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ServicesDepressionDepression has no single cause; often, it results from a combination of things. You may have no idea why depression has struck you.Whatever its cause, depression is not just a state of mind. It is related to physical changes in the brain, and connected to an imbalance of a type of chemical that carries signals in your brain and nerves. These chemicals are called neurotransmitters. Some of the more common factors involved in depression are: Family history Genetics play an important part in depression. It can run in families for generations. Trauma and stress Things like financial problems, the breakup of a relationship, or the death of a loved one can bring on depression. You can become depressed after changes in your life, like starting a new job, graduating from school, or getting married. Pessimistic personality People who have low self-esteem and a negative outlook are at higher risk of becoming depressed. These traits may actually be caused by low-level depression (called dysthymia). Physical conditions Serious medical conditions like heart disease, cancer, and HIV can contribute to depression, partly because of the physical weakness and stress they bring on. Depression can make medical conditions worse, since it weakens the immune system and can make pain harder to bear. In some cases, depression can be caused by medications used to treat medical conditions. Other psychological disorders Anxiety disorders, eating disorders, schizophrenia, and (especially) substance abuse often appear along with depression. StressStress is the "wear and tear" our bodies experience as we adjust to our continually changing environment; it has physical and emotional effects on us and can create positive or negative feelings. As a positive influence, stress can help compel us to action; it can result in a new awareness and an exciting new perspective.As a negative influence, it can result in feelings of distrust, rejection, anger, and depression, which in turn can lead to health problems such as headaches, upset stomach, rashes, insomnia, ulcers, high blood pressure, heart disease, and stroke. With the death of a loved one, the birth of a child, a job promotion, or a new relationship, we experience stress as we readjust our lives. In so adjusting to different circumstances, stress will help or hinder us depending on how we react to it. School ProblemsThere are many reasons for teens to underperforms at school, including a lack of motivation to do well, problems at home or with peers, poor work habits or study skills, emotional and behavior problems, learning disabilities (such as dyslexia), attention deficit hyperactivity disorder, mental retardation or below average intelligence and other medical problems, including anxiety and depression. Also keep in mind that children with sleep problems, such as obstructive sleep apnea, or inadequate sleep, can have problems in school, usually secondary to attentional problems and daytime sleepiness.It is important to find the reason for your child's poor performance, especially if she is failing, and come up with a treatment plan so that she can perform up to her full potential. Another reason to get your child help, is that doing poorly in school can easily lead to problems with low self-esteem, behavior problems and depression. It is sometimes difficult to figure out if a child's problems at school are caused by their other medical problems, such as depression, or if these other problems began because of their poor school performance. Children who do poorly at school may be under a lot of stress, and will develop different ways to cope with this stress. Some may externalize their feelings, which can lead to acting out and behavior problems or becoming the class clown. Other children will internalize their feelings, and will develop almost daily complaints of headaches or stomachaches. A thorough evaluation by an experienced professional is usually needed to correctly diagnose children with complex problems. When you realize your child has a problem at school, you should schedule a meeting with her teacher to discuss the problem. Other resources that may be helpful including talking with the school psychologist or counselor or your Pediatrician. Step-Family IssuesWith the high incidence of divorce in the United States, there are increasing numbers of stepfamilies. New stepfamilies face many challenges. As with any achievement, developing good stepfamily relationships requires a lot of effort. Stepfamily members have each experienced losses and face complicated adjustments to the new family situation.When a stepfamily is formed the members have no shared family histories or shared ways of doing things, and they may have very different beliefs. In addition, a child may feel torn between the parent they live with most (more) of the time and their other parent who they visit (e.g. lives somewhere else). Also, newly married couples may not have had much time together to adjust to their new relationship. The members of the new blended family need to build strong bonds among themselves through:
While facing these issues may be difficult, most stepfamilies do work out their problems. Stepfamilies often use grandparents (or other family), clergy, support groups, and other community-based programs to help with the adjustments. Parents should consider family therapy for their child when they exhibit strong feelings of being:
In addition, if parents observe that the following signs are lasting or persistent, then they should consider family therapy for the child/family:
