I. Grief and Loss

Research indicates that many people who experience loss adapt over time without necessarily needing psychotherapy. However, there are exceptions. 

Grief and Loss: Types of Problems

Complicated Grief. Some people experience “complicated grief” or “complicated bereavement,” typified by grief that does not resolve and instead persists over many months or years. Complicated grief is still a category that is being researched and defined. (Some researchers have proposed a new diagnostic category for the DSMV, called prolonged grief disorder.)

Complicated grief has been described as consisting of an ongoing and unrelenting yearning for reunification with the lost person, problems accepting the death, numbness, bitterness, an absence of meaning in life, and withdrawal from interpersonal relationships. People are more likely to experience complicated grief if they: have had previous episodes of depression or anxiety; were especially dependent on the person they lost; have had past difficulties feeling securely attached to others; and if they lack social support.

Unexpected or Traumatic Deaths. Certainly, unexpected losses or ones caused by trauma can worsen pain and grief for loved ones. This is true of the loss of child, or the loss of a spouse, sibling, or a parent who was not elderly or expected to die. Further, the loss of loved ones to accident, homicide, or suicide can add unique complications and features to the grieving process.

Loss of Family Support and Connection. Other people struggle with more specific aspects of the loss experience.  For instance, the loss of a spouse results in necessarily altered parenting relationships and family dynamics with children and/or the need to find new sources of social support and connection. 

Grief and Loss: Research

Researchers are still discovering what helps people adapt to loss.  Does psychotherapy help people with grief? Research indicates that it does.

However, there was a controversy arising out of a researcher in 2000 reviewing numerous outcome studies and finding that grief counseling could be harmful for up to 40% of clients. This research was widely cited between 2000 and 2007, at which time another pair of researchers reviewed this claim and found it was based on highly flawed data and untried, controversial statistical analyses. One particular problem they found with the research was that it included many clients who had not sought therapy but instead were recruited into it for studies. When the researchers looked only at data involving clients who had willingly sought therapy themselves, outcomes were positive.  

Also, it may be true that a number of years after therapy, former clients function no more or less well than people who did not attend therapy. However, research indicates that therapy near the time of the loss can effectively decrease painful symptoms in eight-twelve weeks that would have taken six months to a year to resolve without therapy.

II. Mood Issues

The treatment of problematic moods is an area I have studied for quite a while, as it arises in both the treatment of children and adults.  

The treatment of anger often involves: understanding what situations or people trigger the anger; identifying unrealistic beliefs that trigger anger; challenging and changing unrealistic beliefs; changing or avoiding anger-triggering situations; and reducing stressors that lead to anger. The intervention I use most for treating anger is cognitive-behavioral therapy.

Almost all treatment of anxiety involves helping people to challenge and change unrealistic beliefs which cause fear. Treatment also involves gradually exposing people to things they fear. All of these approaches are done with the client in control of the pace so as not to feel overwhelmed. The intervention I often use for the treatment of anxiety is cognitive-behavioral therapy.

(Note: for Obsessive-Compulsive Disorder, panic attacks, and social anxiety, see those sections below.)

Depression

The treatment of depression usually involves challenging and disproving unrealistic beliefs that cause depression. This is especially true of negative beliefs a person has about themselves. Another part of treating depression is helping a person have success, be it vocational, social, or other. There is just no substitute for success when it comes to building self-esteem and fighting depression. A third area of treatment involves helping to increase the quantity and quality of a person's interpersonal relationships. The interventions I use most for the treatment of depression are cognitive-behavioral therapy and psychodynamic (interpersonal) therapy.

Obsessive-Compulsive Disorder

This problem is best treated by cognitive-behavior therapy, especially a technique called "Exposure-Response Prevention," in which (1) a person is gradually exposed to the feared object/situation while they prevent themselves from doing their compulsive ritual, and (b) the person uses cognitive techniques to reduce their anxiety.

Panic Attacks

Sometimes a panic attack is a response to a person feeling overwhelmed by having life problems. In such cases, general talk therapy can be effective. At other times, panic attacks take on a life of their own and become the primary problem. This often occurs when the person misinterprets signs of normal anxiety as instead being the sign of some catastrophic event, such as a heart attack or loss of bodily control. At such times, a cognitive-behavioral approach can be very effective.

Social Anxiety

The treatment of social anxiety often involves examining a person's past and current relationships to understand what beliefs that person has about themselves and relationships. Therapy then tries to challenge any unrealistic beliefs that cause social anxiety. Therapy also involves having the person take small and gradual steps to face social situations that cause anxiety.

