Snare 3: Fixation With Happiness

We seem to be obsessed with happiness.  I’m not talking about that profound state of contentment that years of meditating in a cave might provide.  I’m talking about a strongly held belief that life should be comfortable and enjoyable.   When someone with depression enters my office, a stated goal is “to become happy.”  It is then my job to inform that this is something I cannot ever promise, nor would hope to offer.  I do not want someone to be happy when a loved one dies, nor do I want them to be happy and relaxed when danger is nearby.  Our emotions are loaded with information, letting us know what is important and what we need to pay attention to.  If the expectation is that only one emotion is acceptable, the person is left less equipped and one dimensional.

What does this fixation do?  Nietzsche said it best, “False expectations create resentful people.  Grateful people emerge in a world rightly defined, where even the darkness is no surprise, but is in fact opportunity.”   To expect happiness means that we will feel persecuted when reality seeps in and burst the bubble.  I would also add that the struggle will be amplified because there will be no coping strategies or skills to rely upon.   There is no way to prepare for something that you do not accept exists.  Therefore, this ensnared person will not only be hurt and angry that the world is difficult; s/he will have no resources to get through it.

Sadly, such a perspective also creates walls.   People who respond to “How are you?” with, “Perfect!” or “It’s all good!”  leave their audience with nothing to hold on to.  Life is too complex for anything to be easy.  Companions know on some level, there is a lack of honesty.  Vulnerability has also been avoided so the friend will have nothing that s/he can relate to, and therefore nothing that can be shared.  Instead, the interaction will be superficial and empty.  A friend of mine recently shared her loving invitation to such a statement, “When you are ready to deal with life’s imperfections, I’m here.”

Questions to consider:

• What have I been taught about distressing emotions that makes it hard to give myself permission to feel them?
• What is needed for it to be safe enough to experience what I have ignored or minimized?  (Ex: support, skills, openness versus judgment)
• What are the benefits of clinging to happiness?  What are the drawbacks?
• What might the unpleasant emotions help me learn or understand?  How can I use this information wisely?

Snare 2: Despair

I caught myself in this one just recently.  A major event occurred that knocked the wind out of me.  As I noticed my difficulty being comforted by friendly advice, it became evident that it all their words felt empty.  They had no guarantees that the situation would turn out well and I was certain that until I had that, I could not be pacified.  Just as this thought solidified in my mind, I laughed out loud.  I was telling myself that “all I needed” was to take away the pain of not knowing and not having control.  What I was really asking for was to eliminate everything I was having to struggle with.  I wanted to rearrange the furniture rather than move from the building falling apart around me.

Luckily, I saw a truth that at first was unwanted but has now become a point of hope: it is only during times of suffering that our safety nets are shaken enough to provide access to our deepest thoughts, feelings, and meanings.  Normally we are not open to anything dramatically different from what we already know.   In times of crisis, however, the familiar is gone so we finally have room to try on something new.   This was evident with CS Lewis when his faith dramatically changed with the death of his wife, as revealed in “A Grief Observed”.    Richard Rohr describes this very process in his book, “Hope Against the Darkness.”

This does not mean that there will not be profound moments of grief and loss, because struggle means the loss of safety and security, as well who we were before the event changed everything.   However, there is a difference between confronting the pain and seeing what lessons might lie within, and lying down accepting fate, no longer searching and no longer trying to grow.    For suffering to be the transformative rite of passage that Thomas Moore describes in “Dark Night of the Soul”, we must work hard to find the lessons, we must seek out advice that is hard to hear, and we must be willing to be vulnerable enough to ask for help.

Questions that prompt an active role might include :

• What do I think should be?  How is that being challenged?
• What am I being invited to let go of?  What am I being invited to explore?
• What does the world offer me?  What do I want to offer the world?
• What does it mean to be a good human being?
• Who was I?  Who am I becoming?
• What do I want my life to be about?
• What elements of my life do I want to hold on to?   Why are these important to me?