Most stepfamilies, when given the necessary time to work on developing their own traditions and to form new relationships, can provide emotionally rich and lasting relationships for the adults and help the children develop the self-esteem and strength to enjoy the challenges of life. GriefGrief is a normal and natural, though often deeply painful, response to loss. The death of a loved one is the most common way we think of loss, but many other significant changes in one's life can involve loss and therefore grief. Everyone experiences loss and grief at some time. The more significant the loss, the more intense the grief is likely to be.Each individual experiences and expresses grief differently. For example, one person may withdraw and feel helpless, while another might be angry and want to take some action. No matter what the reaction, the grieving person needs the support of others. A helper needs to anticipate the possibility of a wide range of emotions and behaviors, accept the grieving person's reactions, and respond accordingly. Therefore, it is often useful for the person in grief and for the helper to have information about the grieving process. The Process of Grief The process of grieving in response to a significant loss requires time, patience, courage, and support. The grieving person will likely experience many changes throughout the process. Many writers and helpers have described these changes beginning with an experience of shock, followed by a long process of suffering, and finally a process of recovery. These processes are described below. Shock Shock is often the initial reaction to loss. Shock is the person's emotional protection from being too suddenly overwhelmed by the loss. The grieving person may feel stunned, numb, or in disbelief concerning the loss. While in shock the person may not be able to make even simple decisions. Friends and family may need to simply sit, listen, and assist with the person's basic daily needs. Shock may last a matter of minutes, hours, or (in severely traumatic losses) days. Suffering Suffering is the long period of grief during which the person gradually comes to terms with the reality of the loss. The suffering process typically involves a wide range of feelings, thoughts, and behaviors, as well as an overall sense of life seeming chaotic and disorganized. The duration of the suffering process differs with each person, partly depending on the nature of the loss experienced. Some common features of suffering include: Sadness Sadness is perhaps the most common feeling found in grief. It is often but not necessarily manifested in crying. Sadness is often triggered by reminders of the loss and its permanence. Sadness may become quite intense and be experienced as emptiness or despair. Anger Anger can be one of the most confusing feelings for the grieving person. Anger is a frequent response to feeling powerless, frustrated, or even abandoned. Anger is also a common response to feeling threatened; a significant loss can threaten a person's basic beliefs about self and about life in general. Consequently, anger may be directed at self, at God, at life in general for the injustice of the loss, for others involved, or, in the case of death, at the deceased for dying. Guilt Guilt and less extreme self-reproach are common reactions to things the griever did or failed to do before the loss. For example, a griever may reproach him/herself for hurtful things said, loving things left unsaid, not having been kind enough when the chance was available, actions not taken that might have prevented the loss, etc. Anxiety Anxiety can range from mild insecurity to strong panic attacks; it can also be fleeting or persistent. Often, grievers become anxious about their ability to take care of themselves following a loss. Also they may become concerned about the well-being of other loved ones. Physical, behavioral and cognitive symptoms. Often, grief is accompanied by periods of fatigue, loss of motivation or desire for things that were once enjoyable, changes in sleeping and eating patterns, confusion, preoccupation, and loss of concentration. Suffering is often the most painful and protracted stage for the griever, but it is still necessary. For most people, these many emotional and physical reactions are common symptoms that will stabilize and diminish with time as the person moves through the grieving process. If these symptoms persist, it may be important to seek professional help. Recovery Recovery, the goal of grieving, is not the elimination of all the pain or the memories of the loss. Instead, the goal is to reorganize one's life so that the loss is one important part of life rather than the center of one's life. As recovery takes place, the individual is better able to accept the loss, resume a "normal" life, and to reinvest time, attention, energy and emotion into other parts of his/her life. The loss is still felt, but the loss has become part of the griever's more typical feelings and experiences. "In shock your actions are mechanical. You do what you have to do. In suffering your actions are forced by convention or by your own restlessness. But in recovery, your actions are by your own free choice." (Kreis & Pattie, 1969). Obtacles of Healing Grief is a misunderstood and neglected process in life. Because responding to death is often awkward, uncomfortable, even frightening for both grievers and helpers, those concerned may avoid dealing with grief. This can make the experience more lonely and unhappy than it might be otherwise. In addition, society promotes many misconceptions about grief that may actually hinder the recovery and growth that follow loss. For example, many believe it necessary to try to change how a grieving friend is feeling and may do so by making statements such as, "You must be strong," "You have to get on with your life," or "It's good that he didn't have to suffer." Such clichés may help the one saying them, but are rarely helpful to the griever. Society also promotes the misconception that it is not appropriate to show emotions except at the funeral, and that recovery should be complete within six months. A helper needs to avoid these and other ways of minimizing a person's grief. Those in grief need to be encouraged to recover in their own ways. Parenting ConcernsPreschool and early elementary school
