be weakened through vicarious trauma, compassion fatigue or burnout.  Hence it is critical to understand one’s own triggers, as well as the ability to regulate one’s emotional responses.  Self care is essential to maintain a healthy balance to keep counselors up to the large task of helping victims heal.

Please also review AIHCP’s Trauma Informed Care program, as well as its other Mental and Behavioral Health Certifications.

Resource

Compton, L & Patterson, T (2024). “Skills for Safeguarding: A Guide to Preventing Abuse and Fostering Healing in the Church” Intervarsity Press.

Additional Resources

Compton, L., & Patterson, T. (2024, March 14). Absorption Vulnerability: A New Look at Compassion Fatigue. Traumatology. Advance online publication.  Click here
Vicarious Trauma: “What To Do When Others’ Distress Impacts Your Well-Being”. (2024). Cleveland Clinic: Health Essentials. Access here

Matejko, S. (2022). “What Is Vicarious Trauma?”. PsychCentral. Access here

Luster, R. (2022). “Vicarious Trauma: A Trauma Shared”. Psychology Today. Access here

 

Perinatal Grief and Loss

 

I. Introduction

Perinatal grief and loss are deeply complex experiences, emotionally and psychologically speaking. It’s especially challenging for parents who are dealing with the trauma of losing a child either before or shortly after birth. This kind of loss really challenges what society expects around parenthood, bringing to light a grief that is often not recognized as it should be. As we talk more about perinatal loss, we’re also starting to realize just how much social situations impact how people grieve. Exploring these situations carefully shows us that healthcare workers need to get that perinatal loss can lead to what some call “social death.” In these cases, parents find themselves emotionally unseen in their grief (Borgstrom et al., 2016). In the pages that follow, this essay will explore how personal stories of loss interact with broader societal effects. Furthermore, it will examine the critical role and importance of helpful bereavement support systems, using insights from qualitative research methods to shed light on the real, lived experiences of individuals as they confront perinatal grief (Davidson D).

Perinatal losses include stillborn, neonatal death and miscarriages. Please review AIHCP’s Grief Counseling Certification
Please also review AIHCP’s Grief Counseling Certification and see if it meets your academic and professional goals.

 

A. Definition of perinatal grief and loss

The distress felt by parents after losing a baby around birth—we’re talking from pregnancy to a month after—is what’s known as perinatal grief and loss. It’s intense, both emotionally and psychologically. It’s not just about the baby, either; it’s also the crushing loss of all those hopes and dreams parents had started building (Campbell-Jackson et al., 2014). And it’s tricky because society doesn’t always get how truly difficult this is. Research, such as studies on stillbirths, has shown that how healthcare folks act really shapes what parents go through. Compassionate support that respects what parents want, like whether they want to hold their child, is key (A Lathrop et al., 2015). So, getting perinatal grief means looking at both the personal, emotional side and how bigger things, like the healthcare system, play a role in the experience. Generally speaking, a nuanced approach is needed to fully understand it.

 

B. Importance of addressing perinatal grief

Dealing with perinatal grief is really important because it hits parents hard, emotionally and psychologically. Research suggests that when parents face the stillbirth of a baby, they often feel an intense loss, so they really need healthcare providers to give them a lot of support in navigating their grief. For example, some qualitative studies show that allowing parents to connect with their stillborn infants—when handled carefully—can actually help them process their grief and create lasting memories, which can be a big part of healing ((A Lathrop et al., 2015)). Additionally, the effects of perinatal loss aren’t just about the immediate emotional pain; it can even lead to more serious problems like post-traumatic stress disorder (PTSD) after giving birth ((Sawyer A et al., 2015)). So, when we recognize and address perinatal grief, we’re not just easing the immediate pain but also helping to prevent longer-term psychological issues. Ultimately, we’re pushing for a more compassionate and informed healthcare response to these kinds of sad situations.

 

C. Overview of the essay structure

When you’re crafting an essay about the tough subject of perinatal grief and loss, a solid structure is really important. It’s got to help guide the reader through some pretty complicated emotional and psychological territory. The intro needs to set the stage, you know, explain why this topic matters. It should also lay out your main point – that perinatal loss hits parents and families hard. Then, in the paragraphs that follow, you dive into the specifics. We’re talking about the psychological effects, how culture shapes how people grieve, and why it’s so crucial for grieving parents to have good support. Each part of your essay shouldn’t just include hard data and the theories, but also real stories, to make it even richer. And finally, the conclusion should tie everything together, bringing home the point that we need to be understanding and kind when dealing with perinatal grief. It’s also a call for more research and better policies in this delicate area (Smolowitz J et al., 2010-05-20). You can’t just gloss over the importance of this, generally speaking.

