Why It’s Important to Work with a Specialist

Specialist

Let’s talk about the importance of choosing a specialist when deciding on a mental heath provider.

Recently, in an online professional group, a group therapist shared that leading groups is not that much different than conducting individual therapy. Not true! There’s so much more that goes into working with groups – into studying and working with group dynamics- that I was surprised to hear a professional make this statement. When I think about everything that was involved in earning my Certified Group Psychotherapist credential – the hundreds of hours of experience, supervision, and education required in order to earn this title – I wonder how individual therapists can so comfortably make the transition to group therapist without similar training.

The same goes for working with particular disorders and specialty areas. In my work, I have acquired specific specialties in working with eating disorders and substance use disorders. This goes beyond the generalist training that most therapists receive and that equips us to work with more commonly presenting conditions such as anxiety and depression. For me, the ability to work competently with eating disorders and with alcohol and substance use disorders involved years of supervised experience using evidence-based approaches. Not every therapist knows how to work with these disorders, and even the most well-intentioned therapist can do a lot of damage trying. In the same way, I would never try to work with conditions with which I have no (or minimal) experience treating. If someone comes my way who struggles with a developmental disorder, psychosis, or certain personality disorders (among other conditions), I readily refer out to specialists in these areas.

So if you’re seeking help for an eating disorder or an alcohol or drug problem – or for that matter, any specific concern, ask your potential provider:

  1. How long have you been working with this disorder?
  2. Did you receive supervised experience in working with this disorder? How/where were you trained?
  3. What type of approaches do you use to work with this disorder? Are they evidence-based?
  4. Do you collaborate with other professionals on your cases?

Please Contact Us at Gatewell to learn more about choosing a specialist that’s right for you.

 

 

 

Avoiding Reality via Alcohol/Drug Misuse

addictions

One of the frequent goals of alcohol or drug misuse – which can eventually lead to addiction – is the avoidance of reality. Let’s face it – reality is tough. Whether it’s difficult emotions or circumstances, family members or situations, we often struggle to hang in there, and distraction and avoidance are common coping techniques.

But when we avoid – be it through alcohol or substance use  – or through other avoidance behaviors (think shopping, gambling, gaming, binge watching, eating, not eating, etc.), we’re not addressing the problems from which we’re trying to escape.

We’re not repairing – or moving away from – relationships that don’t work. We’re not experiencing and expressing certain feelings that need to be processed and addressed. And we’re not working to figure out a better path for ourselves. So, the problems don’t improve, and we’re often left with an additional problem (e.g., an alcohol or substance use disorder) in tow.

To capture this idea, someone in one of my groups recently paraphrased a sentiment by novelist Ayn Rand: “We can evade reality, but we cannot evade the consequences of evading reality.” Thus, we can choose to escape and avoid, but what we’re escaping and avoiding will not simply disappear. Furthermore, the consequences of avoiding reality can amplify any original difficulties beyond recognition.

If your alcohol or drug use functions to help you avoid reality, take a moment to check it. There’s only a matter of time before the consequences catch up.

 

 

 

The Five-Minute Journal

Gratitude

A couple of months ago, I was introduced to The Five-Minute Journal. As the name implies, the journal calls for brief entries (two per day: morning and night), nothing more than quick, bullet-item lists.

In the morning, you jot down what you’re grateful for and what would make the day a positive one. You also list a couple of things you like about yourself. Come nighttime, you note what went well during the day and a couple of things you could have done to make the day a better one.

Here’s why I like this journal:

  1. It’s easy and doesn’t require much time to complete the prompts, so for those who struggle with journaling, the task doesn’t feel too daunting.
  2. It encourages a focus on gratitude and positive intention setting, both of which can impact your outlook and functioning.
  3. It forces you to name your strengths in a culture that so often suggests you focus on your weaknesses.
  4. It encourages you to take personal responsibility for making your days more positive.
  5. The journal prompts have a way of infiltrating your daily consciousness, impacting thoughts and actions so that they are more consistent with your values.

If these exercises interest you, you can purchase The Five Minute Journal here. Otherwise, you can complete the prompts on your own. Notice any changes in thinking, behavior, or emotional patterns over time. Let us know what you think!

 

Shattering the Political Blank Screen

As a therapist-in-training, I was taught to keep my cards close to my chest. Many of my mentors advocated for minimal personal disclosure, suggesting that revealing this type of information could dilute the therapeutic relationship. They instead recommended a neutral stance, a maintenance of what therapists call the “blank screen.”

But, I’m going to shatter that blank screen right now.

I voted for Hillary. And it’s important for my patients to know that I did.