AnxietyMost people experience a certain amount of anxiety and fear in their lifetimes. It is a normal part of living. For 40 million adult Americans, however, anxieties and fear are persistent and overwhelming, and can interfere with daily life. These people suffer from anxiety disorders, a group of psychiatric disorders that can be terrifying and crippling. Experts believe that anxiety disorders are caused by a combination of biological and environmental factors, much like physical disorders such as heart disease or diabetes. Anxiety disorders are identified as:generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, social anxiety disorder (or social phobia) and specific phobias.Normal anxiety or an anxiety disorder? Anxiety is hardwired into all of our brains. It is part of the body's "fight or flight" response. This prepares us to act quickly in the face of danger. It is a normal response to situations of uncertainty, trouble or feeling unprepared. However, if common everyday events bring on severe and persistent anxiety or panic that interferes with life, you may have an anxiety disorder. What's the Difference? Normal Anxiety Anxiety Disorder
See yourself? If you relate to any of these anxiety disorder descriptions, talk to someone who can help ASAP. Eating DisordersEating disorders are illnesses with a biological basis modified and influenced by emotional and cultural factors. The stigma associated with eating disorders has long kept individuals suffering in silence, inhibited funding for crucial research and created barriers to treatment. Because of insufficient information, the public and professionals fail to recognize the dangerous consequences of eating disorders. While eating disorders are serious, potentially life threatening illnesses, there is help available and recovery is possible.Eating Disorders Information Index Whether you're a girl, boy, woman, man, parent, coach, educator or student we have information for you! You'll find an entire list of our informational pages below, or for more refined, population-specific information simply look at the menu on the left. Anorexia Nervosa Anorexia Nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss. Anorexia Nervosa in Males Anorexia Nervosa is a severe, life-threatening disorder in which the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant distortion in the perception of the shape or size of his body, as well as dissatisfaction with his body shape and size. Anorexia, Bulimia, & Binge Eating Disorder What is an Eating Disorder? Eating disorders such as anorexia, bulimia, and binge eating disorder include extreme emotions, attitudes, and behaviors surrounding weight and food issues. Athletes and Eating Disorders In a study of Division 1 NCAA athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa. Though most athletes with eating disorders are female, male athletes are also at risk --especially those competing in sports that tend to place an emphasis on the athlete's diet, appearance, size, and weight requirements. Binge Eating Disorder Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating. Binge Eating Disorder in Males Binge eating disorder is a severe, life-threatening disorder characterized by recurrent episodes of compulsive overeating or binge eating. In binge eating disorder, the purging in an attempt to prevent weight gain that is characteristic of bulimia nervosa is absent. Body Image Body image is how you see yourself when you look in the mirror or picture yourself in your mind. Bulimia Nervosa Bulimia Nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating. Bulimia Nervosa in Males Bulimia nervosa is a severe, life-threatening disorder characterized by recurrent episodes of binge eating followed by self-induced vomiting or other purging methods (e.g. laxatives, diuretics, excessive exercise, fasting) in an attempt to avoid weight gain. Causes of Eating Disorders While eating disorders may begin with preoccupations with food and weight, they are most often about much more than food. Dental Complications of Eating Disorders: Information for Dental Practitioners The frequent vomiting and nutritional deficiencies that often accompany eating disorders can have severe consequences on one's oral health. Studies have found that up to 89% of bulimic patients show signs of tooth erosion. Eating Concerns and Oral Health Dietary habits can and do play a role in oral health. Everyone has heard from their dentist that eating too much sugar can lead to cavities, but did you know that high intake of acidic "diet" foods can have an equally devastating effect on your teeth? Eating Disorders Can Be Prevented! Eating disorders arise from a variety of physical, emotional, social, and familial issues, all of which need to be addressed for effective prevention and treatment. Eating Disorders in Women of Color: Explanations and Implications Eating disorders do not just affect white, upper-class women. There is still much to learn about how eating disorders effect individuals of all races and further research must be conducted to ensure that our efforts to combat these illnesses are inclusive of all women and men. Emotional, Physical, and Sexual Abuse of Children and TeensEmotional, physical, and sexual abuse are all too common in the United States and can happen to anyone. Nearly one million instances of child abuse are reported each year, and about four thousand children die as a result. About one-quarter of the cases involve sexual abuse.Let's look at the various types of abuse one at a time. Emotional abuse leaves no visible marks on a person, but it's painful nonetheless. An