How to pay for marriage counseling

If you’re hoping to use insurance to pay for marriage counseling, you’re likely to be disappointed. Couples’ counseling is rarely covered by health insurance because marital issues are not considered by the insurance companies to be a health problem. The exception is when one of the parties is in treatment for a mental health or substance abuse condition. Then, marriage counseling can often be covered as part of that treatment. If that is the case, then the partner with the condition will have to be considered the identified patient and billed under his or her name.

If one your employers has an Employee Assistance Program (EAP), then you may be in luck. You and your partner can go see a counselor for a limited number of sessions (usually 3 to 6) paid completely by the program, no questions asked. If you have this kind of benefit, human resources will be able to tell you or it’ll be in the employee handbook. Just call the number to the EAP and the person there will set you up with a counselor in their network. You are not able to work with anyone out of network with an EAP.

Many counselors, including myself, are willing to reduce their hourly fees if it’ll mean that you can commit to a frequency and duration of treatment that can make a difference. This is called a sliding scale. Ask about it.

If you’re involved with a religious organization, many pastors are willing to work with couples in marriage counseling as part of their pastoral duties. Some are very good marriage counselors and this can be a good option if you both buy into the faith they represent.

Marriage counseling can take a big chunk out of most peoples’ budgets if it continues frequently for an extended period of time. It’s impossible to know in advance how long or how often you’re going to need to meet, but, chances are, it’ll have to be for an extended period of time. It’s not cheap, but it can save you the cost of a divorce.

When Madness Takes Cover

So, you’ve stopped drinking, or drugging, or gambling, or sleeping around. Your depression seems to have lifted. You haven’t been violent. Your anxiety no longer makes all the decisions. You’re up in the morning and dressed when you need to be. The madness seems to have gone away.

Has it, really?

Madness takes cover sometimes when it feels threatened. It’ll hide in the bushes and come roaring out when you least suspect it. Make no mistake, madness is cunning, baffling, and very, very patient. While you’ve been collecting key rings at your NA meeting, the madness has been doing pushups in the dark.

Madness prefers the dark. It likes to perform its dirty deeds in secret. The night belongs to Michelob. However, madness is rarely ever a real secret. It’s kidding you when you believe it leaves no trace. You can tell when madness is still afoot if you are willing to read the signs.

These are the signs:

You haven’t done the things promised for your recovery

If the problem behavior is gone, but you still haven’t been to see a therapist, attended meetings, written that letter of apology, changed associates, or done any of the things you promised, then the madness is just hoping you won’t notice.

The behavioral changes have been minor

The more serious the madness has been, the more excited you’ll be when there’s been a slight improvement.

You were drinking every day, now you’re thrilled that you cut down to once a week. You used to gamble away all of your paycheck, now you only buy a few scratch-offs. You used to beat your wife, now you only puts holes in the wall. The underlying attitudes towards drinking, gambling, or violence have not changed; the only thing changed is the frequency and severity.

When gardeners trim bushes back a little, they call it pruning; it doesn’t destroy the bush, it makes it grow more. The same thing happens when only minor changes are accomplished. You wouldn’t be satisfied with your surgeon if you had a mastectomy and he left some cancer behind, so don’t fool yourself by minor behavioral changes.

Other problems have arisen

Sometimes the illness plays whack-a-mole by extinguishing one problem behavior, only to transfer it to another. We see this frequently with addicts who will use one drug until the heat is on, and then switch to a different drug. Instead of scoring heroin on the street and using dirty needles, they get their narcotics from a doctor. You’ll think that’s an improvement, until you start to abuse those pills, too. The underlying issue remains.

Thinking has not changed

If the rationalizations that have justified the madness are still in evidence, then the madness has not gone away. You used to say you needed to drink, so you drank. Now, you don’t drink, but you still say you need to. Guess what? You’ll drink again. If the madness was truly gone, you’d no longer believe you needed it.

No fence has been built

It is not enough just to change the problem behavior to eradicate an illness. You also have to know the route that it takes before it arrives. You need to put up a gate and shut out behavior that, in itself, is not problematic, but leads up to the problem.

