Free Therapy During the COVID-19 Emergency

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Thanks to COVID-19, people with insurance in New York State do not have to pay copays, co-insurance, or deductibles for telehealth sessions for as long as the state of emergency lasts.

That’s one thing to be grateful for.

This is a state mandate. Insurance companies haven’t advertised it, and I haven’t seen it in the news. So, spread the word. Even among us shrinks, there’s been a lot of confusion in the past two weeks. Many of us have been collecting these copays, co-insurance payments, and deductibles because we didn’t know, couldn’t believe it, or were puzzled by the impenetrable prose of bureaucratic pronouncements. But I have it from the horse’s mouth. Free therapy. Read it yourself.

The catch is that it must be a video or phone session with an in-network provider. If you insist on meeting your therapist in person, or if she is still expecting clients to do so, then you still must pay those fees. I guess they’re trying to encourage people to stay home so they don’t spread the virus. That, and to get the help they need before they go stir-crazy in their homes, ready to kill someone over a roll of toilet paper.

You’re out of luck if you have insurance that originates outside New York State because your company’s headquarters is in Chicago, Kansas City, or some other place, unless that state has ordered it, too.

Video counseling is preferred by therapists over the phone variety. But you need a good cellular signal or Wi-Fi connection to see a therapist by video, as well as a private place to talk. That can be hard when you’re all cooped up with other people. I’ve had clients talk to me in their cars or from the bathroom. You can read more about video counseling here.

If you have been particularly anxious these days, or depressed, or if the bonds between you and your loved ones are beginning to fray, don’t let this opportunity pass you by. This is also a perfect time to change bad habits. We therapists can’t do much to change the state of the world, but we can help you with your response to it.

Is it safe to go to counseling during this pandemic?

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I’m sending this letter out to all my clients prior to their appointment.

 

In this age of the coronavirus, you may be wondering if it is safe to keep your counseling appointment. I’ve thought about that, too; and here is what I came up with.

My office does not get a lot of traffic. Compared to a grocery store, a school, a church, a doctor’s office, or a coffee shop, few people go in and out and there’s little physical contact. Moreover, they are generally in good health.

I’m also in good health. I’m experiencing my environmental allergies, but I have no fever, cough, or shortness of breath, the symptoms of coronavirus. I have not knowingly been exposed to anyone with the virus. Nor have I recently been to China, Iran, Italy, Japan, or South Korea. I’ll let you know if any of that changes.

If you don’t have a fever, cough, or shortness of breath; have not been exposed to anyone with the virus; or have not recently been to China, Iran, Italy, Japan, or South Korea; then you are welcome to come. I have no reason to be afraid of you.

In between sessions, I can easily clean the places in my office people touch. If you want, you can see me do it. We don’t have to shake hands.

If your kids are home from school and you have no one to watch them, you can bring them with you, provided they are old enough to stay in the waiting room or young enough not to understand anything if they are with us.

So, come to my office, if you can. But, if you can’t; then keep your appointment anyway by phone. It’s not optimal to have a psychotherapy session by phone, but doing so, permits us to maintain progress you’ve made and address any problems you’ve encountered.

I just got clarification from the insurances I take that phone sessions are fully covered. That didn’t used to be the case. So, contact me if you would like a phone session, beforehand preferably.

I’ve done video sessions in the past; but stopped because there were too many problems and not enough demand. I can begin doing video sessions again and try to solve the problems if there proves to be a need. Let me know if that would be important to you.

So, please, keep your appointments if you can, either by phone or in person, but preferably in person.

If you have any questions about the coronavirus, here’s where I’m getting my information. From the World Health Organization: https://www.who.int/health-topics/coronavirus

Keith

Note: Within one day of posting this announcement, it was already out of date. On Tuesday, March 17, 2020, I stopped seeing clients face-to-face in compliance with the Governor’s recommendation that non-essential businesses close. Counseling is often essential, but it is not essential that I see people in person.

Today, March 18th, I’m just having phone sessions. I’ve signed up with a video provider, but they haven’t set me up, yet. They’re probably swamped. Tomorrow will probably be different.

Helping Therapy Clients in Difficult Relationships Find Peace

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I’ll be teaching a 2 hour webinar for therapists at 9 am, Eastern Time next Friday, 1/17/2020, on goodtherapy.org. Two continuing ed hours will be provided by GoodTherapy for attending this web conference in its entirety. If you cannot participate live, you’ll be able to view it from the Goodtherapy archives.

Every client who comes to therapy is likely to have hurt or been hurt by their loved ones. This is understandable for people who are seeking marriage counseling and trauma recovery, but it is likely also the case when the presenting problem is addiction or any other mental health condition. The focus of treatment should not necessarily be on the harm caused or suffered, but relationships may need to be mended before recovery can be solid.

