A Bit More On Cost

So here I am with a client who has been unemployed for about 4 months now, is three months behind on the mortgage payments, and is awaiting the "call" from the previous employer who has promised a job "next week" for a couple of months now (there is a huge bureaucracy involved, so this sort of delay is not surprising). Therapy is truly helping this person. It's not a "brief" therapy. This could go on for quite a while. By now I'm carrying a back bill of 6 sessions. Not tremendous, and not nothing either. This affects my income, which, in case you wonder, is not large. I enjoy working with this client, not least because I see the steady progress that is being made in some pretty significant areas, and because of the commitment that this client has made to healing.

I'm willing to "carry" this client. I expect to be paid some day, but who knows? In spite of today's headlines that declare that the recession is officially over, this client is caught up in the same financial circumstances that literally millions of other Americans face: the highest unemployment rates in decades; unprecedented home foreclosure rates; a general economy that, before today it seems, has been shrinking. Yesterday, when a check was offered at session's end, after we had talked about the relationship between client's shame and the lack of money, I gave it back and told this client to go buy food instead.

I'm not telling this story to garner praise for my generosity. To me this situation seems obvious and inevitable: one does not take money for therapy when one knows that the client has had to borrow money for food, and when there is an established therapeutic relationship in place that is benefiting the client.

When people I feel a connection with ask me about my work, my stock answer is that it's a good thing that my wife has a real job. We certainly wouldn't be able to live on what I make. And partly, this is because of personal decisions I've made regarding my fees, my non-relationship with insurance companies, and situations like the one described above. Also, I'm not a very good "business" person, not unlike many creative people, so "marketing" isn't something I do. Oh well. C'est la vie.

I know there are "high powered" therapists who make huge incomes because they are good business people, because they approach their private practices as businesses first, and, not insignificantly, because they see largely wealthy clients. This has never been my approach, or my motivation for practicing as a therapist. It's not where I come from, either personally or professionally. So what about every one else? The "average" person, or the poor person needing therapy? A client at a private, expensive residential treatment facility that I used to work at once said, in expressing his gratitude for his situation, that while he was fortunate to be able to pay for his treatment, "poor addicts just die". And so it goes.

Or does it have to?







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The Cost Of Therapy

Typically, psychotherapy is pretty expensive. This is because it has its roots in an aristocratic white social environment, and because it developed out of a western medical milieu where professional medical people held high status and commanded high fees. Nowadays, "psychotherapists" include medical doctors (psychiatrists), psychologists (PhD's, PsyD's, or EdD's), and Masters level practitioners including clinical social workers (MSW, LISW, LCSW, etc.), and clinical counselors (LPCC's, LCPC's, etc.).

The debate about the cost of therapy is never ending, and there does not seem to be any clear cut way of resolving the dilemma. I say" dilemma" because many people who would benefit from good therapy will never have the opportunity to do so because the cost of the service is out of their reach. This is no different in many cases from the costs of medical and health care in general in our current economic system and insurance/(obscenely) profit driven health care system.

So what to do? There are community "mental health" agencies that are supposed to pick up this slack, and make therapy (or more commonly, "counseling") available to the masses. The reality however is that these agencies are typically government funded, and we all know what happens to funding for all "non-essential" services as a general rule: it is, of course, drastically cut. This means that many of these community mental health agencies go out of business. The ones that remain spend most of their time and energy struggling to survive, to raise funds, to meet ever increasing paperwork demands, and to provide direct services to ever growing numbers of people. It is not uncommon, for example, for a therapist at such an agency to be expected to see 25-30 clients a week. Plus do all the paperwork involved. Plus attend meetings. This is not possible if it is also expected that the therapist will be able to remain healthy and to provide quality service.

Then there are the private practice therapists. If insurance is funding the service, it may also not be uncommon for a therapist to see 30 clients (or patients) a week. If insurance is not funding the service, this number is likely to be considerably lower. Still, we all know that there are millions of Americans who do not have health insurance, and so are left to fund therapy services out of pocket. This is where the high cost becomes problematic for many.

The dilemma is extended when you factor in the legitimate need of the therapist to be able to make a living. So what does "make a living" mean? Of course this is different for every person.
Is the British surgeon who makes a million dollars a year under the socialized health care system, and living very well, being deprived because she or he is not making the 2 million she would make in unregulated America? You see how this goes.

So it becomes a very personal moral, ethical, practical and spiritual consideration for each practitioner. How much do I charge for my services? What are my legitimate needs? What are the "customary and usual" fees in my community? Are these within my personally acceptable parameters? Are they too high? Too low?

To be continued......................





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It's Not Rocket Science

Not infrequently I hear myself saying this to clients: "It's not rocket science."

What I'm referring to are the concepts involved in understanding how the psyche generally works.

I'm not even talking about the subconscious, or the unconscious, collective or otherwise. I'm simply talking about the basic rules of the road that seem to apply to everyone. For example, when we're afraid of being judged, we often employ a defense strategy - a "mechanism" - that will keep us protected from feeling the painful feeling of being judged by another. We might decide, internally, and probably out of consciousness (ok, I AM talking about the unconscious) that we don't care what anyone thinks or says about us, and present to the world, to other people, an outward demeanor that looks carefree and confident.


If it's too difficult - embarrassing, shame inducing, contrary to our image of our self - to admit that we were not able to be truly present for an intimate when they really needed us to be, we might offer any number of "rationalizations" or justifications, or just plain excuses, rather than feel the depth of the anger or the betrayal or the pain that our intimate is experiencing.


