Blog For Mental Health 2015

“I pledge my commitment to the Blog for Mental Health 2015 Project. I will blog about mental health topics not only for myself, but for others. By displaying this badge, I show my pride, dedication, and acceptance for mental health. I use this to promote mental health education in the struggle to erase stigma.”

This is the link to the official site for Blog for Mental Health 2015, and I congratulate them on the beautiful image that I was allowed to put in my side bar! I don’t know who drew it but I will try to find out:
http://blogformentalhealth.com/2015/01/30/blog-for-mental-health-2015/

I am very excited to join this cause. I think I can say that my blog is dedicated to educating people about mental health and well-being and calling out society on stigma and stereotypes that are untrue and damaging, as well as being committed to sharing the stories of others who suffer from any mental issues, disorders and people’s courageous roads to recovery through linking to other sites, re blogging great blog posts by people suffering and overcoming on the front lines and by telling my stories about my work as an art therapist, and showing the healing power of art through my journey as an artist myself and others’ finding hope and healing in the arts.

In my blog, “Musings of an Art Therapist/Artist”, I have featured stories abut mental health as well as what I said above, and the impact of art therapy and the creative arts on mental health and well being.

Like almost everybody else, I have personal experience with mental health and mental illness, and I am very aware of how dangerous untreated mental illness can be, having gone to a few terrible funerals of loved ones who died in the front lines/trenches. Luckily, I have witnessed a lot of wonderful transformations on the road to recovery, both of family members, friends and my own patients. Every day I witness huge miracles of survival, strength, resilience and recovery. I see people become healed through caring for their creative spirit as well as their mental and physical body. The work I do I conceive of as spiritual experiences. Or perhaps human experiences with spiritual beings. (Deepak Chopra: “We are not humans having spiritual experiences; we are spiritual beings having human experiences”) I am very humbled and honored in my work as an art therapist to be invited to be a witness and sometimes guide on people’s personal journeys of recovery.

As a therapists, I owe a debt of gratitude to the 12 Step Recovery Program, which has been a beacon of hope and support to many of my patients. I am grateful that I have been able to convince some of my patients to try out this program, attend a meeting, find spiritual connection with others going through similar struggles. It is often a struggle to encourage someone to go to a meeting week after week, but when the person does finally go and finds this miracle of community and mental health, it is wonderful to witness. The 12 Step Meetings of any kind, whether OA (Overeaters Anonymous), AA, Alanon, DA (Debtors Anonymous), or any of the other types of meetings, provide so much support and connection for people who feel isolated and alone on their journey towards well being. If mental health can be seen as a flower with many petals, art therapy is one of the petals, 12 Step can be another if useful, medication management coupled with a caring psychiatrist can be another one, yoga is often one of the petals, mindfulness meditation another, exercise another, making art, music, and other creative arts on your own is another, acupuncture, Reiki and/or other alternative therapies another petal, maybe this image helps one to see that it takes a whole flower or a “village” for mental health to continue to improve and be maintained. “Self-care” is so important to mental health and well being. For myself, this means making art daily, no matter whether it be 20 minutes or several hours, including making art with and alongside my patients; it also means doing my own yoga practice 4-5 days a week for at least half an hour a day, and a few other things. I say this to demonstrate that all of us need some kind of self-care. Quality time with loved ones is of course another form of daily self-care for me and many others.

I am happy to participate in this wonderful “Blog for Mental Health” experience!

For New York Creative Arts Therapists and the Curious: Insurance Information

Many art, music, drama, poetry, dance and other creative arts therapists in New York State, now that we have Licensing (thanks to the tireless efforts of NYCCAT: the New York Coalition of Creative Arts Therapists) want to know more about how health insurance works in NY, especially those in private practice, so this post is some clarification about what I know in my experience since I got licensed in 2005, when we first got licensing.

Before getting my license, I was operating a private practice without a license and not able to take any insurance from patients, so I was naturally more than excited to be recognized finally as equal to social workers and other psychotherapists. The license was far more meaningful in terms of respect for our work and for the creative arts therapies than about insurance reimbursement, but money is a big part of respect.

Having the license gave art therapists working in hospital and other settings the chance to be paid equal to other clinical practitioners. Those in private practice were able to use the license to get reimbursed by SOME health insurance companies.

At present, Cigna, Aetna, and United Health/Oxford are the health insurance companies which I have had good experience with, in terms of getting any reimbursements and having the ability to take on patients who wanted to use their insurance for therapy.  There is only a small percentage of such patients who would be willing to come to a therapist if their particular insurance would not reimburse, so this is pretty important for those who want to take insurance and want a large bulk of their practice to involve health insurance reimbursement. The reason a therapist chooses this is for building or keeping their caseload to a certain amount, not because it is easier!

Taking on patients with insurance brings many challenges. First of all there is the difference between in network and out of network reimbursement. Many people think it’s good to get on “panels” otherwise known as being an “in network provider”, which means that people who have that particular insurance can pay you a copay for each session, which is usually the part on the member’s insurance card that says “Specialist” and then an amount, which usually ranges from 0-$45, sometimes $50. People with the same insurance can have a range of copays, so if you are in network with Cigna, for example, you may have a patient who has no copay at all and no deductible in network, in which case, you usually have to fill out the 1500 claim form and submit it to Cigna and wait to get paid. You may have other patients with copays. With Cigna, if it isn’t 0, it ranges from 25$-45$. The advantage of a patient having a high copay is simply that you get paid quicker, as the fee you get per session is exactly the same no matter what the copay. A patient got the mistaken idea that when her copay went up, at least I was being paid more, but I explained to her that I get the same $67.93 per session no matter what amount she pays. This brings up a big disadvantage with being an “in network provider” with an insurance company. The fee is set and you have no say about how much it will be per session. For every individual session you get paid the same amount. Most insurance companies don’t seem to raise the fee properly every year to account for adjustment in cost of living. In the many years I have been in network with Cigna, and paid $67.93 per session, this year was the first year Cigna raised the individual therapy session fee to $71!

