Wednesday

What Your Therapist Hasn't Told You About Using Insurance

(I have updated this post to reflect the changes to managed care in my area since 2010)


By Unsplash
Once upon a time, I started out as an idealistic new therapist. My work with a non-profit as well as my heart told me that mental health care shouldn't be a privilege for only the wealthy. 

And so I decided to accept insurance, hoping it would help ease the burden of cost for those seeking therapy. And I tried. I really did. Even when I was spending hours on hold (to get payment I had already been promised). Even when I had to write off payment I was owed because it was costing me too much time to pursue it. Even when I was full of private pay clients.

It was a bitter pill to swallow, but I had to admit it: I could no longer afford to be in-network for insurance But I learned a lot of things along the way. Things consumers don't know. Things that I would want to know if I were you. And so I'm here to tell you the

Things I wish all clients knew before/when they are using insurance-approved therapists.

1. Your therapist has to diagnose you to get you reimbursed.

Insurance doesn't reimburse for "marriage therapy" or "I'm having a hard time" or even "grief". It is a medical model, and so this means that payment can only be for a diagnosis. This means that (even in family therapy) a person has to receive a label. And these labels will be part of your official record permanently. This might never matter to you. If you are one of the fortunate ones who has medical, life and disability benefits through your employer... you might never worry about this. But if you're someone who might ever be unemployed, self-employed, or need to purchase your own benefits- a mental health diagnosis can make the difference between preferred coverage or none at all.

2. Your records are not protected.

Your insurer can audit your records at any time they wish. This means any details that your therapist might not have included in the paperwork (perhaps for good reason) is technically open to the eyes of any "claims specialist" the company hires. Again, this might not matter to you. But if you hold high clearance for a job, or have other reasons you want your information to be held confidential- this is important to know.

3. Your care is dictated by the insurer

Most insurance requires some sort of treatment plan to be submitted by in-network providers. This means that (rather than giving you the care that best fits your needs) the therapist is responsible to the (non-mental health professional) claims representative for how you spend your time. To put it simply, an in-network therapist works for the insurance company, not you. It doesn't matter what you and your therapist decide is in your best interest, it needs to fit their matrix of decisions. It also has to fit within the allotted sessions which are determined ahead of time, not based on need.

4. Insurance almost never pays the full fee

This means you are either going to be responsible for the remainder (which you need to clarify ahead of time) or it means your therapist is working for less than a fair market wage. Which leads me to my final, and most unpopoular point.

5. Insurance limits your options

I have said it before, to an angry response. I cringe even as I type. But the truth is: I know very few licensed and experienced therapist on insurance panels.  I have been in this profession over a decade and supervised over 25 interns on their path to licensure. I can count on one hand the number of therapists who I would recommend that are on insurance panels.

That is a dirty secret. I'm not supposed to say that. Therapists don't like that, because it is a sad commentary on the availability of quality mental healthcare. Consumers don't like that because it is obviously unfair. But it is accurate in my area. And so you need to know, that choosing to utilize an insurance-approved therapist means your options will be severely limited.

So what can you do about it? There are options!

1. If possible, pay cash for sessions. 

This ensures that your records and diagnoses are entirely confidential documents. The content of your session stays entirely between you and your therapist. And your care is dictated by what you think you need, not your insurer. Many people have a Health Savings Account (HSA) that will help them pay for sessions and operates just like cash- but they don't realize it.

2. If you cannot afford to do that, consider a non-profit (like the one I co-direct)

Many areas have nonprofits that offer low fee counseling based on income or other eligibility. That takes a little digging, but often you can find it on google by looking for "low fee" or "affordable" or "nonprofit" counseling. You will likely see less experienced clinicians, but you will maintain control and confidentiality.

3. If you need to bill insurance, but have a PPO, attempt to pay for therapy up front and submit for reimbursement.

 This will cost you up front, and your diagnosis will be recorded, but it gives you the freedom to choose any licensed clinician and their records are more protected than if you go with an in-network therapist. Here's an article I wrote about how to do that.

4. If you absolutely must bill insurance and see an in-network therapist, do your due-diligence ahead of time. 

If they are in-network with your insurer, they should have an idea of what level of transparency your insurer expects. They likely know if their notes will be requested, if their treatment plans will be required, and what diagnoses they will need to give you for coverage. Asking ahead of time can help you decide how you want to proceed.

This news does not feel good to report. I don't like the way it is. I hope for a world where quality mental health care is available to everyone that wants it. But if I were you, I would want to know. And I believe in the golden rule. I think consumers deserve to know the nitty gritty details. In fact, I think educated consumers are our best shot at system change. And so... there it is.

Hoping for a change,

Friday

Meet Buddy

 Meet Buddy.










 Buddy is my dog. Well, technically he is the family's dog. These are puppy shots of buddy, but he is over 3 years old now. Let's face it, there isn't a lot of opportunity to take pictures of your dog- so these are still my favorite.

I always say, if incarnation is real- I want to come back as Buddy in another life.



This is Buddy's favorite past time (yes, those are my legs). No matter what is happening, or where we are... Buddy is content as long as some part of him is touching some part of you. It makes him happy. He sighs with contentment and then falls asleep.

Buddy reminds me that we're all kind of this way. We all want to feel connected, safe, warm. We all want someone beside us after we're done with our adventures.


Wishing you connectedness,

Wednesday

In Case Anyone Wonders

If you ever wonder whether therapists lead a perfect life... let me put your questions to rest right now.

In a word? Nope.

I see this as a good thing. How good would a therapist be if they had never experienced loss, hurt, rejection, fear, anger, anxiety? How meaningful would their empathy be if it had to be faked, because they never felt anything like you? How useful would their advice be if it's never been battle tested?