These sorts of things are very common. We have all learned and invented personal versions of them, and other strategies, to protect ourselves from unwanted feelings or thoughts. It's this sort of thing that I refer to when I say "It's not rocket science". Coming to understand these common psychological behaviors isn't all that difficult. What becomes difficult is to learn to see how they operate within ourselves, to learn how to "bust" ourselves when we're doing them, and to learn new ways of seeing and behaving that will contribute to freeing us from our own self defeating ways of doing things in relationship with others and with ourselves.


It does indeed take time, and effort, to learn and to establish new habits, and more self supporting ways of being in the world.






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Simple In Principle, Maybe Not In Practice

Here's the principle: you can experience whatever you want to, if only you'll focus your "consciousness" on that, or "put it" there.

Example: if you want to experience the ever present energy of love, you only need to choose to focus your consciousness on that energy within yourself, instead of on whatever else you may be experiencing, like fear, or anger, or sadness, or any train of thought. As long as you're focusing on the thoughts, or the feelings other than love, you won't be able to experience the love. So it becomes a matter of desire, and of re-focusing whenever you move off track.

Sounds simple enough, in principle. And I agree that it is simple. So what is it that prevents people from being able to do it easily? Is it, simply, a matter of different desires? If I'm depressed, and struggling with hopelessness, and an overwhelming sense of powerlessness to change anything, is it simply that I don't want to change this strongly enough? Are there other operative factors?

I'm quite certain that there are other factors in operation as well, and yet there may be a way in which it is possible to consider the simplicity of this principle as real. One factor that I come across with some frequency in my work is just that people don't understand that the changes they're after will come about in steps, over time, and not all-at-once in a flash of transformation. This implies that it will be necessary to "practice" certain new ways of understanding and of doing things, until a new experience is stabilized, or learned, or established. An obstacle that can then present itself is that people don't "want" to have to make that kind of effort, and so don't, and so don't experience the changes they say they "want".

Disappointment may then follow, and a belief that therapy doesn't work, and resentment may develop on top of that, or a client may come to believe that they themselves are just not good enough, not deserving enough, not strong enough, not capable enough, etc. It can become quite complex, whereas the principle we started with remains in itself, pretty simple.

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The Risks Of Therapy

It would be nice to think that therapy will make you feel better all of the time. After all, that's why people enter therapy, isn't it? I mean, who enters therapy if they think it's going to make them feel worse than they already do? Well, maybe a masochist would do that; would even count on it. But short of that, I think it's realistic to suppose that people enter therapy because they believe it will help them to feel good. There have even been therapy self help books written with titles like "The Feel Good Book".

It may come as a surprise then to discover that the therapeutic process can elicit difficult, painful, frightening feelings also, and that every session will not end with you, the client, feeling better than when you arrived. Along these lines we have other therapy related books with titles like "I Never Promised You A Rose Garden", and "Love Is Never Enough".

If we conceive of therapy as a journey of healing, as a process through time, we will be better able to imagine that this journey might have down's as well as up's; bumps and turns in the road;
bad weather as well as good; and a guarantee of changes along the way. From this point of view we can say that the process of therapy requires a certain amount of courage; a certain adventurousness of spirit; a certain willingness to be surprised, disappointed, challenged, and ultimately strengthened by our experiences.

Not much different from a life well lived, you might say. And you might be right.





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Give An Hour.ORG

Give An Hour.org is a non-profit, non-partisan service organization established to help provide free counseling/therapy services to returning veterans from the Iraq/Afghanistan wars. Services are also being provided to veteran families. Many of these men and women, as well as their children, are affected adversely by the experiences of combat, family disruption, and the often very difficult re-integration process following deployment.

Here are just a few astounding facts to consider:

According to the DoD Taskforce on Mental Health, among troops returning from Afghanistan and Iraq, 40% of soldiers, 1/3 of marines, and fully half of National Guard members are suffering from psychological problems following deployment;

children from military families are twice as likely to die from severe abuse as other children are, and rates of abuse and neglect rise dramatically (40%) during the time of deployment;

a recent Rand Corporation study reports that some 300,000 US troops returning from Iraq/Afghanistan are suffering from Major Depression or Post Traumatic Stress Disorder, while another 320,000 are suffering with brain injuries. Only about half of all of these women and men have sought treatment;

there are an average of 18 suicides a day, among America's 25 million vets.

I've taken the step of signing up, along with some 4,000 other therapists (so far) across the country, with Give An Hour, in order to be able to contribute something in the way of compassionate care to some of these men, women and children. This is not an issue of politics or party lines, but a matter of offering some measure of help to people in dire need.

If you'd like more information on Give An Hour, please click on the title of this post to visit their website.



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Reality Tends To Intrude

For a while, things are going much better. Insights have been gained, new and considerably more compassionate relationship dynamics are being employed with oneself, self care is becoming a real and active part of everyday life, and as a result, you're feeling "exited about life" for the first time in many years. You're experiencing genuine hope for the future, a more open expanse of possibilities, instead of the dark tunnel of despair and depression that has been your abode for so long.

Then, it's as though the wrathful hand of God has slapped you across your beseeching, uplifted face. Not you! it seems to say. Did you really think I'd let you feel good about yourself! Who do you think you are?!

To make matters worse, you are, without really knowing it, the one playing God. It is actually your own self judgment and self criticism, along with your own unrealistic expectations about your recovery, that is exacerbating your slide back down the slope of old behavioral and emotional habits. You were doing things right, you figured, and the results were real. I've arrived! It's been a long journey, but I've finally arrived! Whew!

What you haven't accounted for is what I like to call your "defaults". Those patterns that are simply programmed deeply into your personality, and are the places you will tend to "default to" under stress. The familiar. The well established. The original. Everyone has them, and learning to live with them in more creative and loving ways is a key to continued recovery and development. The reality of "two steps forward, one step back", has to be understood and integrated as a natural part of the healing and growth process. Especially in the early stages of recovery.



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