Mental Health Awareness Month Post Again

I posted ten days ago that I wanted to discuss mental health issues for May’s Mental Health Awareness Month by listing ten random topics rated to Mental Illness and Health. This post aims to finish off this goal with six more such short discussions.

5. Alternative Medicine and Alternative Approaches: These can work alongside the more traditional Western Medical Model Approach of medication coupled with psychotherapy. These alternatives include massage, Reiki, acupuncture and acupressure and other forms of body and energy work, including regular yoga classes, regular meditation, and/or individual yoga therapy. In addition, regular exercise and healthy diet have been shown to play a big role in altering brain chemistry, especially anxiety and depression. And I don’t think there is one kind of diet out there that works for everyone. Ayurvedic Medicine has an interesting approach to nutrition in terms of not seeing food divided into good versus bad; as with most substances, almost any food or beverage can be used well or abused. In Ayurvedic Medicine, there are 3 “doshas” based on a lot of criteria, and for each category, healthy food is very different. A person with a lot of “pitta”, the fire dosha, needs to avoid spicy foods and eat cooler foods while a person with a lot of “vata” needs to eat heavier foods to ground themselves. The other dosha, Kapha tends to need lighter foods. When i had my dosha diagnosed as very “vata” I was pleasantly surprised to learn that my tendency to eat a lot of ice cream isn’t so bad in moderation. This food that’s on the heavy side would not be great for Kaphas. Anyway, I’m not an expert on this, I just find it interesting that the philosophy behind it relies on the idea that different kinds if foods are better for different people. Also I definitely ascribe to the belief, “if it ain’t broke, don’t fix it.” meaning that if a person stumbles on a good combination of treatments, say, an anti depressant that works, weekly massage therapy and yoga classes, moderate exercise and Reiki added on when symptoms arise, go for it! Keep doing the self care that works for you. his person may have had enough psychotherapy and be in a period is working on their mind body connection through these alternative treatments. Even approaches to treatment can be seen from an Ayurvedic point of view: “pitta” people like structure and discipline so the above treatment plan would work for someone like that whereas a more vata person would not take on so many forms of treatment and might do one thing or two for a while and then switch to something else….google Ayurvaduc Medicine and read about it. It’s a fascinating approach to healing that is way older than Western Medicine…

6. The DSM V: wait another year and then fork out your $80 for it and it will finally be here in May 2013! It’s the Diagnostic and Statistical Manual for Mental Disorders, fifth edition. Some new disorders under consideration include binge eating, hoarding and hyper sexuality; substance abuse now termed “dependence” will maybe be considered an addictive disorder. Non-suicidal Injury Disorder and Suicidal Disorder are under consideration. Of course there is controversy on all of the proposed changes…

7. Hoarding seen as a mental illness: as with all behaviors, the quantity, frequency and dependence on a non healthy behavior is usually what tips it into mental illness from plain old eccentricity or just pretty “normal” behavior”, eating emotionally for a few days after a breakup, having a fee drinks every once in a while, punching a wall once when enraged or throwing your cell phone… Many people hoard without it becoming pathological but sometimes moderate hoarding behaviors co occur with ADHD and depression in adults. I’d be interested to know the role of trauma in extreme hoarding behaviours. When hoarding gets to an extreme, the individual tends to engage in and display a lot of distorted paranoid thinking and fantasies, as well as overwhelming feelings of abandonment and social anxiety and phobias. “Don’t leave me, but don’t come too close to me, and don’t touch any of my stuff or move it around. Don’t come in my house; if I leave someone’s going to mess with my stuff so I’ll stay here. You’re trying to get me out of the house so you can take my belongings away…” Binge eating can also go with hoarding for obvious reasons. I see hoarding could be considered a sort of obsessive compulsive disorder, definitely a phobia and form of social anxiety, or a paranoid delusional one or even a form of addiction as well as part of PTSD… How complicated!

Alright it’s almost 1 am here! Time to stop and I’ll put the next three topics in my next post before May is over!!!

Advertisements

Money and Therapy; A Very Confusing Topic

I just wrote a long draft for this post, and it disappeared, so I am very frustrated. I will try a shortened version of what I had in mind.

