A New Lease on your Relationship: Duration

old-couple-21While you’re taking an honest look at your relationship, take an honest look at this. How long are you planning for it to last? When most people let a partner into their life they assume it’s for life. One of the best things about love relationships can be their longevity. You’re sick of the whole dating scene and want to be done with it, forever.

There are other arrangements, however. There are summertime romances, the fling you had when you were away in Europe, the one-night stand, the hook-up at the conference. But it’s not just the kids with their promiscuous ways. There are plenty of middle-aged couples who have a tacit agreement to stay together until their children are grown. There are couples on a five-year plan. Some are together until someone better comes along. There are all kinds of relationships. It’s only the usual ones that come out of hiding and meet the parents.

I once heard from a very practical person, who thought everyone should marry three times in a lifetime. The first, at age twenty, to a forty-year-old, to get started and be maturely guided during a foolish time of life. The second at age forty to a twenty-year-old to add some excitement, feel young, and provide spouses for those twenty-year-olds. The third at age sixty to another sixty year old, for the companionship as they grow old together. You might be the very people to try this and start a new trend. Future generations may thank you if you did. But, what do I know? Something like this has never been tried.

You may not be that person. You may truly intend to mate for life. If so, why? Is it because of what you want, or is it what you think you are supposed to want? Please understand, I am not necessarily advocating the end of marriage as a lifetime commitment. After all, I believe serious relationships are eternal. I am advocating that people get honest about what they expect from one another and alter the terms and conditions of their relationship to fit their realities.

Even when a relationship is meant to be lifelong, what would it be like if the terms and conditions had to be renewed every year or two, as are many leases? I intend to remain in my present office, renting from my present landlord, until I retire; and I don’t plan to retire. Nonetheless, the lease is renewed every year. This gives the landlord and me an opportunity to take a look at the terms and conditions and make adjustments, if needed.

What if you did the same in your marriage and rewrote and renewed your vows every year on your anniversary? You may very well, for one reason or another, at some time, decide not to renew your commitment. But there might be less broken china, broken noses, and injured feelings. There may be more newly-re-wed bliss. You just might be more happy.

A New Lease on your Relationship: Goals

Couple_walking_on_road_holding_hands_IS098V3ONWhen a landlord and a tenant sign a lease, they both know what they’re getting out of it. The tenant gets an apartment and the landlord gets rent. Both are getting something they want, something they didn’t have before they signed the lease. There’s a reason for their relationship.

What is the reason for your relationship with your romantic partner?

Why are you in this marriage? What does it add to your life? What can you do, together with this particular person, that you cannot accomplish alone, or with anyone else?

If you don’t know, then you’re in trouble. If you don’t have a reason, then there is nothing at stake.

People keep committed relationships for all kinds of reasons: for the laughs, for the sex, for the kids, the parents, to get elected. People stay so they can collude with one another, so they don’t have to face an uncomfortable truth, or so they can challenge each other to face those truths. People in committed relationships live longer, have more money, and have better mental health. They don’t have to travel alone, sleep alone, eat alone, grow old alone, and they have a standing date every Friday night. Some of these are compelling reasons, some aren’t; not all are sustainable, but, if you have no reasons, or you don’t know what they are, then what are you doing and why are you doing it?

You can put up with all kinds of things if you have a reason to do so. If you are enraged when he doesn’t put the toilet seat down or when she talks on the phone for an hour with her friend, then perhaps it’s not your partner’s behavior that is the problem, perhaps it’s the lack of a reason to be with them.

Sometimes the relationship is secondary to other goals you may have. What you really want to do is to write novels, complete medical school, rise to the top in politics or business, defend your dissertation. What you want out of a relationship is for it to stay out of the way or support those other goals. Maybe your goal to have children and a spouse is secondary and instrumental to that desire. You may just want to have it all: a successful career, marriage, and children. Even if that’s the case, you will still have to chose. A some point those interests will collide and then you’ll see which is really the priority.