Changing the Mental Health Diagnostic Manual

A client recently sent me this link, highlighting the decision making process around a diagnosis.  In particular, this article focuses on the recent consideration that bereavement may no longer be excluded from the criteria of depression.  http://mobile.nytimes.com/2012/01/25/health/depressions-criteria-may-be-changed-to-include-grieving.xml?single=1.  As the date nears for final revisions for the DSM-V,(the diagnostic manual for mental health) it is highly likely that more information will be flooding the media.  As you consider how this information applies to your own life, please keep in mind that there are good reasons for diagnoses (ex: insurance coverage, validation, medications, support services) and factors that can be detrimental (feel like the label defines the person, tells people that common struggles mean they are sick, etc.)  For more on the subject, please read this previous post: http://www.sbscounseling.com/helpful-versus-harmful-uses-of-diagnoses/.

Class on Anger: Manage or Damage!

You are cordially invited to a class I am offering this coming Sunday at Trinity United Methodist Church.  The topic is on “Managing Anger”.  This common emotion can be both helpful and destructive, so part of our work will be clarifying the difference so we can make better decisions about how to respond.  There will also be information provided about common mental states that lead to either internal suffering or relationship difficulties, as well as their antidotes.  The following Sunday, Pastor Dent will preach on the topic, incorporating some of the points raised in the discussion.  Please feel free to share this information with anyone you think might benefit- the more the merrier!

This class is part of a ten week series on “Handling our Humanness”.  It begins with a class discussion, followed by a sermon the following week.  The class is at 9:30-10:30 a.m. in room 1-11.  Below is a list of the program.  You are welcome to attend as many classes as you feel drawn towards. :

Class                Sermon                        Topic      

Jan. 15              Jan 22             #1 DEPRESSION:  More Common Than the Cold

Jan 22              Jan. 29             #2 ANGER: Manage or Damage

Jan 29              Feb. 5               #3 GUILT: Trusting God with the Past         

Feb 5                Feb. 12            #4 ADDICTION:  Let Go and Let God  (I will lead this)

Feb 12              Feb. 19            #5 WORRY: Trusting God with the Future

Feb 19              Feb. 26            #6 DOUBT:  The Ants in the Pants of Faith

Feb 26             March 4            #7 FEAR: False Evidence Appearing Real

March 4          March 11           #8 GRIEF:  It’s Work, You Know!

March 18        March 25          #9  LONELINESS:  Lonely in a Crowd

March 25          April 1             #10 REJECTION:  Wounded by Unwantedness       

Directions to Trinity United Methodist Church:

http://maps.google.com/maps?hl=en&gl=us&gs_upl=618694l626895l0l628560l44l42l1l34l0l0l191l1033l0.7l7l0&um=1&ie=UTF-8&cid=0,0,15911656145662371170&fb=1&hq=Trinity+United+Methodist+Church,&hnear=0x876b80aa231f17cf:0x118ef4f8278a36d6,Denver,+CO&gl=us&daddr=Denver,+Colorado&geocode=0,39.745278,-104.987222

Hope to see you there!

The Seven Snares of Suffering

Sometimes life is hard.  A universal reality is that we all have dark times marked by pain and struggle, yet we often don’t realize that along this time in our journey there are certain mental snares that crop up.  When they take hold, they distract us with meanings and interpretations that keep us weighed down and defeated.  These steal away opportunities to grow from the struggle as well as hope that there are new joys to look forward to.    The key is to know what to look for and how to respond so they are recognizable and easier to overcome. Over the next several weeks, I will highlight seven snares to look out for.  Todays installment is:

Snare 1:  The belief that an experience has the power to determine your character. 

Self-doubt, shame, and regret plague people who believe that they are permanently marked because of something they experienced or an action taken.   “I’m a failure” is stated with certainty because twenty years ago, the person was held back a grade.  Another person, struggling with the impacts of childhood trauma, tearfully shares their deepest fear, “I’m damaged!” Like the scarlet letter, these negative labels develop and become so overwhelming in the psyche that they overshadow any other qualities or potentials.   They color everything: choices, behaviors, friendships, even what is allowed to be dreamed.  The labels take hold and strip their victim of freedom, esteem, and hope.

This snare denies that we are human beings constantly growing and changing.   We have the capacity to learn, change our environment, and gain new perspectives by inviting different people into our lives.   We also are larger than any one experience.  Hardships and traumas do occur that are beyond our control.  Our power, our responsibility to ourselves, lies in what we do about it.

