Let the Sun Shine (In Winter?)

It's autumn. We are quickly moving into winter when the days get colder and shorter.
We often wake up later, want to go to bed earlier and suddenly get a yearning for bread, candy, cakes and all those other great carbs that call to us from the kitchen. While some folks just don't like these colder, darker months, others actually begin to get the symptoms of depression. These signs include sadness, lower motivation and less enjoyment of activities we usually like to do, pulling away from friends, sleep disruptions, and a feeling that the future just doesn't hold much hope. When depression begins with the onset of winter, it's a subtype known as Seasonal Affective Disorder or "SAD".

Since the 1980's Dr. Michael Terman, a psychologist, has conducted research on the therapeutic effects of "bright light therapy" as adjunctive treatment for SAD at the Center for Light Treatment and Biological Rhythms at Columbia University Medical Center.

Bright Light Therapy (BLT) involves the use of a full-spectrum light box (costing $150-200) that clients sit in front of for 30 minutes a day to mimic the light exposure we typically get in the longer, lighter days of summer. Don't worry about UV radiation as the light used blocks this type of wave length. You won't be staring at the light, just reading by it or eating your breakfast while it's on. The treatment is usually recommended for the morning. When used in combination with talk psychotherapy, BLT can provide a successful treatment for depression without the use of medication (although some cases of SAD do benefit from the addition of an anti-depressant).

For more information check out these links

http://www.nimh.nih.gov/science-news/2006/properly-timed-light-melatonin-lift-winter-depression-by-syncing-rhythms.shtml

http://sunbox.com/

http://en.wikipedia.org/wiki/Michael_Terman

And..don't forget to walk on the sunny side of the street!

"Finding Emo": Is this Therapy/Therapist Right for Me?

Noted psychologist and author, Dr. Barry Schwartz has talked about the paralysis that comes with too much choice. Too many salad dressings to choose from in the supermarket. Too many shampoos to select from at the drugstore. Well, we now have a multitude of therapies and therapists to opt for when the motivation for change hits.

Here's my version of a consumer's guide....
First we have the professionals who are educated, trained and licensed by the state to practice therapy: psychologists, psychiatrists, clinical social workers, marriage and family therapists, pastoral counselors, and licensed mental health clinicians. To keep their licenses, they must abide by state laws and professional ethics. It's not quite the Good Housekeeping Seal of Approval, but it does mean they are answering to a higher legal and ethical authority when it comes to your care.

Most states, though, allow folks without licensed credentials to practice therapy, too. That includes life coaches, relationship advisors, weight consultants, and executive and career coaches. No one needs a license or specific work experience or training to be called a therapist or work under these titles. Can these people be helpful? Sure. Just be aware that you'll have to do your own background checks here, as no legal authority oversees your care.

Next, how to do find the best person for your needs? In Ye Olden Times-- before the spread of managed care in the 1990's--most people counted on their medical doctor or a trusted friend for a referral. Now, we have an insurance directory with lots of names and addresses, but little else to go on. Many people start with an Internet search to narrow things down. There are individual websites, highlighted Google ads and blogs (this one included) that can tell you a bit.
But, do yourself a favor. Check with your state government's website that verifies the current licensing of each professional by their discipline (e.g. psychology, social work, psychiatry).
Make sure he or she is a doctor or masters level clinician of the specialty you want, not economics or astronomy!
For New York go to the "State Office of Professions" at

http://www.op.nysed.gov/prof/

Also, you can see if there are any professional complaints on file.

Note: the state's website is a far better place to check on consumer complaints than on all the consumer rating sites (e.g. Yelp, Healthgrades.com, etc.)

Remember "slam" books and bathroom stall gossip from your school days?

All you need is one anonymous mischievous person to slant the score in a negative way or a friend of the clinician to slant the score in a positive direction. 
 
Instead of letting someone else's experience influence your decision, telephone the clinician yourself and see what your own experience is.

 Most clinicians answer and return calls themselves. It's a great opportunity for you to hear how they respond to you and your questions or concerns in real time.

