Most of the human experience is a series of transitions, changes, and gains and losses. How humans deal with loss, especially death, has become, a subject of increasing importance and concern in recent decades to educators, psychologists, and other health care providers. For many cultural and sociological reasons, Americans have become traumatized by death (Volkart, 1957) and have thus become less able to resolve successfully their issues of bereavement. The incidence of what has been identified as complicated mourning has been rising (Loewald, 1962; Volkan, 1981). As Rando (1993) pointed out, the psychophysical phenomenon has not yet been recognized by the American Psychiatric Association (1987) as a category in the Diagnostic and Statistical Manual of Mental Disorders.

Rando (1993) defined complicated mourning as an attempt by the mourner to deny, repress, or avoid aspects of the loss, its pain, or its implications in the mourner's life, as well as the mourner's "holding onto" the deceased (p. 18). For example, failure of the bereaved to process the loss, coupled with a negatively perceived impact on his/her lifestyle, can render the mourning complicated, with both physiological and psychological detrimental ramifications.

In the helping professions, neither research nor training has kept pace with the need to address complicated mourning. Caregivers themselves lack both didactic knowledge and clinical skills (Rando, 1993; Redmond, 1989), or further, are completely unaware of the necessary skills to work with the bereaved (Kastenbaum, 1993). Studies have yielded insufficient or unreliable results and have especially lacked empirical validation (Feifel, 1990).

Moller (1990) concluded from his field research with dying patients that health care providers have made few significant changes in core values, approach or orientation to these patients, despite the work of Kubler-Ross (1969) and proponents of death-with-dignity. Family and health care providers of the dying individual often find themselves in a situation of coping with their own grief in isolation, with little assistance or resources beyond their own personal abilities (KublerRoss 1969; Rando, 1993).

The consensus among death educators (Feifel, 1990; Moller, 1990; Morgan, 1987; Rando, 1993) is the need for an integrated educational program based on empirical research findings. The evidence suggests bereavement research in general has failed to accumulate an empirical database from which studies could be built (Feifel, 1990).

Morgan (1990) suggested the immediate need for increasing the effectiveness of education on death, dying, and bereavement. Wass (1983), minimizing educational areas, indicated the imperativeness of bereavement research focused on conjugal, child, or parental loss. Raphael (1983) however, discussed three educational components, pointing out their interrelationships: information sharing, values clarification, and coping behaviors.

However, many researchers and educators have ignored learning paradigms and failed to include personality and developmental theories. Thanatology has held to strong philosophical tenets, regardless of the research findings (Wortman & Silver, 1989). Furthermore, neither death educators nor grief researchers agree on how to operationalize complicated mourning, present preventive programs, or design effective training programs. Research on complicated mourning lacks a synthesis into an appropriate learning format reflective of most reliable current research (Morgan, 1990).

Then Perhaps the Internet can be the bridge for seeing death as eternal ("we all die") Crossroads sees the need for social skill training throughout life for one to face the painful surround of death, one's own and others.

Our workshops will offer an opportunity to become more current on bereavement research and practice.

- Remember when you were growing up
- All the wonder of going new places, celebrating holidays, and meeting new friends?
- Where was death?

At least families occassionally talked about sex. Death was really closeted unless it hit your own world. Today, the world is flooded with information including infomation on death. We talk about funerals, where so and so died, and causes of death. Yet, dying is still too scary for us to chat about. (Even Dr. Kavorkian is a very small newspaper item). No, death information is vast and here to stay. Just don't talk about dying. It isn't politically correct!

Of course that means you can't talk about the cognitive and affectual legacy with the dying. Everyone pretends it just isn't happening. Oh, yes, often family members take over and actually control the medical treatment, radiation, and believe death will be kept at bay. The silence is a conspiracy to avoid the reality: death is the final destination (from a physical perspective) for all of us - like it or not! A loved one is one breath away from the final physical destination and denial is often maintained. Is it O.K.?