•  Refuse to believe that any one label is big enough to define a life.  Notice your thoughts.  See what kind of beliefs constantly tell you who you are supposed to be or how you should respond.  These force you into roles that keep you limited and stuck.  Begin to poke holes in these assumptions: notice contradictory information that provides evidence of how complex you really are.  Ask others about their perspectives or approaches so you can increase your repertoire of potential responses.
• Use visuals to change the experience you have of yourself.  Perhaps you can imagine a waterfall that has the power to wash away mental baggage.  Another option would be to imagine cutting loose the beliefs or patterns that constantly pull at you or weigh you down.
• Deconstruct your situation to see what you may have overlooked.  Look for assumptions that might be at play, identify triggers that might be active that bring up the same old feelings.  Consider what advice you may give a friend (which is often contrary to what you tell yourself if negative labels exist).   Finally, identify what you hope to accomplish and what values are important to you so you can incorporate those elements into solutions you consider.    This process will take you out of autopilot and help you become as flexible as a stream that changes direction when a stone falls into the water.

Radio Show Update

Thank you to all who listened to the show Friday, hoping to hear about bullying in step-families.Here is a link that allows you to listen at your leisure: http://itunes.apple.com/podcast/stepwisdom/id485508440 . Some ideas that you can look forward to hearing:

• Bullying is a euphemism for behavior that is hurtful and frightening. We need to recognize that it is really harassment, defamation, abuse, or cruelty so we do not risk minimizing how this feels and the need to wisely respond.
• Although we often talk about this as a phenomenon with children, it is a dynamic that can happen anywhere and at any age. It is particularly difficult when it occurs in the home because that is supposed to be the base that provides the security and love that allows kids to take risks and explore. When the base is unsafe, the world becomes much harder to endure.
• The Cinderella story has numerous examples of bullying in a step family. To name a few: basing family rules and discipline along blood lines, not including the step-child in the family decision making or activities, and criticizing or drawing attention to issues in front of other family members so the child loses “face” along with having problems pointed out. With her own children, the mother figure is so fixated on who she wants her daughters to be, she does help them be successful based on their own skill sets. Instead, she forces them into roles where they are destined to fail.
• One of the greatest tools we have as adults is to model safe expression of feelings, collaboration, value of each person, and respect. With each interaction, we teach children that relationships can be mutual and loving rather than based on power.
• One area that we hope can change is the treatment of people who are in blended families. There is a bias out there that somehow they are less capable or less healthy than families that have not had divorce. If the family has difficulties, problems can be blamed for being “step” and then left unaddressed, children can feel like they are destined to fail in future relationships because they come from a “broken home”, and families can feel second class. How can we as a society appreciate that families can be healthy and happy in many forms?

I look forward to hearing questions and comments to the information discussed. Together we can help create resilient kids and families through preventative measures. When bullying does occur, face it head on and help targets and bullies alike so they both get the help they need to have successful and satisfying relationships.

5 Logical Fallacies That Make You Wrong More Than You Think

When engaged in heated discussions, we often focus on what personal baggage we bring or what old messages might be getting in the way.  The following article, written by Kathy Benjamin, highlights that there are other biological factors to consider as well.  Many experts in social psychology have been aware of the phenomenon she describes, noting how these tendencies are used in war campaigning, advertising and politics.  (For example, see Elliot Aronson’s “The Social Animal”)  But Benjamin takes these concepts and beautifully highlights how they apply to our everyday life and tendency to believe what we want rather than work towards discernment.  By highlighting these points, we are being asked to be more thoughtful, more aware of our own biases, and therefore, more capable of engaging in open and provocative dialogue and possibly grow in the process.

There is some potentially offensive humor used, so if you choose to read this, please do so at your own discrecion: http://www.cracked.com/article_19468_5-logical-fallacies-that-make-you-wrong-more-than-you-think.html

Managing Holiday Munching

This is the time of year when there is more permission than ever to stuff ourselves silly.  There are parties that bring all kinds of culinary delights, neighbors toting plates of cookies and good cheer, and Grandma who made that traditional dessert from the old country.  One bite at a time, we take in extra calories without much thought, until the carols die down and the tree becomes a fire hazard.  Most Americans step on the scale and see that seven extra pounds are being added to the New Year.