So, what are your goals? Do you and your partner have them in common? Are they complimentary or do they clash?

Everything you need to know about confidentiality

Counseling will work to the degree that you are confident my office is a safe place to bring up sensitive matters, but you will have to take some risks. The things we talk about are confidential. I will not repeat the things we discuss in a way that can be traced back and identified with you. There are some limits and challenges to confidentiality, though. You need to know what they are.

The Counselor

Sometimes the counselor can interfere with the counseling being a safe place. You will not be honest with me if you think I will judge, preach, blame, chew you out, abuse, or criticize you. But I will respond to what you say to me. I would not be human if I did not have a reaction. It would seem weird if I just sat there.

The most frequent complaint I’ve heard from clients about other counselors is that they just sit there, inscrutable, and don’t offer any help. I don’t have this problem, but I am always mindful of giving you the space to talk about what you need to talk about without imposing my own values.

The Office

My office has a parking lot in the back, so it would be hard for anyone to see your car by my building. You can enter through the back, so no one is likely to see you go in. When you step into my waiting room, there will be no one waiting to see other counselors. The radio will be playing and there will be a white noise machine by my door to mask sounds coming from my office. I’ve tested it. Unless people are screaming, it’s impossible for anyone to hear what we talk about in my office. My files are locked and you will not see any private information on my computer screen or on my desk.

In the Community

I will not say hi to you if I see you out in the community. I don’t want you to have to explain to anyone you’re with how you know me if you are not comfortable in doing so. If you are comfortable, then go ahead and approach me.

HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides consumers with important privacy rights and protections with respect to their health information, including  important controls over how their health information is used and disclosed by health plans and health care providers. If you would like to read a government document discussing these rights, click here. If you don’t want to read it, I don’t blame you in the least.

Insurance

If you choose to use insurance to pay for your sessions, you or I will have to give them some information. If I’m an in-network provider, I will send a claim after each session telling them that you saw me, the date and duration of the session, the type of therapy provided, and a diagnosis code. They seldom ask for anything more, unless we are trying to get approval for more sessions.

If I’m out-of-network, you will have to send them that information if you want to reimbursed. After each session, I will email you a receipt, called a superbill, that contains that information. You pass it on to them.

If you don’t pay your bill

Payment is due at the time of service. If you fail to pay, there is a $5 late fee. If months go by and you still don’t pay, then I refer the bill to a collection agency. They will have your name, demographic information, dates of service, and charges, but I will not pass clinical information onto them.

Release of information

You may want me to pass on information to others. I frequently have clients who are required to attend counseling or get an evaluation by probation, parole, the courts, a parent, or a spouse. If that’s the case, then I’ll ask you to sign a release that states I have permission to share information with others.

I have found that having to report to the authorities may affect the things you will talk to me about. It can be hard to be honest. For that reason, I give them the minimum amount of information they need.

If others are involved in your treatment

If you are seeing someone else, like a doctor, for medication, for instance; it is generally best if I work together with that person. This may necessitate that I share information with them about you. If that’s the case, I will ask you to sign a release. If there is particular information you don’t want me to include, tell me what that is and we will discuss whether I can exclude it.

If you’ve just come from another facility and I need information from them, I might ask you for permission to contact them. If that’s OK, then sign a release.

In an emergency, then no one in the health care field waits around for releases to be obtained before information is shared that is vital to your safety. If I get a call from an emergency room, for example, I will give them whatever information they need to assess and treat you effectively.

Family Therapy

If you’re coming to see me with your spouse or other family member to improve your relationship, most of the time you will be meeting me with them. If there is something you would like to talk about without your family member present, whatever the reason, then please ask to see me individually.

When I work with couples in marriage counseling, I will often set up individual sessions so we can talk privately. I don’t do this because I believe it’s best to have secrets from your spouse; I do it so it can be easier for you to talk. I will regard the things you tell me as confidential and will not repeat them to your spouse when I see them individually or with you.