Every now and then, I run across people who scoff at therapists they know who are imperfect. They tell me stories like they expect me to agree and laugh with them. Therapists have all the answers, right? So shouldn't their lives be perfect bliss?

In a word? Nope.

Therapy isn't about one perfect person telling an imperfect person how they can be perfect too. (Even writing that sentence makes my skin crawl a little!) Therapy is far more sacred, and far more messy than that. It is about humanness. It is about empathy and connection. It is about weathering storms with someone at your side.

Now, that someone at your side happens to have years (if not decades) of education and experience doing the same. They are an experienced co-pilot who can delicately tease out what is healthful and productive, and what is self-limiting. Their years of experience lets them pinpoint the heart of the matter, distinguish cause from effect, highlight destructive patterns. And all of that is wonderful and helpful.

But how empty would it be if the therapist wasn't fully aware of their own frailty and humanity?

I'm fortunate that I have a daily reminder of my own imperfections. It happens to come in a 3-foot-tall package with the most beautiful blue eyes. A two year old is the best reminder that education and training only means so much. If you can't connect, they're not interested. If you can't roll up your sleeves and dig in the dirt with them... they have no use for you. And regardless of your years of experience and education... they are unimpressed.


I am so thankful for my daily reminder. What a gift.

Monday

Can This Marriage Be Saved?

One of my favorite quotes: "Hope begins in the dark"

Hope.

In my opinion, hope is one of the most significant things that a therapist can offer. Nowhere is this more obvious than in couples' counseling. By the time a couple has come in my door, they have been locked in a painful dance for a long time. Each interaction taking its toll, chipping away at their marriage and their selves.

It's been my experience, that couples know very well what is wrong with their marriage and their partner. They (better than anyone) know the ways in which they hurt one another. They know all the reasons their marriage is "doomed". They can give a detailed account in fact.

And yes, that is valuable information. And yes, it is important for a therapist to know all of it. How do you cure an illness you don't yet understand? So I see value in learning the ins and outs of the couple's past experiences. Their tally of hurts. The many ways that they each have wounded the other.

But then what?

What comes next?

I dare say, that is what couples come to counseling for. They are stuck on the "now what" part. The painful dance keeps playing over and over and they can't seem to get over, under or around it. To me, that is what hope is about.

Hope isn't a trite word... a ridiculous idealized version of reality. Hope doesn't substitute for the here and now. Hope doesn't undo the pain, or fix the problem. But (in a word) hope is fuel. Without hope, there is no motivation to try. No motivation to "show up" emotionally or otherwise.

Hope is the idea that things can be different. Not the guarantee that they will.

But what a powerful substance it is: hope.


In favor of hope,

Thursday

My Apologies

I know, I know. I've really not been here much lately. What's even sadder? I have had a dozen million-dollar-blog ideas. And now I can't remember one. Does that ever happen to you? (Well okay, let's be honest. At least I can tell myself they were million-dollar-ideas. We'll never really know and it makes me feel happy to think they were ever in there ;) )

Here's the good news- I've been busy doing good things!

Here's the bad news- part of that includes... gulp... accounting and bookkeeping.

Chalk this up to one of the many things they never teach you in grad school: "how to RUN a successful business". It's all trial and error. And I know this is going to shock you... but us therapisty types are NOT excellent at administrative tasks. (Yes, I made up a word, but I like it.) I like to think that we're more "people-people" and less "paper-people". So, as my practice has grown, so has my need for good administrative systems.

For example, it would be ideal if I could give my accountant some kind of records at the end of the year. Even more so if the records made sense.

So my work hours have been full lately, but I will be back soon. I see a light at the end of the tunnel.

I like to think that experiences like this are important. They're humbling at least.

Mathematically Challenged,

Tuesday

When You Keep Doing "That Thing" That Ruins Everything

First off, what is trauma? The word might conjure images of busy emergency rooms, prime time dramas, or a devastating and dramatic accident. And yes, "trauma" might fit all of these scenarios. But for the purposes of this posting, trauma shall be defined as:

" An emotional wound leading to psychological injury"

... because I said so. And also, Wiktionary says so. Who can argue with a source so authoritative?

Okay, all joking aside- let's get back to the point: While emotional wounds happen to everyone in life, not all emotional wounds are traumatic. The difference: Does the wound lead to a deeper injury that lasts long after the traumatic experience is over?

For some, childhood is fraught with traumatic experiences. For others, they had a relatively happy and safe childhood that was disrupted by one particularly traumatic experience. Trauma is really in the eye of the sufferer... but a few examples might include: loss, death, divorce, abuse, neglect, bullying, serious illness, a parent who's an addict, a parent with mental illness....

Why do I bring this up? I'm glad you asked! I bring it up because it is my personal (and professional) belief that untreated childhood trauma gets in the way of you living your best life! The ways trauma can affect us are truly countless. To name a few: addiction, eating disorders (including overeating), unhealthy relationship patterns, self-sabotage, difficulty attaching to others, struggles in your own parenting, anxiety, depression.... The list could go on and on.

Why do some experiences shape us to our core, while others seem to roll off our backs? If I knew the answer to that, I'm certain I'd be rich! :) We don't know why particular experiences are traumatic (causing long-term suffering) and others aren't. In my professional experience, there are specific characteristics of experiences that become traumatic later. Some of those characteristics include:
  • involvement of a loved one,
  • involvement of someone who was supposed to be trustworthy or protect you,
  • an experience that caused you to change or question your concept of self,
  • an experience that made you feel unsafe or afraid.
  • an experience that dramatically or abruptly changed your family or your place in it
I'm going to be real with you: we all have key patterns and behaviors that we dislike about ourselves. Whether for habit or for comfort, they just seem to stick around. I'm not talking about those. I'm referring to pervasive patterns of behavior that get in the way of your relationships or personal goals. The ones that cause suffering in your life. Those are often caused by untreated trauma.