So one advantage of being in network is that most people do not have mental health or medical deductibles in network. However, this seems to be changing a lot, and is an important thing to check out when you get a new in network patient. The reason for this is the following: a patient comes and only has one or maybe 5 sessions. They pay you the copay as it says on the card. You submit the claim to the insurance company, only to find out that the person has a deductible of $600 if you’re lucky, or maybe $2000. This is most problematic with someone who comes one to 6 times and then stops, as you get stuck chasing an ex patient for money they now owe you. I have two of these situations going on. In one case the first session which insurance companies pay more for, Cigna pays $150 for the initial session, so I’m stuck texting and leaving messages with this patient that came once. It’s been at least 6 months now and she still owes me $150. In another case, the patient came about 5 times and owes me for those sessions. Through numerous emails and texts, I finally got this patient to start a vague payment plan which is already imploding. I don’t remember how much the patient owes, but it is probably about $300 or more, and I still don’t have it.

Another problem with being an in network provider is that insurance companies have all kinds of strange deals with agencies and schools, which may not be obvious until you have submitted a claim. I have a terrible situation going on because one of my patients had a very confusing plan with Cigna due to the school the patient is affiliated with. I am used to submitting claims to one Cigna fax number and then following up with a phone call to make sure the claim is processing. (Another part of the annoyance of dealing with insurance in network and out of network, paperwork, submitting claims and following up to make sure the claim is processed and paid, a very frustrating and time consuming activity that basically sucks and makes you want to scream at the poor customer service people who have the terrible job of dealing with irate providers all day. So in this weird case, it took a few months to even figure out that I had submitted the claim to the wrong place and faxed it to another place which was incorrect as well, or sent it in the mail. I finally through a few frustrating phone calls and looking again at the patient’s card, found an address to send the claims to. These claims now represent about 18 sessions from January to June 2013, and I have not been paid a cent by Cigna. Through more phone calls to different numbers and getting claim statements in the mail that my claim was being processed, I found out that the institution that handles the claims is waiting for a price quote from Cigna. I won’t go into further detail about this, as it is obviously incredibly frustrating to imagine not being paid for about six months of sessions! The only way to avoid this kind of disaster is to look very carefully at the patient’s insurance card the very first time s/he comes to a session to make sure you have all the info, not just the ID number and the usual stuff but look at the address and contact info and see what kind of Cigna or whatever insurance it is and what it is called, as the companies are huge and have all kinds of subsets of different arrangements.

Also, if you have longterm in network patients, watch out for the new year, which is when their plan could change drastically; the copay could go up or down, and there could suddenly be a large deductible, which, depending on the patient, could drastically change whether or not s/he even is able to continue therapy. Also in July, some employers change things around and have their fiscal year start over, so that is another time when you could suddenly find out your in network patient got their insurance switched to another insurance. It just happened to me with a patient, but luckily I take the other insurance out of network, the deductible was low enough and the patient is invested and ok with these changes…

OK: Out of network, advantages and disadvantages…: As an “out of network” providor, you set your own fee, which is really great, believe me! It means I can finally charge my full fee! The insurance company, if they pay your particular type of license, will pay you a percentage of that fee, and the patient pays a “coinsurance” fee which is the rest, and can range from 50%, not so great, to lower. Of course the more the insurance company pays, the better, and the more likely your patient is to be ok with having you as an out of network provider. Most therapists have these patients pay the fee in full and then they submit the claim to the insurance company, and the insurance reimburses the patient. Of course, being in NYC, and being a “nice” therapist when it comes to these things, as most of these out of network patients tend to be students, often either Aetna or United Healthcare, and as such, they cannot pay up front unless I am lucky enough to get a student whose parent pays me directly, anyway, I usually end up just submitting to the insurance and then either having the patient pay part of it or none of it until the insurance company sends the check to me directly for their portion of the fee. So this can be tricky, as there are many patients who don’t really want to have to pay up front, and given the choice, would just find an in network provider so they could simply pay a low copay. As an LCAT, I am paid out of network by as I mentioned above, Aetna and United Healthcare/Oxford. Blue Cross Blue Shield and GHI do not pay LCATs otu of network, so you cannot bill them. I have some patients who have Blue Cross, for example, who are committed to working with me and just pay me on my sliding scale. This is one of the good cases of not being able to take someone’s insurance. You get paid by your patient and don’t have to submit claims and waste time with insurance companies.

In addition, you don’t have to figure out a diagnosis for the patient, which in some cases is a big relief, as it can be tricky figuring out the right diagnosis for some patients. Not everyone has an obvious depression or anxiety disorder, which is most common for private practice, and some people present with symptoms that do not fit any particular diagnosis very well, so putting down the number for the diagnosis on the claim form is another big important potentially headache making part of taking insurance. Luckily in most cases with insurance the diagnosis is obvious; it is especially helpful when someone comes in who already takes prescribed psychotropic meds, though that is not always an obvious pointer to the diagnosis. There are no particular meds usually for such disorders as the skin picking or hair pulling disorder, which are now included in the chapter on Obsessive Compulsive Disorders; it could take a long time to even find out that your patient has such types of symptoms.