Domestic Violence

I, and most other counselors, will not meet with couples for marriage counseling when there is an ongoing threat of domestic violence. It may seem that marriage counseling would make sense in cases like that, but the situation is often not safe enough for marriage counseling. I don’t want you to bring up something up in my office, thinking it’s a safe place, and pay for it when you get home. When there is domestic violence, I will work with one or both people individually on whatever issues are relevant.

Safety

If I learn in our conversations that you are planning harm to yourself or others, I am obligated to take action towards safety. This may mean that I get you to the hospital. It may mean I call the police. It may mean that I warn the person threatened. If you have physically or sexually abused a child and are that child’s caretaker, I will have to report this so it can be investigated.

Guns

You may have heard that the Safe Act in New York requires that mental health professionals report any client to the authorities who possesses a gun and is likely engage in conduct that puts people or themselves at risk. The authorities would then revoke that person’s permit to possess a firearm.

That is true, but, when they wrote the law, they defined mental health professionals as psychologists, psychiatrists, registered nurses, and social workers. In their haste, they left out licensed mental health counselors and certified alcohol and substance abuse counselors, which is what I am. This leaves me in a very ambiguous position. On one hand, the intent of the law was clearly to include me and my colleagues, on the other hand, they could have, and didn’t.

The way I have settled this for myself is to do what I have always done. If I learn you are planning harm to yourself or others, I take action towards safety. This may mean that I get you to the hospital. It may mean I call the police. Confidentiality is important, but saving lives is more important.

Things You Have Done in the Past

If you confide in me about things you have done in the past, I am under no obligation to report them to anyone. You could have killed someone and I won’t report it. However, things you are planning on  doing in the future is a different matter. If you are planning on killing someone, for instance, I would have to take steps to prevent it.

Court Order

Theoretically, a judge can order me to testify or submit my records to court. However, in thirty years, I have only had one subpoena to do this and, in that case, I evoked privileged communication and the request was withdrawn. I would do the same if it ever happened again.

Consultation and Training

Being able to consult with and learn from other professionals is vital to me as a therapist. Every two weeks I host a peer supervision group with colleagues. I sometimes work with an intern who sees me for supervision. I also attend training and conferences where cases are discussed. If I ever bring up your case in those settings, I will not share identifying information.

My Writing

I do a lot of writing. I have a blog: Madness 101, in which I post twice a week. Currently, I’m working on three books: a self help book about relationships and two novels. Under a pseudonym, I also have written a blog of fiction called The Narrative Imperative.

Certainly, my work as a therapist enters into the things I write about. I seldom write case studies. I don’t like them aesthetically, and I also wouldn’t want my clients shocked to find themselves written up in entirety as an example. If I ever am interested in writing about your case in detail, I will get your permission first.

My fictional work is sometimes inspired by my own experiences and stories I’ve heard, but it is still fiction. Any resemblance to actual people and events is purely coincidental.

Social Media

I’m not on Twitter. Call me a dinosaur, but I don’t tweet.

I’m on Facebook, but, if you’re a client and send me a friend request, I will decline. Not because I don’t like you, it’s just that it crosses boundaries into the personal. If you are already one of my Facebook friends, I will refer you to someone else for counseling. I won’t ask you to like my business Facebook page, because I haven’t created one. I don’t believe it really helps any business but Facebook.

LinkedIn is a different matter. I have a page on LinkedIn and, because it deals with my professional life, I will accept invitations to connect there. However, please don’t expect me to endorse you for a skill I know nothing about.

Electronic Medical Record

I keep your records electronically on an encrypted cloud server provided by TherapyAppointment.com. I use this software for online appointment scheduling, appointment reminders, charting, emailing, billing, insurance claims, and business management. I selected TherapyAppointment.com because it is HIPAA and HITECH compliant. I believe it is more secure than keeping paper records. Click here to read a government assessment of the security of electronic medical records.