Let me put it to you another way. If you suffer from anxiety (for example), well you didn't come out of the womb anxious! Something occurred between birth and now that influenced your level of anxiety. And once you can understand that "something" you can begin to pinpoint it's effects on your life. You can begin to weed out the past that is influencing your today. Only when you can see the problem clearly can you begin to change it.

Wishing you true freedom from your trauma,

And Suddenly, You Realize...

No, I didn't forget that I promised to write more about marriage today, but I'm interrupting myself because sometimes... well sometimes you can't predict what will move you.



Today was just 'one of those days'. You know, the kind of day where you feel vaguely sensitive and agitated. Where your "to do" list isn't getting crossed off and your stresses seem to outnumber your happy thoughts. And then a friend of mine posted this link on Facebook... and my perspective changed in an instant.

 The Matthew's Story. WARNING: If you have experienced a traumatic illness for your child, or loss of your child- use caution when reading.

It's amazing how feeling a sense of the greater community (their suffering, their joy) will help you deal with even the worst days. All of a sudden, the things that were causing migraines seem insignificant and all you can do is whisper a prayer for a fellow human being while you hug your loved ones a little tighter.

I can't make sense of it all, I really can't. It begs much deeper questions than I have answers for. My heart aches.

And even stranger, I feel compelled to share their story. Interesting how the need for community is so deeply ingrained in us. Without even actually knowing them, I want others to hear their story- offer their love, support, sympathy, prayer.... And really, my "to do" list- whether it gets done or not- matters very little in this moment.

Wishing you health, love and the support of those around you,



Wednesday

What Is Marriage For?

"Dearly Beloved, we have gathered here today to celebrate the marriage of Cindy and Paul*.... And now, the vows:

Paul: Cindy, I promise to feign interest in what you say while not really caring. I promise to be kind to our future children, but only be involved so long as you force the issue. I promise to only talk badly about you when you can't hear me. I promise to hold silent grudges for years at a time, only speaking my mind when I am so furiously angry that I can only scream hateful things. I promise to love you in "name" but not in deed.

Cindy: Paul, I promise to make passive-agressive remarks to you in front of our friends and family. I promise to ignore your sexual desires and needs until you give up. I promise to only keep some secrets. I promise to be bored by you and give up trying to connect. I promise to love you in "name" but not in deed."



********************************
Ouch, I hate even writing those words. They pain me. But I've got a point today and I'm going to make it directly: We care too much about the contract of marriage, and not enough about the heart of it.

In my work, I have seen people spend years and even decades in a loveless marriage. They gave up long ago. Their hearts have grown cold and the distance between them is infinite. Yet they ask me to: save their marriage. Translation- 'keep us from the shame, expense, and burden of divorce'.

And I have to say- "Are you even married now?" You look at your lifelong partner and lover, and only see cold distance. You are lonely in your own marriage. You fantasize about life apart. You burden your children and loved ones with the tension you've gotten used to. Is this the marriage you signed up for? Is this what you pictured on your wedding day?

It is time we stopped seeing a marriage as "saved" because two people remained legally married, and start seeing a "saved" marriage as a caring, loving, committed, trusting, connected partnership.

Ask yourself this: if my marriage stayed exactly as it is now for the rest of my life, would I be okay with that? And if your answer is "no!" then might I recommend you look into marriage enrichment now.... and not only when the piece of paper is on the line? Let's find the urgency and passion you once had for your marriage.


Life is so short... why not spend it with your best friend and partner?








ps- I'll be writing about "Can My Marriage Be Saved?"  next... stay tuned!

Monday

Infertility and Silence

While I frequently like to post funny or interesting things on here, today I'd like to take a (serious) moment to talk about a struggle dear to my heart: Infertility. Specifically, the silence surrounding it. This article says it best:

"One in eight American couples will experience infertility, and 1.1 million women will undergo treatment this year. That most won’t talk about it makes it that much more painful: A recent survey of infertility patients reveals that 61 percent hide the struggle to get pregnant from friends and family...."

The article goes on to say that most couples find it easier to claim they don't want children, than to talk about their infertility struggles.

To fear that you will never hold a child of your own is painful enough, but to then suffer that fear in silence and (sometimes) shame? In my mind that's unbearable. My heart hurts to imagine it.

I personally believe that the infertile suffer in silence mostly because of the reactions they have received when they were brave enough to speak. So today, I'd like to offer a list of ideas, should someone in your life be affected by infertility.

1. Please refrain from offering suggestions like: "Just relax/drink/go on vacation... it will happen." This minimizes the medical reality they are facing. Could you imagine saying that to someone diagnosed with cancer? The truth is: infertility is a real condition. It has medical causes. By telling someone to "relax", you are implying it is within their control. Translation: It is their fault.

2. Please don't take it personally when they excuse themselves from child-related events (baby showers for example). It is not a slight against you. It does not mean they wish you ill. Sometimes the gut-wrenching desire to have their own baby (never knowing if they will) becomes unbearable. Sometimes it hurts too much.

3. Please (if you are lucky enough to have your own child) put yourself in their shoes. Look at your own beautiful child and ask yourself: "What if I couldn't have this child? What if I didn't know that I would ever have him/her?" Then magnify that feeling infinitely....

4. Please be patient. The pain of infertility is far-reaching. It is not an injury that happens one day, and then you get over it. It is a re-injury. Month after month. Year after year. Holiday after holiday. The pain can subside and return. Medical intervention can offer renewed hope only to be devastated. Infertility is not something simple.

