When a young person is struggling with mental health challenges, substance use, trauma, or co-occurring disorders, finding the right level of care can feel overwhelming for families and referral partners alike. At River’s Bend, one of our most trusted national partners is Newport Healthcare and its young adult division, Newport Institute—organizations that have built a reputation for providing comprehensive, family-centered treatment for adolescents and young adults across the United States.

For many River’s Bend clients, Newport serves as a critical next step when outpatient care alone is not enough. Through residential treatment, Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), and specialized services for children, teens, and young adults, Newport offers a continuum of care designed to meet individuals where they are and guide them toward sustainable healing. Newport Healthcare provides treatment for children ages 7–11, teens ages 12–18, and young adults up to age 35 through residential and outpatient programs nationwide. Their model emphasizes mental health treatment, co-occurring disorders, family involvement, and evidence-based care.

According to Michael Dzwil, Senior Director of Clinical Outreach, Newport’s mission extends beyond symptom management.

“Our mission is to bring sustainable healing and help individuals find their authentic selves through individualized treatment and family support,” he explains. “That family component is really our bread and butter.”

That philosophy is deeply aligned with River’s Bend’s belief that lasting recovery requires more than treating an individual in isolation. Newport’s clinical model recognizes that healing often involves the entire family system.

“We can’t just treat the adolescent,” says Dzwil. “We have to treat the entire family unit for sustainable healing to happen.”

A Holistic Approach to Recovery

Founded in 2008, Newport originally focused on adolescent substance use treatment. Over time, the organization expanded its scope to address the growing mental health needs of young people, while continuing to treat co-occurring substance use disorders.

“Over the years we started asking, ‘What comes first—the chicken or the egg?’” Dzwil says. “We realized we needed to focus on the mental health piece and the trauma that often comes with it.”

Today, Newport’s treatment approach blends evidence-based therapies with experiential and holistic interventions. Depending on the program and location, treatment may include family therapy, art therapy, experiential therapies, life skills development, academics, career support, and trauma-focused modalities.

“Sometimes talk therapy isn’t always the best route, especially for adolescents,” Dzwil notes. “We’re showing them that mind-body connection and treating the whole person. It’s very patient-centered care.”

This individualized philosophy means treatment plans are never one-size-fits-all.

“We look at what has worked in the past, what hasn’t worked, and what the client actually connects with,” he says. “If a young person is benefiting more from art therapy than equine therapy, we adjust accordingly.”

Helping Young Adults Discover Their Authentic Selves

One of Newport Institute’s distinguishing features is its focus on emerging adulthood—a developmental stage that often comes with unique challenges around identity, independence, education, careers, and relationships.

Newport Institute’s residential and outpatient programs serve young adults ages 18–35 and incorporate clinical care alongside life skills, vocational support, and academic guidance.

Dzwil recalls one young woman who entered treatment struggling with borderline personality disorder and a deeply codependent relationship with her mother.

“She didn’t really know who she was outside of being her mom’s daughter,” he says.

Through Newport’s life-skills programming, therapists discovered her passion for cosmetology. Staff arranged a salon shadowing opportunity and helped her apply to beauty school.

“She eventually became a cosmetologist, moved into her own apartment, and built a life for herself,” Dzwil says. “She later reached out and told us she never would have been able to do those things without Newport.”

For Dzwil, stories like these demonstrate that treatment is about much more than symptom reduction.

“We’re helping young people find who they are in the world so they can build authentic connections and move forward.”

Collaboration That Supports Long-Term Success

One reason River’s Bend values its partnership with Newport is the organization’s commitment to collaboration before, during, and after treatment.

“I see my role as supporting the clinicians, the families, and the referral partners every step of the way,” Dzwil says.

When River’s Bend refers a client to Newport, communication does not stop after admission. Newport’s team works closely with referring providers throughout treatment and during discharge planning.

“We want to make sure that when a client comes home after 60 or 90 days, their outpatient provider knows exactly what happened during treatment,” Dzwil explains.

This continuity is particularly important because, as he points out, treatment success often depends on what happens after residential care ends.

“People make incredible progress while they’re with us, but what happens after Newport is often the deciding factor in how sustainable that progress will be.”

That commitment to continuing care mirrors River’s Bend’s own emphasis on seamless transitions between levels of care.

Listening Beyond the Symptoms

When asked about the impact Newport has had on patients and families, Dzwil shared a story that continues to stay with him.

The young man had been through several previous treatment programs and was repeatedly described as “unmotivated.”

“But when we really listened to him,” Dzwil recalls, “it became clear that what everyone thought was a lack of motivation was actually severe, unmanaged depression.”

That simple shift in perspective changed everything.

“Sometimes all it takes is taking twenty minutes to really listen,” he says. “That ‘I don’t care’ attitude was a defense mechanism—not a lack of desire to get better.”

For River’s Bend, that story captures what makes Newport such a valued professional partner. Their team looks beyond diagnoses, beyond behaviors, and beyond assumptions to understand the person underneath.

As Dzwil puts it, “We’re passionate about helping people find the best clinical fit—even if it’s not Newport. At the end of the day, it’s about doing what’s right for the client.”

In a behavioral healthcare system that can often feel fragmented, that commitment to collaboration, individualized care, and family-centered healing makes Newport Healthcare and Newport Institute an invaluable resource for River’s Bend clients and families seeking hope, healing, and a path forward.

The post Newport Healthcare: Building a Continuum of Care That Changes Lives appeared first on River's Bend, P.C..

• You tell yourself it happened years ago.
• You know you’re safe.
• You know it wasn’t your fault.

Yet certain memories, places, conversations, or even smells instantly transport you back to that moment.

• Your heart races.
• Your thoughts spiral.
• Sleep becomes difficult.

You wonder…

“Why can’t I just move on?”

If this sounds familiar, you’re far from alone.

According to the World Health Organization, approximately 70% of people worldwide experience at least one potentially traumatic event during their lifetime, and many continue experiencing emotional distress long after the event has passed. Research from the National Center for PTSD also shows that trauma can change the way the brain stores memories, making them feel as though they are happening in the present rather than remaining safely in the past.

The encouraging news is that healing is possible.

One evidence-based approach helping many individuals move forward is Accelerated Resolution Therapy (ART).

What Is Accelerated Resolution Therapy (ART)?

Accelerated Resolution Therapy (ART) is an evidence-based psychotherapy that helps people process traumatic memories differently.¹ Unlike traditional talk therapy, ART doesn’t require someone to repeatedly describe every painful detail of what happened.² Instead, the therapy combines guided eye movements with visualization techniques that help the brain reorganize how distressing memories are stored.³

The goal isn’t to erase memories.

It’s to reduce the emotional intensity attached to them.

Many people report that after treatment they can remember difficult experiences without feeling overwhelmed by them.

Research published in Behavioral Sciences and supported by studies through the National Institutes of Health suggests ART may significantly reduce symptoms associated with post-traumatic stress, anxiety, depression, and complicated grief while often requiring fewer sessions than many traditional trauma therapies. ¹,²,^{3 1},²

Why ART Feels Different

Trauma often leaves people feeling trapped in survival mode.

ART works from a different perspective.

Rather than asking, “How do we keep talking about this?”

It asks,

“How can we help your brain process this experience so it no longer controls your present?”

For many people, that shift creates hope.

Clients frequently describe feeling lighter, calmer, and better able to focus on the life they want to build instead of continually reliving the past.

Compassionate Trauma Therapy at River’s Bend 

Healing is never one-size-fits-all.

River’s Bend continues expanding evidence-based treatment options that meet people wherever they are in their recovery journey. This commitment reflects the organization’s long-standing philosophy of pairing clinical excellence with compassionate, relationship-centered care throughout Michigan.

One of the clinicians helping bring this innovative therapy to River’s Bend is Alicia Starkey, LMSW.

Raised in Metro Detroit and earning her Master of Social Work from Northern Michigan University, Alicia brings both professional expertise and deep compassion to her work with children, adolescents, young adults, and families.

As a proud Native American serving on the Health Board for the Saginaw Chippewa Indian Tribe, she understands the importance of culture, connection, and strong family relationships in the healing process.

Her clinical approach blends Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Motivational Interviewing (MI), and specialized training in Accelerated Resolution Therapy to create treatment plans that are personalized, respectful, and grounded in evidence.

For Alicia, therapy isn’t about “fixing” people.

It’s about helping them rediscover the strengths they already possess.

Is Accelerated Resolution Therapy Right for You?

ART may be beneficial for people experiencing:

• Trauma or PTSD
• Anxiety
• Panic attacks
• Grief and loss
• Childhood trauma
• Stress related to difficult life experiences
• Distressing memories that continue to interfere with daily life

Every person’s experience is unique, and a professional assessment can help determine whether ART or another evidence-based approach is the best fit.

You Don’t Have to Carry It Alone

Trauma has a way of convincing people that healing is out of reach.

It isn’t.

Every day, people across Michigan discover that recovery doesn’t always require years of reliving painful memories. Sometimes it begins with finding the right therapist, the right approach, and a team committed to walking alongside you.

At River’s Bend, healing begins with a conversation.

Whether you’re exploring therapy for yourself, someone you love, or simply want to understand your options, our compassionate intake team is here to help you take the next step.