 

II. Understanding Perinatal Loss

Perinatal loss – it’s more than just sadness; it can have deep emotional and psychological effects on everyone involved. When a baby is stillborn, for example, the impacts are often not fully appreciated. Studies actually show that stillbirths can cost families more money than live births because of extra medical care and support that’s needed ((Bhutta et al., 2016)). The emotional pain can also leave parents feeling alone, especially moms who might find it hard to get real support from their friends and family. Some women have shared in interviews that their loved ones just don’t get what they’re going through, which can make them feel even more isolated and helpless ((Collins et al., 2014)). It’s really important for doctors, nurses, and all of us to understand all of this so we can build better ways to help families heal after such a loss. Creating proactive support systems is essential for addressing the unique needs and challenges that grieving families face, and can assist in their recovery process.

Perinatal loss and grief

 

A. Types of perinatal loss (miscarriage, stillbirth, neonatal death)

Losing a baby around birth—we call it perinatal loss—includes some really tough situations like miscarriages, stillbirths, and when a newborn passes away. Each one brings its own kind of pain for the parents. A miscarriage, that’s when a pregnancy ends before 20 weeks, can really hit women hard, and it’s often a shock. They might feel super guilty or anxious, you know? Now, stillbirth is when a baby dies after 20 weeks. It’s not just grief; parents sometimes have to deal with people not really understanding what they’re going through. Then there’s neonatal death, when a baby dies in the first month. This adds another layer because parents have already started connecting with their child. Studies generally show that women react differently and cope in their own ways to these losses. This means support needs to be personalized to what each woman is experiencing (Tuba Uçar et al., 2025), (P de-Juan-Iglesias et al., 2025).

 

B. Statistics and prevalence of perinatal loss

Perinatal loss isn’t just a sad thing; it’s a real public health issue, hitting families hard emotionally and psychologically. When you look at the numbers, you see that in richer countries, somewhere between 1 and 5 out of every 1,000 births end in stillbirth. And then, about 2 or 3 out of every 1,000 babies born alive don’t make it very long. This shows you how often these awful events happen. But it’s not just about the immediate loss; it messes with a mother’s mental health and changes how families work. Qualitative research really brings that point home. A big review even pointed out that more than half – over 56% – of these deaths happen in hospitals, so healthcare workers see this kind of thing a lot (Kirshbaum et al., 2011). What’s more, people’s stories show how tricky it can be to deal with the grief, and often, the whole bereavement thing gets even harder because society can be weird about perinatal loss, which means that family and friends might not know how to help (Davidson D).

 

C. Psychological impact of perinatal loss on parents

The profound psychological effects of perinatal loss on parents can resonate for a long time, and really shape their mental health and overall wellness. Studies have shown that the grief following a stillbirth can often lead to problems. Think anxiety, depression, and a really isolating feeling. Parents will often talk about feeling inadequate or even guilty, and this is made worse because sometimes society just doesn’t get how real their loss is, which makes grieving even harder. How healthcare providers handle things is super important for these parents. If they show empathy, it can lessen the mental health impact and actually help parents deal with their grief in a better way (Bhutta et al., 2016). Plus, a lot of parents will say that holding and seeing their baby who was stillborn is important because it helps them make memories; healthcare professionals should really try to make that happen for parents in a compassionate way (A Lathrop et al., 2015). Actions like that can have a big impact on how these individuals heal from their perinatal loss.

 

III. Grieving Process in Perinatal Loss

Following perinatal loss, the grieving process presents intricate challenges, marked by distinct emotions and societal hurdles. In contrast to other bereavements, stillbirth confronts parents with a unique void: a child without lived experiences to remember in the traditional sense. Because there are no shared stories in the same way as family members that have lived longer lives, this inherent lack necessitates a form of what researchers label “identity work.” This refers to active efforts in establishing a lasting identity for the deceased child. Indeed, parental interviews reveal active integration of stillborn children into family stories, cementing connections between the living and departed, as highlighted in (INFANCY CEISADI et al., 2013). These kinds of endeavors illustrate the critical need for society to recognize the particular grief experienced in these scenarios, thereby stressing the role of robust support systems in enabling healthy grief processing amid deep loss.

Finding new meaning and understanding the loss and how it fits in one’s life is key in perinatal loss.

 

A. Stages of grief specific to perinatal loss

Navigating the grief following perinatal loss involves a winding emotional path for parents, deeply shaped by the particulars of each unique situation. At first, there’s often shock and disbelief. It’s hard to accept that the hopes built around becoming parents are gone. As this difficult time unfolds, intense sadness and even anger commonly surface, forcing parents to face the deep emotional hurt tied to the death of their child. It’s also incredibly important to have good communication and support. Research shows that mothers are often unhappy with the care they receive while grieving (Ahmadi et al., 2016). What’s more, mental health approaches, like Interpersonal Psychotherapy, can encourage healthier ways of coping, building resilience in families dealing with perinatal loss (Gray et al., 2014). Given these nuances, the need for understanding care and customized support is really highlighted.