5. Please don't act like it's a taboo subject. Just like any other painful subject, sometimes the person wants to talk about it. And sometimes they don't. Infertility is no different in that way. If you don't know what to say, that's okay. Sympathy and a listening ear go a long way.

6. Please realize infertility can happen at any time. The questions about "adding number two" can bring about just as much pain. Many times there is an assumption that if you had a biological child you must not suffer from infertility. In reality, infertility can strike even those who have a biological child.

By no means am I an expert in this area. Just someone who feels the pain of my "sisters and brothers in arms". I don't want them to have to add loneliness to the list of pain they feel. As with every loss in life, community support can go a long way toward easing the burden of pain. I have been lucky to be educated by some close friends who suffer infertility, and I wanted to pass along some of what I've learned.

I think it's time to break some silence. Infertility is painful enough without the stigma that surrounds it.

And if you should know someone suffering from infertility who would benefit from counseling, please pass this along to them (or my website in general). I will soon be offering therapy for couples/individuals and groups with an infertility focus.

Wishing that you all would have love and support in your darkest moments,

Wednesday

You're Gonna Give Yourself A Heart Attack

You know how people say "he's gonna give himself a heart attack"? Turns out they may be on to something.

According to this article, the hormone cortisol is directly correlated to death by heart disease. In fact, you have a five times greater chance of dying by heart disease if you have high levels of cortisol. What causes high levels of cortisol? Stress.

(What is not mentioned in the article, is that even low-grade sleep deprivation can also cause high levels of cortisol- because it puts stress on your body). Even more interesting (to me at least) is that high levels of cortisol are related to obesity (especially belly fat), and poor metabolism. So you can see how all those things might equal a higher risk of death from heart disease.


So next time you are overwhelmed with stress in your day, just remember: you're killing yourself.

... ha. Just kidding. Like that would help you relax!

Instead, try remembering that your heart and health are more important than that moment's stress. Visualize a long, healthy life ahead of you. Remind yourself that this is (after all) one moment's stress... and doesn't need to affect a lifetime.

Wishing you heart health (both literal and metaphoric)

Thursday

Why Do Women Do This?

If you have ever been pregnant... you KNOW what I'm talking about.




















































I put these encounters up there with the oh-so-helpful cliches:
"It will change your life forever"
"Things will never be the same"
"Sleep now while you still can!"

What if we lived in a world where every pregnant woman got greeted with- "Wow, I'm so happy for this new phase of your life. It is a blessing, and while some times are hard, I have total faith in your ability to figure this out like generations of women before you?"

.... or would that be equally annoying?

Okay, new plan: don't speak to pregnant women. Unless you are offering: chocolate, foot rubs, or compliments. In that order.


Monday

Ouch! Handling Critcism

Alright, I'm unveiling my new, embarrassing, dirty little secret.... I'm trying vlogging!

Don't hate on me! (Or maybe, do- b/c I'm good at handling it now!)
video

Friday

Optimism

In my job, people really only come to see me at the worst points of their lives. As they start to feel better, I see less and less of them. This means I'm doing something right. It also means I see lots of the hardships, and not alot of the optimism that exists. It's alright, I'm a naturally (ridiculously) optimistic person. It's one of my core beliefs.

But because it's Friday- I wanted to share what I heard:

Gallup (the poll people) randomly calls people during the day and asks them "how they feel" (kind of sounds like a therapist now that I think of it. Hmmm... maybe I'm onto a new marketing idea- cold calling random numbers and asking how they feel...ha! Could you imagine? I digress). Two of the options were: happy or stressed.

Given the state of the economy, and all the gloom and doom you hear on tv- what would YOU estimate the answers were?

NOPE! You're wrong! And even if you're not, just play along. It makes things more fun for me. (Sometimes I get a good deal on something and I'll ask my Hubby to guess how much it cost. He always lowballs his guess- just to steal my fun. Booger. The point is- play along here people!)





On September 7, 2010 people reported
63%- happy
8%- stressed


.... and if that was the number on a TUESDAY- I'm thinking a FRIDAY has to be even better, right? Ahhh, optimism and resiliency of the human spirit. That's what I'm talking about.

Happy Friday

Thursday

Wait, We're Doing What?

In my last post I talk about the new crazy, revolutionary experiment I'm trying.

Okay, let's just be honest. It's actually rather an OLD tradition... that I'm just now considering. I'm late to the party. But I like it better the first way I said it. It sounds more exciting.

Our mission, is to follow the principles of the Sabbath Manifesto, one day a week, for one month (then re-evaluate). I'm excited by this new idea... and a little nervous. I mean, what does one do all day if there is no laptop, cell phone or tv?

Turns out: a whole lot. Our first day's experiment left me with:
-a cleaner house
-yummier food (b/c I had plenty of time to contemplate and prepare it)
-more conversation with my husband than I've had in a month's time
-a house full of laughter
-a day full of sunshine (playing outdoors) and an evening full of candlelight. *sigh*

I'll admit, the first thing I did was forget about the new experiment (when my son requested "bear" on the tv). But after Hubby's reminder (and the sleep rubbed out of my eyes)... I started getting into it. We found ourselves stumped a few times... missing the easy distractions. But we dug deep into our creativity, and ended up at Fairytale town (a place we have wanted to take my son for a while... but hadn't seemed to find the time.)

At the end of the day, Hubby said- "Maybe we should just live life without tv." But I think he was just overcome with appreciation in the moment. It was a momentary lapse of sanity- right?

*gulp*


Wednesday

My Experiment..