Anyway, I digress. All this is to say that people are wrong when they say to wait until your patient walks in the door to discuss fees. This is an old fashioned out dated point of view. It is actually much easier and usually you have no choice about it, to figure this out in a phone conversation or by email before your patient comes to you. I had someone come in only to find out that I did not take her credit card which she was using for all medical fees with Cigna. I was not sure she would find many therapists who would take her credit card, but maybe some therapists out there have started taking credit cards. Anyway it was a waste of her and my time. Sometimes it is clear that the person will not be using their insurance and in most of these cases I do wait to meet them to discuss fees. However, it is much easier to figure out what’s going on with insurance payment right away, especially with non Cigna patients.

In most cases, the patient does not know much about their mental health benefits and needs to be guided to contact Aetna or United or whatever and ask the following questions and then call you back if they find out they can work with you or figure out what they want to do about the fee:
Do I have out of network benefits for outpatient mental health providers? Is there a deductible? How much is it? What percentage of the providers fee does the insurance pay and how many sessions are covered? The last question is very important, as some companies only cover 20 sessions. The average used to be around 32, but now it can be as low as 20. Supposedly, insurance companies are not allowed to limit sessions if the patient has what is called a “biological disorder”. As far as I have found, that only refers to a few diagnoses, depression and bipolar disorder, schizophrenia and maybe a few others, but no anxiety disorders are included. I’m not sure about PTSD. However, even this “rule” seems to not be followed by all health insurance companies…

 

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In addition, Medicaid and I think Medicare patients get no reimbursement for LCATs, so you either have to charge Medicaid patients a super low fee and consider them to be your “Pro Bono” patient, which I have done in rare cases. In my experience, it is worth it to do this when you have a very interesting kind of patient and the work is extremely rewarding and different from any other kind of work you have done. One of my most transformed patients is such a person, and it is one of the most rewarding experiences I have had recently in my private practice. As they say, great things come in small packages, ie. low fee!
This sums up most of the important info I have garnered from my experience as an LCAT in private practice dealing with insurance companies. There are also a few patients I’ve had who had only in network benefits but as their copay was $50, I was able to make a deal with them to pay around that much and not use their insurance…

Also, with art therapy groups in private practice, check with the insurance company what the rate is for that, because it is usually much lower than for individual therapy. Cigna pays only $40 per group session, for example.

Note to LCATs out there: as far as I know, Blue Cross, Medicaid and other insurance companies that limit their reimbursement to psychiatrists, psychologists and social workers do not care about the benefits of art therapy or other variants of creative arts therapies and there seems to be nobody to contact who would have any influence whatsoever on whoever decides what professionals to reimburse or not in NY state, so I would not waste time with individual companies trying to convince them to start paying us. Probably the more politically active among you may know which politicians or other organizations to work with to lobby or promote paying LCATs, so that is a great thing to do, but the insurance companies themselves do not care and are such huge beaurocracies, you might as well bang your head against the wall rather than waste any time trying to change their policies…
I hope this proves helpful. Please feel free to comment and post further questions which I will try to answer…

Pinterest is Really A Form of Art Therapy!

I only started using the social media Imagery site called “Pinterest” about six months ago. I have not fully immersed myself in it and really participated regularly, but yesterday I was looking on a site and saw a bag I liked and “pinned” it to one of my boards. Then some time later I was still thinking about Pinterest and thought, “Wow, It really is similar to a certain kind of art therapy, how fascinating! I’ve got to blog about this discovery!”

To begin with, here is Wikipedia’s description of the definition and origins of Pinterest. I usually attempt to find other sites to cite on my blog but once in a while I find Wikipedia is best at doing the descrtiption and especially history and origin of some kind of phenomenon… I was surprised to find that in its beginnings the originator was interested in keeping it very “closed” and private and even wanted to talk and meet with its users. That strikes me as really a nice way to start a social media site, and I was quite surprised as right now, June 2013, is about 3.5 years since the development began.

“Pinterest is similar to earlier social image bookmarking systems based on the same principle, such as David Galbraith’s 2005 project Wists.[3] It allows users to save images and categorize them on different boards. They can follow other users’ boards if they have similar tastes. Popular categories are travel, cars, food, film, humor, home design, sports, fashion, and art.
Development of Pinterest began in December 2009, and the site launched as a closed beta in March 2010. The site proceeded to operate in invitation-only open beta.
Silbermann said he personally wrote to the site’s first 5,000 users offering his personal phone number and even meeting with some of its users.[4]
Nine months after launch the website had 10,000 users. Silbermann and a few programmers operated the site out of a small apartment until the summer of 2011.[4]
Early in 2010, the company’s investors and co-founder Ben Silbermann tried to interest a New York-based magazine publishing company in buying Pinterest. The publisher declined to meet with the founders.[5]
The launch of an iPhone app in early March 2011 brought in a more than expected number of downloads.[5]”

For those of you interested in the future of Pinterest and where it may be going with marketing and trying to get more traffic and interest businesses in it, I found a good link:

The State of Pinterest: What Content Marketers Need to Know Now

I was actually just trying to find out how many users there are currently. As of mid may there were 11.7 million Pinterest users, which was behind of course Facebook, Twitter and LinkedIn, the other big social media sites. The surprise data reported was that people were giving Pinterest and Facebook the same amount of their time when on the sites! Here is that interesting report on this data:
http://www.mediabistro.com/alltwitter/social-media-users_b22556

Ok. Moving on now that I’ve explained a lot about it the most common types of investigation of Pinterest, that is, looking it as a social media site and phenomenon and also slightly related to a lot of shopping/fashion social media type sites where people post items of things that consumers can actually buy, as Pinterest is a cross between a kind of personality identity statement and a kind of gathering of consumer generated images, which is probably where they are going in terms of the Pinterest people looking to the future in marketing and development.

