“No Surprises Act” – NOTICE

NOTICE

“No Surprises Act”

Dear Current And Potential Future Clients,

Apparently Congress enacted a “No Surprises Act” which is set to go into effect 1/1/2022. The act is described as “new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose” (please see https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/).

It is highly unlikely this could affect our work together. There will be no situation in which you would “inadvertently” receive care from me or with no choice. Also, the final rules about how to implement this in a practice such as mine have not even been written yet by the federal government.

If we currently work together, you are already aware of my charges and your costs. If you are considering working with me, available information suggests I might need to provide you with a diagnosis before we even meet, which of course would be both unethical and impossible without a meaningful evaluation of your circumstances. At this time, multiple professional organizations are scrambling to understand the details of this law, to whom it applies and how to apply it. Guidance so far is uncertain and in many cases conflicting.

Rest assured that I will be as transparent with you about the costs of the services we agree on together. You will have “no surprises” here. This transparency is required by ethical standards by which I have abided for since I have been in practice, and simply because it is necessary for us to work well together. You can find this information under the FEES menu on this website.

In the meantime, you may certainly ask me about any costs about which you may be unsure, and you will be provided clear information.

Please feel free to contact me if you have any related questions. My contact information is available under the CONTACT menu on this website.

I will update this post as more information becomes available and pertinent to my practice.

Covid-19 & Managing Social Isolation

We are clearly in uncharted waters. Many of us are feeling anxious, overwhelmed, confused by conflicting media reports, sad about cancellation of important events and not quite sure what to do. Parents are wondering how to manage work and child care with all the schools closed.

We are social creatures. And in spite of the fact that so much of our contact is on social media, human contact and touch are incredibly important to both our physical and mental health.

So, how should we proceed?

And how do we cope?

First, I will say that it is really important to understand that what we do over the next couple of weeks will have a significant impact on the national trajectory of coronavirus. Many have been really concerned about testing and the lack of availability of test kits. But, that is really only a part of this situation. Testing lets us know about numbers of cases. But numbers alone do not stop the spread. We significantly reduce the spread by staying away from each other. Unfortunately, the corona virus can be spread both before symptoms appear (4-5 days) and even many days after symptoms are gone. Please wash your hands regularly. A friend reminded me to use a hand wipe or tissue when pumping gas.

An excellent article by Dr. Asaf Bitton, executive director of Ariadne Labs in Boston, Mass, entitled, Social Distancing: This is Not a Snow Day gives excellent information with details from the CDC about this. Briefly, he points out that by staying away from each other we can flatten the curve of the projected numbers of people who will become ill and be better able to manage those who need serious medical attention.

We all have the power to help this situation. Banding together, avoiding blame or politicizing, we can agree to stay apart. We can avoid public gatherings. This means more than avoiding concerts and other public events. It means avoiding playdates, sleepovers and even connecting with smaller groups. Even if you are not sick, you can be a carrier. I was heartbroken to have to tell my grandson that we were going to cancel his trip up to CT for his spring break visit. But it was the right thing to do, for all of us.

I, like many if not most of my colleagues, am asking patients to consider phone or video sessions during this time. If you don’t feel well, please stay home. None of my colleagues are charging for last minute cancellations because of illness or even fear. Parents, I know the idea of entertaining your kids over the next few weeks may be overwhelming, but, there are some really cool things you can do. First, do consider having your kids connect with friends and relatives via Skype or FaceTime .

Many museums are offering virtual tours from the comfort of your couch. This is a great way to “visit” the Louvre or the Guggenheim. The web is literally bursting with ideas to keep your kids occupied during this time. Board games, reading together, building forts, baking, dong crafts are all things that can keep everyone busy.

Please don’t forget, that while you are being asked to socially isolate, that does not mean you have to stay indoors. The weather has really been nice. So, go for walks and hikes, play soccer in your backyard, bake together and make sure your kids are doing any homework they have been assigned or are attending their virtual classes. Here is another link to an article in the Guardian with ideas on managing the social isolation.

Please, please be considerate of others. This is temporary. And if we all work together it will be shorter rather than longer. This is not a hurricane. We still have water and power. So we don’t need endless supplies of peanut butter and mac and cheese. Our grocery stores and pharmacies will most likely remain open as they have in Europe. So, shelves will be restocked and you will be able to get supplies. Buy what you need but do not hoard.