What do you think of my new digs? Not bad, right? Many many thanks to Krystal Bagley of "The Clever Mommy Chronicles". If you're looking for graphic design services, I cannot recommend her enough. She is not only incredibly talented- she's also nice! Any project you can think of- I'm confident she could do it! (And pssst- she's an award winning blogger too!)
 


Now, in a valiant attempt to alert the irony police.... I'm gonna spend today talking about one of my favorite topics- Technology and Mental Health. More specifically- my own journey as I balance my love of technology and my love of being mentally healthy.

A few scary facts:
-The total average time [of television viewing] per household in 2005-06 was eight hours and 14 minutes per day.
     -- Reuters (September 22, 2006)

-Children ages 8–18 spend the following amount of time in front of the screen, daily:
     • Approximately 7.5 hours using entertainment media
     • Approximately 4.5 hours watching TV
     • Approximately 1.5 hours on the computer
     • Over an hour playing video games

          ..... and 25 minutes reading books.
     -- NIH

- The average parent spends 38.5 minutes per week in meaningful conversation with their children.
     -- (A.C. Nielsen Co.)

Yikes. I do not share these statistics from a place of finger-pointing superiority. Trust me on this. (As I type, my child is engrossed in Mickey- I'm embarrassed to say.) When I was preparing for a recent speaking gig, I came across these stats and let me tell you- they cut through me like a knife. No one understands the allure of tv like a mom-of-a-toddler-who-tries-to-work-from-home-two-days-a-week. *Insert blushing emoticon here*.

But no one understands the heart-breaking distance in today's modern family like a therapist-who-specializes-in-seeing-the-whole-family either...

What to do, what to do....?

So it seemed only appropriate that I stumbled across The Sabbath Manifesto - which you've probably seen me posting a great deal lately. Regardless of your faith background, I think this old idea's time has come. The creators of The Sabbath Manifesto encourage everyone to take one day a week to:
1. Avoid technology
2. Connect with loved ones
3. Nurture your health
4. Get outside
5. Avoid commerce
6. Light candles
7. Drink wine
8. Eat bread
9. Find silence
10. Give back

They even leave each item open to interpretation. (This is more a spirit of the law over letter of the law- kind of situation- and lets face it, some items may not work for you.)

So in my family, we've accepted the challenge. I'll be sharing our experiences in the next few days. For now, I want to give you a chance to consider- just ONE day a week... reconnecting with loved ones and stepping away from distraction. Statistically that ONE day will save you 8 hours of tv time as a family. Imagine what you could do with 8 collective hours!

Wishing you a connected family


Friday

Anxiety Part II- Bringin The Point Home!



In my last article I talked about the roots of anxiety, and anxiety's purpose within your body. Today I'm gonna discuss how to apply that to your (non caveman) life in the year 2010. And how YOU can begin to take charge of your own anxiety.

This will directly pick up where we left off, so if you have not read it yet, I suggest you do so... so we're on the same page!
It is my personal theory, that once we understand anxiety's purpose (action) we can find meaningful ways to combat it... and even eventually use it as a force of good in our lives. Your anxiety is usually here to tell you something- and if you stop running and start listening... you just might make peace with it!

Anxiety's Messages- I believe all of anxiety can be boiled down into three categories:
1. "You should act!" - and you should!
2. "You should act!" - but you can't!
3. There is no action to take- what now?

Let's break them down-

1. "You should act!"- and you should!
In the case of number one, your anxiety is working with you. It is your friend here. Your anxiety is your warning system- letting you know: "Hey, something ought to be done here. This isn't working out." This could be simple: like a deadline approaching. It could be complicated: maybe you feel anxiety every time you leave for work. But the result is the same: your anxiety is trying to tell you something worthwhile. If you want it to go away... listen! I believe the majority of your run-of-the-mill-anxiety falls into this category. If you make friends with your anxiety, you just might realize it's time to work on that project of yours, or it's time to make a career move you've been putting off.

2. "You should act!"- but you can't!
Here's the trick for distinguishing #1 and #2: Do you have any ability to change the thing causing you anxiety? If the answer is yes: then see #1 again.  Give yourself a pep talk, and get to it! If the answer is no- then this is where your anxiety has started to go rogue on you. It is trying to be helpful, but silly little anxiety- it's not being! Examples of this would be- anxiety about others (other's feelings, other's actions), or anxiety about unpredictable possibilities (car accidents, air travel, someone you love getting sick) because these things are not within your control. Therefore, you can tell your anxiety- "Thank you, message received. I know you are trying to tell me to act. Usually you're my friend. In this case you're wrong though. I have no control here and you telling me to act will do nothing but cause me harm, so therefore I will let you go."

Sometimes, it's as simple as that. Other times... anxiety is harder to let go of, more pervasive, or more complicated to find the root. In this case, consider...

3. There Is No Action To Take- What Now?
This is what happens when you've gone through step 1 (done what you can), step 2 (released control over what you can't) and STILL can't seem to shake the anxiety. This is when the anxiety is persistent, and won't budge. Maybe you can't even figure out exactly WHAT you're anxious about! What the heck is going on here?

This is where we get into counseling territory. Your "fight or flight" survival instincts have gone haywire and are now bossing YOU around. You want to be free of it, but can't seem to shake it. It impacts your life or your happiness in negative ways, but you don't know what to do. This is where an experienced counselor (me? :) ) can do wonders.

Often (it is my opinion) this anxiety sticks around because there is more to it than meets the eye. Usually there are past experiences, hurts, and fears that are unresolved and are (unknown to you) causing you to now feel plagued by anxiety. By figuring out the true roots of the anxiety, you can try Steps 1 and 2 again- and finally have peace from your nagging friend.

That's all the time I have for now. As always, I welcome your comments or emails.