My discovery when I was musing about it had to do with the concept of simply “picking out images of anything that you like” which also translates to, in my words: “express yourself in images more than words, by looking at all there is in the known universe and finding what you love to do, look at, want to do in the future, have already done, or images that express an important aspect of who you are, including mostly images of things that are generated by others, either some photographer who put this image on the internet, or some piece of art work by someone else that you like, or your own image of something personal to your life, including, of course, your own art work…” On my own Pinterest, I have not really paid so much attention to what I do and how much I pin as I do not do it often enough, though, just as with Facebook and LinkedIn, and perhaps Twitter. I expect to follow the same pattern of checking out the site and going on the site not too often, going through periods of more interest, and forgetting about it, until the magic moment when I suddenly really “get into” it and start “using” it not just more often but to its fuller capacity and participating in it more than the average user. With Facebook, it meant starting my own Public Artist Page about my Artist career, a few years ago, and just last year, with my launching of my Tribeca Healing Arts Website, I launched my Public Art Therapy page. Along with this, I was visiting Facebook a lot more frequently and joined some art therapy related groups, most recently the “Visual Art Circle” which I will discuss in another post. With LinkedIn it involved posting more, connecting more, and joining about 50 groups, both Artist and Art Therapy related.

So probably like a lot of other people who blog, have a website and Public Facebook pages and participate in LInkedIn and are into social media, Pinterest is sort of an after thought, and given that all this Social Media stuff, whether personal or mostly professional, including blogging, takes up a lot of time, Pinterest was lowest on my time factor and still is.

As I defined Pinterest above, it is based on a very simple principle that is connected to art therapy, which is that people enjoy images and their non verbal power of communicating about themselves and the world, and that images have a lot of power, and that images are enjoyable; nvesting in expressing oneself through imagery is very healing and, here is a very important part of it — it is a great way to connect with other people and sometimes preferable to communicating just non-verbally!

Most non art therapist do not know that, among the principles of the healing power of art therapy is the idea that just looking at and sorting images as well as picking out images you like is therapeutic and a part of the art therapy process or even can be The Art therapy process which you choose to use to make contact with and engage with patients. With some client populations, certain individuals and also at certain points in the art therapy process, the therapist will use this style of intervention, which may involve showing an individual or groups a few boxes or container or files of “images”, often divided into categories, such as, art by interesting artists, images from nature and landscapes, images of people in various settings and from different ethnicities and cultures, and other such groups of images. The form can be through images the art therapist “pre cut” before the session or group. With the internet now available, the images can be from various magazines or from different websites on the internet, in which case, the art therapist prints out different images to fill these types of categories. In this case where the art therapist did this, what we call “prep work”, the art therapy intervention that is similar to the Pinterest process would be, “Look through these images, maybe pick categories that are appealing to you, look through and pick out images you like, or just images that intrigue you, and this can include images you don’t like or images that disturb you.” (By the way, this last part just made me think of adding a category to my personal Pinterest called “Ugly Images” which would be images I find disgusting, ugly, repelling, gross, unappealing…) Only that last idea does not seem to be what Pinterest aims at.

Usually most users approach Pinterest as a way to express their individual identity through images they love, like, are interested in, and positive about. I don’t imagine most users think to post images of things they find negative and disgusting, but in art therapy, actually, the “Ugly” image or art work can often yield a lot more discovery and information about the Self than what we are pulled towards. Whenever someone makes something they really don’t like, I take extra time to investigate with them its power and what it means to the person and why they hate it so much. In fact the “Ugly Art: Make something with colors you hate and try to make it as ugly and unappealing to you as possible” is a directive I am interested in trying out with people. (yet another post topic).

Anyway, Pinterest involves having “Boards” which are like bulletin boards that you “virtually” take a push pin and stick images on, but you have an unlimited number of these boards and can use suggested categories or invent your own categories. Until I wrote this post, my boards were in this order called:
“My Style, Favorite Spaces and Places, Stuff, Books Worth Reading, People I Admire, Cool Stuff, Bunnies, Art and Artists I Love”. You can have as many boards and thus categories as you want, I think! I have about 118 pins. I have now gone back on Pinterest and added the boards “My Art Work” and “My Past Artwork” and rearranged the order of the boards…

The reason I cited that info about my participation in Pinterest is that I did not think much about what boards I made up and wasn’t really invested in thinking of my own Pinterest as being an expression of where I find the most meaning in life. If I had approached it that way instead of casually, it would be the way it is now…This is to show that I approached this like other social media, attitude being “Looks interesting, why is everyone so into this, I will try it out but I don’t really have time to do it really, its not super important or meaningful, so I will just jump in without giving it a lot of time and energy”, then building up to, “Wow, I didn’t realize all the potential in this social media site, I’m going to give it more time and energy and shape it more to be useful to me and/or an expression of who I am.”

And so, I am going to try to invest a little more time and interest in my Pinterest, as I have not fully explored the potential of this particular social media. What makes Pinterest social, and thus a bit like a very large art therapy group, is that like with other social media, you can “follow” people whose images you like. Also, you can find “pins” (images to pin) which you like and decide to “repin” them from some other person you randomly found on Pinterest by looking up a particular subject. Also of interest about Pinterest, is that you can find images on other sites and often now have the option of clicking on the Pinterest logo to “pin” anything on the internet to your personal boards. You can find a lot of cool images on Pinterest itself by searching for a subject you like. Also, I receive weekly emails from Pinterest with suggestions of boards and pins to investigate. So the social part is “sharing” images with people and also “liking” them, similar to liking on Facebook.