I also want people to recognize that will will get through this together. It is important not to panic. Do not overwhelm yourself by listening to the news 24-7. Sometimes…in fact, many times…the news is someones opinion, not necessarily fact. So, listen for short periods of time in the am and pm. Go directly to the CDC’s website to get current information. And certainly, talk to a psychologist of other mental health professional if you truly feel overwhelmed.

Take care of yourselves. Will will all get through these difficult times together.

I give credit to my esteemed colleague Dr. Ducharme for the wonderful words above (pic copyright nytimes).
This too shall pass.

4 tips to deal with frustration

Have you ever started your day feeling energized and ready to go only to be faced with adversity, frustrations and aggravations!?

Here are a few things that you might want to try and do that may help:

Breathe!
- I can’t say it enough, breathing can really make a difference in how tense you are, so take a second, take a couple deep breathes, re-center yourself and shake off some of that un-needed tension.
Don’t take it personally!
- Will it matter in 5 hours? 5 days? More often than not, whatever happens has little to nothing to do with you, so try and remember that. Plus, as soon as you take yourself out of the equation, it is a lot easier to brainstorm and be effective in dealing with whatever the situation is.
Take a different approach, it’s in the past!
- Move on from where you are and see the silver lining. Stop brooding over what happened, it’s in the past and see the positive of the situation. Maybe starting to think on the following answers:
  - What do I want to happen differently next time?
  - What do I need to do in order to get there?
This too will pass!
- Remember that this is just an emotion and feeling, and if a few minutes, it will change too.

Appreciation: a powerful phenomenon

There are many things that do go well in our life, yet we often tend to think of, and more easily remember what did not go right or where we fell short. Could being ‘appreciative’ of everyday, and consciously be aware of what is actually going right make a difference…

Well, take a read and tell me what you think?

“Gratitude doesn’t just warm your heart, it may also lead to a healthier one, a new study suggests.

Research published by the American Psychological Association found patients with asymptomatic heart failure showed decreased levels of inflammatory biomarkers in the body, which are related to improved cardiac health. The study consisted of 186 men and women who kept a gratitude journal for eight weeks as they received regular clinical care.

“It seems that a more grateful heart is indeed a more healthy heart, and that gratitude journaling is an easy way to support cardiac health,” wrote lead author Paul J. Mills, Ph.D., professor of family medicine and public health at the University of California, San Diego. The study also found that gratitude contributed to spiritual well-being, which was associated with improved mood and better sleep.

This isn’t the first time researchers have discovered a positive association between thankfulness and an improved heart. A 1995 study published in the American Journal of Cardiology found that positive emotions and appreciation are linked with changes in heart rate variability. The new APA findings also saw heart rate variability changes in the patients who had a thankful outlook.

The study results add to a growing list of reasons to express gratitude beyond the Thanksgiving table. Research has shown that thankfulness can increase optimism, strengthen your relationships, improve your immune system and even offset the effects of materialism.

Now that is something to be grateful for”.

Original article: http://www.huffingtonpost.com/2015/04/09/gratitude-heart-health_n_7033612.html

10 aspects of therapy

I came across this ’10 things about therapy everyone ought to know about’ and I thought it was pretty good!

I did not write this, but I agree with all if it, so here it is!

Enjoy the read!

Being a therapist can be an amazing profession full of challenges, heartaches, and celebration. We see you at your worst and see you at your best, but there is no better reward to see you succeed. Here are 10 aspects of the therapeutic relationship that are either unknowns or common misconceptions. I hope this clarifies what you can expect from working with a therapist.

1. I don’t think you’re crazy.

I think you are amazingly unique trying to find your way in the world. None of us is perfect and I surely don’t expect you to be anywhere close to mastery when you’re learning new skills to change your life. Effective change usually requires trial and lots of errors. It means you’re trying! Plus, if I think you’re being irrational, I’ll tell you.

2. Trust is everything.

Your ability to connect with me will be the number one factor determining how well we work together. If you don’t feel like you click with me after a few sessions, it’s OK to let me know and seek out a different therapist. We all need different things and my main priority is for you to achieve your goals.

3. My job is not to psychoanalyze you.

My job is to be curious and to help you gain more understanding. A good therapist doesn’t claim to have all the answers for why you are the way you are although we may have some ideas that we will willingly share with you. When it comes to getting answers and more understanding, we will form hypotheses together and you will come to your own conclusions. A therapist facilitates that process. They don’t tell you how to think/believe/act.