Thursday

Anxiety- Why God, Why?

........Anxiety bites.

There, I said it.

If you do not know this, it is because you
a. Don't Have Anxiety, or
b. Don't know someone who does

Otherwise I pretty much assume you know what I'm talking about, and we can go from there.

Here's the rub: some anxiety is good for you. I realize that sounds impossible, but imagine what would happen if you never felt pressure to perform. What if missing your term paper didn't produce any feelings of worry? Or how about your boss's opinion of your performance? You get the point: a little anxiety is necessary for society (and you) to go on functioning. Without it, we would all be a lot like the main character of "Office Space"... good for comedy; not so good if you prefer to have a home and eat food.

But what about when anxiety tips the scales beyond production into true suffering? What then? Well I'm glad you asked, because I have a theory! (Uh-oh, here it comes) But before I can tell it to you, lets review the prehistoric roots of our anxiety, shall we?

Once upon a time....

Our brains had to determine friend from foe... and quickly. When running into an animal in the forest, there was no time to create spread charts of pros vs cons. All we knew is, our survival depended on one thing: action. We didn't always know what the action ought to be... but we knew there ought to be some.

This call to act is now known as: fight or flight response. In other words, when prehistoric man was in an unfamiliar and/or dangerous situation... our prehistoric brains sent signals to our body. The signals went something like: "RED ALERT! RED ALERT! THAT ANIMAL WILL EAT YOU!" and then depending on your odds, the follow up signal was "FIGHT!" or if the predator was large: "RUN!" Our bodies were flooded with everything needed to make us move fast, and survive the fight or the chase. The way we digested food, the way we breathed, the way we heard, even the way our blood pumped... all were used in harmony to ensure our survival for that moment. Many years of human history perfected this operation. Because, as you might have guessed, any human who didn't experience the fight or flight reaction- was often lunch for the faster animals.

How does this apply to anxiety? Well that prehistoric "Fight or Flight" response is now known as anxiety. Modern humankind doesn't often find itself faced with the risk of becoming a meal. But try telling your brain that! You see, the brain is slooooow to evolve. It got the way it is over a long time. It's not going to change quickly.

Okay, how does this help you?
I believe this is good information for one reason: because once you understand your brain, you can make peace with it (little caveman that it is). When you experience anxiety, it is because your brain is telling to you to act. Remember, anxiety is our "Fight or Flight" response... it is a RED ALERT CALL TO ACTION for survival's sake.

Many people suffer under anxiety's weight: silent and still. I submit that this is the exact opposite of what you ought to do, because even in the year 2010- your body is still doing what it would have done in 1010 and 0010 to stay alive: it would have demanded action then, and it's demanding action now. The only way to get relief, therefore, is to give it what it wants....

In my next blog- I'll tell you how to do just that, and how to tell when anxiety is more than just that....

Deep Breaths,
Krysta Dancy

Monday

No, I Didn't Forget You!

I have to apologize for my absence lately. I know, I know. You were hanging on the edge of your seat after that cliffhanger ending in my last blog, right? Yup. I knew it.

Without further delay...
The Proper Care and Feeding of you Teen- Part II
Question: What one single thing may be to blame for teen attitude, obesity, ADHD and a host of other medical issues we see in teens?

Answer: Sleep loss.

Recently I was reading the book "Nurture Shock" by Bronson and Merryman. It has to be one of the best books I've read in a long time. Think: "Freakonomics" about kids. I thoroughly enjoyed it and plan to frequently refer to it. So get ready! But I digress.

In the book, the authors touch on the obesity epidemic among children, which seems to be spiraling out of control. They point out that many of the common scapegoats (tv watching, high fructose corn syrup, processed foods) don't hold up statistically. But what has gotten the attention of leading experts most recently: sleep loss. The truth is, kids and teens today get a great deal less sleep than their peers would have just 10 years ago. In fact, there is a direct correlation between sleep deficit and obesity.

And sleep loss doesn't just correlate with biological functions (such as metabolism and fat burning) The authors cite fascinating studies in which children are put to bed just one hour later for three days... which caused a loss of two grade levels on their academic testing! In the book "Healthy Sleep Habits, Happy Child", Weissbluth (a pediatric sleep specialist) correlates poor sleep in early childhood with poor adolescent sleep, ADHD, grades and even seizure disorders.

Most scary of all is the information on teens a sleep deprivation. Adolescents have a biological shift in their circadian rhythms. What does this mean? It means that the naturally occurring "sleepy" time we all feel as adults and small children- actually shifts 90 minutes later in an adolescent brain! Meaning that when a teen is forced to rise early (for school) they will not be able to make up for that sleep at night. In their study, 60% of Freshman got 8 hours of sleep. By Sophomore year? Just 30%.

Why does this matter? Because when teens walk around chronically sleep deprived, they actually double their rates of depression. Ask yourself this: "if you are sleep deprived for a week, how do you behave?" Moody? Irritable? Irrational? Distracted? Forgetful?  Now ask yourself: "what qualities in my teen drive me the most crazy?"..... BINGO! Which brings me to the earth-shattering information:

Much of what we consider "normal adolescent moodiness" is now being reexamined. It might actually be the consequences of long term sleep deprivation.

Because of this (and other) research, school districts across the country are considering a late start time. And the ones that implement it have had amazing results!

Our culture has pushed kids to accelerate. After school activities, AP classes, early college courses etc.... By itself, that's not a bad thing. However, when achievement is prided but sleep is not- what are the real long-term effects? Are they worth it? At a time when an estimated 20% of college students are on anti-depressants, ADHD diagnoses are on the rise, and obesity is declared epidemic; perhaps it is time we started touting the benefits of a free, natural remedy: sleep.