example of emotional abuse would be to continually call a child or teen a humiliating name, such as "good for nothing," "stupid," or "idiot." Another example would be to continually belittle the child or teen, such as by always making fun of how he or she looks. Emotional abuse is hurtful, it slows mental development, and it damages self-esteem. Physical abuse includes any form of beating, such as slapping or hitting with the hands or fists-including the use of objects, such as belts, sticks, or kitchen utensils. Additionally, physical abuse includes any other form of abusive treatment that hurts the child, such as burning. And finally, physical abuse includes the neglect of a child's physical needs, such as food, clothing, or proper housing. It's important to remember that-although some parents or guardians slap or spank a child as a means of discipline-it is now widely agreed that physical punishment constitutes abuse if actual injury occurs to the child, or if any marks on the skin are left, such as bruises or abrasions. Sexual abuse includes any kind of inappropriate touching or sexual fondling, oral contact, or intercourse. Sexual abuse also includes forcing a child to watch adult sexual activity. One specific form of sexual abuse is incest. This is sexual contact by a member of a family, related by birth or by adoption. People who commit incest are usually male and may include fathers, stepfathers, brothers, grandfathers, or uncles. Most victims are girls, but boys can be victims, too. And incest does not discriminate: It occurs within every religion, race, and socioeconomic group. Although it may seem ironic, the person who commits incest has often been similarly abused himself in the past. Furthermore, he is often an alcoholic. The spouse of this person may be absent from home because of illness or work and may or may not know about the abuse that is taking place. If the spouse does know or suspects what is going on, she will often deny or ignore the problem and, ultimately, do nothing to stop it. Female victims can be almost any age, from toddlers to teens. They are often threatened that if they share their horrible secret with anyone, terrible things will happen. Shame and bribery may also keep them silent. Often, these girls rebel against their mothers for not protecting them. They are also more likely to abuse alcohol and drugs, and they are more likely to engage in prostitution-especially if the incest occurred at an early age. If you or someone you know is being abused emotionally, physically, or sexually, you can call the Children's Protective Services Department in your county for help. You can also talk to your health care professional, a school nurse, counselor or teacher, or someone at your church. Your local YMCA, YWCA, police department, or hospital should have information on shelters and safe homes. And the Health Education Center at your local Kaiser Permanente facility has resources available, too. The important thing is to get help and to remember that the abusive situation is not fault of the victim. Finally, don't think that running away from home can solve the problem. The only thing that will help end the abuse is to find someone you trust who can help you stop it. Physical and sexual abuse are crimes, and health care professionals and other professionals are required by law to report abuse to local law enforcement authorities. While this may make some children and teens worry about putting a family member in jail, it's an important step toward ending the cycle of abuse and getting the abuser to seek help. Jail, incidentally, is usually necessary only in extreme cases. The main objective of the police and the social service agencies is to help everyone involved solve the problem in the best manner possible. Anger or Rage ProblemsRage is a shame based expression of anger. Rage is by definition abuse. Ragers react to strong emotions with rage. (i.e. feelings of fear, sadness, shame, inadequacy, guilt or loss convert to rage.)Ragers were typically shamed or punished by their caretakers for expressing emotion when they were young; i.e.: "Be a man and don't cry", "Nice girls don't get angry" or "I'll give you something to cry about". Raging gives the rager a feeling of power - offsetting their shame and feelings of inadequacy. Rage sets up a neurochemical reaction in the brain that can be addictive, producing what is known as rageaholism or ragaholics. What Rage Looks Like: Screaming, physical expressions of anger, violence or threats of violence, sulking, manipulation, emotional blackmail, silent smoldering, and anger used to punish. What Healthy Anger looks like: Healthy expression of anger involves confrontation of what makes you angry and an effort to set boundaries. (What you will do in response to what makes you angry.) i.e: When you (a behavior), I feel (a feeling) , and to protect myself I will _________. Healthy anger is not used to punish, is not violent, and isn't used to intimidate, control or manipulate. It is expressed, discussed, and moved through. Healthy anger is not stuffed down and ignored. (Stuffed anger created resentment and a wealth of physical / mental and emotional problems.) Healthy anger is not expressed in passive aggressive and manipulative ways. Unhealthy Anger is component of Alcoholism, Addictions and Abusive Relationships. Anger management is critical to recovery from addictions and trauma, childhood sexual mental or physical abuse, and relationship recovery. Addictions are in part a coping mechanism to deal with feelings by masking them. Alcoholics and Addicts often "use at" the source of their anger. (i.e.: I'm angry at ______ so I'll have a drink, take a drug, or act out sexually. Obviously this is a highly self destructive response to anger. Unexpressed anger related to childhood abuses often results in addictive problems