4. I’m not here to give you advice.

I’m here to share my knowledge with you and help you make your own decisions that are balanced, rational, and well-explored. Strengthening your own reasoning and decision-making skills will increase your independence and self-esteem. Win-win!

5. Work through your emotions with me instead of quitting, anger included.

Therapy is the perfect place to learn how to express your feelings. That’s what I’m here for, to give you a space to try out new ways of being, thinking, and feeling. Take advantage of this. When we learn how to work through our negative emotions with others, it increases our relationship skills and makes us more comfortable with voicing our hurts. This is a necessary component to maintaining relationships and managing your emotions in a healthy way.

6. I expect you to slide backward to old behavior patterns and I’m not here to judge you.

Most people judge themselves enough for at least two people. I encourage my clients to come clean. It’s only through acknowledging our steps backward that we can figure out what’s standing in the way so that you can catapult forward. Relapse is VERY common and it’s nothing to be ashamed of.

7. You deserve to be happy.

Happiness is not reserved for special people. Everyone has regrets, things we wish we never would have done, people we’ve hurt along the way, people who have hurt us either intentionally or unintentionally. I’m a firm believer that we can heal our wounds and step into happiness. You deserve it just as much as the next person.

8. I can’t “fix” your life or your problems. Only you can.

I can help you gain more clarity, more understanding, and form a plan of action, but therapy is not a magic pill that erases all issues. It takes work, but if you’re up for the challenge, I’ll be there every step of the way!

9. The quickest way from point A to point B is action.

If you continue to come to therapy without putting any new behaviors or thoughts into action, progress will be a slow process for you. The path to action is different for everyone, but if you never do anything different, you’ll never get a different result. You’re the only one who can decide to take action. You hold all the power.

10. I want you to have the life you want.

I know your struggles, your dreams, your insecurities. There is nothing I want more for you than for you to bring your dreams into reality, push through your fears, and have the life you want. Your success is the ultimate gift to a therapist!

People come to therapy for all kinds of reasons. Usually people are experiencing a moderate level of discomfort in their lives and have noticed a toll on their work/school performance and in their relationships. Beginning therapy can be scary for some as they are showing a willingness to face tough topics, but for others, it’s a huge relief to finally be taking action to move in a different direction.

Therapy isn’t always easy, but I think it’s the most worthwhile gift you can give yourself. Find someone you trust and who puts you at ease. The relationship you build with your therapist is the most important aspect of all.

Source: http://www.mindbodygreen.com/0-12657/10-things-i-wish-everyone-knew-about-therapy.html

Resiliency skills…

…the funny thing about it is that engage in those behaviors, and in many cases, they come in handy!
To me resiliency skills are part re-framing of the situation and part reality check. After all, when life feels overwhelming and the only thing you can think about is to put your head in the sand, ‘re-framing’ doesn’t come that naturally.

As much as we may use these tools everyday, I think it’s nice to remind ourselves that we do things right!
Below are 10 skills around resiliency. This is a topic dear to my heart with the asylum seeker community, and skills worth reading and using for everyday coping, no matter what walk of life you are from.

Enjoy.

Make connections. Good relationships with close family members, friends or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper.

Avoid seeing crises as insurmountable problems. You can’t change the fact that highly stressful events happen, but you can change how you interpret and respond to these events. Try looking beyond the present to how future circumstances may be a little better. Note any subtle ways in which you might already feel somewhat better as you deal with difficult situations.

Accept that change is a part of living. Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.

Move toward your goals. Develop some realistic goals. Do something regularly — even if it seems like a small accomplishment — that enables you to move toward your goals. Instead of focusing on tasks that seem unachievable, ask yourself, “What’s one thing I know I can accomplish today that helps me move in the direction I want to go?”

Take decisive actions. Act on adverse situations as much as you can. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.

Look for opportunities for self-discovery. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life.

Nurture a positive view of yourself. Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.

Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.

Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.

Take care of yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience.

Additional ways of strengthening resilience may be helpful. For example, some people write about their deepest thoughts and feelings related to trauma or other stressful events in their life. Meditation and spiritual practices help some people build connections and restore hope.

The key is to identify ways that are likely to work well for you as part of your own personal strategy for fostering resilience.

Original (and more in-depth article) can be found here: http://www.apa.org/helpcenter/road-resilience.aspx