 

B. Individual differences in grieving experiences

Dealing with perinatal grief and loss means we really need to get that everyone grieves differently. What works for one parent after losing a newborn might not work for another; things like where they come from, what losses they’ve been through before, and how they deal with tough stuff all play a part. Some parents, for example, might really want to see and hold their baby, finding it comforting, while others might be scared or unsure—and that can change how they grieve. Qualitative studies, as pointed out by (A Lathrop et al., 2015), show us that not all parents can easily say what they want when it comes to being with their stillborn child. It really drives home how important it is for healthcare providers to be there with good, sensitive guidance. Given this variability, it’s super important for those in healthcare to have talks with parents about what choices they want to make right after the loss. These moments? They can really stick with you. When we acknowledge these differences in how people grieve, we’re not just supporting each parent’s journey, we’re also building more compassionate practices around perinatal care.

 

C. Cultural influences on grief and mourning practices

Cultural factors play a major role in how we, as individuals and communities, deal with the tough issues surrounding grief and mourning. This is especially true when talking about the loss of a baby around birth. The best ways to mourn aren’t the same everywhere; some cultures are okay with showing a lot of emotion, while others prefer to keep things more subdued. Take Vietnam, for example. There, having an abortion starts a specific mourning journey, often influenced by both feeling ashamed and honoring ancestors. Lots of Vietnamese women struggle with what society expects from them when grieving and with the moral questions their loss brings up. As pointed out in the research, some women use the Nghia Trang Online memorial to worship ancestors. This helps them stay connected to the fetus they lost and also express their grief. It really shows how much culture can affect how we grieve, revealing the complicated mix of love, loss, and remembering (Earle et al., 2007), (Heathcote et al., 2014).

 

IV. Support Systems for Grieving Parents

Navigating the landscape of grief after perinatal loss is, generally speaking, a difficult journey for parents, presenting challenges that require significant support structures. Research suggests, and rightly so, that mothers and fathers alike often face deep grief and anxiety, particularly in later pregnancies; this highlights a need for interventions designed to meet both parents’ emotional needs (A Yamazaki et al., 2014). Traditional healthcare environments, however, may sometimes fail to fully recognize the specific pain tied to stillbirth, thus it’s important that health providers are trained to provide empathetic and comprehensive support during these times (Totten et al., 2013). Furthermore, effective support, in most cases, ought to facilitate healthy bonding with future children, and not just focus on grief itself. These systems should include community resources, counseling, and peer networks that offer grieving parents a safe space for sharing experiences and feelings. Acknowledging the complexities inherent in perinatal grief allows support systems to better guide parents through their loss and help them foster resilience despite profound sorrow.

Support is essential when overcoming a miscarriage or loss of an infant. Please also review AIHCP’s Grief Counseling Certification

 

A. Role of healthcare providers in providing support

Healthcare providers, in dealing with perinatal grief and loss, are essential not just for clinical reasons; they also provide vital emotional and psychological support to grieving families. It is important to communicate well, since families find comfort in empathetic conversations that acknowledge their emotions and requirements when facing such hardships. For example, one study showed that mothers were often not satisfied with the care they got after a loss. This underscores how important it is for providers to build an understanding atmosphere. Such an environment should respect patients’ dignity and be responsive to their needs (Ahmadi et al., 2016). Furthermore, healthcare providers need to help with the complicated medical and financial issues that can come with perinatal loss, which can add to the stress faced by grieving families (Ahmadi et al., 2016). When providers emphasize both clinical skill and emotional support, they can greatly ease the pain and suffering linked to this profound experience, improving the quality of care bereaved families receive overall.

 

B. Importance of family and community support

The ripple effects of perinatal grief and loss touch more than just the immediate family. A supportive community is really important. Family connections often act like a key support during such tough times, aiding resilience and helping with emotional healing. Empathetic relatives can ease the pain of grief, providing comfort and shared understanding. Furthermore, community involvement matters a lot when it comes to dealing with the wider implications of stillbirths, shown by studies about the impact on mental health and the resources needed for bereaved families (Bhutta et al., 2016). Qualitative research shows us how much structured community support systems and integrated bereavement protocols are needed, which can help with the grieving process (Davidson D). In the end, building strong family ties and community networks is crucial for navigating the complexities of perinatal loss, helping individuals recover and find hope.

 

C. Resources available for grieving parents (support groups, counseling)

Dealing with the difficult emotions of perinatal grief often requires help from others, which shows how important resources like support groups and counseling can be. These resources give grieving parents an essential place to share their stories, feel understood, and get caring support from others who have gone through similar pain. Studies suggest that support programs for bereaved parents can greatly improve their emotional health, especially when care is tailored to individual needs (Boring et al., 2019). In addition, personalized counseling methods, such as Interpersonal Psychotherapy and Cognitive Behavioral Therapy, are key to effective bereavement counseling, as seen in local mental health programs (Gray et al., 2014). Through these resources, parents not only find comfort in shared experiences but also learn coping skills that can help them heal and build resilience after experiencing profound loss.