later in life. (To stuff down the feelings of shame, anger, isolation, fear, sadness and loss the abuse creates.) Very often chronic relapsers in recovery programs, or chronic addicts are survivors of childhood abuse. The sad irony is that by pushing feelings down alcohol and drugs make it impossible to work through our feelings and move past them, keeping the survivor trapped in a downward spiral. This is part of why even moderate drug or alcohol use in non addicts severely compromises their progress in therapy. (If you are stuffing down your feelings how can you work on them?) Regarding anger, the Big Book of Alcoholics Anonymous says: "It is plain that a life which includes deep resentment leads only to futility and unhappiness. To the precise extent that we permit these, do we squander the hours that might have been worth while. But with the alcoholic, whose hope is the maintenance and growth of a spiritual experience, this business of resentment is infinitely grave. We found that it is fatal. For when harboring such feeling we shut ourselves off from the sunlight of the Spirit. The insanity of alcohol returns and we drink again. And with us, to drink is to die. If we were to live, we had to be free of anger. The grouch and the brainstorm were not for us. They may be the dubious luxury of normal men, but for alcoholics these things are poison." Stress and Anger Management Workplace ProgramsSardelich Counseling is pleased to offer workplace training in anger management, stress management, assertiveness skills, forgiveness, improving judgment and impulse control, skills in optimism and improving self-talk. Our trainings are designed to help improve the skills necessary to increase productivity of employees and to equip management with the tools necessary to engage their employees more effectively. Research findings suggest that increasing ones capacity for empathy also increases one's productivity and improved teamwork. Anger management trainings will be a cost savings to your organization because they will teach skills which will ultimately reduce tension and friction, improve moral, and decrease the chances of employee law suits.Sardelich Counseling focus' on helping employees become more productive, more passionate about their work, and in tern, generate more revenue for your organization. Anger management training should be viewed as a major benefit to employees, as it will teach skills that are frequently overlooked by employers. We will customize a program to meet the needs of your company. We can directly train HR staff to help improve their ability to work with difficult employees or we can train employees in groups to better work with their co-workers. We typically offer on-site trainings, which can last from a few hours to a few days depending on your organizations needs. We will provide targeted and tailored training that will effectively reach your organization's objectives. Everyone trained will receive a workbook, and additional training collateral. We also offer pre and post evaluations of all participants as well as unlimited email access for one month after a training for additional support. We realize your company's financial success comes from a direct result from your employee's happiness and professional development. Sardelich Counseling is dedicated to helping your company reach its long-term goals of success and profitability. Please call for a free consultation. Services Offered:
How does Corporate Training Work? The first step is to call or email our office so that we can learn more about your organizations needs. Most companies like to have our agency perform an on-site training as either part of a regularly scheduled training or company meeting while some will elect to have a special training organized for specific staff members. For trainings over 30 employees, we typically like to interview some key staff to develop what is called a "Needs Assessment". This will better help our staff understand not just what HR is requesting, but what the actual participants are hoping to learn. We also offer pre and post evaluations for participants. These will help those attending better understand what they need to learn as well as show what they have retained after the seminar. Corporate anger and stress management trainings can last from a few hours to a few days, depending on what your companies expectations are for achieved results. Training over four hours are usually more didactic, with participants going into break-out groups and practicing skills with a group leader. Shorter workshops are usually in the form of a presenter using client workbooks, a PowerPoint presentation, and the use of DVD's. There will be group discussion and participation, as well as a detailed Q & A during and at the end of the presentation. Most companies view stress and anger management as a cost savings, as skills in these areas can greatly reduce liability, absenteeism, and improve moral and productivity. Please feel free to call with questions or email. Diversity Training ProgramsOnce a company has determined they are on a diversity "journey," and are ready to begin a diversity training program, it is essential that all employees know what is expected of them and how they will be held accountable for their behaviors.While the majority of the diversity training Sardelich Counseling delivers is customized, the designs are based on some generic diversity training. Critical Stress DebriefingCaught off guard and "numb" from the impact of a critical incident, individuals and communities are often ill-equipped to handle the chaos of such a catastrophic situation. Consequently, survivors often struggle to regain control of their lives as friends, family, and loved ones may be unaccounted for or are found critically injured, lay dying or are already dead. Additionally, the countless others who have