The great news is that the dieting doldrums are not destiny.  If the season is approached with realistic goals and a plan of action, there is no reason you can’t enjoying reasonable portions of a variety of holiday delights.   To do this, we first need to know what we are dealing with:

• Food will be everywhere, often made up of ingredients hardest to resist- sugar, salt and fat.  It will also be limitless-, with the ability to pile on as much as our inner child can handle.
• Because food is presented as a gift of love, you may feel guilty if you don’t eat what you are given.   There is no reason why you have to eat the food in the moment.   As long as emphasis is made on the effort and love behind the gift, you can look forward to something special when you are hungry and have made allowances in your calorie intake for a dessert.
• There is a belief that “special occasions” mean freedom from portion control.  In this case, a special occasion might mean six weeks of uncontrolled eating!
• People don’t want to be confronted with their craving driven eating.  Therefore, you will be encouraged to eat how they want you to so they avoid guilt.  Body cues and healthy habits are easy to ignore when everyone else is over-indulging.
• You will be around people who are most likely to trigger you.  Emotional eating is often driven by distressing emotions we are trying to soothe.

Looking over this list, the idea of reasonable eating may seem absolutely unreasonable!  But do not despair- we can put the odds more in our favor!  Start by altering the environment- limit access.  Talk
to friends away from the finger food so you have to walk across the room to get any morsels.  Once dinner is served, keep food in one location and off the main table so easy grazing is not possible.  If a second helping is desired, it requires a commitment.  Instead of simply reaching over and grabbing the serving platter, the consumer must travel.  An added bonus is that this makes it much easier to count the number of servings taken.  Even better is to remove the option of a second trip.  This simple internal boundary will help you manage what is on your plate the first time, promote greater control over portion sizes, and avoid the mind’s tendency to linger over more ways to get stuffed.  If the buffet style is not an option and the food is close by, keep platters around you that are less seductive like green vegetables or the gravy boat.

Then address factors that help override normal body cues:

1. Wear tighter clothes with buttons and belts
2. Sit next to people who share healthy eating habits
3. Use your salad plate as your entrée plate
4. Eat only when you are fully aware of what you are putting in your mouth.  Regularly check-in to see how full you feel
5. Commit to how much food makes sense
6. Slow down.  It takes twenty minutes for the message “full” to get from the stomach to the brain.  The lag time allows for a lot of unnecessary calories.
7. Watch out for taking “tastes” when it comes to super sweet or fatty foods and alcohol.  It is theorized that one bite leads the sensitized brain to a binge, terminated only when sufficient
   serotonin activity is reached (which can be thousands of calories later).
8. Have one serving of a given category (meat, starch, vegetable, dessert) rather than a sample of everything.   Choose one item and if any feelings of deprivation rise up, remember there will be opportunities to eat the other options at future meals.
9. It is more important to take care of yourself than be polite!  If they aren’t responsible for what goes on your hips, they have no say over what gets on the lips.

With these strategies, it is more than possible to enjoy the holiday without feeling deprived, but also without engorgement and unwanted weight gain.  With food needs in balance, there will be more room for all the other joys the holiday has to offer.  Here’s wishing you happiness, meaning and beauty this holiday season and throughout the coming year!

Thought for the day

I have heard many people despair that they feel afraid about something and then conclude that they are weak or somehow less than. Fear is a natural emotion that surfaces when stepping into unknown territory, facing something without enough tools or resources, or there is a lack of safety in some way.  This reaction is a call to action to be cautious and take precautions as much as possible.  Therefore, fear can be informative, motivating, and protective.

Where fear becomes problematic is when it creates avoidance and limits opportunities by closing doors.  They key is to listen to what the fear is saying but work against the knee-jerk reaction to avoid dealing with the situation.  Many times, it is moving into and through the fear that causes the greatest healing, growth, and potential for change.

“Courage is not the absence of fear, but rather the judgement that something else is more important than fear.”   (Book- Life Unlocked)

Impacts of Managed Care on Therapy

Impacts of Managed Care on Therapy

Even though health care is a hot topic, people often lack awareness of how policies directly affect them.  “Behavioral health” (a.k.a. mental health insurance) is no exception.  Rather than being put off guard by unexpected impacts, the following is an overview of some main issues that surface when an insurance company becomes part of your therapy.  Armed with information, you can then make an educated decision about utilizing insurance benefits or paying out of pocket.