Ready to Learn More?

Contact River’s Bend today to speak with our intake team and learn whether Accelerated Resolution Therapy (ART) with Alicia Starkey, LMSW, or another evidence-based treatment approach may be right for you. Your path toward healing can begin today.

References

1. Storey, D. P., Marriott, E. C. S., & Rash, J. A. (2024). Accelerated Resolution Therapy (ART) for the treatment of posttraumatic stress disorder in adults: A systematic review. PLOS Mental Health, 1(4), e0000123. DOI / publication ↩︎
2. Kip, K. E., Rosenzweig, L., Hernandez, D. F., et al. (2013). Randomized controlled trial of Accelerated Resolution Therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD). Military Medicine, 178(12), 1298–1309. DOI / publication ↩︎
3. Kip, K. E., Elk, C. A., Sullivan, K. L., et al. (2012). Brief Treatment of Symptoms of Post-Traumatic Stress Disorder (PTSD) by Use of Accelerated Resolution Therapy (ART). Behavioral Sciences, 2(2), 115–134. DOI / publication ↩︎

The post Why Do I Still Feel Stuck After Trauma? How Accelerated Resolution Therapy (ART) Helps the Brain Heal appeared first on River's Bend, P.C..

Emotional labor and mental load can leave people feeling exhausted, even when they appear to be doing fine. These invisible responsibilities often include managing emotions, anticipating needs, organizing daily life, and caring for others.

Why Do Invisible Responsibilities Feel So Exhausting?

Remembering the doctor’s appointment was just the start. After noticing a coworker seemed overwhelmed, checking in post-meeting came naturally. On top of that, reminding a teenager about homework and scheduling a parent’s follow-up filled the rest of the day—all while buying the birthday gift, planning dinner, answering endless questions, and keeping up a smile.

No one asked you to carry all of it.

Still, somehow, you did.

For millions of people, this invisible work happens every day.

It rarely appears on a calendar.

It usually isn’t listed on a job description.

Often, it isn’t even recognized by the people who benefit from it.

Yet it carries a real emotional cost.

Researchers increasingly recognize that these responsibilities can affect mental health, relationships, and overall well-being. Although invisible work looks different across families, workplaces, and cultures, one thing is clear:

Invisible work is still work.

Understanding Emotional Labor and Mental Load

People often use these terms interchangeably. However, emotional labor and mental load describe different experiences.

Emotional Labor

Sociologist Arlie Hochschild first introduced the concept of emotional labor to describe the effort required to manage or display emotions as part of paid work.

Think about:

• Nurses comforting anxious patients
• Teachers remaining calm during stressful situations
• Customer service representatives responding kindly to angry customers
• First responders maintaining composure during crises

Emotional labor requires people to regulate their emotions, even when their outward response does not match what they feel. This effort can become exhausting over time.^4,5

Mental Load

Mental load refers to the invisible planning, organizing, anticipating, and remembering that keeps households, workplaces, and families functioning.

Examples include:

• Remembering birthdays
• Scheduling appointments
• Monitoring children’s emotional needs
• Planning meals
• Keeping track of medications
• Coordinating family schedules
• Anticipating problems before they happen

Unpaid Care Work

Unpaid care work includes the practical and emotional responsibilities involved in caring for children, aging parents, family members, neighbors, or loved ones without financial compensation.

Together, emotional labor and mental load can create an overwhelming burden that is difficult to describe.

What Does the Research Tell Us?

No single national survey measures every aspect of invisible work. Therefore, studying emotional labor can be challenging.

Instead, researchers examine related topics such as household responsibilities, caregiving, workplace emotional demands, and cognitive labor.

Taken together, the findings reveal several important patterns.

Gender

Research consistently shows that women perform a larger share of household management and cognitive labor than men.^1,3

According to the U.S. Bureau of Labor Statistics, women continue to spend more time on household activities than men, while men generally report more leisure time.

Studies of mental load suggest that women often carry more responsibility for anticipating family needs. In addition, they may organize daily life and coordinate childcare even when household chores appear equally divided.^1,2,3

This does not mean men do not experience emotional labor.

Many men carry significant emotional burdens related to financial responsibility, caregiving, leadership roles, military service, first responder work, or occupations that discourage emotional expression.

Rather than belonging to one gender, emotional labor simply tends to look different across people’s lives.

Age and Life Stage

Invisible work often increases during life’s busiest seasons.

Adults who raise children while supporting aging parents are often called the “sandwich generation.” They frequently describe feeling pulled in multiple directions.

National caregiving research estimates that approximately one in four American adults provides care for another adult, while many simultaneously manage careers, parenting responsibilities, finances, and relationships.

Older adults may experience increasing caregiving responsibilities, while younger adults often navigate workplace expectations alongside establishing households and families.

The common thread is not age.

It’s responsibility.

Race, Culture, and Community

Our experiences of emotional labor are also shaped by culture, family expectations, community responsibilities, and workplace environments.

Research suggests that individuals from historically marginalized communities may experience additional emotional demands associated with navigating discrimination, representing their communities, educating others, or managing bias in professional settings.

Cultural values can influence how families share invisible work. For example, expectations about caregiving, family loyalty, and intergenerational support may affect whether asking for help feels acceptable.

Every family’s story is different.

Understanding those experiences without making assumptions is an important part of compassionate behavioral healthcare.

Income and Resources

Financial resources can significantly influence emotional labor.

Higher-income households may have greater access to childcare, meal services, transportation, housekeeping, or eldercare support.

Lower- and middle-income households often carry many of these responsibilities themselves while balancing demanding work schedules and financial pressures.

Family caregivers frequently report financial strain, reduced work hours, and increased stress while supporting loved ones.

The challenge isn’t simply having more responsibilities.

It’s having fewer opportunities to set them down.

When Invisible Work Becomes Emotionally Heavy

Over time, chronic emotional labor can contribute to several challenges:^4,5

• Anxiety
• Depression
• Burnout
• Sleep difficulties
• Irritability
• Compassion fatigue
• Relationship conflict
• Emotional exhaustion
• Feelings of resentment
• Difficulty relaxing

Many people continue functioning while quietly becoming overwhelmed.

They tell themselves:

• “Everyone feels this way.”
• “It’s just part of being a parent.”
• “I don’t have time to fall apart.”

But carrying invisible responsibilities without adequate support can gradually affect both mental and physical health.

Workplace burnout and emotional exhaustion can affect many professions, especially jobs centered on helping others. Learning to distinguish healthy rest from avoidance may help people respond to stress earlier.

Emotional Labor in the Workplace

• Healthcare professionals.
• Teachers.
• Social workers.
• First responders.
• Therapists.
• Administrative professionals.
• Customer service representatives.
• Leaders.

Many professions require employees to remain calm, compassionate, patient, and emotionally available regardless of what they themselves may be experiencing.

This emotional regulation is often expected, but rarely discussed.

Employee well-being depends on more than individual resilience. Healthy workplace cultures, psychological safety, supportive leadership, and realistic expectations also matter.

Supporting emotional health benefits both individuals and the organizations they serve.

Therapy Can Help Make the Invisible Visible

One of the greatest strengths of therapy is giving people language for experiences they have never fully understood.

Therapy cannot eliminate every responsibility.

But it can help people:

• Recognize unhealthy patterns of overfunctioning
• Identify unrealistic expectations placed on themselves
• Improve communication within relationships
• Develop healthier boundaries
• Reduce perfectionism
• Address anxiety and burnout
• Build healthier family systems
• Learn to ask for and accept support
• Separate self-worth from constant caregiving

Most importantly, therapy can help people remember one essential truth:

Therapy helps people remember that caring for others should not require losing themselves.

The goal is not to care less.

The goal is to make caring sustainable.

Supporting Families, Caregivers, and Professionals

Invisible work affects nearly every family in some way.

• Parents.
• Adult children.
• Healthcare professionals.
• Teachers.
• Employers.
• Caregivers.
• Students.
• Couples.

When we recognize emotional labor and mental load as real experiences, we can respond with greater understanding. As a result, we become better equipped to build healthier relationships, stronger workplaces, and more supportive communities.

Awareness is often the first step toward meaningful change.

Frequently Asked Questions

You Don’t Have to Carry Everything Alone

Sometimes the hardest part of emotional labor is that no one sees it.

If invisible demands leave you exhausted, overwhelmed, or disconnected, you do not have to manage them alone. Support is available for stress related to work, caregiving, parenting, relationships, and daily life.

At River’s Bend, our clinicians understand that emotional well-being involves more than what appears on the surface. We help individuals, couples, and families develop healthier coping skills, strengthen relationships, and support lasting well-being.

Ready to lighten the load?

Contact the River’s Bend intake team to learn more about our therapy services. Personalized behavioral healthcare can help you create a healthier, more sustainable way to care for yourself and others.