been traumatized by the critical event may eventually need professional attention and care for weeks, months and possibly years to come. The final extent of any traumatic situation may never be known or realistically estimated in terms of trauma, loss and grief. In the aftermath of any critical incident, psychological reactions are quite common and are fairly predictable. Critical Incident Stress Debriefing (CISD) can be a valuable tool following a traumatic event.Since the late 1970s and early 1980s, the victim assistance movement has received more positive attention than ever and has gained tremendous momentum with the passage of state and federal legislation designed to provide resources and services to those who are physically or emotionally traumatized or victimized (Young, 1994; Davis, 1993). One organization dedicated to assisting trauma survivors is the National Organization for Victim Assistance (NOVA). An important division of NOVA involves its Crisis Response Team (CRT) and emergency trauma specialists; these individuals are placed on "stand-by" for any national or international emergency considered to be a critical incident. Directed by Marlene A. Young, Ph.D., NOVA is a highly respected non-profit organization that has responded to many "high profile" tragedies such as the Mount St. Helens' eruption in 1980, the Air Florida airline crash of 1982, the South Korean airline Flight 007 Disaster of 1983, the Mexico earthquake of 1985, and the Milwaukee Jeffrey Dahmer serial murders to name only a few (Young, 1994). NOVAs CRT personnel are all highly trained specialists in Disaster Management, Debriefing, Victim Assistance, Victimology and Crisis Intervention in times of community crisis (man-made crisis, natural or industrial disasters). All NOVA team members are highly experienced trauma workers and crisis intervention response specialists who go as national volunteers to various disasters as a public service to the requesting community or state. The NOVA Team is carefully selected and typically represents a cross-section of the community where it is to be deployed. Most NOVA Teams are made up to represent various disciplines to better assist the community such as Clergy, Emergency Service Providers, Media Relations, Public Safety Personnel and other professionals representing the disciplines of Education, Nursing, Psychology, Psychiatry, Victim Advocates, Law Enforcement, and Medicine. When specifically requested, NOVAs main objective is to provide intense and immediate emergency consultation, crisis intervention services with additional follow-up during a limited period of time. Usually one team of 10 specialists will be deployed and will work up to 3-4 days. The activated team will be relieved by additional teams as needed depending upon the magnitude of the catastrophe. What is a Critical Incident? The author defines examples of a "critical incident" as a sudden death in the line of duty, serious injury from a shooting, a physical or psychological threat to the safety or well being of an individual or community regardless of the type of incident. Moreover, a critical incident can involve any situation or events faced by emergency or public safety personnel (responders) or individual that causes a distressing, dramatic or profound change or disruption in their physical (physiological) or psychological functioning. There are oftentimes, unusually strong emotions attached to the event which have the potential to interfere with that persons ability to function either at the crisis scene or away from it (Davis, 1992; Mitchell, 1983). Clinically, traumatic events and their impact on individuals are fairly predictable. When a person has been "exposed" to a critical incident, either briefly or long-term, this exposure can have a considerable impact on their global functioning. Historically, some of the first documented cases of traumatic stress or what used to be called "transient situational disturbance" (TSD) can be traced to military combat. In time, researchers began to find evidence that emergency workers, public safety personnel and responders to crisis situations, rape victims, abused spouses and children, stalking victims, media personnel as well as individuals who were exposed to a variety of critical incidents (e.g., fire, earthquake, floods, industrial disaster, workplace violence) also developed short-term crisis reactions. Trauma Reactions NOVA personnel refer to short-term crisis reactions as the "cataclysms of emotion" where feelings and thoughts run the gamut and include such diverse symptomatology as shock, denial, anger, rage, sadness, confusion, terror, shame, humiliation, grief, sorrow and even suicidal or homicidal ideation. Other responses include restlessness, fatigue, frustration, fear, guilt, blame, grief, moodiness, sleep disturbance, eating disturbance, muscle tremors or "ticks", reactive depression, nightmares, profuse sweating episodes, heart palpitations, vomiting, diarrhea. hyper-vigilance, paranoia, phobic reaction and problems with concentration or anxiety (APA, 1994; Horowitz, 1976; Young, 1994). Flashbacks and mental images of traumatic events as well as startle responses may also be observed. It is important to consider that these thought processes and reactions are considered to be quite normal and expected with crisis survivors as well as with those assisting them. Some of the described symptoms surface quickly and are readily detectable. However, other symptoms may surface gradually and become what the author calls "long-term crisis reactions." These responses can be masked within other problems such as excessive alcohol, tobacco and/or drug use. Interpersonal relations can become strained, work-related absenteeism may increase and, in extreme situations, divorce can be an unfortunate by-product. Survivor guilt is also quite common and can lead