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Bereavement

Bereavement is a normal process that people go through when they have suffered a major loss. While grief is typically associated with the death of a loved one, people may also experience a grief reaction to an incurable illness, the end of a significant relationship, or a major life change such as job loss. Some of the symptoms of the grieving process include sleep and appetite changes, lack of productivity at work or school, withdrawal from social contacts and family members, and crying spells.

The immediate phase of the grieving process can last up to two months. Milder symptoms can last for a year or longer. If these symptoms persist without improving, or someone is not able to return to normal functioning within a reasonable time, psychological counseling may be helpful.

Here at the Tarnow Center for Self Management our experienced clinical staff can offer individual, family and group counseling for clients of all ages who have experienced a loss. Regardless of the nature of the loss, grieving proceeds through five distinct stages (listed below). This journey isn’t linear; we don’t just move straight through. Instead, most people go back and forth between stages several times before reaching Acceptance. For many, it is often helpful to have a professional to guide and support them as they move through the grieving process.

The Five Stages of Grief

• Denial: Denial is our mind’s way of protecting you from fully experiencing a loss. Initially, it may be a numb feeling, or a state of shock. As time goes on, denial becomes more of a distortion of the truth, a way of looking at things that tells us what we want to believe. The message of Denial is, “This isn’t happening.”
• Anger: As we move into anger, we’re starting to address the reality of the situation. Anger protects us from feeling the pain by focusing our pain outward. The message of Anger is, “Who is to blame?”
• strongBargaining: Eventually, we realize that it just doesn’t matter. Anger hasn’t gotten rid of the problem, and it may have actually created some problems of its own. So now we start looking for resolution. Sometimes we bargain to prevent a certain outcome (“If you just take this away from me, I’ll…”), and at times we bargain to avoid the pain (“If I just buy this car/suit/pair of shoes, I’ll feel better.”). The message of Bargaining is, “This will make it all better.”
• Depression: But many times, it doesn’t. There are just some things that cannot be undone, and some problems that cannot be fixed. Sooner or later, we have to face that from which we’ve been running all this time: reality. But reality is hard. Reality is painful. Reality is… depressing. It’s really difficult to sit with reality for very long, and we often bounce right back into Bargaining. But when we’re able to stay with our pain long enough to work through it, we work our way to Acceptance.
• Acceptance: Acceptance is exactly that. Where Denial tells us “This isn’t happening,” Acceptance tells us, “This is happening, and we’ll get through it.” Acceptance is when we stop running away from the truth, and instead accept that truth as part of our worlds, and then look ahead to how to make the best of it.

Conduct Disorder

Conduct disorder (CD) is sometimes thought of as a more severe form of Oppositional Defiant Disorder (ODD). It involves an ongoing pattern of behaviors in which the child violates the basic rights of others or routinely breaks society’s rules. The behavior typically involves destruction, aggression, and/or dishonesty. The conduct is divided into four groups, and examples of each are listed below:

Conduct Disorder is more typically seen in males than in females. Male children with Conduct Disorder frequently fight, steal, vandalize, and have school discipline problems. Female children with Conduct Disorder are more likely to lie, be truant, run away, or use substances. Boys demonstrate more confrontational aggression (fighting) and girls demonstrate more non-confrontational aggression.

If you recognize any of these patterns in a child or a loved one, a psychological evaluation is recommended. The Tarnow Center offers both assessment and treatment for Conduct Disorder using a biopsychosocial approach that addresses the medical and psychosocial needs of the individual and the family. Appropriate intervention for Conduct Disorder includes:

• Individual Therapy: Cognitive-behavioral approaches to individual therapy are most effective in treating Conduct Disorder. The goal of therapy is to develop skills which teach the child anger management, coping with peer relationships, and problem-solving, among others.
• Family Therapy/Parenting Skills: Family therapy helps the client’s parents learn specific strategies to provide the structure and support that the CD child needs while he/she is working to change maladaptive behaviors.

Bipolar Disorder

Bipolar Disorder is a mood disorder where the person “cycles” between a very good mood (or irritable mood) and a very depressed mood. It is known as “Bipolar” because the person’s mood seems to go between two extremes, or “poles.” The two extremes are known as “Mania” (elevated, or irritated mood) and “Depression” (sad, depressed mood). The symptoms for both Mania and Depression are listed below:

There are a few different types of Bipolar Disorders:

• Bipolar I and Bipolar II both involve episodes of depression. What distinguishes the two are the presence and intensity of the manic symptoms. People with Bipolar II experience levels of high energy and impulsivity that are not as extreme as mania, and are instead known as “Hypomania.”

• Cyclothymic Disorderis a mood disorder where the person’s mood alternates between less severe forms of mania and depression.

If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended. The TarnowCenter offers both assessment and treatment for Mood Disorders using a biopsychosocial approach that addresses the medical and psychosocial needs of the individual and the family. Appropriate intervention for Bipolar Disorders includes:

• Medical Evaluation: Medication can be critical in helping the client better regulate his/her mood swings. Once medication and mood have been stabilized, the client can move on to learning Self-Management skills that help identify and control triggers for mood dysregulation.

• Individual Therapy: The goal of individual therapy is to help the client identify warning signs that their mood is going to change, and then practice strategies to regulate behavior and functioning.
• Family Therapy: Family therapy helps the client’s family to better understand the nuances of bipolar depression, and learn how to support the client as he/she works to control the mood transitions.

Depression

Depression is often described as feeling sad, “blue,” or “down in the dumps.” All of us feel this way at one time or another. There are a lot of events that occur in our lives that are hard to process, and it is normal to feel depressed after life hands you a tough loss. Examples might be:

• Loss of a loved one such as a family member, friend, or pet
• The end of a relationship (divorce, break-up, etc.)
• A traumatic event such as being in a car accident, or being the victim of an assault

But sometimes, the feeling of sadness won’t go away. What separates feeling “sad” from clinical depression is when the person is experiencing some (or all) of the following for 2 weeks or more:

If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended. The TarnowCenter offers both assessment and treatment for Depressive Disorders using a biopsychosocial approach that addresses the medical and psychosocial needs of the individual and the family. Appropriate intervention for Depression includes:

• Medical Evaluation: Medication may be useful in cases where the depression is having a more severe impact on the client’s functioning. Medications can help the client fight off the “heaviness” of the depression in order to better practice effective coping skills.
• Individual Therapy: The goal of individual therapy is to reengage the client with his/her life. Therapy helps the client identify thoughts and behaviors that contribute to depression, and then practice specific techniques to challenge the depressive mindset.
• Family Therapy: Family therapy helps the client’s family to better understand depression, and learn how to provide the client the support and structure that he/she will need to work through the depression.
• Group Therapy: Group therapy serves to get the client into a room with his/her peers and away from isolation and rumination. Group enables the client to share his/her “automatic thoughts” that lead to depression, and thereby challenge these thoughts with feedback from the group.