Patient Portal

I also selected TherapyAppointment.com because it enables me to involve you in every aspect of your treatment. You can look up, schedule or change appointments, view and download account balances, pay your bill online, and exchange secure, encrypted messages with me. I send you a summary after each session to remind you what we talked about.

Any messages I send through this service self destructs after two weeks, like in Mission Impossible. You will have to cut and paste if you want to save it.

To take advantage of this, you will need to set up a patient portal and keep your password safe. If we have never met and have not yet set up an appointment, then you can click here to register as a new client. If we have met any time since December 2013 or have an appointment in the future, then I already registered you. Click here to log in. Call me at 585-732-1970 if you don’t know your username or password.

Phone and Texts

You may call or text me at 585-732-1970. This is my cell number, both business and personal. If I don’t pick up it’s because it’s not a good time to talk. If you leave me a voice mail message or text, I will try to get back to you by 9 pm at the latest.

I work by myself in a private practice and it is impossible for me to always be available for emergencies. If you’re in crisis, nearly anywhere, you can get help by calling 911. If you’re in the Rochester area, dial 211 to call Lifeline at any time.

Email

You can email me at keithwilsoncounseling@gmail.com, but it is not an encrypted form of communication, so I prefer to use the email service provided in the patient portal.

Feedback and Complaints

The best way for me to get better at counseling is to get accurate, constructive feedback from my clients. I try to do this in a way that doesn’t overwhelm you with surveys or detract from the reason you see me. Please let me know, by email or when we meet, any reactions you have to our sessions or the summaries I send, positive or negative. This feedback helps me improve.

I try to follow the ethics guidelines set forth by the American Counseling Association and the New York State Office of Alcoholism and Substance Abuse Services. Click on the links if you want to read them.

I am licensed by New York State as a Mental Health Counselor (LMHC) and a Certified Alcohol and Substance Abuse Counselor (CASAC). (Click on the links to verify) You can contact those offices if you have a complaint.

 

So, that’s it. I’ve tried to think of everything to enable you to trust me. If you still have trouble trusting, that’s not unusual. Maybe you were hurt in the past. Tell me about it and we will work through it together.

Relationships, part 69: A New Lease on your Relationship

If you leased out a portion of your life, what would the terms and conditions be?

You own an apartment building with an almost infinite number of apartments, but, once someone moves in, you can never evict them, and they can never leave. You can move them from one apartment to the other.

There’s only a single penthouse suite and a few luxury suites. Most are ordinary, efficiency studios. There are a huge, but unknown, number of basement apartments. You’d like to pretend those tenants weren’t even there. However, many of the occupants of the basement apartments are chronically disgruntled, so that they often play their music loud and let roaches, bedbugs, and other undesirables inside.

The penthouse is a splendid apartment. You live in it, as is your right as landlord, and have been sharing it with a roommate. Things have started to get tense between you and you thought of kicking him out, however, you don’t want him to feel ill used. He would just make your life miserable if you stuck him in a basement apartment. Besides, the two of you might just get along if you got a few things straight.

The name of this apartment building is, you might have guessed, Your Life. The tenants are all the people you’ve let into Your Life. Most of the people in Your Life are associates occupying the efficiency apartments. Close friends have the luxury suites. The tenants in the basement apartments are your exes, your might’ve-beens, and those bullies in middle school that still rent space in your head. Oh, I forgot, there are a few rent controlled apartments that have been occupied by your family members since before you bought the building, but that’s beside the point. The person you share the penthouse with is the love of your life and you’re trying to figure out how you can evict him.

As I said, you can never get anyone out of the apartment building altogether, but you can move your partner from the penthouse to the luxury suites, meaning you would still be friends, the efficiencies, or in the basement. If it’s got to be done, it’s in your interest to do so kindly and with fairness, if only because, to some extent, you still have to live with him or her.

So, what can you do to make your expectations clear, your promises credible, and your exit strategy explicit? You can do what landlords have always done. You can create and, together, sign a lease.