to serious depressive illness or neurotic anxiety as well (APA, 1994; Mitchell, 1983; Young, 1994). What is Critical Incident Stress Debriefing (CISD)? Debriefing is a specific technique designed to assist others in dealing with the physical or psychological symptoms that are generally associated with trauma exposure. Debriefing allows those involved with the incident to process the event and reflect on its impact. Ideally, debriefing can be conducted on or near the site of the event (Davis, 1992; Mitchell, 1986). Defusing, another component of CISD, allows for the ventilation of emotions and thoughts associated with the crisis event. Debriefing and defusing should by provided as soon as possible but typically no longer than the first 24 to 72 hours after the initial impact of the critical event. As the length of time between exposure to the event and CISD increases, the least effective CISD becomes. Therefore, a close temporal (time) relationship between the critical incident and defusing and initial debriefing (i.e., there may be several) is imperative for these techniques to be most beneficial and effective (Davis, 1993, Mitchell, 1988). Research on the effectiveness of applied critical incident debriefing techniques has demonstrated that individuals who are provided CISD within a 24-72 hour period after the initial critical incident experience less short-term and long-term crisis reactions or psychological trauma (Mitchell, 1988; Young, 1994). Subsequently, emergency service workers, rescue workers, police and fire personnel as well as the trauma survivors themselves who do not receive CISD, are at greater risk of developing many of the clinical symptoms the author has briefly outlined in this article (Davis, 1992; Mitchell, 1988). From the authors perspective, when applying debriefing techniques, an appropriate and effective protocol must be followed when assisting responders and crisis survivors of any critical incident. Most approaches to CISD incorporate one or more aspects of a seven-part model. The model that the author suggests here consists of several key points that can be followed as a general guideline and applied when addressing responders and survivors who are involved in man-made, natural or industrial disasters. An Emergency Crisis Intervention Response Specialist must lay the constructive groundwork for an initial "assessment" of the impact of the critical incident on the survivor and support personnel by carefully reviewing their level of involvement before, during and after the critical incident. What is Marriage and Family TherapyWhat is Marriage and Family Therapy?A family's patterns of behavior influences the individual and therefore may need to be a part of the treatment plan. In marriage and family therapy, the unit of treatment isn't just the person - even if only a single person is interviewed - it is the set of relationships in which the person is imbedded. Marriage and family therapy is:
Research indicates that marriage and family therapy is as effective, and in some cases more effective than standard and/or individual treatments for many mental health problems such as: adult schizophrenia, affective (mood) disorders, adult alcoholism and drug abuse, children's conduct disorders, adolescent drug abuse, anorexia in young adult women, childhood autism, chronic physical illness in adults and children, and marital distress and conflict. Marriage and family therapists regularly practice short-term therapy; 6-12 sessions on average. Nearly 65.6% of the cases are completed within 20 sessions, 87.9% within 50 sessions. Marital/couples therapy (11.5 sessions) and family therapy (9 sessions) both require less time than the average individuated treatment (13 sessions). About half of the treatment provided by marriage and family therapists is one-on-one with the other half divided between marital/couple and family therapy, or a combination of treatments. Who are Marriage and Family Therapists? Marriage and Family Therapists (MFTs) are mental health professionals trained in psychotherapy and family systems, and licensed to diagnose and treat mental and emotional disorders within the context of marriage, couples and family systems. Marriage and family therapists are a highly experienced group of practitioners. Liz Sardelich has 18 years of clinical practice in the field of marriage and family therapy. She will evaluate and treat mental and emotional disorders, other health and behavioral problems, and address a wide array of relationship issues within the context of the family system. A Marriage and Family Therapist will broaden the traditional emphasis on the individual to attend to the nature and role of individuals in primary relationship networks such as marriage and the family. MFTs take a holistic perspective to health care; they are concerned with the overall, long-term well-being of individuals and their families. MFTs have graduate training (Liz was trained with 2 way mirrors for the most effective training) in marriage and family therapy and at least two years of clinical experience. Marriage and family therapists are recognized as a "core" mental health profession, along with psychiatry, psychology, social work and psychiatric nursing. Since 1970 there has been a 50-fold increase in the number of marriage and family therapists. At any given time they are treating over 1.8 million people. Why use a Marriage and Family Therapist? Research studies repeatedly demonstrate the effectiveness of marriage and family therapy in treating the full range of mental and emotional disorders and health problems. Adolescent drug abuse, depression, alcoholism, obesity and dementia in the elderly -- as well as marital distress and conflict -- are just some of the conditions Marriage and Family Therapists effectively treat. Studies also show that clients are highly satisfied with