I started by describing a lot of potential scenarios (in private practice as opposed to clinics or training institutes or agencies) for therapists and patients to raise questions such as the following:
1. What is it about the exchange of money for therapy that directly affects the therapy?
2. With insurance companies often paying the bulk of your therapists fee, does your copay to your therapist hold any meaning for you or your therapist?
3. Is there such a thing as too low or too high a fee?
4. What does it mean for the therapy for a patient to be paying a very low fee over a long period if time due to real financial hardship?
5. Is the therapy compromised or changed when an outside party such as a parent or friend pays for all the therapy?
6. What is it like as a therapist to be mistakenly seen as very wealthy by your patients due to some misconceptions about therapists in private practice and their incomes?
7. What is it like for a therapist to have a patient who makes over twice the therapist’s income?
8. Is it wrong for a therapist to let a patient who has money problems and is paying a low fee get very far back in payments to the therapist and owe months of therapy? Who should bring up the topic?
9. Is there something strange about this scenario: therapist goes to a supervision group and pays a monthly fee 30$ more than the fee s/he charges her own supervises in the supervision group she runs.
10. What makes most therapists say no to bi-weekly (2 times per month) instead of weekly sessions and what makes a few therapists accept this scenario as well as a low fee due to the patients’ financial hardship?

In the world of many therapists the whole topic of the fee and sliding scale and how to handle the negotiations of it is hotly debated. Some say if you don’t pay attention to the fee and how it is paid you are avoiding a lot of important issues. Others have a philosophy of really using the sliding scale fee and accommodating people other therapists would never work with. I confess I fall in the category of those, the ones who lower their fee to accommodate patients with little money and at times I accept a patient coming only twice a month. In most cases it is a patient who has been coming weekly for a long time but not always. There are other reasons I have accepted this type of patient besides money issues though I agree with most therapists’ opinion that much more can be accomplished with the regularity and structure of weekly sessions. I also would never run a supervision group that did not meet weekly as I think the group process works with weekly meetings and consistency and keeps the group functioning for support as well as clinical issues.

Many years ago I read in the New York Times magazine a profile of a British therapist. I don’t remember his name or why the article was on him but I do remember him saying, ” I strongly believe that therapy should not cost more than (don’t remember the amount but it was equivalent to about $80 which these days might be around $120 as this was written around ten years ago)…” anyway I was really struck by his point. He actually thought there was a limit to a decent fair fee for his services despite his education, training and experience. Sort of like saying an ice cream cone from a truck shouldn’t cost more than 3$. This was and is very unusual in our profession to actually say that it’s indecent to charge more than a typical amount such as $100-$120 per session as your highest rate. Putting a limit on the value of therapy. Most therapist’s focus much more on the difficult issue of, can this particular patient afford to pay my highest fee and if not what can they afford. On the patient’s side, I have seen people say I don’t want to pay you less than such and such as I don’t want you to feel disrespected so this is what I could afford to pay you.

I admit I had a conversation with someone about couples therapy and how insurance companies often pay too little for it. Yes, some therapists charge more for couples than individuals. The reasoning is that couples therapy is much more difficult to do, which I think is definitely true. In addition, most couples don’t stay in therapy that long with some exceptions. While it is not unusual to have a patient in therapy for five years or more, the average couple dies not remain in therapy that long. I could diverge into a discussion of couples therapy but that is for another post. I will add that it’s not unusual for a couple to go to a couples therapist and end up with one partner continuing with the therapist individually and thus stopping their couples sessions. It is one way people kind of accidentally find a therapist they like for individual…

Back to money. The idea of going to someone’s office to share intimate details of your life and expose your self in various verbal and nonverbal ways is hard for some people to wrap their head around. Usually the boundaries of not knowing much about your therapist helps with this scenario and makes the whole money transaction make more sense to most patients. I am going to a doctor of the mental, emotional and spiritual body so of course I am paying as I would for a doctor of the “physical” body. This is how I would explain the process to a curious and puzzled Martian.

People may notice they are sometimes treating their therapist like their mother (transference) but it helps to have the distance and strangeness of the personal information mostly flowing one way, from the patient to the therapist.

I admit or confess to sometimes wracking up a large bill with a patient who is on a low fee and having a very hard time confronting the patient about it. It certainly would be easier if the patient brought up the topic. Confronting someone who has a job they work hard at and are paid little for who has loyally stayed my patient when s/he could have found someone in network on their limited health plan and now owes me for quite a few months if therapy is not easy. I also have a patient who left therapy suddenly owing me about $300. She has paid off most of it but still owes enough that I need to chase after her every once in a while.

The majority of my patients not using their insurance pay me some fee lower than my regular fee and pay it on time.

The one insurance company I am in network with pays me a little more than half my regular fee. What does this mean? Probably that the insurance company undervalues my work in a much more insulting way than any patient is capable of doing. It says with your license, level of training and experience we agree to pay you almost half your fee. If course experience usually doesn’t mean much to the insurance companies nor do they raise your fee according to inflation and cost if living.

Raising your fee is another big topic which a lot of therapist’s struggle with.

Money and therapy: big topic to be continued in the next post!