 

V. Conclusion

To sum up, navigating perinatal grief and loss demands a sensitive awareness of the deep emotional effects on both mothers and fathers. Studies emphasize the intricate, often unspoken, aspects of this grief. Consider, for example, Pakistani men, who face the social disapproval associated with infant loss in their communities (Harrison R et al., 2025). The emotional path typically moves between initial shock and a search for understanding, all closely tied to cultural and religious views. Moreover, it’s important to acknowledge how perinatal loss influences later pregnancies, where guilt from the previous loss is a key factor connecting the intensity of grief to higher anxiety during pregnancy (Keser E et al., 2024). So, a well-rounded strategy for perinatal grief must include supportive actions. These actions should recognize these emotional details and tackle the differing experiences across various demographic groups, to encourage a broader, more inclusive awareness of this delicate subject in healthcare and in wider social settings.

Please also review AIHCP’s Perinatal Grief Counseling Program

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

 

A. Summary of key points discussed

Delving into perinatal grief and loss reveals some key takeaways that highlight just how complex this experience truly is. To begin, there’s a real need for tailored, well-vetted interventions for grieving parents. We see this emphasized in the systematic literature review, which looks closely at how well different support systems work, from expressive arts therapy to multimodal interventions that combine peer support with healthcare resources (Boring et al., 2019). The emotional and psychological effects of perinatal loss, furthermore, ripple outward, affecting not only parents but also their broader support networks. Because of this, it becomes even more important to have comprehensive and easily accessible support systems for family and friends who are affected indirectly (Feder et al., 2016). This interconnectedness really shows us that bereavement isn’t an isolated thing, it’s a communal one. It demands an inclusive healing approach that tries to address both the immediate and the long-term emotional needs within families touched by such a loss.

 

B. The need for increased awareness and sensitivity

Perinatal loss carries deep emotional consequences, often underestimated and requiring increased attention from healthcare providers and society in general. The bereavement of losing an infant is coupled with a feeling of social exclusion, which can deepen the grief experience and impede recovery. Support groups like HOPE highlight the importance of social justice in perinatal care, as the insights from women who participate expose systemic failures in addressing the various needs of people grieving such a loss (Fermor et al., 2016). Moreover, the physiological elements, for example milk leakage and breast engorgement, add more complexity to the emotional aspects of perinatal grief, therefore healthcare providers must provide comprehensive information and coping strategies (Bakhtiari et al., 2016). Support and understanding can greatly help the care and healing processes for people experiencing perinatal grief.

 

C. Call to action for better support systems and resources

It’s clear that better systems of support and resources are vital for parents experiencing bereavement, particularly when dealing with perinatal grief and loss. Studies suggest that bereavement interventions, as they exist right now, often aren’t as effective or well-designed as they could be. In fact, just a handful of studies show good results for parents working through their grief (Boring et al., 2019). Because of this, many are advocating for the creation of support programs that are evidence-based, address the many needs of these parents, and are specifically tailored to them. For example, models that prioritize the active involvement of those affected, along with therapies such as Interpersonal Psychotherapy, could make support both more accessible and more effective (Gray et al., 2014). We can help bereaved parents not only get emotional support, but also provide the resources they need to heal and build resilience as they cope with their deep loss by using thorough and personalized care strategies.

Additional AIHCP Blogs

Miscarriage and Loss: Click here

Additional Resources

Lebow, T. (2022). “Miscarriage Grief: How to Cope with the Emotional Pain”. PsychCentral.  Click here

Nathan, E. (2024). “Grief After Miscarriage” Psychology Today. Access here

Guarnotta, E. (2022). “Dealing With Perinatal Loss: What You Can Do & Who Can Help”. Choosing Therapy.  Access here

“Coping with Grief in Perinatal Loss” Forever Families.  BYU. Access here

 

 

 

Why Acute Stabilization Isn’t Enough for Long-Term Recovery

Poor choices and bad coping can lead to addiction. Please also review AIHCP's Substance Abuse Counseling Certification

Written by Kazar Markaryan

I. Introduction

While acute stabilization is a sine qua non of modern recovery practices, it shouldn’t be the point where treatment ends. Stabilization secures medical safety, manages withdrawal, and provides immediate symptom relief; the clinical team’s goal is to reduce physical risk and restore basic functioning. After this phase, patients confront habits, triggers, relationships, and psychological structures that once supported substance use. Long-term recovery demands planning, consistent support, and skill development that continues far beyond the hospital. The answer to why acute stabilization isn’t enough shows us a clinical reality: short-term safety must connect with sustained care that treats cognition, emotion, and behavior within the context of real life. Evidence from multiple longitudinal studies shows that relapse risk remains high when aftercare is sporadic or completely absent. Ongoing therapy, monitoring, and structured community support greatly reduce readmission rates and improve social functioning. In the most literal sense, stabilization is the starting line of a lifelong course, not its finish.