I find the name “Pinterest” is itself interesting and inviting. The idea of a “virtual” online kind of bulletin board or group of boards that are unlimited in size for “pinning” images on is cool in the way that people sometimes find ways the virtual world can imitate the real world. If I had the time and space I would love to get pushpins and pin cool images on a bunch of boards, but it would of course not allow for unlimited images or the amount of sharing that takes place on Pinterest.

In fact, I actually do have a kind of “Board”, my Inspiration Wall in my new studio. I had one in my old studio too. I put up postcards of art by artists that I admire as well as some of my own images, and my new studio’s Inspiration Wall is actually on two little walls and for the first time includes an image I made with an artist friend,another form of art therapy, combining the studio visit with another artist with making art together…

I have not fully explored all the possibilities and scope of Pinterest yet, but I really do enjoy the connection with art therapy and the healing power of looking at images you like and feeling inspired or comforted or excited by them!

Great Video about Creativity!

Great Video about Creativity!

The artist who made this video, “The Art Soiree”, Natasha Reilly-Moynihan, has a great playful approach and shows it in different settings with adults and children. I am honored to be featured in my new studio talking about my “Quilt” multi-media project. Check it out!

Big News: Goodbye to Studio 307 on My Tenth Anniversary!

I have not posted in here recently until tonight when I added some photos to the last post on Altered Books. Anyway, the reason is that on Wed., Feb. 7, about a week and a few days ago, with just three weeks left of February which is of course, a very short month, I got stunned with the news that my landlord of 20 years was not going to renew my lease on Studio 307, where I make my art and work as an art therapist/psychotherapist, Reiki practitioner. Since I started in that studio on March 1, 2003, I have renewed my lease annually in February. As usual, I was not thinking about the lease renewal, as I am used to getting a notice under the door telling me to go to the management office across the st. and renew my lease. So I am not being “evicted”; I am simply not given the opportunity to renew my lease after 20 years of renting studios in that building. I started in 1993 with my first NYC art studio (not my first studio, which was actually in Paris, France, a tiny studio at the top floor of a building), on the fifth floor in Room 503. In 1998, I moved to the fourth floor to a slightly bigger studio in 408. I don’t recall if there was a window in there. So I stayed in 408 until I moved down to 307, my current studio, which is the biggest studio I have ever had. It’s about 346 square feet, but feels larger as the ceilings are so high. I have to take photos of the ceilings in there as I have been taking my “last” photos of the studio in the past few weeks and I will post some at the end of this post.

This was shocking and awful news for me, to be quite honest. Over these twenty years I have seen many people come and go. I have had several different kinds of neighbors next door in 308. I have been friendly with about 5 other people on the floor. The current people I know on the third floor and in the building were also shocked by the news, as I have been a great tenant. This is a commercial building but I have seen all kinds of people rent from there, not just visual artists. I knew one musician and have had quite loud neighbors. I have always been known as quiet,except for when there are several loud children in the studio, usually on the weekends. And I know an artist on the floor who regularly brings his two young daughters to the studio. There are lots of children who come to the building. There are no pets allowed but I have seen people bring their dogs there, and on 2 occasions in my ten years in 307, I had patients bring very tiny dogs during their sessions…

Anyway, I was certainly in no way ready to move out. My practice is in fact in process of growing by the month, and I am getting ready to start my art therapy group that I have discussed in this blog, but I am postponing beginning the group until I am in my new studio.

By the end of the day after hearing this news, I had spoken to quite a few people and looked online right away for studios in the neighborhood and elsewhere. I quickly found that most of the studios are listed on Craigslist, although I looked all over the place and also contacted my connections in the neighborhood. I also got a real estate lawyer to look at my current lease and advise me. As I thought, I found out that week from her that the landlord can do whatever he wants and is not required to renew my lease at any time or give the reason why the lease will not be renewed. So I have to get all my paintings and other stuff out of my studio by 4:45 on Feb. 28, 2013. At present I have exactly 12 days left of having the studio. While looking at other spaces, I worked on figuring out how to make sure I get my large two months deposit back. All these practical matters have to be attended to as I at the same time inform my family, friends and patients and supervisees that I am leaving the studio, and most of all, get used to the idea myself.

This is a big loss for me. I have become extremely attached to this studio which is far more than just a “work space”. In another post, perhaps I will look back upon all that has happened over the ten years of being in this studio. Suffice it to say that I have shed many a tear over this big “termination”. There is nothing like being forced to move out of your space that has been your heart and soul for so many years and that has seen so much creativity of myself and countless others, adults and children, family members, many friends, colleagues, patients and supervisees. Since June of 2008 I have facilitated supervision groups in the studio that are based on art making as a major form of processing clinical work. I could go on and on about what this studio means to me, but I will continue reminiscing in another post.

The good news is that I have a new studio around the corner on Franklin St. I have not yet signed the lease, but I expect to give my deposit tomorrow and sign the lease next week. I will have to paint the walls in the new studio, as they are a dark red and blue, but it’s an opportunity to “make it my own”. I’m thinking of painting one of the walls gold, as I love gold walls, and the new studio is significantly smaller by about maybe 90 square feet or so but even more so because the ceiling is very low, so it will seem far smaller than my current one. So I must embrace the intimacy of the new space while still figuring out how to continue to have groups of 3-6 members in there, which I am determined to do.

I was going to wait to sign a lease to give the news to the people who come to my studio, especially my patients and supervisees, but I realized there is not much time left, so by mid Tuesday, I started telling people and continued through my last patient on Friday at 7pm.