Madness comes masquerading as something harmless so that you will not see it coming. Pedophiles start off by making friends with a child. There’s nothing wrong with making friends with a child, right? But, then they gradually groom the child to accept more and more sexual behavior. We protect children from pedophiles by not permitting them to live near schools. This is not because it is bad to live near a school, but it is bad for pedophiles to live near schools.

Authentic recovery means that you see through all the disguises.

History is minimized

If the story you tell about the illness differs significantly from your partner’s, then the madness is still lurking about. If you talk about your depression only in terms of your suffering and leave out how it affected others, then you’ve not incorporated other points of view into your own. Your limited perspective is still all you have. You have an incomplete appreciation of the costs of your choices. You should be able to tell your partner’s side of the story as well as your own.

You’re withdrawn

If your partner complains that you’re virtually unreachable, emotionally inaccessible, or sexually uninterested, then the madness may be in hiding. It doesn’t want people to ask too many questions, know too much, or get too close.

You’re always angry with your partner

You may be blaming other people for calling out the madness and challenging it. you may be using anger as a way to keep others away, off balance, and uninformed. You may still be taking sides with the madness, against your partner.

Your partner is working harder at recovery than you are

Your partner has been on you like white on rice. Ever since you had that affair, she’s been monitoring your phone, checking your whereabouts, scanning your emails, opening your letters. She met every single female acquaintance you have and gave them all the stink eye. She scrutinizes your expression when every waitress approaches. She tried every new position you wanted in an attempt to reawaken your sex life. She found a therapist for you, set up the appointment, went to every session, paid, and did the homework assignments. Your partner is working harder than you are.

If you have not taken responsibility for change, then you will not make the right choices the moment your partner’s back is turned.

You say everything is changed

You’re not the one to judge whether anything has changed. When your madness fools people, it fools you first.

You want to move on and not get stuck in the past

That’s the madness talking, trying to convince you to not learn from the past. Truly recovering people remind themselves of the past regularly, so that they’ll not repeat it.

You want credit for improvements

An adult straightens the house every day. He scrubs the toilets when they need it and mops the floor when it’s dirty. He doesn’t expect a medal for it. He just does it because it needs doing.

A toddler tickles the furniture with a feather duster once in a while and everyone will fall all over him, saying he was very helpful. That’s what they do for a child. Are you a child?

When madness takes over: the less you do, the more credit you think you deserve.

In a healthy world: you don’t earn special points for doing what you should have been doing all along.

It’s still all about you

Not only have you stopped the problematic behavior, but you’ve been going to therapy, attending AA, writing in your journal, and getting in touch with your feelings. These are all good things, but you’re still as self-involved as ever.

Real change means taking action towards becoming more loving, generous, caring, and empathetic towards others.

There are no signs

You looked over this list and you did not find a single thing that indicates madness may be lurking. There seem to be no signs. Well, that’s your sign. If you aren’t seeing signs, then you’re fooling yourself. There are always signs.

The road to recovery is the same road as the road to ruin; you’re just traveling in a different direction. You pass by the same markers as when you were heading to ruin. You should be seeing them now and recognizing them for what they are. You should also be seeing some signs that indicate you are heading in the right direction. You should be seeing meaningful change.

The Shrink’s Links: How to Fly a Horse

Bringing you the best of mental health every week.

genius

Kevin Ashton thinks we make too much out of creativity, geniuses, and inspiration. He believes great insights and achievements are made by ordinary thinking.

“… each of us is more like Mozart than not. We can all create, we can all contribute, and we all should.”

Click here to go to the website

Scarcity Mentality: Why you aren’t happy when you’ve got it so good

Starving child

Food has never been cheaper. Houses never warmer in the winter or cooler in the summer. People not only live longer, but they stay healthier longer. Information about almost anything is at your fingertips. Crime and violence, by any objective measure, is at an all-time low. There’s opportunity to travel in less than 24 hours to almost anywhere in the world. If you did, and if you went to a poor country, you would see how good you have it. If you have it this good, why aren’t you happy?

Maybe you are happy, I shouldn’t assume too much, but many who have it this good aren’t. You know them. You live with them, work with them, hear their horns honking behind you the moment the light turns green. Why aren’t they happy, when they have it as good as you?