Wishing you a restful evening,

Krysta Dancy

Adolescence... ah where to begin

Teenagers. Few words generate such a collective knowing sigh.

Whether you're a future, present or past parent of a teen- you can understand the sentiment. A time in life when freedom and limitation fight for position. A time when self-reliance and mooching don't seem to notice their own contradictions. And the hormones... yes, the hormones.

As part of my practice, I work a great deal with teens.  From this experience, I've gathered several conclusions and tips. I'd like to share a few with you. In no particular order:


The Proper Care and Feeding of Your Teen.... Part 1 (Part II is here)!

I find that what is most helpful for parents, is to recall the history of us as a people. I'm not talking about "the good ol' days". I mean human history. Since the dawn of humanity, teens have ruled. Depending on the era, thirty was considered "grandparent age" and anything beyond that qualified you for impending death. Not only were teens the parents; they were the warriors, the leaders, the hunters, the foragers. In other words, nature made sure that teens were (above all else)- hormonal, aggressive and passionate. It made sense that with the peak of fertility (and likely parenthood) teens would also be fiercely independent, strong-willed, and full of hubris. This ensured our survival as a species.

Fast-forward to our present day. Not only are teens NOT in charge, they are still living under the rule of parents. Not only are they NOT the warriors, they aren't even the drivers (for a while). Not only are they NOT the parents, they are told they ought not to be having sex at all. There is nothing to hunt and gather, there are no fires to stoke, there are no civilizations to pillage or protect. There are simply endless hours of school, malls, and (of course) sleeping. At a time when they are the most virile and agitated, they are told to do precisely the opposite: "sit still. take notes. be obedient. do what I say."

Now I for one am thankful that the average life expectancy is longer. I am thankful that adolescents no longer call the shots and I can expect to live peacefully to a ripe old age. I am also thankful that we encourage our teens to explore their own identities during their teen years. We give them a break from the stresses of adulthood for a little longer. We encourage parenthood to start only after the hubris of youth has died down- and I think that's good for society and for individual development.

But you can see how this is a recipe for discontent, right? You can see how adolescent angst would rear its ugly head. So what's a parent to do when they have a caveman teenager in gentler, calmer times?

I'm so glad you asked! I have ideas! :)

Point 1: Give your teen a purpose.
Remember, teens were built to be the movers and shakers of society. They were made to create (and destroy) civilizations. Their energy has been an asset to human history... until now. So its up to you as the parent, to help that energy finds its own use. In other words: wear them out!

For some teens this will be an after school job. For others, it's extra curricular programs. For still others, its pitching in more with the running of the household. Each situation is unique to your teen and family. But what is universally true is that they need purpose (just like we do).

It is my belief that human energy cannot be created or destroyed. It is simply re-routed. I believe a great deal of turmoil in the home is due to misplaced teen energy. If a teen has no purpose, no meaning to their existence (at a time when nature made sure they would crave it), what is s/he to do with that useless feeling? Get angry? Mopey? Agitated? Depressed? Yup, and a whole lot more. So put that energy to work somewhere meaningful, and drain the conflict out of your home!

I counsel teens, sometimes for long periods of time. You know what happens every year (like clockwork)? I lose clients around the time school lets out for the summer. It's a typical ebb and flow of my industry. Family vacations have some to do with it, and unpredictable schedules. But it also has to do with the fact that parents and teens start telling me "everything is fine", we're doing great!

Guess what happens every September? My office is flooded with phone calls of frantic teens and their parents, reporting that the remainder of the summer was a disaster. The honeymoon period of catching up on their sleep is quickly replaced by the melancholy of boredom. So with summer just starting, now is the time to preemptively help you and your teen, by finding a purpose for them and their time. It's good for you both!

... check back later... next time I'll talk about what one single thing may be to blame for teen attitude, obesity, ADHD and a host of other medical issues we see in teens today....

ETA- Part II can be read here.

Hoping your summer is purposeful,
Krysta

Thursday

Confessions of a Therapist

I'm gonna level with you: today wasn't great.

I adore my job, and everything that goes with it. The chance to help people make real, meaningful change in their lives really gets me excited. The chance to offer support, encouragement, a listening ear, a sounding board, a solution, a safe place.... how could life get much better?

But some days the losses outnumber the wins.

Some days people get in their own way. Some days people don't want what I'm offering. Some days I mess up and get in my own way.... Yikes.... I hate those days the most.

I'm not supposed to have flaws, right? I am the paid expert in the room. The expert at "life, relationships and happiness", right? So what does it mean when I am the one who messes up?

I have no idea. But I hope it means I'm real. I hope it means I'm reachable. I hope it means I can relate to the one crying on the couch, because I have been that one crying on the couch. I hope it means I never begin to think I am infallible. I hope it means I remain genuine, humble and graceful.... and deep down- I hope those things count for more than perfection in my clients' eyes.

Here's hoping for a better day tomorrow,
Krysta

Sunday

What Do You Need?

     As I sit comfortably on the couch, I hear my toddler over the monitor: "Mama. Mom. Mom. Mum-mum. MAA!"

     He's supposed to be sleeping, but try telling him that. The irony is, he's been asking to do just that for hours. Poor little guy is overtired, and has been slumping in his stroller the better part of the afternoon. And if his glazed expression and irritability weren't clues enough, on his own impetus he literally stood up, turned off the tv and said "Night Night" to the room before walking to his bedroom. He left us giggling as we stared at his little back disappearing down the hall.

     So I know he needs sleep. I know he is overdue. It would seem that even he knows that. And yet here he is: "Mamma... MUM UM... MOM!" while he runs around his crib squealing and kicks the walls.