More to say about the wonderful support of everyone who has walked into the studio this week as well as the many friends and family members who have been talking to me all week about this big transition.

Today marked my first day starting the big job of packing and going through the big painting racks which need to be taken apart and have so much on them as they go up to the very high ceiling. I found much old discarded art work of various people to throw out as well as other random things. Starting the process makes me realize what a big job this is going to be, even though I have good help on it. I am going to have a goodbye party and sale of art work next Saturday, so I hope to get rid of a lot of old art. Unfortunately I have a lot of very large paintings from the 1990’s to get rid of.

In addition there is the gigantic mandala, 7 feet in diameter, on the wall that my patients face, which I have to figure out how to dismantle and get out of the studio. It was that art piece, probably the biggest thing I have ever made, that symbolized for me how “married” I was to the studio. It was as though unconsciously as I created it many years ago, maybe around 2004 and 2005, that I was saying with it, I am staying here forever, as this mandala cannot fit out the door!

Never had I imagined that my leaving this studio would be not of my own free will. I am still shocked, stunned…

While many people have said how sad this is, others have commented on it being an opportunity to start anew. Alas, both are true. As Nietzsche said, “What does not kill you makes you stronger.”…

Goodbye 368 Broadway and goodbye Studio 307. Apparently I will be able to continue on without you, but I will always miss you…

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Interview About My Art Therapy Career!

Interview About My Art Therapy Career!

I am very excited to announce that the first of a two part interview that took place in my studio/office with art therapist Victoria Scarborough is now online at the above link! The interview is about how I started out in the field, my past experience, my present experience and current projects I am working on, as well as how I balance being an artist with being an art therapist. As on this blog, there is some personal information in it, in case you don’t want to know too much about me. (ie. patients out there and former patients and others, only read it if you don’t mind knowing a bit about how my personal life impacts my professional life…)

I will announce on this blog when she posts Part 2 of the interview.

New Art Therapy Group Forming

I am starting a new art therapy group for women suffering with and dealing with issues around anxiety and depression. Any woman age 19 and up who would benefit from this group is invited to join.

The group will meet at my downtown NYC studio for an hour and a half on Thursdays, either from 11-12:30 or 12-1:30 pm, depending on the preferences of group members.

Thus, the group is great for students, freelancers, women who work part-time, or women who can leave their job to come during their lunch hour…

As it is an art therapy group, art making and sharing and processing of art work will be emphasized along wuth verbal processing.

You do not need a formal diagnosis to join this group. The fee will be low for those whose insurance does not cover it or those with no insurance. Those with Artna or Cigna or possibly other insurance will pay a low copay.

Please call or email me directly with referrals or if you are interested in jining the group.
It will start some time in September once I have at least 4 definite participants.

Natasha Shapiro, LCAT, ATR-BC
917 374-7082
natashart@yahoo.com
For more info about me, check out my art therapy blog:
https://natashashapiroarttherapy.wordpress.com

New Art Therapy Group For Women!

I am starting a new art therapy group for women with issues around anxiety, depression, self-esteem, body image and related issues.

The group meets weekly at my art studio office in downtown NYC on Fridays from 1-2:30 pm.

Contact me if you have referrals or for more info on the group.

Time to make art and process verbally in a supportive atmosphere!

natashart@yahoo.com

Silence and it’s Many Meanings

Unfortunately I already wrote a beginning to this blog 2 times, and it got erased both times, so I’ll try again.

Silence. Quiet. Breath. Pregnant pause. Calm. Peaceful. Meditative. The silent moments in a therapy sessions, filling the room. Hearing the noise in your head when you try to quiet the mind. Death. Sleep. Dreaming. Awakening. Feeling words in your head but they can’t come out. Non verbal communication. Silent witness. Silent treatment. Quiet art making, uncomfortable silence, an angel just flew through the room. Silent meditation retreat….

These are just some associations to the idea of silence. It can be deeply relaxing to be silent with someone or incredibly uncomfortable. Both children and adults at times choose on purpose to stop talking. In some cases, as a result of some kind of trauma, including deaths, accidents and all kinds of abuse, a child or adult can become “selectively mute.” S/he has not stopped being able to talk, but has “chosen” to stop saying anything out loud. The younger the person, the less control they tend to have over it. Adults in group settings report noticing that they have decided not to say anything for whatever reason, often to see what happens if they do not talk, and whether anyone notices. In a group therapy setting, a good group therapist will notice this pretty quickly and note it to the group and the person without putting pressure on him or her to say anything. In 12 Step groups, members will just wait until the new person feels comfortable enough to talk. The positive effect of this, is that the person will feel accepted and ok to just sit there and be welcomed and supported without having to say anything, which is often too scary for them. Usually the effect is positive, and the person will continue attending meetings because they feel no pressure to do anything but just show up, and often eventually after many meetings, this person will suddenly be moved to share with others. The same may be true for group therapy. Usually the group therapist asks the members to “just show up consistently” and the rest will take care of itself. In fact, when I was in one of my early jobs in my career doing a weekly group with my caseload, I forgot what this group was called, but every case manager did the group once a week, anyway, I got very concerned with coming up with ways to “fill” the group, with talk about some topic, or special music or other types of ways to hold the group. I still remember my supervisor saying, “You’re trying too hard, which is why you are finding this group stressful for you. Just show up and the group will be fine with that. Try to work less.” It was some of the best advice I ever got about leading/facilitating group therapy; I did what she said, and felt more relaxed with the group, and they probably felt more relaxed with me. Group art therapy is especially holding and comfortable for people who don’t like to talk in front of others that they don’t know well, especially when very intimate and personal issues are being shared. The good thing is that the silent member of the group can still communicate a lot nonverbally about himself or herself in the art work.