In my last post I talked about Rat Park and how, simply by making lab rats happy, we can make them addiction proof. It doesn’t work that way with humans. Well, why not?

We’re not rats.

In many ways, we’re just like rats. We eat, shit, die, and rot just like any animal. But, unlike any animal, we know it. We’re self-conscious. That makes all the difference. I can’t get into all the ways that makes a difference in one little post; the whole blog is about that, but here’s one way:

The key to being unhappy when you’ve got it good is to assume that the good things you have are finite. There is only so much pie. So, if you want pie, you’ve got to fight to ensure you get your fair share. Then, if you eat your pie, you can’t keep it; it’s gone. If you don’t eat your pie, someone else might take it. Even if you have enough pie, someone may have more, indicating an injustice that might be a problem some other time, so you better object now, while you have the chance.

We call this assumption a scarcity mentality. It’s a pretty good way of being miserable when you could be happy.

The alternative is called an abundance mentality. That’s an assumption that there’s plenty more where that came from; easy come, easy go. So what if you ran out of pie? You can always make more. An abundance mentality enables you to be generous, forgiving, patient, and trusting.

Between the two, it’s easy to see that having an abundance mentality can make you a happier person. So, what’s the problem? Have an abundance mentality and be happy.

The problem is you’re going to die, and you know it.

If you know you are going to die, that means you know you only have so much time. There are limits. Things are finite.

Despite all this, having an abundance mentality is a very, very good thing. People have different ways of getting around this problem. They know that it is better to be trusting, forgiving, generous, and patient, but they also know it is difficult, or impossible, to do so when they must compete with others over limited resources, within limited time. So, what do they do to maintain a mentality of abundance?

They can deny the limits, extend the limits, and accept the limits.

Those who deny the limits try not to think about them. They shut out thoughts of death. They don’t like to be reminded that, although they may live in plenty, there are others who live in want. They protect themselves from disturbing images, dissenting voices, rotten smells, and uncomfortable vibes. There are many things available to help them live in the big rock candy mountain. Everything from alcohol and drugs to gated communities, self congratulatory media, repressive immigration policies, polite conversation, and the remote to the TV. With the assistance of these tools, they can go on believing they can live forever, they can have whatever they want, and no one needs to get hurt. Then they can be patient and kind and keep their abundance mentality, so long as things continue to go their way.

Those who extend the limits are the people who bake plenty of pies so everyone can have some. They take care of their health so they can live longer. They cure diseases so everyone can live longer. They plant trees so everyone can eat, build buildings so everyone can have a home, and conserve resources so everyone can have what they want. These are the heroes of science, technology, and philanthropy. They do great things so that their name and their deeds will live on long past them. They attach themselves to causes larger than themselves. They have faith that there is more than they know. They believe in the infinite. In these ways, they create abundance in the face of scarcity. We would not have civilization without them. They die, too; but when they do, we say that their lives mattered.

People often say they don’t understand what it means to accept the limits. You do it all the time. No matter how much you eat, the time comes when you put your fork down. Even if you’re a shopaholic, the point comes when you finish shopping. Every night when you turn out the light and go to sleep, you rehearse death. You say, enough is enough, I’m tired. You say it all the time. Accepting limits means recognizing that, while there may be only so much pie, there’s only so much pie you can eat.

Use any of these methods to create an abundance mentality, you’ll be happier when you do.

The Shrink’s Links: Spiritus Christi Mental Health Clinic

Bringing you the best of mental health every week.

Spritus

You can still get mental health treatment in Rochester, even if you’re not made of money. If you have a high deductible health insurance plan, or have a high co-pay, or if you are violating the law and have no insurance at all, just contact the Spiritus Christi Mental Health Clinic. It’s a free clinic. Amazingly, there is no waiting list. As of today, you’ll be able to see someone within a week.

The clinic is a ministry of Spiritus Christi Church, but you don’t have to belong to the church to use it. You just have to have a need. A couple dozen therapists, including myself, volunteer there. They don’t have to belong to the church, either. They just have to be licensed.

Oh, they also host a number of groups. Check out their website.