Far too many people drift into relationships without ever making the momentous decision to be together. You decide to leave a toothbrush, provide an underwear drawer, share rent without ever deciding the terms and conditions of the relationship. Since it’s hard to talk about relationships, you let it go without saying what you expect and can be expected in return. Is it any wonder that you get confused? Are you really surprised when you wake up one day and find yourself caught up in much more than you ever intended and are not sure of how you can get out?

In traditional relationships there are occasions when the couple might talk about their terms and conditions. That’s what wedding vows are for, after all. Many clergy insist that, as a condition of their officiating at the wedding, you go through pre-marital counseling in which you consider uncomfortable issues such as how to raise children and celebrate holidays. Many lawyers insist on pre-marital agreements that deal with prickly matters such as finances and the dissolution of the marriage.

Unfortunately, when it comes to wedding vows, poetry and sentiment often prevail over practicality. No one planning a wedding really wants to tackle the tough issues and declare in the front of a church, before parents, grandparents, and everyone, just how you want your partner to relate to his ex, what sexual positions you loathe, how big a check your partner can write without clearing it with you, and the myriad of other issues that can sink a marriage.

Far too often, people get deep into relationships without ever talking about these things. Sort of as if you moved into an apartment, or had someone move in, without ever signing a lease, or even talking about rent and security deposit.

The other problem with wedding vows is, when you are planning a wedding, you may not know what you really want in a marriage. You think what you want is what you think everyone else has. You expect what you saw on some TV show, what your parents had, or the relationship you wish your parents had. That’s a little like signing a lease without reading it first, or like a landlord downloading a template of a lease without considering what’s in it.

So, if you are running into problems in your relationship, this is the perfect time to consider how to fix the problems and discuss with your partner whether he or she would agree to a new, or amended, contract.

What would the terms and conditions be?

The Shrink’s Links: Lincoln’s Depression

Bringing you the best of mental health every week.

Lincoln

Lincoln’s Great Depression

Abraham Lincoln fought clinical depression all his life, and if he were alive today, his condition would be treated as a “character issue”—that is, as a political liability. His condition was indeed a character issue: it gave him the tools to save the nation

Click here to go to the page

Relationships, part 68: The Problem with Talking About Love

couple-talking-saidaonline1When you were a baby and became uncomfortable, you didn’t know what you wanted. You could scream, but you had no words to describe what was going on with you or what would change it. Your parents didn’t either. They would try one thing and then another; give you food, change your diaper, burp you, maybe just hold you and sing. When you stopped crying, they figured they had it. That must have been what you wanted.

In time, you began to associate all the various things they did for you when you cried with this experience of wanting. The food, the diaper, the burping, the singing: they called them your desires and you learned to call them that, too; but they weren’t your desires, they were only the symbols of your desires. For instance, just because you stopped crying when they gave you food, does not mean that it was food you needed. Maybe you just needed someone to pay attention to you. Maybe you needed love.

Babies who are not loved will sicken, weaken, and may die. Grown adults who are not loved will not do so well, either. But there’s a problem with love, you can’t ask for it. You can only ask for its symbols.

You can ask your husband to bring you flowers, but, if he does, you will know you had to ask for them and they won’t count for as much. You can ask your wife to be more sexy and wanton, but, deep down, you know that’s not who she is. You can’t compel affection, command spontaneity, arrange for grace. True love cannot be bought and sold, ordered and filled. The government cannot provide it after filling out a four part form; you can’t even get it from Amazon.

The symbols of desire can be insistent and dictatorial. You may believe that if you do not obey them: buy those shoes, have sex with this person, drink that beer, go on this vacation, marry that person, get a divorce; you will be destitute and unfulfilled. But, all those things are just the symbols of the nameless, inchoate desire. They are a paper tiger, a powerless tyrant, a blustering, threatening Saddam Hussein with no weapons of mass destruction.

