This Blog Is About

This blog is about---You! Each and every post is about you. Use it to challenge your usual patterns, as a tool for self-discovery, to stimulate your thinking, to learn about yourself and to answer your questions about others.

Monday, January 30, 2012

An Inconvenient Convenience

The I-Thou

 The truth hurts.  Or does it?  Maybe it might, in the short run. In the long run, usually not.  Exceptions?  Yes.  The exceptions are that we don't need to volunteer every little thought we have, to our partner, just because it is true.  The obvious example is, for most couples---the passing attraction to a stranger on the street does not need to be shared.  This is unnecessary.
For some, unnecessary hurt.  For others, just a little pinch.  But why?  No need to do that.  No, we're not talking about that here.

The point here is that lying, in large part, diminishes closeness.  It is such a habit for some people that they may never think of this:  That to steal a free-ride in the moment, they have robbed themselves of empowering their relationship in the long run.

The blessing of being truly known, really seen, by another, depends in large part, on honesty.  By the same token, for you to get close to that other person, you have to know them.
In fact, the more deeply honest we are with each other, the more potential there is for real intimacy, emotional intimacy.  (BTW, that makes sex better too).  But, even in relationships other than your primary relationship, presenting your self simply and honestly enhances your chances of closer friendship with that person.

If you are fortunate enough to be the recipient of a piece of honest, open communication from another, do this:  Listen.
Take it in.  Consider what you are hearing.  Try to understand it.  Refrain from advice-giving and judgement-making.  Just realize that another person has honored you with their truth and now you know them better.  It's a gift, isn't it?

You can comment below---

Wednesday, January 25, 2012

"Revisioning Later Life..."

A View to the Future

"The years beyond midlife have the potential for being the most productive and satisfying period in our lives.  Although these years hold many challenges---including health concerns and physical aging---perhaps the most important challenge we face is finding meaning in our lives.  We have many choices:  we can focus on loss, disappointment and perhaps depression or, alternatively, transform this period into a time of profound psychological and spiritual growth.
This transformation requires a rebirth---a new way to live and be in the world.  We need to reassess and prioritize our interests, our passions and ways to pursue meaningful and intimate relationships.  For C.G.Jung, "aging is not a process of inexorable decline, but a time for the progressive refinement of what is essential."
Recent research has shown that the human brain can remain active, creative, and highly functional during our later years.  Too often we forget that mental and spiritual health is less a matter of fate than a matter of choice.  We can either shrink from life or enlarge it by engaging the passions of our soul, mining the richness of our true Self, and living the life we are truly meant to live."
(from the N.Y. Center for Jungian Studies)

Have you figured out how to age positively?  Do you know an elder who is living well?  A role model?  Let us know.

Friday, January 20, 2012

Just a Reminder

Recently Mike Weintraub gave me one of those little rubber bracelets:  It said, Life Happens.  And, it sure does.  Surprises pop up on our path, often.  Sometimes they are wondrous, unexpected bits of luck.  Sometimes they are shocking disappointments.  When  the difficult events occur, we need to remember this:


         "Be compassionate and patient with yourself."  Joan Worley

Sunday, January 15, 2012

The Pay As You Go Choice

Paying Out of Your Own Pocket For Your Therapy

Those who have no health insurance or, more commonly, have a health insurance plan that does not include mental health benefits, pay for their therapy themselves.  Occasionally, someone who does have an applicable insurance benefit will choose not to use it.  Why would they do that?
Here are some of the advantages to self-pay therapy:  First and foremost, it is entirely private. The information that you offer in your therapy sessions is between you and your therapist, period.  When a third party is in the picture, the confidentiality is compromised; it's as simple as that.
  Various insurance companies have different reporting requirements.  Some demand clinical treatment reports that the therapist must write on the patient and which can be quite extensive.  They may include a five axis diagnosis, a number designating your level of functioning, some physical information such as weight and height, a delineation of the stressors in your life and more.  The purpose is to prove "medical necessity".  If you have budgeted for a small co-payment, you are in the midst of your therapy process, and the insurance company decides your treatment is not a medical necessity, you may no longer receive the benefit of your sessions being partly subsidized. Some insurance companies require repeated requests for authorizations and may decline a request so, then, unless you can negotiate a fee with your therapist, your treatment will halt.  But then, what happens to all the information the insurance company has collected on you?  I don't know.  But, as long as you remain a subscriber, it seems that there is the chance that you will try again to use their coverage, so it probably makes sense that they would keep your information.  Some say the information is kept in databases accessible to certain entities at the insurance company's choice.
Prior to some sort of report being asked for, because you are a subscriber, the company will already have your basic information, such as, name address, phone number, social security number, and birth date. In addition, a one axis diagnosis will be required for the therapist to be able to bill them for your sessions.
Complete confidentiality is such a cornerstone of therapy, (a therapist is trained to not even reveal that you are their patient, i.e., if someone called your therapist to talk about you, not only would they not enter into a discussion of your personal business, they would not even acknowledge that you were their patient); the code of confidentiality allows a person to come into the therapy office and feel comfortable enough to reveal all; this is why it is so important.
A topic that got a lot of attention when I was in graduate school but which I haven't heard much mention of recently is, labeling.  The concern is that once a person is given a mental health diagnosis, in any context, it may remain associated with their name.   The idea was that they could be labeled and that there might be implications to having a label follow you in life.
In a private pay situation, there is no need for a formal diagnosis.  The therapist may or may not think about this, depending on the case.  But, if it were a part of the therapist's treatment planning, it would be held in confidence.
Even more to the practical perspective, in the U.S., therapy with a credentialed, licensed therapist is an expense you can deduct from your taxes.  You can also claim it as an expense on a medical reimbursement account.  In that case, it is helpful for your finances to pay for your therapy yourself (if you decide to take advantage of these options, of course, you do reveal to the government and the resource who processes your medical account that you are seeing a therapist.  But that it is extent of it).  
So, you control completely who knows what about your therapy.
The fee for therapy may seem high at first blush because most Americans are used to paying a small co-payment for their doctor visits.  ~On the other hand, many do pay out of pocket for the dentist, the chiropractor, the optometrist or the acupuncturist.~  But, if you think just a bit about these services and what the fees are, it will begin to make sense.  If you have any questions about how a fee is set by a therapist, you can ask me in a comment here; also, there is some information on that topic in the post, The Imperfect Therapist.
On the subject of having control, when a patient uses health insurance (referring to HMO type here) to pay part of the fee for therapy, the insurer decides how frequent the visits will be and how many there will be.  If a subscriber calls and inquires about their benefits, as one of my patients did the other day, they may be told, as she was, that the number of visits is "unlimited".  Technically this may be true; possibly this is what it says in the insurer's contract with her employer-the purveyor of this benefit.  However, that statement,  is actually misleading since the number of visits may be fewer than the patient would like if, again, "medical necessity" is not possible to be proven.   There are some subtle ways  the insurer may use to discourage visits from occurring more frequently than they would like to pay for.  
For example, should a provider be able to make a case for medical necessity in a patient report, the insurer may ask for these reports more often and award fewer visits for the report each time.  When this happens, to be able to continue in a process they find beneficial, some patients will opt to schedule sessions less frequently to make overall therapy last longer.  Of course, they miss out on an optimal experience, in making that adaptation.
Back to the subject of confidentiality:  Every company is different.  Some are more hands off than others.  Some are quite pesky.  One of the things that can happen is something called an audit.  It has nothing to do with money, at least on the face of it.  It is a supposedly random check on the quality of a listed provider's (therapist's) record keeping.  The insurer will randomly select a case and the therapist is required to hand over all clinical notes on the requested cases.  Any and all records found to be not to their liking, the therapist will have to correct or supply required information.  This can be a current case or one from the past.  While this is a very occasional occurrence,  it does happen.  This compromises confidentiality completely.

Another infrequent event is if the insurance has denied any more coverage of future visits, the therapist, on the patient's behalf, may produce an appeal.  Sometimes this leads to the therapist being required to discuss the case with a "clinical case manager" or "care manager".  These are people licensed to be therapists, who are employees of the insurer, and can decide whether or not a case can continue to be covered.  (Yet another person privy to your personal business)

Here is a link to an article on this subject which I found after I wrote mine.  It says  most of the same things but more concisely:

Another one I liked, that is an easy read:

For description of the Medical Information Bureau, see this site:

Also see the second half of my post titled, Answering Questions

Tuesday, January 10, 2012


Keeping your introverted and extroverted sides in balance

 — Dolores Hope worked indefatigably for numerous charities. From 1969 to 1976 she served as president of the Eisenhower Medical Center in Palm Desert, California, then became chairwoman.
In 1982, she explained her philosophy: “I like being with people, but I also need to have my time alone. I think it’s terribly important to have some time during the day when you stop and take all the energy that you have given out and pull it back in, find the source of your energy. Then you work from there.”