A. Substitution and the Silent Shift

Addiction transfer is a not-so-rare clinical phenomenon in which one dependency replaces another. A person who stops drinking might begin to use prescription stimulants, or someone who quits opioids might start to develop compulsive spending or gambling behaviors. The underlying mechanism remains the same – seeking relief or stimulation. An escape through repetitive reward cycles. Preventing this from happening requires vigilance during treatment planning. A therapist can begin by identifying the conditions under which substitution behaviors arise: stress, loneliness, or boredom. The focus then moves to building tolerance for discomfort and developing new emotional regulation methods. One important element for long-term sobriety is the patient’s active role in noticing the early pull toward replacement behaviors. Recognizing patterns before they try to consolidate can allow clinicians to intervene early with behavioral or pharmacological supports. This is the reason why acute stabilization isn’t enough, but requires a more thorough approach.

B. Stabilization Treats Physiology First

Stabilization treats physiology first. We’re talking detoxification, medical management, and psychiatric monitoring, restoring the body to safety. Nurses and physicians work together to reduce acute withdrawal and to prevent seizures, dehydration, or cardiovascular complications. The patient receives medication to manage cravings and mood instability. For many, this marks the first full night of sleep in months. The brain begins to recover biochemical balance; thinking becomes clearer. Yet this clarity will expose emotional pain that had been numbed by substance use. Without follow-up care, the newly sober person faces this unmediated pain alone, and that’s not such a good thing.

C. The Goal of Stabilization

The goal of stabilization is not a lifetime of abstinence alone but readiness for therapy. Medical stability opens up a brief but crucial window, and that window must be used to align goals and engage motivation. Acute stabilization isn’t enough because it is only a short-term solution. The patient should understand treatment as a continuous process rather than a discrete, one-time event. The medical team’s role shifts from crisis control to capacity building. Discharge planning should begin during stabilization, not after it. Every hour spent preparing for continuity will increase the probability of sustained recovery.

II. Continuing Care and Its Limits

Research consistently demonstrates that continuity of care represents best practice, yet a large proportion of individuals fail to engage or maintain contact after discharge.

A. Continuity of Care and Engagement Challenges

Continuity of care represents best practice, yet a large proportion of individuals fail to engage or maintain contact after discharge. Some don’t attend the first follow-up session. Others start but drop out within weeks. And we’ve got a smaller portion that continues to use substances while attending outpatient care. One longitudinal study of post-acute programs reported that patients who had engaged in structured aftercare for more than 90 days had double the rate of long-term abstinence compared to those who didn’t. Still, the data has also revealed persistent difficulty maintaining engagement. These findings suggest that while the infrastructure for continued care exists, human behavior and external conditions often undermine participation.

B. Barriers That Block Ongoing Treatment

The barriers to follow-up can be both practical and psychological. Transportation, employment conflicts, childcare, and financial strain all limit attendance. Shame and fatigue play equal roles. A person leaving detox might feel cured because the body feels stronger, and the mind feels lighter. This false sense of completion can lead to avoidance of continued care. Addressing these barriers requires anticipatory guidance: clinicians have to talk about them before discharge. Transportation vouchers, telehealth sessions, flexible scheduling, and early motivational outreach are low-cost interventions that can change attendance rates dramatically. When these supports exist, dropout declines, and continuity improves.

C. Coordination Between Hospital and Outpatient Teams

Continuity is sustained through coordination. Hospitals and outpatient clinics have to communicate directly rather than hand patients a referral sheet. A practical discharge plan names providers, confirms appointments, and transmits medical records. Ideally, the patients leave with the next session already scheduled and transportation arranged. Medication continuity is equally essential. Interruptions in pharmacotherapy for opioid use disorder, for example, will probably trigger acute relapse within days. Coordination ensures dosage accuracy and prevents treatment gaps. When care fragments, the risk will rise.

D. Measurement and Monitoring as Tools for Retention

Programs that record attendance, toxicology results, and functional indicators can intervene quickly once the warning signs have appeared. Data-driven monitoring allows for personalized adjustment – more frequent visits during stress periods or medication adjustments in response to cravings. Routine outcome tracking will also create accountability across teams. It moves treatment from intuition to evidence. The habit of measurement embeds recovery in a transparent, observable framework that patients and clinicians can follow together.

III. Therapeutic Components Beyond Stabilization

Psychotherapy becomes the core of post-stabilization care. Cognitive-behavioral models train the brain to recognize distorted thinking and automatic reactions.