     And because I'm a therapist and get to think about things like this for a living, it makes me contemplate: why don't we take what we need when it's offered? Because this experience sure has me thinking it is a innate human characteristic.

     Like the addict who won't admit there's a problem and get treatment, or the combat vet who refused the VA's services, the dieter who turns down an accountability partner, or the person who tells you (with tears in their eyes) that everything is okay.... Why do we refuse what we so badly need? Why do we insist on proudly plowing ahead when what we really want is to sit, for one moment, and accept grace?

     Is it pride? Fear? Denial? I'm not sure. But what is clear to me: it is harder to admit and accept what we need, than not to. Which surprises me when I first think of it. But the more I contemplate it, it sounds about right.

Meanwhile, the monitor is finally quiet- thank you!


Wishing you grace and kindness in your life,

Krysta

Wednesday

Forgiveness

Much has been said on the subject of Forgiveness. (Or, the "F" word as I like to call it...) I doubt I can say much more profound or helpful things on the subject, so instead I want to tell you about my own experience with it. 

I was flying to Los Angeles for my best friend's 30th birthday. It was Friday afternoon and I was feeling more than a little excited about the prospect of a girls' weekend, away from the kiddos, at a friend's beach house. Really, could life get any better than gossip magazines on a 45 minute Southwest flight- where I did not have to ONCE get someone a cracker, change a diaper, or dig through my bag of tricks!?

I was so in my own head, I didn't even notice him. But there he was, sitting right across the aisle from me the entire flight. Time had changed him slightly, and I almost made it the whole way there without realizing his presence.  But as soon as he turned and spoke, "excuse me ma'am" (he had bumped me with his bag) it was like a movie moment... in an instant, we both recognized one another.

This was The Guy. You know the guy. The one that screwed you over royally. The one that took your pride, your reputation, your dignity and your self-respect in the name of their own interest. The one who climbed to the top on countless backs, including yours. The one who no doubt has a body count in his wake. The one who you *should* have known better than to ever work WITH, much less work FOR.

And this was The Moment. You know the moment. The moment you dream of, where you are calm, cool, and collected. Where you catch them off guard (for once) and you have all the clever things to say. The moment where you slice them to shreds by your words and leave them, mouth agape, staring as you walk away, wishing they had just done things differently. Oh yes, you know the moment. It might only be fiction... but here it was.

We're all smooshed together like cattle, waiting for the door to open. He has just been totally taken off guard to realize who I am... and I have had years preparing just the things to say....

And as I contemplate my options, the funniest thing happens, a huge grin spreads across my face. I looked at him- crumpled business suit, beat up and overstuffed briefcase, flying Southwest (coach) on a Friday night, looking haggard and out of breath and I realize: he's still hustling. Not one thing about him has changed in the least.

On the other hand, I look at myself. How since the time he knew me, I became a grad student, an intern, and finally a licensed therapist. I became a wife and mother. I am going to the beach for a girls' weekend. Most of all, I am smiling, happy, content.

And I let him walk away.... Smiling like a goofy idiot the entire time...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I realize for you that might seem either A. Unsatisfying or B. Noble
But I assure you it was neither. You see, what I hadn't realized is that at some point I had stopped laying awake at night fantasizing all the ways to make him hear me. I had stopped thinking about him very much at all. Instead of his betrayal being a formative and angering thing, it had become simply a part of my history. And like all history, it made for interesting discussion... but I didn't feel much about it.

My decision to let him walk away wasn't based on some level-headed nobility. I was not taking the high road here. What happened is he had become the best thing of all: inconsequential.

And to me, that is what forgiveness is all about. You see, my forgiveness didn't mean jack to him. He really could not have cared less I imagine. I was just one of many.

But instead of that run-in RUINING my weekend... it MADE my weekend. I had the best story to share with my friend when she picked me up. Because you see... forgiveness set me free.

Oh, it was sweet!

Wishing you health and happiness,
Krysta

Friday

You're The Expert!

I've become aware of the fact that it makes me intensely uncomfortable when clients (or others) say "Well, you're the expert!" with any sincerity (joking is always appreciated.) I'm never quite sure how to respond to that. Especially since there are some days I feel like the expert of NADA!

In part it is the truth- I'm "the expert" on mental health, psychology etc... (assuming there's no one more qualified in the room, then they're the expert! :) ). On the other hand, there's something very important that I'm not the expert on: you.

Television and movies like to portray the mental health field in one of two ways: either a bumbling idiot who commits ethical and legal violations galore, or as the consumate expert on everything and everyone. I'm not sure which is worse honestly. While the first can be excused for dramatic license (I suppose), the second sets up false expectations for therapy. I also think that false expectation of "The Omnipotent Expert" scares a lot of people away from the field, who would benefit greatly.

The reality is this, I'm a therapist, not psychic!  I do not posses magic pills, nor wands. In a perfect world, I would- but unfortunately I'm still waiting on that... What I do posses is experience, knowledge, expertise... but without your input- they may as well be useless. I can only help so far as you are willing to meet me.

As much as it might be fun, I don't socialize at parties "knowing" everything about everyone in seconds of meeting them. Likewise I don't have "The Answer" to your problem within the first hour of meeting you. Like all human relationships, there is a learning curve. And (sadly) I can only apply expertise to what is available to me. Meaning: if you hide something, I can't help you there.

I say this because part of what is important to me, is to demystify the counseling process. Like anything else in life, counseling is a relationship. It takes time to learn one another. It takes time to establish trust. It takes time to learn clients' stories and feelings. And then it takes time for the client to internalize the changes. And maybe that's not magic enough for some, but for me- it feels magical.  To be trusted on this most important issue: a person's very life, is a great honor. It's much less about "expert" and much more about partnership.