The Silent Treatment. Who has not used that with a romantic partner or parent? It’s so nasty and effective. If you’ve been on the receiving end of the silent treatment, you probably felt very hurt and upset. It’s very hard to deal with a loved one refusing to talk, especially when there is probably a lot to talk about and both people involved feel hurt and angry… Often the “Silent Treatment” can really be toxic and put a stop to any kind of positive form of processing and communicating, as both people move further away from each other, unless the silence gets broken.

Silent Retreat: quite the opposite of the above paragraph, as going on a Silent Retreat with a meditation group can be very eye opening for the individual. Choosing to be in a structured situation of complete silence for a week or even a weekend can be very powerful. People notice their inner voices that won’t shut up because as they are quiet, they become highly aware of their mind, which is usually very noisy, as all our minds are full of noisy voices, often critical exacting voices constantly commenting on what we’re doing and what’s wrong with it. When you choose to be silent for so many days, you become extremely painfully aware of your different “Selves”. It becomes like peeling an onion, and the more time you spend, the better you can be at quieting your mind so you can become more aware, more awake, more present to the here and now, and get out of your “Noisy Mind”. Some people choose one day of the week to be quiet all day, as a kind of day of rest and way to get in touch with where you’re at and Be Here Now…

There is another kind of noise in our world that we can choose to shut out and it is not necessarily sound though sometimes it does involve actual sound. Try a day with no TV, no internet, no texting, phoning or emails, no radio or outside info from the outer world. You don’t have to stop talking all together to become more present to your inner state and to what is going on around you. This is what vacations are truly for, to take a break from your life and all the “noise” in it and get relaxed and calm to be in a state of mind where you can accept yourself and even get to know yourself better.

Art Therapy as Food

The holiday season is here and that means trouble for people with any kind of eating or food issues. Holiday dinners and tons of holiday parties which seems so cheerful and fun for some, for others can be big triggers. If you’re in some recovery process of relearning healthy eating and trying to follow a good schedule of meal times and eat nutritionally well, this is a time of many challenges. It’s a good idea to try to be flexible with yourself and allow yourself to eat more and eat things you don’t normally consider healthy rather than fall into the trap of self-punishment or get caught up in obsessing about food and body. It’s also a great time to focus on the non-eating activities of the holidays. Make your own wrapping paper or make your own cards. Make a holiday card to send out to family and friends. Make a fun photo or art calendar for 2012. If you like singing focus on the songs and sing a longs at the parties you go to. Enjoy dressing up if you like doing that…If you go to O.A. meetings talk about this season and your struggles with it tripping you up and any worries you have about getting into old bad habits/and/or destructive behaviors… Just a few suggestions for this time of year that itself is a big trigger for many.

I mentioned some art activities in the above paragraph but this post is meant to try to focus on art therapy and the question, Why is art therapy so effective at helping people with eating disorders as well as body image issues, food and exercise addictions, obsessive thinking about food, weight, body, etc.? Unlike other types of “obsessions” and “addictions”, such as alcoholism and drug addiction, when a person has issues around food and eating, s/he cannot simply avoid food, grocery stores and restaurants for obvious reasons. Triggers are everywhere and food and meal planning are necessities for becoming healthy. One has to change one’s relationship to food altogether and then rigorously watch out for and identify triggers and then have a plan for how to deal with them. For re-learning how to eat, how much to eat, what it feels like to be full, etc., cognitive behavioral therapy techniques can work very effectively to help a person manage their day to day life and find the difficult balance between being observant and watchful of one’s behaviors and familiar feelings or lack of feelings that trigger self-destructive behaviors around food and exercise. Just being able to call your therapist or some other helpful person when you feel challenged and scared you’re going to “relapse” is of course very useful. I have had many patients who reported that calling me when something difficult came up was very helpful or even knowing that s/he could call was also helpful. Speaking up when you’re feeling vulnerable is always helpful and can really get you through some bad moments if you know whom to talk to and can get in touch with him/her.

So where does art therapy fit in? To battle an eating disorder like bulimia or binge eating or anorexia and other related issues, one needs to learn more than ways to avoid unhealthy behavior. Besides becoming armed with ways to identify triggers for unhealthy behaviors and learning to identify one’s feelings rather than using food to literally stuff one’s feelings or cut off from them, you have to learn ways to notice when you feel a self-destructive impulse coming in, what was going on in you and what can you substitute the unhealthy behavior with, ie. learning about self-soothing. Any disorder or issue involving dissociating, getting out of one’s body, etc. can be very much helped by activities that bring you back into your body. A major part of the art therapy process in working with trauma of any kind involves using art making to learn or relearn self soothing.