services of Marriage and Family Therapists. Clients report marked improvement in work productivity, co-worker relationships, family relationships, partner relationships, emotional health, overall health, social life, and community involvement. In a recent study, consumers report that marriage and family therapists are the mental health professionals they would most likely recommend to friends. Over 98 percent of clients of marriage and family therapists report therapy services as good or excellent. After receiving treatment, almost 90% of clients report an improvement in their emotional health, and nearly two-thirds report an improvement in their overall physical health. A majority of clients report an improvement in their functioning at work, and over three-fourths of those receiving marital/couples or family therapy report an improvement in the couple relationship. When a child is the identified patient, parents report that their child's behavior improved in 73.7% of the cases, their ability to get along with other children significantly improved and there was improved performance in school. Marriage and family therapy's prominence in the mental health field has increased due to its brief, solution-focused treatment, its family-centered approach, and its demonstrated effectiveness. Marriage and family therapists are licensed or certified in 48 states and are recognized by the federal government as members of a distinct mental health discipline. Today more than 50,000 marriage and family therapists treat individuals, couples, and families nationwide. Membership in the American Association for Marriage and Family Therapy (AAMFT) has grown from 237 members in 1960 to more than 23,000 in 1996. This growth is a result, in part, of renewed public awareness of the value of family life and concern about the increased stresses on families in a rapidly changing world. What are the qualifications for a Marriage and Family Therapist? Marriage and family therapy is a distinct professional discipline with graduate and post graduate programs. Three options are available for those interested in becoming a marriage and family therapist: master's degree (2-3 years), doctoral program (3-5 years), or post-graduate clinical training programs (3-4 years). Historically, marriage and family therapists have come from a wide variety of educational backgrounds including psychology, psychiatry, social work, nursing, pastoral counseling and education. The Federal government has designated marriage and family therapy as a core mental health profession along with psychiatry, psychology, social work and psychiatric nursing. Currently 48 states also support and regulate the profession by licensing or certifying marriage and family therapists with many other states considering licensing bills. The regulatory requirements in most states are substantially equivalent to the American Association of Marriage and Family Therapists Clinical Membership standards. After graduation from an accredited program, a period - usually two years - of post-degree supervised clinical experience is necessary before licensure or certification. When the supervision period is completed, the therapist can take a state licensing exam, or the national examination for marriage and family therapists conducted by the AAMFT Regulatory Boards. This exam is used as a licensure requirement in most states. How can I find a Marriage and Family Therapist? AAMFT Clinical Members meet stringent training and education requirements that qualify them for the independent practice of marriage and family therapy. AAMFT requires Clinical Members to abide by the AAMFT Code of Ethics, the most stringent ethical code in the marriage and family therapy profession. This code delineates specific ethical behavior and guidelines for members to follow to ensure the ethical treatment of clients. Clinical Membership in the AAMFT signifies an MFT's dedication to his or her ongoing professional development. Each month, AAMFT Clinical Members receive important updates on current clinical and research developments in the field, as well as numerous opportunities throughout the year to attend professional development conferences. Individual CounselingClients can receive individual counseling to explore the concerns they face in a safe and confidential environment. Often, clients experience challenges that leave them feeling alone and unsure about where to get the support they need. Staff members can help clients explore, understand, and work through problems on a one-to-one basis. Personal counseling can help clients find alternatives, expand choices and overcome obstacles that interfere with personal development and a sense of well-being and interpersonal relationships. The clarification and resolution of personal problems often facilitate a student's ability to concentrate, and stabilize and enhance relationships.A wide variety of issues and problems are brought to Sardelich Counseling. Some are short term situations that become more easily addressed after a few meetings with a counselor to develop some problem resolution strategies. At other times, the difficulties run deeper and have been painful for a longer period of time. Regardless of the duration or severity of your difficulty, counseling can play an important role in getting you to being productive and satisfied with your life. While there is no clear-cut way to classify issues, a helpful way to describe the kinds of concerns patients bring to the Sardelich Counseling is to think of Personal Difficulties, Interpersonal Difficulties, and Social Environment Difficulties. Below are simply some examples of the different kinds of issues we help students, in whatever unique way you may experience the challenges of life. About Us | Services | Client Forms | Links | Contact | Home
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