SIX WAYS TO SAVE MONEY ON PSYCHOTHERAPY!

Save some money!  Here are a few pointers on how to be a healthier person and have healthier relationships:

1)  Consider replacing the word “should” with “could” EVERY time you use that word.  The word “should” is such a strange word.  What does it really mean?  “You SHOULD… according to whom?  According to someone else?  According to an arbitrary set of rules you’ve grown up with?  Replace it with “could” and your options will not only open up, but what you end up doing will be more in tune with what YOU choose rather than what some arbitrary rule states you “should” choose.

2)  You can be “right”, or you can have a healthy relationship.  Think about it.  Some of us have been brought up to believe there’s ONE “right” way to do things.  In reality, there are multitudes of ways to do the same thing, all of which, which when acted upon, lead to a slightly different outcome.  For example:  Say a couple is driving to a dinner party for which they are late.  They get in an argument along the way about which route to take.  One route might be 2 miles longer; on the other hand, the other route might be bogged down with traffic.  No matter which route they take, they will inevitably end up being late.  If they are 15 minutes late, but arrive at the party arguing with each other, is that necessarily “better” than if they are 20 minutes late but arrive at the party in good spirits?

     With cooking, there are many different ways to prepare a particular dish.  So many people believe there’s only ONE “right” way to cook.  If you vary your preparation a bit, the outcome will be slightly different than if you follow the recipe word for word.  “Different” doesn’t mean it’s “WRONG”; it just means it’s different.  Even if you’re a chef for a 4-star restaurant, whose business depends on customers expecting the exact same thing each time they order it, the way you prepare it doesn’t make it the “right” way.  It just makes it “your” way.

     Some people ask me, “What’s the “right” thing to do (in any given situation)?”  I usually respond, “Well, there are probably infinite ways of doing it, each having a slightly different outcome— so what outcome are you hoping for?  And which way of doing it will increase the likelihood that you will achieve the outcome you want?”

3)  Healthy relationships stem from being on the same team together.  If you see your partner as an adversary, you will end up taking a defensive stance toward him/her and you will end up fighting as adversaries tend to do.  Try giving your partner the benefit of the doubt instead.  Instead of assuming that s/he has ulterior motives, consider the possibility that s/he simply is stating a preference.  Then you won’t feel insulted or compelled to “compete” as a way to simply hold your ground.

4)  For any relationship to be mutually respectful, it is inevitable that each partner will need to relinquish some preferences in order to effectively compromise.  Expecting to have everything “your way” will work only if by some bizarre coincidence“your way” is ALWAYS the same as your partner’s way.  If having everything “your way” is so important to you, then consider living by yourself instead of insisting your partner conform to your every preference.  Relationships involve compromise.  Be prepared and willing to do that if you want to be in one.

5)  Consider the possibility of not keeping ANY secrets from each other.  Secrets in any relational system are TOXIC.  Holding on to secrets will eventually and inevitably lead to feelings of mistrust and betrayal.  What secret is worth that?  This includes all secrets— those between partners, and those between parents and their children.  Building trust requires being fully transparent with each other.  If you feel compelled to take action on something that you will not feel comfortable sharing with your partner (or children), think twice before doing so.  Resisting impulses isn’t easy, but giving into them can lead to your relationship ending.  You may get by with having your cake and eating it too in the short run, but, trust me, it will always, at some point, come back to haunt you.

6)  If you do end up hiding something from your partner, and s/he finds out (and believe me, s/he will find out), you will have to accept the reality that s/he will no longer feel able to trust you from that point on.  You will want to “put it behind you”, because it’s troublesome to “deal” with it on an ongoing basis.  But trying to “put it behind you” will only INCREASE your partner’s feelings of being dismissed.  You will have to take full responsibility for your betrayal, and to be patient and understanding with your partner’s difficulty trusting you again.  It will be YOUR job to earn back his/her trust.  To respond with annoyance or impatience everytime s/he brings the issue up will only serve to foster his/her mistrust of you.  It will be the “betrayed one’s” job to constantly monitor and assess whether or not s/he can eventually trust you in the future.  On the outside chance that s/he never does find out, consider the impact of keeping this secret will have over time on the relationship between the two of you.  In Pink Floydian terms, it will just add another brick in the wall.

Famous Quotes, the Way a Woman Would Have to Say them During a Mtg

via the Washington Post, 10/16/15

........
"Woman in a Meeting" is a language of its own.

It should not be, but it is. You will think that you have stated the case simply and effectively, and everyone else will wonder why you were so Terrifyingly Angry. Instead, you have to translate.

