I have made the conscious choice not to work with the managed care (ie. insurance) industry in my practice. While sometimes frustrating to new clients, this was not a poorly conceived choice but, rather, a decision made after long and careful deliberation on my part. As we shift into 2014 and the true emergence of the Affordable Care Act, I wanted to take a moment to offer some clarification as to why I have decided not to accept insurance from my clients in favor of a fee-for-service model.
My goal is to assist others in empowering themselves and coming into greater contact with the world around them. I have invested significant time and energy in my training and personal development in order to be the very best I can be at offering my services. Yet, far too often, clinicians working in the managed care system are expected to provide only the minimum of care to clients and to complete treatment in ridiculously short periods of time (at times only being authorizing to conduct six to eight treatment sessions).
In addition, managed care staff often seek extremely detailed and intimate information about clients and the content of psychotherapy sessions in order to approve (or deny) treatment. This information is entered into a computer database, the security of which is beyond my (or my client’s) control. I have deep concerns that this deeply personal and confidential information can easily be available to others within and beyond the managed care organization, shared with other insurance companies, or even sold to (or hacked by) unrelated parties.
Case in point, the federal government and insurance industry has developed a national database of medical and mental health records, in which your managed care records are stored. Regardless of intention or regulation, there is no way to tell how the information from the national data bank will be utilized. I habor concerns that client information could be used for the benefit of health or life insurance companies or employers who are highly interested in any history of information about your health so that they can protect, manage and assure their own future profits and interests.
Most managed care companies do not allow individual clients the freedom to choose their doctor or therapists. Instead, they require you to choose from a list of pre-approved providers. In the realm of psychotherapy such providers often qualify for managed care panels only if they agree to provide short term care (perhaps as short as one to three private sessions), are willing to accept low fees for services, agree to share confidential client information with the managed care entity, and are willing to give up control of clinical decisions to administrators and CEO’s rather than their own skilled judgment.
Because of this, I have chosen to work beyond the bounds of the managed care world. I endeavor to keep my fees as reasonable as possible, in order to provide quality and compassionate services to the men and women of my community.
In decades past, psychotherapy was a deeply creative, at times radical, re-imagining of human well-being, growth and potential. Therapists and clients engaged in a rich dance of vulnerable uncertainty, balancing trust and risk-taking in a creative and idiosyncratic push for change, insight and growth. However today’s therapies are, sadly, far too lacking in such elements. Rich Simon, editor of Psychotherapy Networker notes, “Today's treatment is more and more shaped by predetermined DSM categories and empirically validated, standardized treatment protocols from which deviation isn’t welcomed, if even tolerated. Part of the reason is, of course, that old bugaboo—the power wielded by insurance companies, who eye any treatment approach or idea that strays off the reservation with deep suspicion or outright rejection. But another part of the problem is that we live in cautious times with heightened concerns about HIPAA guidelines and confidentiality, making it much harder to actually see therapists at work who inspire us to push the boundaries of the familiar and show how to engage clients with a spirit of daring and invention."
My practice is dedicated to a reclamation of what therapeutic counseling was, and again could be: A radical, compassionate, growth promoting opportunity for individualized personal change, insight and relief from the alienation and neurosis that sadly plagues our experiences in the modern world free from the dictates of corporate and governmental interests. My clients deserve (and generally demand) no less.
Cheaper Is Not Always Better. Managed care may offer a lower financial cost upfront, but, as outlined above, you may be paying a high price behind the scenes.
Consider Paying Out-Of-Pocket For Your Psychotherapeutic Counseling. Your emotional health and well-being is too valuable to leave in the hands of managed care for-profit companies or governmental agencies. Demand that what you disclose in therapy remains private.
Education. For additional resources, visit the National Coaltion of Mental Health Providers and Consumers at www.thenationalcoalition.org
In times of stress and uncertainty, as we rush from one indoor location to another, it can be easy to become “ungrounded”—to lose that deeper connection to ourselves and that which supports and nourishes us. When we are ungrounded we tend to feel anxious, depressed or uneasy. Often, it is hard to put a finger on what is “wrong”.
There are many ways to ground and center ourselves at such times. Taking a deep, slow breath and scanning our bodies is a start. Beginning at the top of your head, be aware of the physical sensations present, then slowly guide your awareness down through your body…your face, neck, shoulders, arms, chest and back, hips, legs and feet—simply pay attention as you scan. And breathe. What do you become aware of? This isn’t about changing anything, it’s about connecting with yourself. When you reach your toes, take an extra moment to bend your knees slightly and, with a slow, deliberate breath, gentle bounce up and down for 20 or 30 seconds. Allow the bounce to be soft and rather subtly. Imagine that any anxiety or unwanted sensations are being knocked loose from within you and falling to your feet where they are expelled into the ground.