Art making in the presence of a therapist or in a group with an art therapist can be healing in many different ways. There are many different forms of art making that are soothing to most people. Being given a blank piece of paper or a canvas has been shown to actually increase anxiety and trigger self-criticism in many people. So one must pick particular art making activities that are able to decrease anxiety levels and can even help a person get back in his/her body. Making a mandala with oil pastels or watercolors, which involves tracing a circle or filling in a circle that the therapist has already pre-made for the session is a very popular and tremendously healing activity. Not only are mandalas soothing, as a symbol for the self, the mandala can give one information about one’s feelings about oneself. How you treat the boundary of the circle is of course important. I have found that having people do the mandala with their non-dominant hand can release a lot of worry about how it will look and decrease perfectionistic tendencies. For some, the lack of control of the non-dominant hand becomes too frustrating to be therapeutic, but this seems to be in a minority of cases. Making the mandala on black or colored paper is also a useful way to reduce anxiety and increase excitement about the task, just by being stimulated by the color of the paper or soothed by its darkness. Mandalas are very useful for identifying one’s body energy in the here and now. For example, I have done workshops involving doing a quick mandala at the beginning of the session, followed by some form of meditation exercise, and then a much longer time to make and complete a second mandala. People are always pleasantly surprised to see that their energy at the beginning (often more chaotic or too controlled or else a minimal effort to complete the picture without much satisfaction), has completely changed from the meditation and the art making at the end of the session. The two mandalas can be compared and give a person an actual blueprint or “emotional x ray” of what was going on in their bodies at the beginning of the session, and how changed their energy feels by the end of the session, usually descriptions include “more grounded”, or that the picture feels “more whole”. At some points in treatment or recovery or self-care, it can be useful to do daily or weekly mandalas and then write a few words about one’s feelings and thoughts. put it away and look at your mandalas later as a group to see what changes may have occurred.

Other soothing art making activities involve collage, beading, and decorating boxes as well as making dolls or decorating and covering/painting pre-made dolls. For some people painting is incredibly soothing. The metaphors of art therapy in direct relationship to food are interesting in themselves. The materials and the media are a different form of food which can literally be used for symbolic filling up. If the art therapy session is highly structured with some form of directive and structured around time to make art and time to process, this structure can help a person feel more regulated and grounded. Most impulsive unhealthy behaviors are performed when one is not grounded in one’s body and in some kind of anxious or compulsive state or fughe state. Meals in themselves are what structures the day for many people, and when there is no structure to when one eats, one can get easily caught up in feeling out of control. There are many art directives that are helpful for all sorts of aspects of recovery and regaining a healthy lifestyle as well as a healthy relationship with one’s body. Identifying and making pictures of different forms of hunger: emotional hunger, mental hunger, physical hunger and even spiritual hunger. Just describing and identifying these states is helpful. However as in most cases with art therapy, having an image to play with, observe and help organize oneself is highly useful. It is a great tool for measuring progress in therapy; to have something tangible like a body of work over time — what better way to actually see self transformation/

Of course there are all kinds of directives and activities (the art therapy “menu”) specifically geared around confronting and dealing with eating issues. I have named only a few above. Positive self image collages are another great art activity that is fun, non-threatening and promotes thinking good thoughts about oneself. Making affirmation boxes, a great transitional object for you to bring home and add to on your own. For some people that I have worked with, doing a body tracing by lying on the paper and having the therapist trace around your body and then filling it in in any way with whatever materials there are at hand is very useful in working on these difficult body image issues. Again, this is even better if you are in long term therapy and do one every couple of months or so to be able to compare the different images and notice what has changed for you. This is one of those activities that is best done when you have come to trust your art therapist and are ready to grapple with difficult feelings, even trauma memories, that can surface while filling in the body tracing. This is a prime example of why our training in working with trauma is so important. It is also a great activity to do with pregnant women in a group or individual session.

Besides the structure and the helpfulness of particular directives, non-directive forms of art therapy also work well. I have had patients with eating disorders who enjoyed having choices of what to do and figuring out on their own what they liked, being able to explore my art studio and feed themselves. What can replace walking into a deli or grocery store hell bent on buying certain foods to fill an empty hole inside that one is barely aware of?  Walking into the art studio/office and taking in the visual stimulation. The atmosphere may be overwhelming at first, but the excitement of just picking out a material and playing with it is hard to describe in words and hard to pinpoint in terms of feelings. I get the same feeling in art supply stores, but there is a big difference between an art supply store and an inviting healing creative space. (I knew I was on the right track with my studio when  a father who had no interest in art making suddenly picked up a piece of cardboard and started painting! freely with all sorts of colors; his kids who had been focused on their own projects of course rushed over and asked for cardboard so they could imitate him!) As an art therapist, I can say that there is nothing like the satisfaction of having a patient who has been talking to you for months suddenly out of the blue pick out some art materials with no encouragement, suggestions, or pushing from me. It is delightful to witness!

Certainly the art materials and art making can just function as a good distraction from obsessive thinking about food and body. Havi ng an hour of respite from one’s own intrusive thinking is not only worth while but provides hope that this experience can be repeated, both in the studio and at home. So there is a lot to be said for allowing for discovery and choice of media, especially with people who are very aware of how “in control” they feel from moment to moment. In some cases, consuming the therapist’s materials can replace bingeing. There is a delicate balance between feeding oneself emotionally and spiritually in a session and working on mindfulness, versus mindless consuming and using of art materials that can be perseverative and imitate unhealthy behaviors outside of the studio. I try to stay mindful that any substance or activity has healing properties when used in a mindful prescribed manner versus when the material, activity or person is abused or addictively consumed to fill an empty hole. As therapists, we can sense sometimes during, sometimes after a session, whether the session has been a healing one or a “filler”; it is not so bad to have some sessions be fillers once in a while anyway.

This is only a mere blog post, not meant to be an exhaustive discussion of the merits of art therapy for  people with eating disorders and related challenges. Please feel free to share your experiences as a therapist or patient…

As a side comment, I was thinking tonight about the challenges of being a therapist and eating healthy meals. A lot of us work through the dinner hour and come home exhausted and starved with no energy to cook a proper meal. It can become a major family issue; how to have meals with partner and/or child/children all together and at regular meal times. I try to have extremely moderate goals, such as, let’s try to have a family meal at least once a week, not too great I admit, but I get home late several evenings a week and then there are other schedules besides my own to accommodate. This is going into a new related topic, probably good for next week’s post…