References

1. Reich-Stiebert, N., Froehlich, L., & Voltmer, J.-B. (2023). Gendered Mental Labor: A Systematic Literature Review on the Cognitive Dimension of Unpaid Work Within the Household and Childcare. Sex Roles, 88, 475–494. DOI / publication

2. Daminger, A. (2019). The Cognitive Dimension of Household Labor. American Sociological Review, 84(4), 609–633. DOI / publication

3. Aviv, E., Waizman, Y., Kim, E., Liu, J., Rodsky, E., & Saxbe, D. (2025). Cognitive household labor: gender disparities and consequences for maternal mental health and wellbeing. Archives of Women’s Mental Health, 28(1), 5–14. DOI / publication

4. Humphrey, N. M. (2023). Emotional labor and employee outcomes: A meta-analysis. Public Administration, 101(2), 422–446. DOI / publication

5. Yin, Y., Sun, S., Song, L., Jin, C., & Wang, Y. (2023). Emotional labour strategies and job burnout: A meta-analysis of Chinese employees. Asian Journal of Social Psychology, 26, 219–237. DOI / publication

The post The Invisible Work We Carry: Understanding Emotional Labor, Mental Load, and the Cost of Caring appeared first on River's Bend, P.C..

Rest vs. avoidance at work can be difficult to recognize. Both may involve stepping away from a task, postponing a conversation, or creating distance from stress. However, they do not serve the same purpose.

Modern workplaces often reward perseverance. Employees may feel pressure to answer one more email, attend one more meeting, or finish one more project before taking a break.

At the same time, growing awareness of workplace burnout has encouraged more people to prioritize rest and self-care. That is a positive shift, but it also raises an important question.

When does stepping away help you recover, and when does it become a way to avoid what needs attention?

The answer often depends on what happens after the break. Healthy rest restores your ability to return. Avoidance may provide temporary relief, but it often leaves the original stressor unresolved.

Rest vs. Avoidance at Work: What Is the Difference?

Healthy rest is intentional and restorative. It gives your mind and body time to recover so you can return with more energy, focus, or emotional stability.

Avoidance is different. It reduces discomfort in the moment without helping you address its source. As a result, the task or concern often feels more difficult over time.

• Rest says: “I am stepping away so I can return.”
• Avoidance says: “I am stepping away so I do not have to deal with this.”

Myth #1: “If I Am Resting, I Am Avoiding Responsibility”

Reality: Healthy rest is an active part of emotional resilience. It is not the opposite of productivity.

Research shows that recovery supports sustained cognitive performance. Sleep, restorative breaks, movement, and psychological detachment from work can support attention, creativity, decision-making, and emotional regulation.^1,2

In addition, healthy rest allows the nervous system to recover after prolonged stress. Therefore, a purposeful break can help you work more effectively when you return.

Myth #2: “If I Stay Busy, I Cannot Be Avoiding Anything”

Reality: Constant activity can sometimes become a form of avoidance.

Avoidance does not always look like doing nothing. In fact, it may appear productive from the outside.

• Organizing for hours instead of beginning an important project.
• Answering emails instead of preparing for a difficult conversation.
• Taking on extra responsibilities to avoid addressing personal stress.
• Working longer hours to escape uncomfortable emotions outside work.

This pattern is sometimes called productive procrastination. You remain busy, yet you postpone the task that feels emotionally difficult. Although this may reduce discomfort temporarily, it can increase anxiety because the underlying challenge remains unresolved.

Myth #3: “Burnout Means I Just Need a Vacation”

Reality: Rest may relieve some burnout symptoms, but it may not resolve the underlying causes.

Burnout can develop when workplace stress continues without being successfully managed. Time away may be restorative. However, lasting improvement often requires addressing the factors that created the stress.

• Unrealistic workloads.
• Limited control over work.
• Lack of healthy boundaries.
• Chronic emotional exhaustion.
• Insufficient recovery time.
• Workplace conflict or unclear expectations.

A weekend away may restore some energy. Still, it usually cannot solve ongoing workplace stressors by itself.³

Myth #4: “Avoidance Is Always Harmful”

Reality: A temporary pause can sometimes be an adaptive coping strategy.

Short-term emotional distance may help you regulate your emotions before facing a stressful situation. For example, you might:

• Take a walk before responding to a difficult email.
• Sleep on an important decision.
• Practice deep breathing before a challenging meeting.
• Wait until emotions settle before starting a difficult conversation.

The important question is whether the pause helps you re-engage or becomes indefinite. Healthy coping creates capacity. Avoidance continues to delay resolution.

How to Tell Whether You Need Rest or Are Avoiding Something

To identify rest vs. avoidance at work, consider what happens during and after your break.

If returning feels easier after the break, you were probably resting. On the other hand, if returning feels progressively harder, avoidance may be contributing.

Why the Workplace Can Blur the Difference

Today’s workplace can make genuine recovery difficult. At the same time, it can create more opportunities for subtle avoidance.

• Constant digital connectivity.
• Blurred boundaries between work and home.
• Increasing workloads.
• Remote or hybrid work expectations.
• Pressure to remain available.

For this reason, sustainable performance requires both productivity and recovery. One should not come at the expense of the other.

Five Ways to Choose Rest Instead of Avoidance

1. Schedule Recovery Intentionally

Treat breaks, lunch, movement, and sleep as necessary parts of a healthy routine. Do not treat them only as rewards for productivity.

2. Notice What You Are Avoiding

Ask yourself, “What feels uncomfortable about this task?” Naming the emotion may reduce its intensity and make the next step easier to identify.

3. Break Difficult Tasks Into Smaller Steps

Large projects can trigger avoidance because they feel overwhelming. Therefore, begin with one clear and manageable action.

4. Build Healthy Workplace Boundaries

When possible, set realistic expectations for after-hours communication. Clear boundaries protect recovery time and reduce the pressure to remain constantly available.

5. Seek Support When Stress Persists

If workplace stress affects your sleep, relationships, concentration, or daily functioning, consider speaking with a mental health professional. Support can help you identify stressors and develop healthier coping strategies.

When Workplace Stress May Require Professional Support

Everyone experiences stressful periods at work. However, additional support may be helpful if symptoms become persistent or interfere with everyday life.

• Persistent anxiety or panic symptoms.
• Emotional exhaustion or numbness.
• Increasing irritability or difficulty concentrating.
• Frequent absenteeism.
• Withdrawal from coworkers or loved ones.
• Relying on alcohol or substances to cope.
• Loss of interest in activities you once enjoyed.

These experiences are common, and support is available. Evidence-based therapy can help people develop healthier coping strategies, strengthen emotional resilience, and address factors that contribute to chronic stress.

Frequently Asked Questions About Rest and Avoidance

Take the Next Step

River’s Bend has provided evidence-based outpatient behavioral healthcare in Michigan since 1995. Our clinicians support people experiencing workplace stress, anxiety, depression, burnout, and other behavioral health concerns.

Available services include individual therapy, group therapy, Intensive Outpatient Programs (IOP), Partial Hospitalization Programs (PHP), psychiatric services, and secure virtual care.

If stress, burnout, anxiety, or emotional exhaustion are affecting your life, you do not have to navigate them alone. Complete our “Let’s Get Started” form to connect with the River’s Bend intake team and explore appropriate support.

References

1. Bennett, A. A., Bakker, A. B., & Field, J. G. (2018). Recovery from work-related effort: A meta-analysis. Journal of Organizational Behavior, 39(3), 262–275. View publication.

2. Wendsche, J., & Lohmann-Haislah, A. (2017). A meta-analysis on antecedents and outcomes of detachment from work. Frontiers in Psychology, 7, 2072. View publication.

3. Bes, I., Shoman, Y., Al-Gobari, M., et al. (2023). Organizational interventions and occupational burnout: A meta-analysis with focus on exhaustion. International Archives of Occupational and Environmental Health, 96, 1211–1223. View publication.

The post Rest vs. Avoidance at Work: Why Knowing the Difference Can Protect Your Mental Health appeared first on River's Bend, P.C..

When a client needs an intensive outpatient program (IOP), identifying the appropriate level of care is only part of the clinical decision. Finding the right therapeutic environment within that level of care can be equally important.

At River’s Bend, intensive outpatient care is not built around a one-size-fits-all group model. Our extensive portfolio of specialized mental health and substance use programming allows clients to be matched according to clinical presentation, treatment needs, population and stage of recovery.

With locations serving Troy and Metro Detroit, along with virtual and hybrid options, River’s Bend provides professionals and families with access to 25 specialized intensive outpatient and recovery groups.

Why Specialization Matters in Intensive Outpatient Treatment

IOP provides a higher degree of structure and therapeutic intensity than traditional outpatient treatment while allowing many clients to continue living within their communities.

But level of care alone does not determine clinical fit.

A client experiencing grief and trauma may have different therapeutic needs than someone seeking treatment for a substance use disorder. An adolescent experiencing co-occurring mental health and substance use concerns requires a different treatment environment than an adult. Men, women and specialized professional populations may also benefit from programming designed around shared clinical or life experiences.

That is why River’s Bend has developed a diverse portfolio of specialized IOP programs in Michigan rather than relying exclusively on generic intensive outpatient groups.

The question is not simply, “Which group has an opening?”

The more important question is, “Which treatment environment best meets this client where they are?”

Specialized Mental Health IOP Programs

River’s Bend offers numerous mental health IOP programs designed to provide both clinical intensity and greater specificity in treatment placement.

Programming includes multiple mixed-gender, in-person and virtual Mental Health IOPs as well as dedicated Men’s Mental Health IOP and Women’s Mental Health IOP options.