III. Relationship Problems

Major or Moderate Problems

Relationship problems can be brief and limited in scope (e.g., handling a new, difficult boss). Or, they can be chronic and far-reaching (e.g., having lifelong difficulties with intimacy in all relationships). Moderate problems can sometimes be successfully treated in as little as four-six sessions. Major problems can require more time. How long you stay in therapy is really up to you. However, whether you come for a handful of sessions or for many months, we should always be making progress along the way.

Causes

One advantage to being a child and family therapist is seeing how adult relationship problems can stem from childhood experiences. As we all know, a child can develop problematic relational patterns or a poor self-image due to how they were treated by their parents and siblings. These problems then carryover into adulthood and affect relationships and life satisfaction.

But there are other reasons a person can be having relationship problems. I do believe that our innate temperaments and endowments can lead us to have strengths in some relational skills but deficits in others. For instance, a person who is more naturally aggressive may be very good at asserting their needs but not so good at staying calm during arguments. Another person who is naturally gentle may be good at being kind and empathic but not so good at facing conflict.

Sometimes, the problems are not due to you but instead arise from having to deal with someone else who is difficult or troubled. For instance, a difficult co-worker or supervisor can significantly affect a person's level of happiness.

Types of Relationship Problems I Treat

A. Romantic

Often, people come to therapy wondering whether they should leave or stay in a romantic relationship. Although sometimes this question leads to couples therapy, in other cases it makes more sense for us to meet for individual therapy so you can decide if you want to continue the romantic relationship.

B. Family

Adults sometimes come to therapy to deal with problematic relationships with their parents or siblings. In such cases, the request for therapy is often triggered by a more recent change, such as a parent who is meddling in the parenting of their grandchildren.

C. Friendships

Many people discuss problems in therapy both with acquiring enough friends and with dealing with existing friendships. The latter category can include having to confront a friend about a relationship problem.

D. Workplace

Solutions To Relationship Problems

No matter what the issue, the answer can usually be found in one of three areas:

a. Changing unhelpful ways of thinking.  Such changes can include correcting ideas about what causes another person's behavior; changing overly negative views of oneself; or more accurately understanding the communications of others.

b. Developing new skills. Targeted skills can include assertiveness, communication, empathy, problem-solving, and conflict-resolution.

IV. Workplace Issues

I have frequently worked with clients around workplace relationships and issues. Also, for my whole career, I have been a provider for a number of Employee Assistance Programs. Thus, I have been fortunate to have a lot of experience with workplace matters. 

Workplace Issues: Why They Are So Emotional

Workplace issues can involve working for a difficult boss or with difficult coworkers; responding to a poor performance review or a performance improvement plan; work stress from demanding responsibilities; fear of job loss; and searching for a new job.

Dealing with these problems is very stirring. Our jobs are not only our source of income but also where we invest a lot of pride and energy.

Further, most therapists will tell you that workplaces can often bring out in people the same issues as families do. Bosses can remind us of fair or unfair parents; co-workers can resemble helpful or rival siblings; offices can feel like a safe home or an abusive one. 

Thus, it is not surprising then that the main need I have seen with clients who are having workplace problems is this: help managing their emotions. Staying calm and maintaining self-esteem are vital to one's emotional well-being. Staying calm is also crucial to avoiding making a disastrous decision (say, yelling at your boss) and to creating a plan of action.

Therapy can help people stay calm in a number of ways – reminding them of their strengths and past successes; normalizing their reactions; helping them look at criticism objectively and separate the accurate feedback from the inaccurate; thinking of responses to the situation that arise from calmness versus hurt and anger.

Workplace Issues: Dealing With Bosses

When it comes to action plans with supervisors, I tend to divide bosses up into two loose categories. One category is for bosses who are fairly reasonable and emotionally healthy. These bosses are fairly trustworthy and are likely to be able to listen to and understand you. These bosses are also likely to respond fairly rationally and predictably to any reasonable request you might make for them to change their behavior. If I see sufficient evidence that your boss falls into that category, I might recommend you speak openly and directly with him or her.

In the second category are bosses who are not reasonable and/or emotionally healthy. These bosses are not trustworthy and are unable to listen to and understand you. Further, if you openly and reasonably ask such bosses to change their behavior, these bosses might explode, ridicule, punish, demote or fire you. So, with these bosses, I recommend a much less direct and open approach.

There are many plans of action people can create in response to workplace situations, but which I will recommend to you depends on the type of boss or co-worker you have (see above). These plans include:

1. Communication Strategies. These strategies include ways to get bosses to clarify their expectations and goals; ways to find out if you are doing a good-enough job or if you might be at risk for termination; and ways for you to clearly state problems you might have with a boss's or co-workers behavior.

2. Performance Change Strategies. These strategies aim to change any problematic ways you have of doing your job that leave you at risk of stagnation, demotion or termination.

3. Image Management Strategies. These strategies aim to change the negatively distorted way your boss, co-workers or others perceive you and your work.