A. Psychotherapy as Core Post-Stabilization Work

Psychotherapy is key to long-term recovery. Clients learn to map their triggers, to identify the sequence leading to use, and to practice alternative responses. Behavioral rehearsal is essential. The brain rewires through repetition, not insight alone. A therapist might run through simulated scenarios – arguments, celebrations, boredom – and help the patient practice adaptive reactions. This is work done weekly, sometimes daily. The skills should replace old reflexes gradually; it can’t happen instantly. Over time, this structured practice builds confidence and autonomy.

B. Medication-Assisted Treatment and Biological Stability

For opioid, alcohol, or nicotine dependence, pharmacological aids help to reduce cravings and blunt reward sensitivity. These medications must be managed through long-term follow-up. Doctors monitor adherence and evaluate emotional side effects. Adjustments are common as the patient’s metabolism, stress, and environment change. When pharmacotherapy is combined with behavioral therapy, outcomes improve significantly. Stabilization without this ongoing medication support often leads to early relapse because underlying neurochemical imbalances remain uncorrected.

C. Social Support as a Living Buffer

Peer groups, therapy collectives, alumni programs, and family systems create accountability. Group formats normalize the struggle and reduce the feeling of isolation. Family sessions can rebuild trust and clarify roles. Stable housing programs offer predictable routines that reduce exposure to triggers. Employment support or vocational training adds meaning and daily structure. These practical conditions protect against the emptiness that often precedes relapse. The idea of why acute stabilization isn’t enough reappears here: detox can cleanse the body, but without reintegration into social systems, it can’t sustain psychological health. Programs that merge social support with ongoing therapy consistently produce better long-term outcomes and lower relapse rates.

D. Relapse Prevention as Maintenance Protocol

Relapse prevention functions as a maintenance protocol. Skills degrade without reinforcement. Scheduled booster sessions – monthly or quarterly – refresh coping mechanisms and reestablish connection. Clients are reminded that relapse is a process. Early detection often begins with subtle emotional shifts – irritation, secrecy, disconnection. Therapists teach awareness of these precursors. When these are addressed early, full relapse can often be completely avoided. Ongoing contact provides space to process slips without shame and to rebuild momentum quickly. The continuity itself becomes therapeutic.

IV. Systems and Policy That Sustain Recovery

Recovery exists within systems. When healthcare institutions create continuity between acute, outpatient, and community-based services, relapse rates go down.

A. Integrated Systems and Financial Coverage

Effective systems assign a case manager who remains involved from detox to stable housing. This person coordinates appointments, medications, and documentation. The patient sees recovery as a continuum rather than a series of separate programs. Financial coverage is another determinant. Insurance that reimburses only for acute care inadvertently encourages premature discharge. Policy must reflect the chronic nature of substance use disorders; it must be able to fund extended therapy, medication maintenance, and vocational rehabilitation. More weeks in structured treatment equal better long-term recovery rates.

B. Training and Data-Driven Improvement

Clinical training also shapes outcomes. Professionals trained in motivational techniques, trauma-informed care, and collaborative discharge planning increase patient retention. Motivational interviewing, for example, helps clinicians evoke intrinsic motivation instead of imposing compliance. When a counselor expresses genuine curiosity rather than control, patients stay longer in treatment. In addition, systems that collect and share outcome data can refine their programs iteratively. Learning from each discharge, successful or not, builds institutional knowledge. When systems track performance and adjust care paths, the standard of recovery rises across populations.

V. Conclusion

Clinical practice should redefine stabilization as the starting point, not the endpoint. The question of why acute stabilization isn’t enough arises wherever relapse data is analyzed.

A. Stabilization as the Starting Point

Short stays deliver safety but rarely deliver stability of identity or purpose. Long-term recovery requires layers of care – medical, psychological, and social – woven together with deliberate continuity. Extended treatment, active aftercare, and consistent community engagement translate to improved employment, health, and emotional regulation. Hospitals that link patients directly to outpatient services within one week of discharge witness markedly higher retention rates. Each contact – each session, call, or check-in – will extend the protective structure around recovery.

B. Systems Must Evolve to Reflect Evidence

Systems must evolve to reflect this evidence. Funding structures should reward continuity rather than crisis management. Clinicians should receive resources to track outcomes, conduct outreach, and coordinate with community programs. Recovery housing and vocational support should be viewed as treatment components, not optional add-ons. When these layers coexist, relapse declines and quality of life improves. Every year of sustained remission strengthens neural recovery and social stability. Society benefits as individuals return to productive roles, families regain cohesion, and communities experience fewer overdoses and hospitalizations.

Stabilization, though necessary, can never serve as the finish line. The process of healing extends into behavior, relationships, and environment. Long-term recovery grows in the space where structure, purpose, and connection meet. Understanding why acute stabilization isn’t enough invites clinicians, policymakers, and patients to build systems that reflect the real timeline of change – one measured not in days of detox, but in years of growth.