Click here to go to the website

Acknowledgment: April is the Cruelest Month

April

Contrary to popular belief, suicide rates do not peak at Christmas time. Here in Western New York, as elsewhere, they peak in April. So does all kinds of psychiatric hospitalization, depression and relapses of addiction.

Why is this so, when hopes of Spring abound? Maybe the contrast between the inner weather and the outer weather is too great to bear.

As usual, poets know it better than anyone. Here’s TS Eliot, in The Wasteland:

APRIL is the cruellest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain.
Winter kept us warm, covering
Earth in forgetful snow, feeding
A little life with dried tubers.

What is Madness?

Someone asked why the name of this blog is Madness 101. Shouldn’t I call it Mental Illness 101? Isn’t mental illness the proper, politically correct term?

It is, but it’s not really mental illness that I’m writing about. I’m writing about the related subject of madness.

Illness is something that happens to you beyond your control. Some diseases are inherited, like Huntington’s; others are transmitted, like Ebola. Mental illness is thought to involve a multi-factor genesis called the Diathesis-Stress Hypothesis. (I love saying that. Try it yourself. Once you learn how to say it, you’ll love it, too. Diathesis-Stress Hypothesis.)

The Diathesis-Stress Hypothesis states that people are born with a genetic predisposition which is then activated by stress. You may have schizophrenia written into your genetic code, for instance, but it is not until you encounter the peculiar stress of adolescence or early adulthood that the symptoms of schizophrenia emerge. You may tend towards depression, on one hand, or anxiety, on the other. Most of the time you are fine, but when that decisive straw lands on your camel’s back, the camel falls one way or the other.

Other conditions are normal reactions to abnormal experiences. Almost anyone who smokes enough tobacco will become addicted to it. Addiction is the result of ordinary physiological processes whereby the body changes as a result of the substance ingested. All addictions are just as inevitable if you use the substance enough, although studies suggest that the path towards addiction may be speeded up or slowed, depending on genetics.

Post Traumatic Stress is another normal reaction to abnormal experience. It is true that not everyone who experiences a particular horrible event develops post traumatic stress over that event. However, we do believe that the accumulation of stressful events, or experiencing a single event in early childhood, when you are particularly vulnerable, will lead to the development of the condition.

The Diathesis-Stress Hypothesis is a powerful theory, but it leaves out one important factor: personal choice and responsibility. I’m not saying people choose to be schizophrenic; but the person with schizophrenia does choose whether or not to isolate himself, take his medication, and work with the people available to help him. The depressed person has a choice about whether to stay in bed all day or open the blinds to let the sun in. The anxious person can decide whether to avoid or face that which makes her anxious. The alcoholic chooses whether or not to drink.

When an alcoholic doesn’t drink, he is still an alcoholic, but he is not adding, through his own actions, to the condition. Similarly, the depressed, anxious, or psychotic person can do a lot towards addressing their conditions. They do not have to simply be passive victims.

I am aware that people with mental illness are subject to extreme social prejudice. I know that they often get blamed and blame themselves for things that are out of control. I work with them intimately on a daily basis. However, I am a counselor and it is my business to help people identify the ways that they contribute to the problems they face and the things they can do about them. It does them no good to tell them that they are the unlucky recipients of flawed genes or a chemical imbalance or have too much stress in their lives if they do not also address how they unnecessarily add to that stress.

Madness is my word for the things ill people do to make themselves more ill.

Having alcoholism is not madness, but drinking when you know you have alcoholism is madness.

Being depressed is not madness, but not getting up to start the day is madness.

Having anxieties is not madness. It’s very normal, and even may be desirable, to have anxieties; but, letting your fears control you is madness.

You are not responsible for having an illness, but when illness takes over your life and controls you and the people around you, that is madness.

In this series, I will describe the ways of madness and the things you can do about it.

The Shrink’s Links: Secular Organizations for Sobriety

Bringing you the best of mental health every week.

SOS

If you like the idea of a self help group to assist you in your recovery from chemical use, but think AA and it’s kin talk about God too much, there is another choice: Secular Organizations for Sobriety, otherwise known as SaveOurSelves. It’s AA without the Higher Power.

Click here to go to the website