Background

The relationship between managed care and therapy has changed over the last thirty years.  Back in the 1980s, therapy was seen in a positive light where people could address concerns when life threw a curve ball and generally provide enhancement that would lead to greater overall satisfaction.  Once managed care became involved, this focus shifted to a medical model of necessity.  Clinicians now needed to find a diagnosis for the “problem” and demonstrate how this was to be addressed.

Impacts

With this new approach, many facets of therapy have changed, not just how services are paid for:

Confidentiality

Insurance companies require a therapist to provide personal information for reimbursement.  This includes a diagnosis, services rendered, and the duration of treatment.  Because they also have case management to determine medical necessity, they may also request access to case files for specifics about the treatment plan and other sensitive information.  For ethical therapists, there are concerns about the impacts on clients:

1.  Providers are unable to control how the private information is handled once it is in the hands of the insurance company.   It is unknown what kind of information is accessible and to whom, what policies are in place that protect client rights, etc.
2. It is common for managed care entities to allow outside parties access to information.  For example, if the insurance company is contracted through an employer, the human resource department might receive information about services rendered.  Certain government entities may be allowed access as well as contracted companies for running statistical analysis.  The use of this information is beyond the control of both the therapist and the client.

Utilization of therapy

Managed care requires there to be something wrong (pathology model) to justify the expenditure.  Many people have come to believe that the need for counseling suggests they must be mentally unstable or weak to need help.  Therapy is a place for privacy, but it should never be something to be ashamed of.   Many times, individuals come into counseling for support, to increase skills to deal with difficult situations, or to address issues before they become unmanageable.   These instances do not suggest mental illness; rather, it highlights that there are times when help is needed to face the complicated challenges life brings in a healthy way.

Stigma that may have long term impacts. 

Some of the above mentioned fear is not without merit.  Our society continues to have detrimental assumptions about mental health, and these have wider impacts than just self-esteem.  There are documented cases of individuals being denied insurance (home owner’s, life/term) due to participation in counseling.  I am aware of one person who was overlooked for a government promotion requiring security clearance and another person who was almost denied entrance into medical school because background checks revealed utilization of mental health services.   There is also the problem of pre-existing conditions which impacts the accessibility of not only services but also medications.  The new health care law will hopefully address this last point.

 Limiting Access to Providers

Part of the cost-containment strategy is to contract with individuals willing to take a reduction in their fees and comply with the insurance companies policies.   There is no guarantee, however, that they will have someone on the panel that has the necessary expertise to address a client’s needs.  A colleague of mine highlighted that you may by a pair of shoes on sale but they are little good to you if they leave you with blisters.  The therapeutic relationship is similar; it is important to find the right fit so the money is invested wisely.

 Determination of treatment

For those who are in-network, they may not always be able to practice in the way they feel best suits the client.  Dr. Miller (1998) expresses concern that utilization reviewers often lack the expertise to challenge a course of treatment.  He writes, they “often have merely a bachelor’s degree or a master’s degree with limited experience. These reviewers routinely overrule and change the treatment decisions of greatly experienced specialists with a master’s or doctorate degree.”  In addition, without any knowledge of the client’s context or the dynamics that surface in therapy, they are lacking vital information that significantly impacts treatment decisions.

 Fewer benefits than regular health insurance

In many cases, the financial benefits do not outweigh the risks.  Some insurers do not offer any mental health coverage; others have high deductibles that must be met before the benefits take effect or have co-pays that are little reduction in the cost.  There is also a common practice of limiting the number of allotted session, regardless of need.   This means that services are based on fiscal impact rather than what is best for the client.

At this time, there are five major insurances and a few smaller entities providing coverage for the five million plus individuals in Colorado.^[i]  Each policy has different coverage so it is impossible for a provider to know any specifics without talking directly to the insurance company about the individual plan.  If you want to go through your insurance, know that some policies offer coverage only for providers they are contracted with, while others provide coverage for both in-network and out-of-network.  Most agencies have a customer service number on the back of the insurance card or a website where the benefit plan can be made explicit.

Utilizing insurance is a highly-individualized decision.  Be an informed consumer! Know your rights, determine the cost-benefit ratio, and ask questions.  That way, you can make a choice that right for you.  Once determined, you can then focus on your needs rather than on whether to use your insurance plan.