A break in a relationship can bring up many difficult questions for both the clinician and the client. Was the harm momentous, or was it much ado over nothing? Can a perpetrator’s complaints be taken seriously or are they simply justifying their actions? Are the victim and perpetrator in denial? Is the victim playing the victim? Is the victim forgiving too easily or making restitution impossible? Is the perpetrator staying in the relationship out of codependency or authentic love? How can things be made right? Is it okay to confess a betrayal to someone ignorant of it? How can the client effectively demand an apology? How do you make an apology stick? What can be done when reconciliation is impossible? What does peace look like?

In this 2-hour continuing education web conference, I will discuss how to answer these questions and more. I will describe a process of healing and potential forgiveness for anyone in a relationship affected by selfishness, violence, abuse, addiction, or betrayal; whether they are the victim, the perpetrator, or both. I will explain how to assess the damage done and recognize codependency and vindictiveness, blocking the way from injury to peace. I will give pragmatic advice on how to help clients find safety, assert needs, apologize, make amends, and promote change.

It’ll be all based on my book, The Road to Reconciliation: A Comprehensive Guide to Peace When Relationships Go Bad

See, Do, Teach

If you think that going to therapy means you can go to a shrink’s office, unload all your problems, and walk away a new man, you’ll be disappointed. You might feel better for a minute, but if you go home and do the same things you’ve always done, you’ll get what you’ve always got.

Therapy involves learning new skills. The couple who’s coming in for marriage counseling needs to learn to listen and respond differently. The anxious person must learn to relax; the depressed one, how to keep going; and the addicted one, why and how to stop using their substance. Every person must be able to observe themselves accurately and compassionately. The greater part of all this learning occurs outside the therapy hour, far from your shrink’s office.

A surgeon once told me they have a saying in medicine: see one, do one, teach one. Only when you complete all three can you say you know the procedure well enough to do it on your own. See one means you watch someone perform a surgical procedure. When you try your hand at it under supervision, you are doing one. Teach one requires you to explain it to someone else, so they can do it, too.

There’s a lot of wisdom in this method, which can be applied with variations to almost any kind of learning. It’s not enough for me to tell you how you can calm yourself down in sixteen seconds by square breathing, you must do it. Then, it’s not enough for you to do it, you must explain to someone else how to do it. I have often found that I think I know something when I start writing about it, only to be confronted by all the ins and outs of the topic before I’ve reached the end of the page. Teaching someone is how you work out the kinks in a skill and develop real mastery. Then, if you really want to learn something, learn it well enough to explain it to your grandmother.

Learning a new skill in therapy is harder than learning a surgical procedure because you really need to use the skills when you are under extreme duress. You need to learn to listen when your spouse is yelling at you, how to calm yourself when you think you’re going to die, how to go on when you wish you would die, and why and how to stop using a substance when it seems like nothing but the substance could solve your problem. You need to be able to observe yourself accurately and compassionately when you are the most ashamed. That’s hard. It’s as hard as a surgeon learning a new procedure, not on a patient, but on himself, blindfolded, without anesthesia. To be able to learn to do that is going to take more than watching one, doing one, and teaching one. You’re going to have to do ten thousand.

This is where drilling comes in, otherwise known as repeated conscious practice. No one likes to drill, but a musician who hasn’t done his scales will not know how to play. An actor who hasn’t rehearsed does not know her lines. A basketball player who hasn’t shot from the foul line countless times will not score a point when the game is at stake. The idea of drilling is to repeat something often enough so you can do it in your sleep. If you’re ever going to be able to listen when your spouse is yelling at you, listening must be automatic.

If change is ever going to occur as a result of therapy, then most of the work, and the drilling, must occur between sessions. The anxious person must take up meditation; the depressed one, action; and the addicted one must repeatedly choose not to use his substance. Everyone must practice observing themselves accurately and compassionately if they’re ever going to have a chance of doing it when it’s hard.

Freud, Explained

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Of all the figures in shrinkdom, Freud is the most revered and reviled, the most quoted and misquoted, and the most influential and ignored. It used to be that every shrink wanted to be like him, now we want to challenge him and be as different as we can. Perhaps this is what he gets from being first in the field. More than anyone, he broke the ground for what has become modern psychotherapy, turning over centuries of assumptions about human nature. We should not be blamed for wanting to see what we can grow on this plot. However, it pays to sometimes go back to first principles and relearn the basics.

It is said that the great golfer, Arnold Palmer, used to start off every golf season by stopping at a country club, asking to see the golf pro, and taking a lesson. Most pros must have been intimidated to have Arnold Palmer as a student, for he was already a better golfer than all of them. Nonetheless, he would insist on a lesson, going back to basics: the grip, the stance, the swing, before going on with his season. He needed to remind himself of the fundamentals.

In that spirit, let’s return to Freud and re-examine the first principles of psychotherapy, many of which have since been distorted. Continue reading