River’s Bend also offers specialized Grief and Trauma IOP programming, including both mixed-gender and women-only groups.

For younger clients, the Adolescent IOP provides hybrid treatment for adolescents experiencing co-occurring mental health and substance use concerns.

This breadth gives the clinical team more options when determining where a client may be best positioned to engage in meaningful therapeutic work.

Substance Use Disorder and Recovery Programming

Substance use disorder treatment has been an important part of River’s Bend since the organization’s early years. Today, River’s Bend continues to provide specialized Substance Use Disorder IOP in Michigan while offering multiple ways to access treatment.

SUD programming includes morning and evening virtual IOP options as well as in-person programming in Troy and at River’s Bend West.

Additional Enhanced Recovery Groups include men-only, women-only and in-person options.

River’s Bend also provides specialized recovery programming for professional populations through the Health Professional Recovery Program (HPRP) and Lawyers & Judges Assistance Programming (LJAP).

Together, these programs reflect an important clinical philosophy: behavioral healthcare should respond to the person receiving treatment rather than require the person to conform to a generic treatment environment.

Consistent Therapists. Greater Continuity.

Specialization is only one part of the River’s Bend IOP model.

Each IOP is assigned therapists who remain with the group throughout the course of treatment. Rather than clients encountering a disconnected rotation of clinicians, this approach creates greater therapeutic continuity.

Consistent clinicians can develop an understanding of the individual within the context of the group, observe clinical progress over time and build upon therapeutic work from one session to the next.

For clients, that continuity can create a more connected treatment experience. For referring professionals, it provides confidence that the client is participating in an intentional therapeutic process rather than simply completing a prescribed number of group hours.

Your Client Remains Your Client

For therapists and other behavioral healthcare professionals, making a referral for IOP often means entrusting an established client to another clinical organization during a period when additional support is needed.

River’s Bend respects that relationship.

When a professional refers a client to River’s Bend for intensive outpatient treatment, our role is to provide the additional clinical intensity, structure and specialized treatment the client needs, not unnecessarily replace the therapeutic relationship that already exists.

When clinically appropriate, our intention is to return the client to the referring professional for continued care.

We believe strong behavioral healthcare depends on communication, collaboration and continuity between providers.

Looking for an IOP in Michigan? Start With Leah.

Choosing among mental health IOP, substance use IOP, adolescent IOP and specialized recovery programs can require a conversation about more than a diagnosis.

Healthcare professionals do not have to navigate River’s Bend’s programming alone.

Leah Bogdanski, BS, CPS, Director of Business Development, serves as the direct connection for River’s Bend referral partners. Leah can help professionals discuss clinical fit, navigate current programming and availability, coordinate referrals and connect with the appropriate River’s Bend clinical team.

One Call. One Contact. One Trusted Partner.

Start with Leah.
Direct: 248-804-8553
Email: lbogdanski@riversbendpc.com

River’s Bend provides specialized intensive outpatient and behavioral healthcare programming for individuals and families throughout Troy, Metro Detroit and Michigan, with in-person, virtual and hybrid treatment options available based on program and clinical appropriateness.

The post A Different Approach to Intensive Outpatient Care: Specialized IOP Programs at River’s Bend appeared first on River's Bend, P.C..

When healing after trauma requires more than symptom management

Every behavioral healthcare professional has seen it.

A patient completes inpatient treatment. A student returns to school after a psychiatric hospitalization. An employee prepares to transition back to work. A client appears clinically stable, yet trauma continues to interfere with daily functioning.

The question becomes:

What happens next?

Successful behavioral healthcare is rarely determined solely by stabilization. Long-term recovery depends on continuity of care, evidence-based interventions, and timely access to the appropriate level of treatment.

As trauma-informed care continues to evolve, one therapeutic approach is receiving growing attention among behavioral health professionals for its ability to reduce trauma-related distress efficiently while minimizing the need for repeated exposure to painful memories.

That approach is Accelerated Resolution Therapy (ART®). ¹

For healthcare providers throughout Michigan—including discharge planners, school counselors, Employee Assistance Program (EAP) representatives, therapists, physicians, and inpatient treatment teams—understanding when ART may be appropriate can strengthen referral decisions and improve patient outcomes.

Understanding Trauma Beyond the Diagnosis

Trauma affects far more than memory.

Research from the World Health Organization estimates that most adults worldwide will experience at least one potentially traumatic event during their lifetime. While many recover naturally, others develop persistent symptoms that interfere with emotional regulation, relationships, occupational performance, academic success, and physical health. ²

The National Institute of Mental Health and the National Center for PTSD describe trauma as altering how emotionally significant memories are processed, contributing to intrusive thoughts, hypervigilance, avoidance behaviors, sleep disruption, and heightened physiological responses. ³

These symptoms often persist despite strong patient motivation.

For referral partners, recognizing this distinction is critical.

Many individuals leaving inpatient care or traditional outpatient therapy remain functionally impaired—not because they lack insight, but because their nervous system continues responding as though the threat remains present.

What Is Accelerated Resolution Therapy?

Accelerated Resolution Therapy (ART®) is an evidence-based psychotherapy developed to help individuals process distressing memories through guided eye movements and voluntary image replacement techniques.⁴

Unlike traditional exposure-based therapies, ART does not require patients to repeatedly verbalize every traumatic detail.

Instead, the therapist guides the individual through structured eye movements while facilitating cognitive and emotional processing that reduces the physiological distress associated with traumatic memories.

Importantly, ART does not erase memory.

Rather, it changes the emotional response connected to that memory.

Patients generally retain factual recall while experiencing substantially less emotional activation.

What Does the Research Tell Us?

Growing evidence supports ART as an effective intervention for trauma-related symptoms.

Clinical studies published through the National Institutes of Health have demonstrated significant reductions in symptoms of PTSD, depression, anxiety, grief, and overall psychological distress following ART treatment.

The ART International Training & Research organization reports favorable outcomes across civilian populations, military veterans, first responders, survivors of violence, healthcare workers, and individuals experiencing complicated grief.⁵

While ongoing research continues to expand the evidence base, current findings suggest that many individuals experience meaningful improvement in fewer sessions than required for many traditional trauma-focused psychotherapies.

For healthcare systems facing increased behavioral health demand, interventions that are both evidence-based and efficient deserve thoughtful consideration.

Why This Matters for Referral Partners

Discharge planning is ultimately about reducing risk while promoting long-term recovery.

Trauma frequently becomes the underlying factor driving repeated crises, emergency department utilization, psychiatric readmissions, substance use relapse, occupational impairment, or academic decline.

Referral partners increasingly seek outpatient providers capable of addressing these root causes.

Accelerated Resolution Therapy may be particularly valuable for individuals who:

• Continue experiencing trauma symptoms following inpatient stabilization
• Are stepping down from residential or partial hospitalization programs
• Have difficulty discussing traumatic experiences
• Experience persistent anxiety or intrusive memories
• Struggle with traumatic grief
• Demonstrate functional impairment despite medication management
• Require evidence-based trauma treatment within an outpatient setting

Rather than viewing discharge as the conclusion of treatment, ART may become one component within a comprehensive continuum of behavioral healthcare.

Trauma Treatment Within a Continuum of Care

No single therapy is appropriate for every patient.

Successful trauma care depends upon accurate assessment, individualized treatment planning, and coordination across providers.

At River’s Bend, Accelerated Resolution Therapy complements—not replaces—a broader evidence-based behavioral healthcare model that includes:

• Comprehensive clinical evaluations
• Individual psychotherapy
• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavior Therapy (DBT)
• Motivational Interviewing
• Medication management
• Intensive Outpatient Programs (IOP)
• Partial Hospitalization Programs (PHP)
• Family involvement when clinically appropriate

This multidisciplinary approach allows clinicians to match treatment intensity with each individual’s evolving needs while maintaining continuity throughout recovery.

Meet Alicia Starkey, LMSW

River’s Bend West is proud to offer Accelerated Resolution Therapy through Alicia Starkey, LMSW.

Alicia earned her Bachelor of Arts from Oakland University and her Master of Social Work from Northern Michigan University.

Raised in Metro Detroit and a proud member of the Native American community, Alicia brings cultural humility, family-centered care, and evidence-based practice into every therapeutic relationship.

Her clinical experience includes inpatient behavioral health treatment for children and adolescents ages 7–17, along with extensive work involving family engagement, parenting support, and trauma-informed interventions.

Her therapeutic approach integrates:

• Accelerated Resolution Therapy (ART)
• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavior Therapy (DBT)
• Motivational Interviewing (MI)

Why River’s Bend?

Behavioral healthcare partnerships succeed when communication is timely, transitions are seamless, and patients receive evidence-based care aligned with their clinical needs.

For more than 30 years, River’s Bend has partnered with hospitals, physicians, therapists, treatment centers, school systems, employers, Employee Assistance Programs, and community organizations throughout Michigan to strengthen continuity of care. That commitment includes personalized treatment planning, prompt assessments, collaborative communication, and a full continuum of outpatient behavioral health services.

Because healing rarely ends at discharge.

It depends on what happens next.

Frequently Asked Questions

Start with Leah.