Seems to me like good advice from a person who lived a happy life which included a lot of service to others.

Thursday, January 5, 2012


A Seasonal Pattern of Winter Blues
Just when everyone is asking you to parties, just when people are running around feeling festive, when it  seems like every magazine is showing pictures of happy family groups around a cozy fireplace, you feel tired and sad.  And you've noticed that every year at this time you feel this way---out of sync with the culture in the cold winter months.  Do you also notice having an unusually difficult time concentrating and a craving for carbohydrate laden foods?  Just when everyone else seems to suddenly find your company desirable, you just want to curl up on the couch and hibernate.
If this is a seasonal pattern for you, you may be suffering from Seasonal Affective Disorder or SAD.
Sleep disturbances, weight gain and fatigue which are symptoms of this disorder certainly do not help you to feel better!  If this tends to begin every year around the same time and also, remit at about the same time of year, that is another clue.

Other problems that can create these symptoms are an under active thyroid, chronic fatigue syndrome, fibromayalgia and low blood sugar or hypoglycemic issues.  The difference is that these will not come and go in a seasonal pattern.  A person with SAD can be just fine with a stable mood most of the time until that certain month every year when they get moody, unmotivated and just generally out of sorts.

However, a complicating factor can be if an individual already has a Depressive Disorder and then it is exacerbated in the colder, darker months of the year.  They may have SAD in addition to the first disorder.  If you think you fit in this category, you should see a therapist who will be able to help you delineate the problem, and may refer you to a psychiatrist for medication assistance.  

If you are plagued with SAD, here are some things you, yourself can do, to improve your condition:  
  • A therapist can be engaged to help you with changing negative thoughts that are produced by this condition and which then contribute to sustaining it.  A therapist can help you re-structure your time so that you don't isolate and don't sleep too much or too little.  A therapist can help to figure out what is needed specifically for you to alleviate your symptoms.
  • Keep good habits; keep your biological rhythms steady; keep a consistent sleep routine.
  • "Spend alone time in meditation...It calms and energizes body and mind."  Norman Rosenthal, M.D.
  • Reduce your stress by scheduling activities that you enjoy.  Even if you are not feeling sociable, try to make dates with companions who lift your spirits.
  • Physical exercise is an excellent antidote.  I don't have SAD but I experience the stress of our societal pressures just like anyone else.  As of December 1, I began a program of walking every day.  It has done wonders for me!  It is energizing---even when I feel so tired I don't know how I can do it, I make myself---afterwords I have more energy.  Also, it gives me little bursts of happy feeling.  Of course, good nutrition will enhance the effect.
  • Regarding diet, be sure to take in enough protein.  Protein is brain food; it gives you long-lasting, even energy rather than the upsurge and subsequent crash you can experience from carbohydrates, especially simple carbohydrates (pasta, pastries, white grains, candy).  "A protein rich diet sustains well being because it provides the amino acid tryptophan.  Without it the body can't make serotonin, one of the brain's feel good chemicals.  Ross recommends eating 20 to 30 grams of protein per meal to boost mood."  Heidi Smith Leudtke.
  • The current state of the art treatment for the SAD Disorder is light therapy.  This is done with the use of a therapeutic light box.  "Models with intensities of 2,500 to 10,000 lux are considered effective", says Rosenthal.  The usual recommendation is to begin with 15 minutes of light therapy and add five minute increments until you reach the desired effect.  For a more natural, easier way to address this problem, just make a point of spending time outside.  Get outdoors into the sunlight.  Even in winter, it is bright outside and will help you.  The only exception to the recommendation of using artificial light to treat winter blues is if you have been diagnosed with Bipolar Disorder; "...visible spectrum light used in treatment may be associated with switches into Manic or Hypomanic Episodes." DSM-IV.
Above all, don't let your winter blues go untreated.  There's no need to be unnecessarily unhappy.  See a nutritionist for supplements to help with sleep and brain serotonin, or a doctor for anti-depressants, or a psychotherapist for problem solving and comfort.

Sunday, January 1, 2012

Inspiration for the New Year

Some plain advice for beginning the new year in a positive frame of mind

"Let this coming year be better than all the others. Vow to do some of the things you've always wanted to do but couldn't find the time.

Call up a forgotten friend. Drop an old grudge, and replace it with some pleasant memories. Vow not to make a promise you don't think you can keep.

Walk tall, and smile more. You'll look ten years younger. Don't be afraid to say, 'I love you'. Say it again. They are the sweetest words in the world."  Ann Landers