<snip>

To illustrate this difficulty, I have taken the liberty of translating some famous sentences into the phrases a woman would have to use to say them during a meeting not to be perceived as angry, threatening or (gasp!) bitchy.

"Give me liberty, or give me death."
Woman in a Meeting: "Dave, if I could, I could just -- I just really feel like if we had liberty it would be terrific, and the alternative would just be awful, you know? That's just how it strikes me. I don't know."

"I have a dream today!"
Woman in a Meeting: "I'm sorry, I just had this idea -- it's probably crazy, but -- look, just as long as we're throwing things out here -- I had sort of an idea or vision about maybe the future?"

"Mr. Gorbachev, tear down this wall!"
Woman in a Meeting: "I'm sorry, Mikhail, if I could? Didn't mean to cut you off there. Can we agree that this wall maybe isn't quite doing what it should be doing? Just looking at everything everyone's been saying, it seems like we could consider removing it. Possibly. I don't know, what does the room feel?"

"The only thing we have to fear is fear itself."
Woman in a Meeting: "I have to say -- I'm sorry -- I have to say this. I don't think we should be as scared of non-fear things as maybe we are? If that makes sense? Sorry, I feel like I'm rambling."

"Ask not what your country can do for you. Ask what you can do for your country."
Woman in a Meeting: "I'm not an expert, Dave, but I feel like maybe you could accomplish more by maybe shifting your focus from asking things from the government and instead looking at things that we can all do ourselves? Just a thought. Just a thought. Take it for what it's worth."

"Let my people go."
Woman in a Meeting: "Pharaoh, listen, I totally hear where you're coming from on this. I totally do. And I don't want to butt in if you've come to a decision here, but, just, I have to say, would you consider that an argument for maybe releasing these people could conceivably have merit? Or is that already off the table?"

<snip>

"I have not yet begun to fight."
Woman in a Meeting: "Dave, I'm not going to fight you on this."

"I will be heard."
Woman in a Meeting: "Sorry to interrupt. No, go on, Dave. Finish what you had to say."

[end excerpts]

The article is online at:
<http://bit.ly/KenPopeFamousQuotes>

Ken Pope
 

A Resilience Framework to Promote Stable Remission From Depression

This valuable re-post, from my friend and colleague, Ken Pope, PhD:

The new issue of *Clinical Psychology Review* includes an article: "A resilience framework for promoting stable remission from depression."

The authors are Waugh, Christian E.; & Koster, Ernst H. W.

PLEASE NOTE: As usual, I'll include both the author's email address (for requesting electronic reprints) and a link to the complete article at the end below.

Here's the abstract: "A significant proportion of people in remission from depression will experience a recurrence of depression. One theoretical mechanism for this recurrence is that with each additional episode of depression, people become more sensitive to the deleterious effects of less powerful stressors. We propose that research on resilience--the ability to adapt to and recover from stress--can inform interventions to prevent recurrence in people in remission. We conceptualize resilience as a dynamic process that may be deficient in people in remission from depression, rather than as a static personal quality that is unattainable to people who have experienced psychopathology. The three aspects of resilience that we suggest are the most important to target to prevent recurrence are (1) improving stress recovery from minor daily stressors that may aid remitted people in coping with major stressors, (2) increasing positivity, like promoting positive emotions during stress, and (3) and training flexibility--the ability to identify different demands in the environment and employ the appropriate coping strategy to meet those demands. We offer suggestions for the appropriate assessment of changes in resilience in remitted people and provide some examples of effective resilience interventions."

REPRINTS: Christian E. Waugh: Wake Forest University, P.O. Box 7778, Winston Salem, NC, US, 27109, waughce@wfu.edu

The article is online at:
<http://bit.ly/KenPopeResilienceDepressionRecovery>

Ken Pope

Effects of Childhood Maltreatment

This research was recently summarized by my friend/colleague Ken Pope, PhD, from "Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment", to be published soon in JAMA.  The authors are David D. Vachon, PhD, Robert F. Krueger, PhD, Fred. A. Rogosch, PhD, and Dante Cicchetti, PhD.  The following is his enlightening summary:


PLEASE NOTE: As usual, I'll include both the author's email address (for requesting electronic reprints) and a link to the complete article at the end below.

Here's how the article opens:

[begin excerpt]

Worldwide prevalence estimates suggest that child physical abuse (8.0%), sexual abuse (1.6%), emotional abuse (36.3%), and neglect (4.4%) are common.1,2 These forms of abuse and neglect are collectively referred to as child maltreatment (CM). At least 4 assumptions pervade the scientific literature on CM: (1) harmfulness (CM causes substantial harm), (2) nonequivalence (some forms of CM are more harmful than others), (3) specificity (each form of CM has specific consequences), and (4) nonuniversality (the effects of CM differ across sex and race).