Whether you’re coordinating a hospital discharge, supporting a student returning to school, assisting an employee through an EAP, or identifying the next appropriate level of behavioral healthcare, you don’t have to navigate those decisions alone.

Leah Bogdanski, BS, CPS, serves as River’s Bend’s dedicated professional referral partner. She works with physicians, therapists, hospitals, treatment centers, school counselors, discharge planners, Employee Assistance Programs, and behavioral healthcare professionals across Michigan to simplify referrals and strengthen continuity of care.

Start with Leah.

Visit the Professional Partners page to discuss a referral, schedule a meeting, explore River’s Bend’s continuum of care, or connect with the appropriate clinical team:

References

1. Howe EG, Rosenzweig L, Shuman A. Ethical Reflections on Offering Patients Accelerated Resolution Therapy (ART). Innov Clin Neurosci. 2018 Aug 1;15(7-8):32-34. PMID: 30254798; PMCID: PMC6145606. https://pmc.ncbi.nlm.nih.gov/articles/PMC6145606/  ↩︎
2. Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., De Girolamo, G., Dinolova, R. V., Ferry, F., Florescu, S., Gureje, O., Haro, J. M., Huang, Y., Karam, E. G., Kawakami, N., Lee, S., Lepine, J., Levinson, D., . . . Koenen, K. C. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(sup5), 1353383. https://doi.org/10.1080/20008198.2017.1353383  ↩︎
3. Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/  ↩︎
4. Evidence-Based – Accelerated resolution Therapy. (2026, June 9). Accelerated Resolution Therapy. https://acceleratedresolutiontherapy.com/evidence-based/  ↩︎
5. Authentic Relating Training. (2026, June 11). Home – ART International. ART International. https://authenticrelating.co/  ↩︎

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When access to care shouldn’t depend on a patient’s ZIP code

A patient is ready to leave inpatient treatment.

A university student is preparing to return home after a behavioral health crisis.

An employee living hours from the nearest specialty provider is motivated to continue treatment.

A family wants evidence-based care but cannot travel several times each week.

These situations occur every day across Michigan.

For healthcare professionals, discharge planners, university counseling centers, Employee Assistance Programs (EAPs), physicians, therapists, and residential treatment facilities, the challenge is often not identifying who needs care—it’s finding where they can receive it.

Access to specialized outpatient behavioral healthcare can be limited by geography, transportation, work schedules, childcare responsibilities, and provider shortages, particularly in rural communities.

Fortunately, geography no longer has to determine access to high-quality behavioral healthcare.

River’s Bend provides virtual behavioral healthcare services across the state of Michigan, allowing many individuals to receive evidence-based care from experienced clinicians without needing to live near the Troy or West locations. This statewide accessibility supports River’s Bend’s mission of providing compassionate, evidence-based behavioral healthcare while strengthening continuity of care for referral partners throughout Michigan.

The Challenge Facing Referral Partners

Behavioral healthcare does not end when a patient leaves the hospital or completes residential treatment.

In many ways, that is where recovery truly begins.

The period immediately following discharge is one of the most critical phases in a person’s recovery journey. Delays in establishing outpatient treatment can increase the likelihood of symptom recurrence, disengagement from care, and unnecessary readmissions.

For referral partners across Michigan, several common barriers often complicate successful transitions:

• Long travel distances to behavioral healthcare providers
• Limited specialty services in rural communities
• Transportation challenges
• Work and family obligations
• University students returning to campuses across the state
• Individuals relocating after residential treatment
• Limited availability of clinicians with specialized expertise

These barriers can interrupt continuity of care precisely when consistency matters most.

Virtual behavioral healthcare helps bridge that gap.

Expanding Access Across Michigan

River’s Bend’s virtual services allow eligible clients throughout Michigan to connect with experienced behavioral healthcare professionals from the comfort and privacy of their own homes.

Whether someone lives in Detroit, Traverse City, Grand Rapids, Marquette, Kalamazoo, Alpena, Midland, or anywhere in between, geography does not have to prevent access to care.

For many referral partners, this statewide accessibility changes the conversation.

Instead of asking:

“Is there a provider near the patient?”

The question becomes:

“Who is the best provider for this patient’s clinical needs?”

That shift allows healthcare professionals to prioritize quality, clinical expertise, and continuity of care rather than proximity alone.

Virtual Care Without Compromising Quality

One of the most common misconceptions about telebehavioral health is that virtual treatment is somehow less effective than in-person care.

Current research tells a different story.

Studies supported by the National Institutes of Health (NIH), the American Psychological Association (APA), and the Substance Abuse and Mental Health Services Administration (SAMHSA) have demonstrated that telebehavioral health can provide outcomes comparable to in-person treatment for many mental health conditions when delivered appropriately by qualified clinicians.¹

Virtual care has been associated with:

• Improved access to treatment
• Greater appointment consistency
• Reduced transportation barriers
• Increased convenience for families
• Improved continuity during life transitions
• Greater flexibility for working adults and students

Rather than replacing traditional care, virtual behavioral healthcare expands the ways evidence-based treatment can be delivered while maintaining meaningful therapeutic relationships.

Comprehensive Virtual Behavioral Healthcare

Many people are surprised to learn that virtual care extends beyond individual therapy.

River’s Bend offers a variety of behavioral healthcare services virtually for eligible individuals throughout Michigan, helping meet people where they are while maintaining the structure and support they need.²

Depending on clinical appropriateness and program availability, virtual services may include:

This flexibility allows referral partners to identify clinically appropriate options without limiting recommendations to geographic location.

Virtual Group Therapy: Building Connection Beyond Distance

Group therapy remains one of the most valuable components of behavioral healthcare.

Some professionals wonder whether meaningful therapeutic groups can exist virtually.

Experience—and growing research—suggests they can.

Virtual group therapy provides opportunities for individuals to:

• Learn practical coping strategies
• Build healthy interpersonal skills
• Develop peer support
• Practice emotional regulation
• Reduce isolation
• Strengthen accountability

For individuals balancing work, school, caregiving responsibilities, or transportation challenges, virtual participation may actually improve consistency and engagement.

Call out: Most commercial insurance plans are accepted. At this time, River’s Bend does not accept state-funded insurance plans.

Supporting Hospitals, Universities, and Referral Partners

River’s Bend’s virtual services support a wide variety of referral partners throughout Michigan.

Hospitals & Discharge Planners

Virtual programming can help facilitate smoother transitions from inpatient hospitalization, Partial Hospitalization Programs (PHP), or residential treatment while reducing delays in establishing follow-up care.

Universities & College Counseling Centers

Students frequently transition between campus and home communities throughout the academic year. Virtual services help maintain treatment continuity regardless of where students are located within Michigan.

Employee Assistance Programs (EAPs)

Employees often struggle to balance behavioral healthcare appointments with work schedules, family obligations, and travel time. Virtual care increases accessibility while minimizing disruption to daily responsibilities.

Residential Treatment Centers

Patients returning home after residential treatment often benefit from structured outpatient services that reinforce progress and reduce treatment gaps.

Across each of these settings, the goal remains the same:

Deliver the right care at the right time—regardless of location.

Understanding Insurance for Virtual Behavioral Healthcare

Insurance is one of the first questions referral partners ask when discussing virtual treatment.

Many commercial insurance plans now include benefits for medically necessary telebehavioral health services when provided by eligible licensed clinicians.

River’s Bend works with many major insurance plans commonly used throughout Michigan, including:

• Blue Cross Blue Shield of Michigan
• Blue Care Network
• HAP
• Priority Health
• UnitedHealthcare

Because benefits, employer-sponsored plans, authorization requirements, and individual coverage vary, River’s Bend’s intake team verifies insurance eligibility before services begin whenever possible.

This helps patients and referral partners better understand available benefits and next steps before treatment starts.

Why Referral Partners Choose River’s Bend

Since 1995, River’s Bend has partnered with healthcare professionals across Michigan to provide evidence-based outpatient behavioral healthcare rooted in clinical excellence, collaboration, and compassionate care.

Virtual services are not simply about technology.

They are about expanding access while preserving the quality of care, professionalism, and trusted relationships that referral partners expect.

Whether supporting a patient stepping down from inpatient treatment, assisting a university student, coordinating care through an EAP, or helping a family in a rural community, River’s Bend strives to make access to behavioral healthcare easier—not more complicated.

Frequently Asked Questions

Start with Leah

Successful behavioral healthcare depends on more than a referral—it depends on the right partnership.

Whether you’re coordinating a hospital discharge, supporting a student returning to campus, assisting an employee through an Employee Assistance Program, or helping someone access behavioral healthcare from anywhere in Michigan, River’s Bend is here to help.

Leah Bogdanski, BS, CPS, serves as River’s Bend’s dedicated professional referral partner. She works with hospitals, physicians, therapists, universities, Employee Assistance Programs, treatment centers, school counselors, and behavioral healthcare professionals across Michigan to simplify referrals, strengthen continuity of care, and connect individuals with the services that best meet their needs.

Start with Leah.