Your ultimate experience of love and the true object of your desires was encountered before you ever had a language. Things that you experienced during this period are beyond the reach of language and reason. They are like the foundation of your house: buried deep and inaccessible. They, nonetheless, support everything and determine the shape of the structure.

So, that’s the problem with talking about love. We know what we are talking about, but can’t find adequate words to describe it.

In my next post, I will talk about love in a totally inadequate manner. I will treat it as a business contract. We shall see if that reveals the foundation.

The Shrink’s Links: How to Date Successfully

Bringing you the best of mental health every week.

If you expect to be alone for Valentine’s Day and don’t want to be, you may be interested in attending a class that my friend, Dolly Malik, will be leading on how to date successfully.

The class will be at the Rochester Brainery on Monday, February 16 at 6.30 pm.

Click here to go to the page for more information

Relationships, part 67: How Do I Love Thee, Let me Count the Ways

What do you mean when you say I love you? The word love can be used to cover a multitude of sentiments. There is tremendous variety among those who march under the banner of love, from the most selfless angels to the most hate-filled devils.

When you say love do you mean?

· I want what’s best for you, even if it doesn’t involve me. If you mean this, then you are talking about Agape, the highest form of love. If you mean this then you are prepared to sacrifice, you want your beloved to become strong and independent, the best that he or she can be, even if it means that you must withdraw from his or her life. This is the kind of love that is demanded of parents who must give up nearly everything for their children and then let them go to live their own lives. It’s also demanded of life partners even though it may not be necessary.

· You turn me on, sexually. This is what the ancient Greeks call Eros, erotic love. It’s often where people start when they meet someone and are attracted to them.

· I have a lot of fun with you. This is Ludus, a form of love that is mostly playful. Ludic love loves variety and adventure, trying new things, new positions, new activities, and unexpected combinations. It sees seriousness as deadly and commitment as a trap. It just wants to have a good time.

I am yours and you are mine. This is Philos, from which we get to word affiliation. The connection you have with the other is meaningful. You are friends.

· Together we can build something important. Here we have Pragma. You guessed it, a pragmatic, practical coalition that’s all about achieving a common goal.

· You’re my best friend. You are just like me and, even when you are not, you understand and support me better than anyone ever has before. This kind of love is called Storge. Seriously, it’s called Storge.

· I need you. This is Manic love, love that views the object as a possession that the lover needs to feel complete. Below the surface, the Manic lover is really saying, I don’t think anyone can love me. Prove me wrong. You seem to be offering love, but on a deeper level you’re really searching for it. You might extend yourself to your beloved with affection, gifts, services, and many other things, but will be disappointed by the responses you receive. Until you learn to properly love yourself, none of the responses you get, however loving, will make you feel loved.

Having one kind of love does not preclude having another in equal or greater amounts. One kind can grow out of another. If you have them all, then I guess you hit the jackpot.

However, some of these types of love are more sustainable than others, some are more satisfying, some are a good or a bad match to you.

What kind of love do you and your partner have, if any at all?

Announcement: Video Counseling

WIN_20141030_110819After more than a year, I have resumed the practice of offering video counseling to folks who, for one reason or another, cannot come to see me at my office.

I used to do this quite a bit, back when I had just started my practice and was building up my caseload. Then two things happened: I got busy, I began to experience problems with my connection to the internet.

My internet connection was fine for email and web pages, and the like, but Skype uses a great deal of data. It would slow down or shut down at inopportune times; not the thing you want to have happen in the middle of a delicate therapy session. Therefore, I stopped seeing clients over Skype.

Then someone who had been seeing me face-to-face began to travel a lot on business. She asked about Skype sessions. I looked into it and found that another service, etherapi.com, was tailor made for video counseling. It relies on a low bandwidth transmission that does not strain my connections the way Skype does. Not a lot of detail, but plenty for counseling. They also pay close attention to the privacy needs of therapists and their clients.

Consequently, I now offer video counseling in my array of services. Click here if you would like more information.