The strongest assumption is that CM causes harm. In a meta-analysis, nonsexual forms of CM (physical abuse, emotional abuse, and neglect) were associated with a wide range of mental health problems, including depression, anxiety, eating disorders, substance use, and suicidal behavior.3 Evidence from research on sexual abuse is less consistent. Although early literature reviews concluded that child sexual abuse predicts a range of psychiatric outcomes,4- 6 later meta-analyses based on community samples7 and college samples8 suggested that child sexual abuse is weakly associated with later adjustment problems. Unsurprisingly, these findings are controversial9 and have been criticized10,11 and defended12,13 on several occasions.

The nonequivalence assumption is evident in the legal system, where some forms of CM are felonies but others are legal, and in the scientific literature, which focuses predominantly on sexual and physical abuse.14 However, meta-analytic data do not show appreciable differences in harm across types of CM.3 Furthermore, study-level comparisons are confounded by differences in samples and methods, and individual-level comparisons are rare and usually fail to model patterns of CM co-occurrence. The ubiquity of the assumption of nonequivalence must therefore be based on factors other than comparative evidence of harm, such as cultural mores and differences in the ability to measure and document maltreatment.

The specificity assumption is based on early studies suggesting that certain exposures may be linked to particular mental health outcomes.15,16 However, subsequent evidence suggests that various forms of CM may have nonspecific, widespread effects on mental health.13,16,17 An unanswered question is whether such widespread effects are the result of CM affecting common factors that underlie multiple psychiatric disorders.

The nonuniversality assumption has received occasional support from research showing sex differences18 and racial differences19 in outcomes related to CM, motivating some to recommend treatments tailored to sex and race.20 However, research in this area is scarce, and few studies have directly statistically tested sex or race as a moderator. Prevalence rates may differ between populations, as might various risk factors and service response variables, but the question whether the effects of CM generalize across populations remains unanswered.

To test each assumption and overcome the limitations of previous research, this study rigorously assesses multiple forms of CM, relates them structurally, and uses them to predict a broad range of ensuing maladjustment in a large, racially diverse sample of boys and girls aggregated over 27 years. We hypothesized that our results would correspond with meta-analytic evidence supporting the assumption of harm; otherwise, our results would contradict the other assumptions, including nonequivalence, specificity, and nonuniversality. That is, we hypothesized that different forms of CM would have equivalent, broad, and universal consequences. Such findings would have substantial etiologic, clinical, and legal implications.

[end excerpt]

Here's an excerpt from the Discussion section:

[begin excerpt]

Our results suggest that physical abuse, emotional abuse, and neglect are equivalent insults that affect broad psychiatric vulnerabilities. Our results also highlight an important problem--one that may explain mixed findings in the literature on child sexual abuse. Specifically, child sexual abuse is an infrequent event that is almost always accompanied by other types of CM. This pattern of rarity and lopsided co-occurrence has several consequences. First, it poses a statistical constraint that severely attenuates the correlation between sexual and nonsexual CM. For example, if nearly all people with a given disorder are men but very few men have that disorder, then sex will be nearly uncorrelated with the disorder (despite the fact that almost all cases are in men). This constraint explains why sexual CM and nonsexual CM are weakly correlated factors in our structural model: whereas 89% of cases of sexual CM are accompanied by nonsexual CM, only 9% of cases of nonsexual CM are accompanied by sexual CM.

Second, there is no practical way to understand the specific consequences of sexual CM because its correlates may be attributed to other forms of co-occurring CM. Statistically controlling for co-occurring CM removes what little covariation is left after the attenuation caused by unidirectional redundancy, further gutting the variance in the sexual abuse variable and producing unreliable parameter estimates. Alternatively, cases of "pure" sexual abuse (without co-occurring CM) are extremely rare and unrepresentative. This intractable issue may explain why research on sexual CM produces mixed results. The infrequency of sexual CM combined with its unidirectional redundancy with nonsexual CM attenuates their correlation and undermines efforts to identify the effects of sexual abuse, which are almost certainly detrimental. As such, previous meta-analyses of the literature on child sexual abuse7,8 may produce misleading results.

This study also partially addresses a potentially confounding variable: SES. Because factors associated with low SES predict the occurrence of both CM36 and mental illness,37 low SES may explain the association between CM and psychopathologic disorders. In the current study, all children were sampled from families with low SES, attenuating this potential SES confounder. However, a different pattern of results may be found in populations with higher SES.