I think there is an "adaptive" denial that allows us time and space to accept the harshness of the loss of loved ones. We need to be respectful of the dying and survivors. The cultural surround (the situation) may dictate what is said and done. Professionals might look at their influence and non-involvement. Physicans are powerful, influencing the family communications.

What remains for us to do? Explore sites like this, exchange ideas, and set a flexible course. Most death occurs at the end of the uncharted waters. Not even professionals hold all the answers (or even the questions). ...could be a topic throughout life.

I've tried to give you a sample of one topic that is part of our "Death System". Comments may be directed to drteddy@griefworksinc.com.

This is an exciting endeavor. I would appreciate any honest feedback. Hopefully, Crossroads can grow a community of ideas (very much like days of old when people actually met weekly to hash and rehash topics and/or concerns).

Thanks for Tuning In,
Respectfully,
Dr. Teddy Tarr

Dr. Tarr maintains a full clinical practice and is on staff at Baptist Hospital.

Dr. Tarr served with Hospice on a bereavement team for 6 years and as a crisis counselor with Switchboard of Miami. Her passion is developing training programs (with a network of psychologists) and overseeing the delivery of a variety of workshops, focusing on loss and resolution.

Dear Health Care Provider -

Following the deaths of ten family members in nine years, I recognized how unprepared I was to deal with such traumatic losses. I had no guidance for feeling festive at holidays with a table full of empty chairs. Despite wonderful support from remaining family and friends, my sense of helplessness was all-pervasive.

If I felt this way, I reflected, even with such support, how did others feel and handle their losses? Thus, I felt impelled to acquire the knowledge and tools to work with those traumatized by experiences with death.

After completion of undergraduate studies, I pursued graduate work in clinical psychology, specializing in death and dying education, as well as supervision. In 1994 Crossroads Counseling Center opened, and in the Spring of 2000 we launched the Conference Center for special programs in bereavement.

In our fast-paced culture, with its emphasis on technology, possessions, and public achievement, most mourning is complicated because of tacit proscriptions that circumscribe the healing process.

Our culture promotes and sanctions values that center around instant gratification and the appearance of feeling "good" all the time. Under pressures of such a milieu, the bereaved emerge intact, stronger, wiser and more loving.

We support a postmodern view of mourning that encourages a continuing-bond approach to loss. We also support a modern view of loss that is traditional.

After our programs, you will be able to help your bereaved clients to:

• Recognize the many avenues and aspects of mourning.
• Accept the painful loss and its meaning for their future.
• Acknowledge their anger and resentment and work though past issues.
• Identify other unresolved losses and conflicts that may arise with their griefwork.
• Return to their daily lives and activities, and continue their mourning tasks as they need to.

• Our programs are conducted in a combination of experiential and didactic methods, with ample opportunity for you to participate and express your clinical and personal concerns.
• You will receive plentiful resource materials, notebooks and handouts for ongoing use.
• Our physical setting is comfortable and warm, and our groups are small (25-30 maximum).
• Our emotional setting is accepting, nonjudgmental, serious, light-hearted and focused on your concerns.
• Our programs are grounded in past and current research, historical perspectives of bereavement and our present cultural outlooks.
• Our programs incorporate perspectives appropriate to cross-cultural populations.
• Our programs integrate bereavement with personality development, developmental theories and pyschosocial factors.
• Our programs emphasize key therapeutic principles, with a range of participatory exercises for your applications.
• Our programs have a spiritual core, in recognition of each individuals inner resources and intuitive longing for a larger Whole. Through my years in this work, I have come to realize the following:

Crossroads maintains full responsibility for all programs and content. We also offer CEs for nurses and all mental health board members, such as social workers, mental health counselors and marriage and family therapists. Nurses ... Social Workers ... MH ... MFT ...

We truly look forward to sharing our expertise with you and helping you guide your clients

• through bereavement processes
• toward healthy resolution, for
• reclamation of their interests, and
• rejuvenation of their lives.

For additional information about our programs:
Phone: 305 666-3650
Fax: 305 666-1145
Website: https://www.griefworksinc.com

In more responsive practice,

Teddy Tarr, Psy. D.
Director