Visit the Professional Partners page to:

• Discuss a patient referral
• Explore virtual behavioral healthcare options
• Determine the most appropriate level of care
• Schedule a meeting or tour
• Connect with River’s Bend’s clinical team

References

1. Walter, K. H., Glassman, L. H., Levine, J. A., Jun, H., Bonkowski, J. F., Chung, S. Y., & Schmied, E. A. (2026). Telebehavioral Health, In-Person, and Hybrid Modalities of Treatment delivery among US service members: Longitudinal observational study. JMIR Mental Health, 13, e83809. https://doi.org/10.2196/83809  ↩︎
2. Perle, J. G., Smucker-Barnwell, S., Morland, L. A., Villalobos, B. T., Moore, H. D., Frye, W. S., Wright, C. V., Loew, M. M., & Wright, S. D. (2025). A compendium for the 2024 APA Guidelines for the Practice of Telepsychology: Guideline applications and resources. American Psychologist, 81(2), 270–282. https://doi.org/10.1037/amp0001579  ↩︎

The post Beyond Geography: How River’s Bend’s Virtual Behavioral Healthcare Expands Access Across Michigan appeared first on River's Bend, P.C..

You don’t have to be a therapist to notice when someone isn’t themselves.

You might be a teacher who realizes a student who used to participate has stopped raising their hand.

A hairdresser whose longtime client suddenly talks differently about the future.

A librarian who notices a regular visitor becoming increasingly withdrawn.

A daycare worker who sees a parent who normally chats at pickup becoming overwhelmed and disconnected.

A senior center employee who realizes someone has stopped coming to activities they once enjoyed.

A bus driver who sees the same people every morning—and notices when one of them seems different.

These everyday relationships matter.

During a recent conversation about suicide prevention, River’s Bend Director of Business Development and Suicide Prevention Specialist Leah Bogdanski talked about the importance of helping more people recognize when something may be wrong. Her point was simple: suicide prevention cannot belong only to mental health professionals.

Sometimes the person who notices first is simply the person who happens to be paying attention.

Look for Changes, Not a Checklist

There isn’t one behavior that tells you someone is thinking about suicide.

Instead, pay attention to changes from what is normal for that person, particularly when several changes happen together or follow a difficult life event.

Leah identified several warning signs during our conversation, including withdrawal, changes in personal appearance or hygiene, increased alcohol or drug use, expressions of hopelessness, talking more about death, and giving away possessions that are important to someone.

Here are some changes worth noticing.

They’re pulling away.

Someone who normally talks with coworkers stops joining conversations.

A teenager spends increasingly more time isolated from friends and family.

A regular customer who always chats suddenly doesn’t.

Withdrawal doesn’t automatically mean someone is experiencing suicidal thoughts. But a meaningful change in connection can be a reason to check in.

They seem hopeless.

Pay attention not only to behavior, but also to language.

Someone might say:

“Nothing is ever going to change.”

“Nobody cares about me.”

“My life doesn’t matter.”

Leah specifically identified statements expressing hopelessness or a sense that no one cares as things we shouldn’t simply brush aside.

Something significant has happened in their life.

Loss can take many forms.

A death.

A divorce.

A breakup.

A job loss.

A serious diagnosis.

Financial problems.

Legal trouble.

Retirement.

A major transition.

A traumatic experience.

A life change alone doesn’t tell us someone is suicidal. But when significant stress or loss is accompanied by withdrawal, hopelessness, increased substance use, or other concerning changes, pay attention.

Their alcohol or drug use has changed.

An increase in alcohol or substance use can be another reason for concern, particularly when it appears alongside depression, isolation, grief, anger, or other significant behavioral changes.

You don’t need to determine why someone’s substance use has changed before checking in.

You only need to notice that it has.

They stop caring about things that used to matter.

Maybe they stop participating in activities they once loved.

They disengage from relationships.

Their appearance or hygiene changes significantly.

They stop making plans.

Something that once seemed important to them suddenly doesn’t seem to matter.

Again, the important word is change.

You aren’t diagnosing the person.

You’re noticing them.

They begin giving things away or talking differently about death.

Giving away prized or meaningful possessions is one of the warning signs Leah specifically identified during our conversation. An unusual increase in talking about death can also warrant attention.

Don’t assume comments about death are simply jokes or that someone is “being dramatic.”

Listen to the words.

Consider the context.

Notice what else has changed.

What About a Sudden Sense of Calm?

Sometimes people become especially concerned when someone who has been severely distressed suddenly appears much calmer.

A change like this should be understood in context rather than treated as proof that someone is suicidal. But if you have already been seriously worried about a person, an abrupt change is another reason not to assume everything is fine simply because they appear better.

Check in.

You don’t lose anything by letting someone know you noticed them.

You Don’t Have to Decide Whether Someone Is “Really” Suicidal

This may be the most important part.

Your job is not to diagnose.

Your job isn’t to determine someone’s level of suicide risk.

And your job isn’t to wait until you have enough evidence to prove something is wrong.

Your job is to notice and care.

If you’re concerned, start a conversation.

You can say:

“You haven’t seemed like yourself lately. How are you doing?”

“I’ve noticed you’ve been pretty withdrawn. I wanted to check on you.”

“You’ve said a few things lately that have me worried about you.”

And if what you have seen or heard makes you concerned about suicide, Leah’s advice is even simpler:

Ask the question.

“Are you thinking about suicide?”

As Leah explained in our longer conversation about suicide prevention, direct language matters. You don’t have to know what the answer will be before you ask.

Ordinary People Can Make an Extraordinary Difference

Teachers notice students.

Hairdressers listen to clients.

Librarians know their regulars.

Daycare workers see families during stressful seasons of life.

Senior center staff build relationships with people who may be experiencing grief, isolation, illness, or significant transitions.

Bus drivers see people day after day.

Coworkers know when the person at the desk beside them isn’t acting like themselves.

Neighbors notice when routines change.

None of these people are expected to become mental health professionals.

But all of us can become better at noticing one another.

That’s part of what Leah means when she says suicide prevention belongs in communities—not only inside behavioral healthcare organizations.

If You’re Unsure, Reach Out Anyway

Maybe you’re wrong.

Maybe the person is simply having a difficult week.

Maybe they don’t want to talk.

That’s okay.

Checking in still communicates something valuable:

I noticed you.

You matter to me.

You don’t have to struggle without someone knowing.

And sometimes that small moment of connection can open the door to a much more important conversation.

If you’re unsure, reach out anyway.

If you’re worried, ask.

And if someone tells you they are thinking about suicide, don’t try to manage the situation alone. Help them connect with appropriate crisis or professional support.

Call or text 988 to reach the 988 Suicide & Crisis Lifeline. You can also contact 988 when you are concerned about someone else and need guidance about what to do next. If there is an immediate life-threatening emergency, call 911 or seek emergency medical care.

For a deeper conversation about what to say, what not to say, and what to do if someone tells you they are thinking about suicide, read our companion article:

What I Wish More People Knew About Suicide Prevention: Ask the Question — A Conversation with Leah Bogdanski

Real Talk. Real Support.

Notice the change. Start the conversation. Ask the question.

The post Recognizing Warning Signs: Changes That Shouldn’t Be Ignored appeared first on River's Bend, P.C..

There are moments in behavioral healthcare when progress can feel very far away.

A therapist may have worked with someone for months and recognize that weekly therapy is no longer providing enough support.

A physician may see symptoms becoming more severe.

A family may watch someone they love continue to struggle despite everyone’s best efforts.

And the individual at the center of it all may begin wondering whether anything is ever going to help.

Those moments can feel discouraging. For professionals who care deeply about their patients, they can also create a sense of helplessness: What else can I do?

But needing a different level or type of treatment does not mean treatment has failed.

Sometimes it means we have learned something important:

This person needs something different.

That distinction matters because behavioral healthcare is not one intervention, one program, or one straight path toward recovery.

People change. Symptoms change. Circumstances change. And effective treatment should be able to respond.

Hope is not pretending everything is okay.

Sometimes hope is recognizing that there is another clinical option to explore.

When Weekly Therapy May Not Be Enough

Traditional outpatient therapy can be tremendously effective. But there are times when a person needs more structure, more frequent therapeutic contact, greater psychiatric support, or a different treatment environment.

That is where understanding the continuum of behavioral healthcare becomes important.

Depending on clinical assessment, someone experiencing greater symptom severity may benefit from a higher level of outpatient support, such as an Intensive Outpatient Program for Mental Health or Substance Use (IOP) or Partial Hospitalization Program (PHP).

Someone else may be leaving inpatient or residential treatment and need a structured step-down before returning to traditional outpatient care.

Another person may benefit from continuing care, psychiatric services, individual therapy, family therapy, group therapy, specialized recovery programming, or resources elsewhere in the behavioral healthcare community.

The question isn’t:

“Why didn’t therapy work?”

A more useful question may be:

“What level of support does this person need now?”

For referring professionals, recognizing that distinction can open another path forward when a patient appears stuck.

For individuals and families, it can replace the feeling of we’ve tried everything with something more hopeful and more accurate:

We may need to try something different.

The Right Level of Care Is Only the Beginning

Determining the appropriate level of care matters.

So does clinical fit.

Two people may both need intensive behavioral healthcare while having very different clinical presentations, histories, treatment needs, and stages of recovery.