Sexual abuse may be an underreported type of CM that is difficult for child protection agencies to substantiate. Thus, an important limitation to overcome is collecting data on these missed cases; doing so may also help address the methodologic problem of rarity and lopsided co-occurrence. Other limitations of this study include reliance on official documentation, absence of data regarding psychopathologic disorders prior to CM, and use of psychological reports from counselors and children who only knew the participants in the camp setting.

[end excerpt]

REPRINTS:   Robert F. Krueger, PhD, Department of Psychology, University of Minnesota, 75 E River Rd, Minneapolis, MN 55455 krueg038@umn.edu

The article is online at:
<http://bit.ly/KenPopeAssessingDiffFormsOfChildAbuse>

Ken Pope

 

LOVE this, from THE VELVETEEN RABBIT

"He said, 'You become. It takes a long time. That's why it doesn't happen often to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don't matter at all, because once you are Real you can't be ugly, except to people who don't understand.'"

From Harvard Medical School Newsletter: (Sept. 2015)

From Harvard Medical School Newsletter: (Sept. 2015)
Having a dog can help your heart — literally
Dog lovers know how much warmth and comfort their canine companions add to their lives. But they might not know that a growing body of evidence suggests that having a dog may help improve heart health.

Pet ownership, especially having a dog, is probably associated with a decreased risk of cardiovascular disease. This does not mean that there is a clear cause and effect relationship between the two. But it does mean that pet ownership can be a reasonable part of an overall strategy to lower the risk of heart disease.

Several studies have shown that dog owners have lower blood pressure than non-owners — probably because their pets have a calming effect on them and because dog owners tend to get more exercise. The power of touch also appears to be an important part of this "pet effect." Several studies show that blood pressure goes down when a person pets a dog .

There is some evidence that owning a dog is associated with lower Cholesterol and Triglyceride levels. A large study focusing on this question found that dog owners had lower Cholesterol and Triglyceride Levels.

A large study focused on this question found that dog owners had  lower Cholesterol and Triglyceride levels that non-owners, and that these differences weren't explainable by diet, smoking, or Body Mass Index (BMI). However, the reason for these differences is sill not clear. 

Dogs' calming effect on humans also appears to help people handle stress. For example, some research suggests that people with dogs experience less cardiovascular reactivity during times of stress. That means that their heart rate and blood pressure go up less and return to normal more quickly, dampening the effects of stress on the body.

If you own a dog or are thinking about it, the potential benefits for your heart health are a nice plus. However, pets should not be adopted for the primary purpose of reducing heart disease risk. And definitely don't add a dog to your life if you're not ready or able to take care of one, including making sure it gets enough exercise.

Insurance Billing Medical Codes...

For those of you who aren't aware, the medical "codes" used for insurance billing have been dramatically overhauled as of October 1st, 2015. These codes used to be referred to as "ICD-9" codes; they are now "ICD-10" codes. They are far more complex and detailed-- it seems everything having to do with insurance keeps getting more and more complicated these days. Anyway, here is a blog from Next Avenue that explains what to expect.

What the New Medical Code Overhaul Means to You
Prepare for complications with doctors, hospitals and insurers

Richard Eisenberg
By Richard Eisenberg
Money & Work Editor
October 1, 2015
NEXT AVENUE BLOGGER
Nurse filling out medical records
Credit: Thinkstock
Your doctor and medical staff may get crankier. Your health insurance claims may be denied or delayed. You could be pressured to pay health care balances in full, rather than over time. Welcome to the new world of medical coding taking effect Oct. 1, 2015.

That’s the day that the number of medical diagnostic codes will skyrocket from 14,000 to 68,000 and the number of codes for inpatient hospital procedures will balloon from 4,000 to 87,000.

Technically, the switch is known as the conversion from the ICD-9 (International Classification of Diseases), adopted in the U.S. in 1979, to ICD-10.

Now at Your Doctor’s Office: New Medical Codes
It’s been put off three times since the U.S. Department of Health and Human Services’ initial 2011 date. The World Health Organization first adopted the expanded medical codes in 1990; some countries have used them since 1994. “We’re the last industrial nation to adopt it,” says Peter Strack, senior advisor, Strategy and Development, Business Advisory Services for the Altarum Institute, a health systems research and consulting organization.

MORE 8 Medical Bill Errors to Watch For

Here, “this change has been fought tooth and nail by the American Medical Association and the medical world for several years. It’s hard to believe it’s truly going to happen,” says Martine Brousse, president of the Santa Monica, Calif., patient advocacy service AdviMed and a medical billing advocate for Nerd Wallet.