 (By the way, many clinicians, including myself don't "do" email for their clinical appointments. Licensed professionals are legally and ethically bound to protect the confidentiality of their client's identities and info. As wonderful as the Internet email may be, it is very easy to hack into and there is no control over how long it is kept and who can access it!)

So, write down your questions ahead of time. Insurance concerns? Fees? Days or times you want an appointment? Years of experience with the area of knowledge you need (anxiety, marital counseling, work stress, parent/child conflicts)? You should get a call within two days. If not, try at least one more call...sometimes poor cell phone reception makes messages (and phone numbers!) incomprehensible. If the answers sound promising, make an appointment and see how the "in person" chemistry goes. (On the telephone and in-person dynamics can be worlds apart.)

Lastly, give yourself at least three sessions to judge the therapeutic "fit" The first meeting is usually filled with excitement, emotions and nerves and a lot of information exchange. The second meeting may still focus on bringing the clinician up to speed on your current problems and their history, making it hard to assess the relationship. By session number three, you should have an idea of the clinician's plan of action and whether you agree with it.

Differently trained mental health professionals will offer different approaches. However, the treatment should be backed by clinical research that is available for you to look up and read about, too. The U.S. Government's National Institute of Health has a great website just for this purpose at

http://www.nlm.nih.gov/medlineplus/

As a federal website, MedlinePlus does not accept commercial or medical advertising of any kind (unlike WebMD or MedicineNet), so you can trust that the information and outcomes are research based.

Til next time, take good care!

Uncovering the Mystery of Insurance Coverage for Couples Therapy and Family Therapy

I like a good detective story, but no one told me that I would become self-trained in the mysteries of health insurance coverage.
As a psychologist, I'm educated and experienced in providing individual, couples and family counseling.
I love doing it and I'm happy to accept insurance as part of my payment. So here is what I've discovered in my side career as an insurance sleuth.

Health Insurance coverage is based on a medical model known in your insurance contract as "medical necessity".
The medical model is: an individual is sick, goes to a doctor, receives a medical diagnosis and treatment for the symptoms of that disorder The doctor is reimbursed for the treatment provided minus the copay.Unfortunately, this model doesn't fit couples and family therapy very well at all.

First Problem: health insurance reimbursement is based on the individual's medical disorder.The insurance community has no way to define a couple or family as having a reimbursable medical disorder. For example, an individual can have an anxiety disorder, depression, obsessive compulsive disorder, but a couple cannot be diagnosed this way.

While couples and families may be experiencing life stressors and relationship problems that cause significant conflict and dissatisfaction, these are not medical symptoms or a reimbursable mental disorder .
Clearly, poor communication skills, problems with negotiating decisions, difficulties with compromising, or understanding the emotional or psychological needs of a partner, spouse or family member can all be addressed by counseling,

Unfortunately, they are not considered "medically necessary" problems by the health insurance community.As a result, couples therapy and family therapy generally do not qualify for health insurance coverage because they are not reimbursable services as defined by the health insurance company's rules and regulations.


Second Problem: while health insurance companies will reimburse doctors for preventative physical health care (i.e., annual physicals, Pap smears, mammograms, teeth cleaning), they do not cover any preventative care services for mental health.
As a result, health insurance will only cover psychologists for services once you have a mental disorder condition, not to prevent one.

So, dear readers, that is the sad story for now.
Hopefully, in the future, there will be greater enlightenment in the health care insurance industry about the value of covering a wider variety of counseling services for folks who are not yet so stressed as to be "ill".

Until then, couples and family therapy is an "out of pocket" expense for interested clients.

*********Now for the good news!
Effective couples therapy and family therapy is not a weekly expense, Sessions are scheduled once to twice a month.
Effective couples therapy and family therapy can be targeted for maximum impact. Specific skills and issues can be identified and worked on with an intensive approach.
Effective couples therapy and family therapy CAN MAKE A DIFFERENCE to relationships within a few sessions.

Until next time, please take good care, one and all!