Consider:

• Someone experiencing profound grief following the death of a loved one.
• A person beginning treatment after a recent sexual assault or other trauma.
• An adolescent navigating co-occurring mental health and substance use concerns.
• Someone in the early stages of recovery from a substance use disorder.
• A healthcare professional whose recovery may intersect with professional responsibilities and licensing requirements.

Each may need significant support.

That does not mean they need the same therapeutic environment.

A person’s experiences can affect what they need from treatment, where they feel safe enough to participate honestly, and which therapeutic environment allows them to engage most meaningfully.

This is one of the principles behind River’s Bend’s approach:

Treatment should fit the person whenever possible—not simply place the person into a generic program because that program happens to be available.

Why Specialized Treatment Environments Matter

River’s Bend has intentionally developed a broad portfolio of specialized intensive outpatient and recovery programming for mental health and substance use disorders.

Currently, that includes 25 specialized groups across Troy, West Bloomfield, virtual, in-person, and hybrid settings.

But the number itself is not the most important part.

What matters is what that depth makes possible.

River’s Bend programming currently includes multiple Mental Health IOP groups with men’s-only, women’s-only, and mixed-gender options; grief- and trauma-focused programming; Substance Use Disorder IOP; Early Recovery Groups; an Adolescent IOP for co-occurring needs; Health Professional Recovery Programming; and Lawyers & Judges Assistance Programming.

Having greater depth gives the clinical team more possibilities to consider following assessment, including:

• Clinical presentation and treatment needs
• Stage of recovery
• Age and population
• Group composition
• Treatment focus
• In-person, virtual, or hybrid modality
• Schedule and ability to participate consistently
• The environment in which someone may be best positioned to engage in treatment

Consider a person beginning treatment following a recent sexual assault.

Even if IOP is determined to be an appropriate level of care, placing them into the first available mixed-gender mental health group may not provide the therapeutic environment best suited to their needs.

Or consider someone whose depression is intertwined with profound grief after a significant loss. A general mental health group may provide support, but a grief- and trauma-focused environment may offer an opportunity to work within a setting more closely connected to what that individual is experiencing.

Specialization does not mean every person fits neatly into a category.

It means clinicians have more options when asking:

“Where is this particular person most likely to engage, feel understood, and benefit from treatment?”

That is very different from asking:

“Where do we have an opening?”

Program availability, modality, and clinical appropriateness are determined through assessment and are subject to change. That is precisely why the conversation should begin with the person—not the program list.

Treatment Should Help People Understand What They Are Experiencing

Good behavioral healthcare should not only give people a place to talk about what hurts.

It should help them understand what is happening and develop skills for responding differently.

Treatment education can give people language for experiences that previously felt confusing or uncontrollable.

A person might begin to understand:

• Why their body reacts in certain ways following trauma
• How thoughts, emotions, and behaviors influence one another
• Why grief can feel manageable one day and overwhelming the next
• What happens as anxiety begins escalating
• How substance use can become connected to emotional distress
• How relationships, sleep, stress, and physical health can affect mental health
• How to recognize triggers before they become overwhelming
• What coping and emotional-regulation skills they can practice outside treatment

Education can help shift treatment from something being done to someone toward something they learn to actively participate in.

That philosophy has helped shape River’s Bend programming.

Amy Fresch, Clinical Director of River’s Bend Troy, has been instrumental in developing much of the evidenced based treatment education used throughout River’s Bend’s IOP programs. That educational foundation is designed to help clients develop greater understanding of their mental health while learning practical skills they can continue using beyond the program itself.

The objective is not simply to help someone feel better while they are sitting in a treatment group.

It is to help them leave treatment better able to understand themselves and respond to life outside of it.

Recovery Is More Than Symptom Reduction

When someone is struggling significantly, it is understandable that everyone wants the symptoms to stop.

But recovery can involve something larger.

Progress may look like someone:

• Recognizing their triggers earlier
• Learning to regulate difficult emotions
• Understanding patterns that once seemed inexplicable
• Communicating differently
• Developing healthier coping skills
• Rebuilding relationships
• Asking for help before reaching a crisis
• Returning to work, school, family life, or meaningful activities
• Understanding that one difficult day does not erase months of progress

Sometimes it is the person who once could not imagine getting through the week realizing they now have tools for getting through today.

Sometimes it is sleeping again.

Calling someone instead of isolating.

Walking into group when staying home would be easier.

Recognizing a familiar pattern and choosing a different response.

Recovery can be built through hundreds of moments that may not look extraordinary from the outside.

Together, they can change a life.

For Professionals: When You Feel Stuck, Stay Curious

Behavioral health professionals sometimes carry hope for patients during periods when those patients have difficulty finding hope themselves.

That isn’t always easy.

There may be patients whose symptoms continue worsening despite thoughtful outpatient work. Others repeatedly move through periods of crisis. Some return from hospitalization and need significantly more support than weekly therapy can reasonably provide.

It can be tempting to experience those moments as treatment failure.

Instead, they may be clinical information.

When progress has stalled, it may be worth asking:

• Does this person need greater treatment intensity?
• Would psychiatric support be beneficial?
• Is trauma, grief, substance use, or another clinical factor affecting progress?
• Would a specialized treatment environment provide a better fit?
• Does this person need to step up to PHP or IOP?
• Are they leaving inpatient or residential treatment and in need of structured step-down care?
• Has the person’s clinical presentation changed since the original treatment plan was developed?
• Is there another provider or community resource better equipped for what this person needs right now?

The referring professional does not need to have every answer.

Sometimes the next professional act is simply recognizing:

The question has changed.

And then collaborating with people who can help determine what comes next.

Treatment Is a Continuum, Not a Destination

One of the most important ideas we can give individuals, families, and professionals is that behavioral healthcare exists along a continuum.

A person experiencing an acute crisis may first require emergency or inpatient care.

As they stabilize, their needs may change.

PHP might become appropriate.

Later, IOP may provide the right amount of structure.

Eventually, the person may transition to traditional outpatient therapy, psychiatric care, recovery programming, community support, or other continuing-care services.

Another person’s journey may look completely different.

They may never require hospitalization. They may move from traditional outpatient therapy into IOP for a period and then return. Their needs may change again months or years later.

There is no single “correct” recovery path.

And there is no prize for needing the least intensive treatment.

The objective is the right care at the right time.

That is why one of the most useful questions throughout recovery remains:

What does this person need now?

Hope Can Be Clinical

We often talk about hope as an emotion.

In behavioral healthcare, hope can also be practical.

Hope can look like:   

• Another assessment
• A different level of care
• A safer or more appropriate treatment environment
• A clinician recognizing something that has not yet been addressed
• Treatment education that finally helps someone understand what they are experiencing
• A new skill that changes how someone responds to an old trigger
• A group where someone realizes, “I’m not the only person who feels this way.”
• A treatment team recognizing that what worked six months ago is not necessarily what the person needs today

For professionals, hope can mean knowing there are additional options when your patient needs more than you can provide alone.

For families, it can mean understanding that needing more care is not necessarily a setback.

And for the person struggling, hope can begin with learning that where they are today does not determine where they will always be.

Treatment cannot promise an easy path.

Recovery rarely moves in a perfectly straight line.

But the right treatment can create another path forward.

And sometimes that is exactly where hope begins.

When You’re Not Sure What Comes Next

You do not have to determine the entire treatment pathway before reaching out.

River’s Bend works with therapists, physicians, hospitals, treatment organizations, individuals, families, and community partners throughout Michigan to help people navigate behavioral healthcare.

Professional partners can reach out to Leah Bogdanski, BS, CPS, River’s Bend Director of Business Development, when they are concerned about a client and need help understanding potential resources and next steps.

Leah can help begin the conversation and connect the provider with the appropriate River’s Bend clinical team when assessment at River’s Bend may be appropriate.

That assessment might indicate PHP.

It might indicate one of River’s Bend’s specialized IOP or recovery programs.

Another River’s Bend service may be appropriate.

Or the person may need a hospital, crisis service, or community partner outside River’s Bend first.

As Leah has expressed in discussing River’s Bend’s role in the community:

“If we can help, we’ll make the connection. If we can’t, we’ll help find the resources that can.”
 — Leah Bogdanski, BS, CPS

That philosophy matters because the goal is bigger than admission to any one program.

The goal is helping someone find the care they need—and continuing to help as those needs change.

The post Hope Is Part of Healing: How the Right Treatment Helps People Recover appeared first on River's Bend, P.C..

You’ve noticed something has changed.

Maybe someone you care about has become quieter or more withdrawn. They aren’t spending time with people they normally enjoy. They seem overwhelmed, hopeless, angry, or simply not like themselves.

Maybe there isn’t one thing you can point to.

You just have a feeling:

Something isn’t right.

So you think about asking.

Then the doubts begin.

• What if I’m overreacting?
• What if they don’t want to talk?
• What if I embarrass them?

And perhaps the most frightening question:

What if I ask about suicide and make things worse? ¹,²

According to Leah Bogdanski, BS, CPS, River’s Bend Director of Business Development and Suicide Prevention Specialist, that fear should not keep us silent.

Her advice is remarkably simple:

You Don’t Need to Know for Certain Before You Ask

One of the things that makes these conversations difficult is uncertainty.