The explosion in new codes is likely to lead to coding errors, which will lead to health claim reimbursement delays and denials.
But it really is. And you can expect to see some not-so-pleasant ripple effects immediately.

The Long-Term Benefit and Short-Term Chaos
Ideally, the extra codes will ultimately improve medical care in America. That’s because they’ll offer greater precision about treatments and diseases, which could then help the medical world better understand our ailments and how best to manage and approach them. Also, the new codes could help public health officials identify disease outbreaks sooner.

“ICD-10 provides greater granularity around clinical procedures and medical interventions,” says Strack. “We’ll see an improvement in clinical research looking at quality-outcome measurements.”

But more immediately, the coding cacophony could make life tougher for some patients, medical practices and hospitals. “There will definitely be challenges post-implementation,” says Strack. “We’ll see the industry bracing for that impact. In the short term, there will be bumps.”

MORE Why Your Doctor Won’t Friend You on Facebook

According to The New York Times, “the change is causing waves of anxiety among health care providers.” Dr. Barbara McAneny, a cancer specialist in Albuquerque, N.M., told the Times: “I don’t think physicians are ready. I don’t think health plans are ready.”

Expect a Boom in Coding Errors
The explosion in new codes is likely to lead to coding errors, which will lead to health claim reimbursement delays and denials. The Wall Street Journal says some coding experts fear denials could double during the transition to the new codes. (Medicare will offer a one-year grace period for physicians’ coding confusion as long as their codes are in the right broad categories.)

“ICD-10 requires a certain amount of data precision that doctors have not been used to,” notes Strack. “With five or six times the number of codes than before, there are a lot more decisions to go through for every claim.” Some ailment codes will be based on particular circumstances for patients, too.

“No one is sure how great the error rate will be,” says Dr. Orly Avitzur, Consumer Reports medical adviser and a neurologist based in Tarrytown, N.Y. “Billing departments will be inundated over the next three months fixing codes.”

Which Patients Will Get Pinched
Avitzur believes health care consumers using out-of-network physicians and health providers are the most likely to feel the effects of the coding change in their wallets. “Those require payment at time of service and require you to submit your bill and wait for a reimbursement check,” she notes.

Brousse expects that some medical practices will see a drop in income over the next few months due to billing processing delays by insurers and will, in turn, tighten the screws on patients. Many practices have had to spend tens of thousands of dollars preparing for the ICD-10 conversion (though they may be able to start charging higher fees by being more precise about conditions they treat).

The immediate cash-flow crunch in doctor’s offices, however, will mean “they will be a lot more aggressive at getting co-pays and deductibles upfront,” Brousse says. “They might also be more aggressive in requiring patients to pay their balances in full, instead of in monthly payments.”

What to Expect at the Doctor
Whether you’re going to an out-of-network doc or an in-network one, though, prepare for some crankiness and a little less personal attention between now and the end of the year. Medical practices — as well as hospitals and clinics — will be required to spend more time providing much more information to insurers and to Medicare than in the past.

“Your doctor and the office staff may be a bit more distracted,” says Avitzur. “It’s like learning a new language for us.”

Adds Brousse: “From being a billing manager, I can tell you: This is not easy. Any mistake will lead to a rejection by an insurer.”

Coding will be especially complicated for patients with injuries — like a fractured wrist due to a fall — notes Avitzur. “Injury codes will require a lot more detail and information about the sequence of diagnosis than before,” she says.

Strack also expects challenges for complex medical procedures such as “interventional cardiology” and obstetrics. A Wall Street Journal article said cardiologists will “have not one, but 845 codes for angioplasty.”

Brousse anticipates “a large number of appeals and backlogs” due to the new codes. One potential snag: You’ll be expected to have the right diagnostic code to get pre-approval from insurers for some tests and procedures. “I’m really worried that patients may have to delay treatment due to clerical errors,” she says. “It could be harmful for their health.”

If insurers delay approvals for procedures due to coding errors, you may find yourself waiting longer to get scheduled for, say, an MRI.

What to Do If You Have Coding Woes
If your health claim is denied, Brousse says, contact your insurer and ask why. “In many cases, an insurance rep can call the medical office and get the correct diagnosis over the phone,” she notes.

Another tip: Check with your state’s insurance department to see if your state has a grievance process for health claims. “If treatment is denied by your insurer and your doctor says it’s medically necessary, the state may be able to step in and issue an order to pay for coverage,” says Brousse.

And patients, be patient: Strack estimates that “by the end of the first year [under ICD-10], the panic should have subsided considerably.”