 

Author’s bio: Kazar Markaryan is the Chief Operations and Financial Officer at Tranquility Recovery Center in Sun Valley, California, where he oversees financial strategy, operations, and organizational growth. He believes real healing can begin only when people feel seen, supported, and ready to begin again.

References:

Baker, M. (2025, April 11). What Is Post-Acute Care and Why It’s Key to Recovery. Advantis Medical Staffing. https://advantismed.com/blog/what-is-post-acute-care

Leno, D. (2023, November 16). The Importance of Stabilization During Treatment | Malibu Wellness Ranch. Malibu Wellness Ranch. https://malibuwellnessranch.com/the-importance-of-stabilization-during-treatment/

Vogel, L. (2018). Acute care model of addiction treatment not enough for substance abuse. Canadian Medical Association Journal190(42), E1268–E1269. https://doi.org/10.1503/cmaj.109-5668

 

 

Please also review AIHCP’s Meditation Substance Abuse Counseling Certification and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

How to Counsel Male Patients on Multivitamins

Vitamin supplements can treat a deficiency within the body but should be started under the guidance of a healthcare professional or holistic and integrative healthcare specialist

Written by Emily Stokes. 

Men hoping for a boost in energy levels or a more robust immune system may be inclined to consider taking multivitamins. And especially as men age, the quest for improved health starts to become top of mind. If you’re a provider, you’ll want to be ready with accurate information to answer questions and help men make the right choice given their current health considerations, diet, and bloodwork. 

 

In this article, we’ll unpack the best practices you can use to counsel male patients as they weigh the benefits of adding multivitamins to their regimen. Ultimately, using simple and direct language is best to help patients make informed decisions. 

Screen Patients First

Whether you’re a primary care provider or a nutritionist, you’ll want to start your interaction with a male patient the same way. Begin with a screening where you gather information about their current diet, lifestyle habits, medications, and health priorities. 

You can ask your male patient to map out a normal day of eating. Are they consuming well-balanced meals and snacks? Are they adhering to a vegan diet or pursuing other types of unique nutritional choices? Ask about their alcohol intake, too, and inquire about smoking or vaping habits. When you have a clear picture of their nutritional habits, you’ll be able to identify lapses or fine-tune your suggestions. 

Ask whether your patient is taking medications, including both prescription and OTC drugs. Maybe they’re managing a chronic health condition or stress through medications, for example. And if they’re already taking specific vitamins, it’s important for you to know about those. Lastly, work to understand their goals with multivitamins. They may be eager to enhance energy levels or support their immune system. Make sure you write down all of their answers so you have them in your records. 

 

Consider Using Labs to Inform Guidance

A low-dose vitamin regimen is simple enough for most men to add to their diet. But labs can also be a useful resource when you’re trying to advise on multivitamin supplements. While labs might not be necessary for everyone, there are certain scenarios where they can make sense. 

Blood tests can involve comprehensive panels or specific tests targeting certain vitamins. In either case, tests can spot deficiencies and offer a better understanding of a patient’s nutritional status. For instance, labs might confirm suspected anemia by showing low iron levels and red blood cell counts. Or, if the initial interview with a patient indicated that they’re eating a poor diet, labs can reveal deficiencies of vitamin B12 or D. Labs also can make sense for individuals considering higher-dose regimens for iron or vitamin A. Similarly, older patients should have labs to help spot vitamin levels that could be adjusted. 

Ordering labs can establish a baseline against which providers can compare future results once a patient has started a multivitamin regimen. It’s wise to clarify to patients that vitamin deficiencies and surpluses both can be problematic. Over time, labs can offer a factual indication of whether adding multivitamins is a helpful decision. The benefits of taking multivitamins for men can be great, but it’s always good to check progress. 

 

Understand Your Patient’s Goals

Interacting effectively with patients is key to building a positive rapport and helping patients trust your guidance. Plan on prioritizing the patient by asking clear yet open-ended questions that encourage them to talk. Start by asking them to share what their goals are with adding a multivitamin to their diet. Confirm what they’re saying by repeating it to them before moving to follow-up questions. This step ensures that you fully grasp what they’re reporting to you. 

Some male patients may enter this conversation having done personal research on multivitamins. In other cases, they may have heard about multivitamins through conversations with a friend, but know very little about them. Use questions to figure out what your patient knows and thinks. And share honest, fact-based research to demonstrate the efficacy of multivitamins. While multivitamins don’t lower the risk of cancer or heart disease, they can help individuals with certain vitamin deficiencies or dietary issues. It can be helpful to create and practice a script prior to a patient’s appointment. For example, tell a patient your plan for them, given their existing condition, lab results, and other information. Then explain that you’ll follow up within a few months to see if the multivitamins are helping. 

 

Tailor Your Plan to the Patient’s Needs

Does your patient want to improve their immune system’s resiliency? Are they feeling tired and eager to increase their energy levels each day? Use your patient’s goals to help guide your advice. 