There usually isn’t a flashing sign telling us that someone needs help. Instead, we notice changes.

During our conversation about suicide prevention, Leah described warning signs such as:

• Withdrawing from friends and family
• Losing interest in personal appearance or hygiene
• Talking or thinking more about death
• Giving away prized possessions
• Expressing rage or significant emotional distress
• Experiencing depression or grief
• Increasing alcohol or drug use
• Feeling like a burden
• Expressing hopelessness
• Saying things such as “My life doesn’t matter” or “Nobody really cares about me”

Any one of these things does not necessarily mean someone is thinking about suicide.

What Leah encourages people to notice are changes and patterns.

You don’t have to determine what those changes mean before talking about them.

You can simply start with what you have noticed.

Start With What You See

If you are worried about someone but aren’t sure what is happening, Leah recommends asking clarifying questions.

That might sound like:

• “You haven’t seemed like yourself lately. How are you doing?”
• “I’ve noticed you haven’t been spending much time with your friends. Is something going on?”
• “You’ve mentioned feeling hopeless a few times lately. Can you tell me more about that?”
• “I know you’ve been going through a lot since your loss. How are you really doing?”
• “You said something earlier that worried me. Can we talk about it?”

There is an important difference between saying “What’s wrong with you?” and saying “I’ve noticed something has changed, and I care about you.”

You aren’t confronting them.

You’re inviting them into a conversation.

And then you need to be willing to listen to the answer.

If You’re Worried About Suicide, Say “Suicide”

This is where many of us hesitate.

We ask:

• “Are you okay?”
• “Are you safe?”
• “Are you thinking about hurting yourself?”

Those questions may feel safer to us.

But Leah recommends something much more direct:

“Are you thinking about suicide?”

She is intentional about using the word suicide.

As Leah explained, asking whether someone is thinking about “hurting themselves” can mean many different things. Asking about suicide is clear.

She also recommends telling the person why you are asking.

For example:

“You’ve been talking a lot about death lately, and you’ve told me that you feel like nothing is going to get better. Those things have me worried about you, so I want to ask you directly: Are you thinking about suicide?”

Leah described how the directness of that question can surprise someone.

A person who is having suicidal thoughts may not expect anyone to actually ask them about it.

As Leah explained during our interview, sometimes hearing that direct question creates an opportunity for the person to “say the truth out loud.”

That is why the goal isn’t to find a clever way around the word.

The goal is to create an opportunity for honesty.

Don’t Wait for the Perfect Words

Many people delay difficult conversations because they are afraid they won’t know what to say.

But this isn’t a speech.

It is a conversation.

You don’t need a carefully rehearsed opening. You need curiosity, compassion, and a willingness to stay present.

A simple structure can help:

• Notice: “I’ve noticed you seem really different lately.”
• Explain: “Some of the things you’ve said have me concerned.”
• Ask: “Can you tell me what’s been going on?”
• Clarify: “Are you thinking about suicide?”
• Listen: Give them room to answer.
• Connect: If they need help, help bring professional support into the conversation.

What matters isn’t whether every word is perfect.

What matters is that the other person understands:

I noticed. I care. I’m willing to hear the truth.

Before the Conversation, Check Yourself Too

Leah brought up another part of starting these conversations that we don’t talk about enough:

Check yourself first.

Maybe you recognize that someone is struggling, but you aren’t emotionally prepared to manage what they may tell you.

That does not mean you should ignore what you see.

And it does not mean you have failed them.

Leah explained that if you aren’t in the right mindset to have the conversation yourself, you can still say something like:

“I can see that you’re struggling. I may not be the right person to know exactly what to do, but can you sit with me while we call someone who can help?”

That is an important distinction.

Supporting someone does not require pretending to have expertise you don’t have.

You can recognize your own limits and still stay beside the person while you bring in professional help.

As Leah put it during our conversation, you’re still the person helping because you’re the one making that connection for them.

What If They Say They’re Fine—but You Still Don’t Believe Them?

This is another reason Leah’s emphasis on patterns matters.

Someone may tell you:

“I’m fine.”

But you may still see significant changes in their behavior or continue hearing things that concern you.

You don’t have to interrogate them or force them to talk.

But you also don’t have to pretend your concern disappeared.

• Ask another question.
• Explain what you are noticing.
• Stay connected.

And if the warning signs remain serious enough that you are concerned about the person’s safety, Leah’s advice is to involve professional help rather than trying to make the risk determination yourself.

You might say:

“I hear you saying that you’re okay, but I’m still worried because this feels really different from you. I’d rather take that concern seriously. Can we talk with someone together?”

Sometimes caring about someone means being willing to remain concerned even when it would be easier to accept “I’m fine.”

What If They Say Yes?

If you ask:

“Are you thinking about suicide?”

and the answer is yes, the conversation changes.

Leah’s guidance here is just as simple:

“You call for help.”

• Don’t debate them.
• Don’t tell them their feelings are selfish.
• Don’t make them defend why they feel the way they do.
• And don’t promise to keep suicidal thoughts secret.

Instead, acknowledge what they have trusted you enough to share.

Leah offered language such as:

• “That’s a really hard place to be.”
• “I’m so sorry you’re going through this.”
• “I care about you.”
• “I’m concerned about your safety.”
• “Are you willing to get help?”
• “What can we do together to make sure you stay safe right now?”

You don’t have to decide what level of intervention the person needs on your own.

Bring in people who can help.

The 988 Suicide & Crisis Lifeline can be reached by calling or texting 988. If there is an immediate life-threatening emergency, call 911 or seek emergency medical care.

And whenever possible, stay connected with the person while help is being arranged. Leah specifically recommends not simply leaving someone alone when you are concerned about their safety.

Starting the Conversation Is an Act of Connection

One theme came up repeatedly during our conversation with Leah: human connection.

She believes it is central to suicide prevention.

When we are actually present with another person, we have an opportunity to notice.

• Their demeanor.
• Their words.
• Their withdrawal.
• Their shaking hands.
• The expression on their face when we ask a difficult question.

Knowing the warning signs helps us recognize those moments. Human connection gives us an opportunity to respond to them.

You will not always know when someone is struggling.

You won’t always say exactly the right thing.

And asking someone about suicide doesn’t mean you are responsible for everything that happens next.

But you can notice.

You can ask.

You can listen.

And you can help connect someone with people who know what to do next.

Continue the Conversation in Our Community

Suicide prevention becomes stronger when more people know how to recognize concerns, start conversations, and connect others with support. 

On September 24, 2026, the Oakland County Suicide Prevention Task Force will host its annual Community Discussion: Digital Innovation in Suicide Prevention at Oakland Community Health Network in Troy. 

From social media outreach and crisis text support to AI, digital storytelling, and online peer connection, this year’s discussion will explore how technology is creating both new opportunities and new challenges in mental health and suicide prevention. 

The free event runs from 9:00 a.m. to noon, with registration beginning at 8:30 a.m., and includes breakfast, resources, and 2 CEUs. 

Parents, grandparents, high school and college students, teachers, police, fire and EMS professionals, public health and medical professionals, behavioral healthcare providers, and faith-based organizations are all encouraged to attend. It is an opportunity for both professionals and community members to learn, connect, and become better prepared to support the people around them.

You Don’t Have to Navigate the Next Step Alone

Families aren’t the only people who face these situations.

Therapists, physicians, school counselors, social workers, discharge planners, and other professionals sometimes recognize that someone needs additional behavioral healthcare but aren’t certain what level of care or resource is appropriate.

River’s Bend works with professional and community partners throughout Michigan to help make those connections.

Leah Bogdanski serves as a point of contact for professionals navigating behavioral healthcare resources, referrals, levels of care, and connections with the appropriate River’s Bend clinical team.

Sometimes a hospital, crisis resource, or another community partner may be what the person needs first.

Leah summed up River’s Bend’s role during our conversation in a way that fits the larger message of this article:

If we can help, we’ll make the connection. If we can’t, we’ll help connect you with resources that can.

Because in that moment, the most important thing isn’t where someone receives help.

It’s that they receive it.

If You’re Worried, Ask the Question

At the end of our conversation, we asked Leah what she would want someone to remember if they remembered only one thing about suicide prevention.

Her answer was immediate:

“Ask the question. If you are worried, ask the question.”
 — Leah Bogdanski, BS, CPS

• Maybe the person says no.
• Maybe they tell you what has actually been happening.
• Maybe your question opens a conversation they desperately needed someone else to begin.

You cannot know until you ask.

You don’t need perfect words.

You need to care enough to start.

Notice the change. Start the conversation. Ask the question.

If you or someone you know is experiencing suicidal thoughts, emotional distress, or a mental health crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline. If there is an immediate life-threatening emergency, call 911 or seek emergency medical care.

For more guidance about what happens after someone tells you they are struggling, read our companion article, “What Real Support Looks Like After Someone Says ‘I’m Not Okay.’”

And if you are a Michigan professional partner who is unsure where someone belongs within the behavioral healthcare continuum, reach out to Leah Bogdanski at River’s Bend. You don’t have to know the appropriate program or level of care before starting the conversation.

The post How to Start a Conversation When You’re Worried About Someone appeared first on River's Bend, P.C..