Let me tell you a little bit about my clientele. . . . I see a wide range of individuals and have over the years. Many are women, some of them mothers. A number of them are men and women of color. Many, especially in Miami, where I now practice, are of Latin-American descent. Some are first-generation immigrants, having come to this country as young children or adolescents. An additional, fairly large percentage are members of the LGBTQ community. Some have married same-sex partners. A small portion of my patients have physical disabilities. Many of my patients have experienced sexual assault and trauma as children or as adults. A large percentage of my practice is comprised of individuals who have suffered from serious mental illness, disorders such as major depression, bipolar disorder, eating disorders, severe substance misuse, and other conditions that have required access to affordable and ongoing mental health treatment.

Almost all of them will be deeply impacted by the results of last night’s election. At stake are their marriages and families, their health insurance and access to treatment, their recovery, and their lives.

There is no way I can support someone on my couch but not out in the world. I can’t offer empathy and compassion devoid of my beliefs and actions outside of the room. I’ve worked for over 15 years helping people to live more authentic lives, and I’d better be sure I’m doing the same.

So, as the dust settles on this election, my patients can know that, regardless of any personal preferences I might have had about any of the candidates, I did my best to do right by them. They can know that I will continue to support them both as a therapist and as a citizen, and that our joint effort toward a brighter, safer, and more inclusive democracy gathers strength and momentum even, and especially, in the shadows.

 

 

 

 

New Year, New Insurance Plan? Gatewell’s Primer on Finding the Health Insurance That’s Right for You

insurance

It’s that time of year again – time for open enrollment in the health insurance world. Are you confused by all the terms and choices? Gatewell finds all of the options overwhelming, and we’re in the business!  So, we’ve compiled this guide to help you sort out some of the key decisions associated with choosing a plan.

Premium: This is the monthly payment that you’ll pay to the insurance company, regardless of services rendered. If your insurance is through your employer, often the premium is deducted from your paycheck. Premiums can range from nearly nothing (in a company plan, since the employer will subsidize) to thousands of dollars (in an individual/family plan). Typically, the higher your premium, the less you’ll pay for the items below.

Deductible: This is the amount you are responsible for before your insurance starts kicking in for health expenses. Some plans have no deductible (or at least no deductible for some or many services), while others can have deductibles in the thousands. If this is the case, you will have to pay that amount out-of-pocket before your insurance plan starts paying for services. Generally speaking, the lower the deductible, the better.

Copays/Coinsurance: This is the amount you are responsible for at each doctor’s visit/for each service. Copays might range from $10 to hundreds, as a percentage of the service (higher for surgeries, hospitalizations, etc.). Typically, plans that have lower copays have higher premiums.

Out-of-Pocket Maximum: This is the amount that you are responsible for in total (not including premiums) before your financial portion is complete. Once you meet your out-of-pocket max (usually a number in the thousands), your insurance will pay 100% of medically necessary services. You might still be responsible for services with out-of-network providers, and you’ll still be responsible for services that aren’t covered by your plan.

Are you someone who rarely seeks out medical care? It might make more sense for you to choose a lower premium plan with a higher deductible or higher copays/coinsurance. If, on the other hand, you have a number of specialist providers already at your service, you might be better off paying more up front (a higher premium) so that your deductible and responsibility per encounter are lower. You might also opt for a plan that has a lower out-of-pocket max if you typically spend a lot on medical expenses and want a lower cap (so that the insurance company will start covering more completely earlier on).

Are there typical medical expenses that you incur (or imagine you’ll incur this year)? You might want to do a side-by-side of plans you’re considering. For instance, if you’re prone to accidents, you might want to consider a plan that doesn’t charge a hefty ER/urgent care copay. Or, if you think that you might need residential psychiatric care, see what the different plans you are considering offer in terms of treatment at this level of care. Keep in mind, it’s likely you’ll also need an authorization from an insurance company to embark on this kind of covered treatment and that often, insurance companies will cut coverage when they see fit.

If this isn’t confusing enough, you might have options of different insurance companies to explore (via an employer) or on your own. Any individual who does not have access to insurance through the workplace can purchase insurance individually (just hop on the insurance company website and see if they have individual plans in your location). You might even qualify for a subsidy (a reduction in monthly premium), based on income, through the Affordable Care Act.

It’s also a good idea, before making an appointment with any healthcare provider, to know what expenses you will incur. Make sure you’re aware of your deductible and copay/cosinsurance going into the appointment. Find out if the provider is in-network or out-of-network on your plan (you can typically do this by performing a doc search on your insurance company website, though you’ll want to call the provider to verify since the listings can be outdated). If the provider is out-of-network and you still want to see him/her, find out what percentage of the visit will be covered. This will just be an estimate, however (and likely a low one). If the insurance company tells you that 50% of your $100 physical therapy appointment will be covered, that won’t necessarily mean that you’ll get a check from your insurance after the appointment (and paying out $100) for $50. It means that the insurance company will reimburse you 50% of the value of the service as they see it, not as it actually is. So, in this example, they might say that a physical therapy appointment is valued at $75 (what they call their “usual and customary”) and, therefore, you’d only receive $37.50 reimbursement (50% of the $75).

If you have questions regarding your insurance coverage and services at Gatewell, please contact us for additional information.