If a patient wants stronger immune support, inform them that multivitamins are only one small part of a care plan. Your patient will need to focus on rounding out their diet and getting more sleep to see real results. Further, if a patient wants to feel less fatigued, do bloodwork first to check for problems like low vitamin D or anemia, as well as thyroid issues. If lab results reveal a specific deficiency, it may be best to target it with a specific vitamin. 

Some patients may want to take multivitamins to manage prostate health. In those instances, it’s critical to help your patient understand that supplements with one ingredient can actually have a negative impact and won’t prevent prostate cancer. Some men may enter an appointment assuming any sort of supplement is good. Present research-based information and resources to back up your statements. Focus on helping patients set reasonable expectations for how multivitamins can play a role in their daily health.

 

Avoid Over-Supplementing

In general, providers can follow a few key guidelines when working with male patients to determine a multivitamin dosage plan. For starters, in most cases, it’s best to recommend low-dose multivitamins over more concentrated vitamins that contain only single nutrients. And help your patient steer clear of iron in their chosen multivitamins. While many women deal with iron deficiencies, it’s not as common a problem in men. If men have too much iron, they could suffer from gastrointestinal discomfort, like stomach pain or constipation. More severe problems like diabetes and organ damage are possible, as well. And does your patient smoke? Too much beta-carotenene in a multivitamin can contribute to a rising risk of lung cancer. 

Make sure your patient targets only high-quality vitamin brands, as well. Seals from USP or ConsumerLab add credibility, indicating that products have been verified by third-party testing. Vague or misleading labels should be avoided. Make sure to provide information about independent reviews or proper dosage, too. 

 

Offer Reasonable Dosing Suggestions

It’s not enough to simply recommend a type of multivitamin. Your patients will need clear advice regarding how often to take multivitamins and in what context. One of the best options for patients is a one-a-day formula. With these, patients will only need to remember to take a pill consistently each day.

Communicate specific instructions or drawbacks connected to different options. For instance, some multivitamins may need to be taken with food. Caution your patients that failing to do so could result in an upset stomach or poor nutrient absorption. Olive oil and other fats can help facilitate better absorption. And while gummies may sound more convenient to take, they can come with added sugar or a smaller list of nutrients. 

Older patients who require more specific nutrient quantities may be better off opting for tablets, capsules, or softgels. Additionally, advise patients currently taking other medications to space out their doses. Medications could impact absorption, and patients will need to be aware of potential drug interactions. Multivitamins with too much vitamin K or fish oil could contribute to bleeding if the patient is already on blood thinners, for instance. Calcium and iron can harm the effectiveness of some thyroid medications if taken too close to the medication dosage. Be sure to gather a comprehensive list of your patient’s medications to help determine their best path forward. And encourage your patient to go over dosage instructions with their pharmacist. 

 

Create Thorough Documentation and a Follow-Up Plan 

Ultimately, it’s wise to document everything when you’re working with patients and trying to address a problem. With proper documentation, it’s easier to determine whether a care plan is effective and where changes can be made. This documentation can be your point of departure as you look toward follow-up visits. 

Create a chart that outlines the patient’s current status, including their baseline labs and dietary practices. Write down the goals that they’re hoping to achieve, such as improved immunity or prostate health. Indicate that you’ve talked through potential risks that come with adding a multivitamin, including drug interactions, and provided them with educational handouts.

The chart also should include details like the name of the recommended multivitamin and its dosage. And indicate when the patient will have his next appointment. Six months or even a year can be a reasonable timeframe before meeting to reassess. You’ll help ensure compliance and audit standards, and ensure that you’re offering the best care possible when you commit to thorough documentation. 

 

Help Patients Make the Right Decisions

Counseling male patients effectively boils down to creating a detailed plan that considers their current health status, goals, and drug interactions. Begin with an interview and, in some cases, labs, to determine what their diet looks like and where the patient may have deficiencies. Explain what the best multivitamin options are for men and offer fact sheets from trusted sources to help guide their understanding. Caution your patient about drug interactions and dosages to help ensure a healthy integration of multivitamins into their lifestyle. And set up a follow-up appointment to check results. With a targeted, organized approach, you’ll help patients feel confident about their plan going forward.

 

Author’s Biography

Emily Stokes is a Midwest-based writer. Her writing explores a range of topics, including fine arts, real estate, and wellness practices. With experience in academic and blog writing, she can tailor her style to fit a variety of needs. 

 

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

Signs of Trauma and Abuse Video Blog

It is imperative within trauma informed care to be aware of and looking for signs of trauma or abuse in clients.  This video looks at some signs of abuse and trauma.  Please also review AIHCP’s Trauma Informed Care program, as well as its Crisis Intervention program and Grief Counseling program.  AIHCP offers a variety of healthcare certification programs. Please click here