Posts Tagged ‘New York Times’

Age Old Battle

Wednesday, June 23rd, 2010

I continue to struggle with a viewpoint posed in a recent New York Times article. In “Playing the Fool” as posed by the writer, the premise is that it is oftentimes best to go along with patients who are drug-seeking rather than risk the battle of denying them access to their drug. Really? Because I work all day every day to help clients learn to do just the opposite; to choose the harder thing over the easier thing; to break old patterns and live a more authentic, accountable life. Hmmm.

This philosophy ties in to the base premise behind all addictive patterns, in my definition. I believe that all addiction is an attempt to self-soothe, to mask, change or alter one state of being or feeling into another by the use of outside means. OK, in plain english, it’s using drugs or alcohol or shopping, cutting, sex, gambling, bulimia to avoid, to feel something different, even if only for a short time. It’s not being able to sit with the discomfort of the tough decision or interaction or feeling in the moment. Is not the prescriber in the article implicitly defending doing this very same thing? Giving in to the perceived “quick and easy” decision by prescribing rather than sitting with the discomfort of saying “No”?

I have many clients who struggle with differing stages of use and recovery. One thing I tell every one of them is that your MD is not a mind reader, that the information you give the doctor has an enormous impact on their treatment. Nobody walks around with the label “In Recovery” on their foreheads, so it’s your responsibility to educate your care givers. Ask for non-narcotic pain relievers, mention how proud you are for X-number of days being sober, your medical care provider will appreciate and support your efforts that they may otherwise unwittingly undermine by prescribing a narcotic (which for the MD is cheaper and easier, it’s more difficult to be creative in a non-narcotic mindset).

Is this not a perpetuation of addictive behavior in a less blaming, distasteful dose?

How does addiction continue to win over healthy choices?

It is this age old battle that I continue to fight daily, choosing the discomfort, the tough choice, keeping the long-term goals in sight and saying it’s worth it. C’mon, welcome the discomfort! The harder thing, the more difficult action, will truly set you free.

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The Marriage Effect

Wednesday, April 21st, 2010

The New York Times Magazine had an interesting article this past weekend titled “Is Marriage Good for Your Health?” and as many can surmise, yes, marriage does have many positive side effects. If you have recently looked into purchasing health or life insurance, being married has a major impact on the rate that gets quoted (i.e: married rates are lower than single ones). This article was particularly interesting in how it goes a bit further and looks at the effect of a bad marriage, too.

I was at the CTAMFT Annual Conference on April 9 and the keynote speaker was Dr. Sue Johnson, the author of “Hold Me Tight” and the creator of Emotionally Focused Couples Therapy in 1985. My insufficient summary of her field of study is that of adult attachment, especially after trauma.

During her presentation she referred to her own research study, of which a coincidentally similar research study is referred to in the Times article:

Researchers have also started to examine the salutary health effects of social relationships, including those of a good marriage. In one recent study, James A. Coan, an assistant professor of psychology and a neuroscientist at the University of Virginia, recruited 16 women who scored relatively high on a questionnaire assessing marital happiness. He placed each woman in three different situations while monitoring her brain with an f.M.R.I. machine, which offers a way to observe the brain’s response to almost any kind of emotional stimulation. In one situation, to simulate stress, he subjected the woman to a mild electric shock. In a second, the shock was administered, but the woman held the hand of a stranger; in a third, the hand of her husband.

Both instances of hand-holding reduced the neural activity in areas of the woman’s brain associated with stress. But when the woman was holding her husband’s hand, the effect was even greater, and it was particularly pronounced in women who had the highest marital-happiness scores. Holding a husband’s hand during the electric shock resulted in a calming of the brain regions associated with pain similar to the effect brought about by use of a pain-relieving drug.

What the article does not mention is the fourth effect – the one when the woman holds the hand of an abusive husband. Dr. Johnson’s research illustrates that when the woman holds the hand of an abusive husband, the shock is felt as extreme, the neural response is high and even a placebo calming effect of hand-holding is entirely absent.

So then how do we redefine the “marriage effect” in a more realistic light? So many couples that seek therapy are under the impression that staying together “for the sake of the kids” is the best choice, “Our parents did it and so should we”. Is it best to change the relationship first, to do the hard work of therapy, before considering leaving a marriage? Yes, absolutely. An in-tact healthy family is still the best model for successful growth, health and stability for all members. But abuse and violence are very different situations and must be handled differently as well.

The new research highlights this exact experience. Toxic environments; from the water and food we consume to the office to the home and the relationships within them, have real and lasting effects on our brains and well being in every way. Discord cannot be ignored.

Things aren’t always what they appear to be from the outside, just look at the MRIs.

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The Cost of Mental Health Care

Sunday, November 22nd, 2009

The New York Times has run two articles recently, “How to Find Mental Health Care When Money Is Tight” and “In Anxious Times, Medical Help for the Mind as Well as the Body” which ran 2 weeks ago. While I found many important and useful links and points of information, I was left wanting to clarify the points of cost and access.

Mental health practitioners are concerned first in helping people who want it. Yes, we are in this business to make a living, but part of the calling is also seeing that nobody goes without care when it’s needed. At MFT3 we have what is called a sliding scale fee structure. What that means is that we will reduce the rate to make sessions more accessible to a potential client. This policy is based on creating a relationship that is mutually satisfying; I don’t want a client coming in less frequently than therapeutically sustainable due to cost, I would rather take a smaller fee and create a better healing environment.

Of course, argument goes to the notion if someone is already in a depressed or anxious state, that discussing costs may not be a first thought or come naturally. I always discuss cost first over the phone but also check-in with the client as we move forward and adjust as necessary as situations change.

I have also developed a large and diverse network of collaborative professionals who are in every type of agency, and can refer to a no-cost practitioner if that best suits a client’s needs. I personally have never found the size of a fee having any impact – pro or con – on someone’s ability to be seen by a therapist. This notion flies in the face of the ethics of the field.

As we have been learning, not all insurance plans are created equally and the mere fact that someone has insurance does not ensure that they have good mental health coverage. Also, as jobs are lost so goes insurance in many instances. By having created a personal financial relationship separate from insurance via sliding scale, I find that clients are more apt to continue with sessions in the midst of job loss as a support through the depression associated with the loss, the work of finding a new job, supporting all family members through potential lifestyle changes, and so on.

My point is to always ask about cost, especially if it may be an extra stressor during an already tough time. As professionals, we are well aware and prepared to work with you in this matter. Yes, therapy will cost you money, but let us not underestimate the costs associated with not treating mental illness in a timely manner, too.

Please note that depression, particularly, is an isolating condition, and that getting out and finding a therapist is a very important step in breaking the solitary hold it can have on someone. If prescription medication is indicated, note too that some may take as long as 3 months to stabilize in your system, not a quick fix.

And always, if the need is critical, call 9-1-1 first.

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