Another manner of grounding connects you, not only internally, but externally but assisting you in re-linking with the land that ultimately supports you. When climate permits, take off your shoes and socks and head out-of-doors. Walk on the bare earth…feel the grass under your feet, or mud squish between your toes. Breathe. Really allow yourself to experience the sensation of being connected to the earth. Imagine your stress, your worries and cares are draining down through your body and pouring out the soles of your feet into the ground and descending downward even further, where they are released and composted into something else.
A third method of grounding that can be utilized during times when the climate (or your comfort level) won’t allow you to walk about barefoot, is to approach a tree. Approach with awareness and respect. Breathe (see a theme here?). Pay attention to your physical experience as you come closer to the tree. Again, there is no need to change anything, simply be aware. Reach out and place your hands on or around the tree trunk (that’s right, I’m encouraging you to hug a tree). Pay attention to the feel of the bark under your hands and the sense of contact between yourself and the tree. Then give your attention to what cannot be seen. Visualize the inner world of the tree, the delightful way in which it is rooted into the landscape and the marvelous and efficient manner in which it’s deep roots draw sustenance from the earth. Lean forward against the tree and once more breathe deeply. Imagine your feet sprout roots that dig down into the deep layers of the earth as well. As you breathe, imagine the power of the land is being drawn upward into the soles of feet and then fills your whole body with relaxed power. Allow this visualization to continue for as long as feels appropriate, then allow the image to fade. See the roots from your feet draw up into you once more. With a final breathe, give thanks and go back about your day.
These three exercises can be done individually or together as your time and desire allows. However you have engaged with them, be sure to pay attention as you go back about your day? Has you experience of anxiety or unease shifted? Let me know!
“It is no measure of health to be well adjusted to a profoundly sick society.”
We live in a culture awash in toxically confluent sentiment and behavior. What is that, you ask? Confluence is a state of being wherein an individual experiences a complete lack of boundary between his or herself and another. The person in a state of confluence cannot tell what he or she truly feels and is unable to differentiate their own wants, needs and experiences from that of another. Turn on the radio and chances are good (very good) that you will hear a song detailing the drama, and likely extolling the virtues, of confluence.
Make no mistake; confluence has its role in human existence. After all, what is the spiritual experience if not a dissolution of boundaries and a joining of the individual with a greater whole? Or the union of lover’s in passions intimate embrace? The problem arises when an individual becomes trapped in a state of chronic (what I am calling “toxic”) confluence, unaware of the boundary between him or herself and another. Unable to make true contact (and equally unable to retreat or withdraw into him or herself) the individual suffers.
The chronically confluent individual places a lower priority on one's own needs, while being excessively preoccupied with meeting or controlling the needs of others. Because our culture has made such a virtue of condependence and confluence it can be very difficult to differentiate true empathy and compassion from toxic confluence as the intentions may frequently appear similar. However, empathy and compassion promote connection, mutual respect and clear communication. Chronic confluence, on the other hand, is chatacterized by denial, excessive compliance, manipulation and control. In a person's speech pattern, confluence can be detected by an over usage of the term "we" rather than "I" as the chronically confluent person attempts to speak for all instead of for self.
“Love and violence, properly speaking, are polar opposites. Love lets the other be, but with affection and concern. Violence attempts to constrain the other’s freedom, to force him to act in the way we desire, but with ultimate lack of concern, with indifference to the other’s own existence or destiny…We are effectively destroying ourselves by violence masquerading as love.”
If you think that you might be operating from a place of chronic confluence, here are some considerations:
When you are in contact with another, how do you feel (both emotionally and physically)? Is your body tight? Is there rush of energy accompanied by panicked or anxious feelings without clear cause? Do you feel a need or desire to control the actions or words of another? Or is your own sense of well- being dependent on the actions and words of another?
If so, you may be entering a place of toxic confluence. Check your intentions. Are you engaging in a way that is clear and direct or are you acting in a manipulative manner? Can you take a breath, then clearly state your true needs, wants, desires or fears to the other? Or are you taking on a role of victimhood or martyrdom? If so, what does that do for you?
Do you feel like you have a choice as to whether you engage with this person or not? Where are you in the moment? Are you valuing yourself as much as you value the other?
Can you take responsibility for your own emotions and allow the other to take responsibility for their own? There is a distinct (and often subtle) difference between being supportive of another and being obligated to another. When the individual takes on the responsibility for another's moods, feelings, decisions or actions, it shifts the relationship from one of openness and respect to manipulation and control.
The distinction between compassion and empathetic engagement with another, and chronically confluent codependency can be blurry. As always, awareness and honesty can help you live a more balanced, contactful life.
Bryan Dieterich, MA, LPC