Short Term-Solution Focused Therapy

With mental health benefits being slashed or all together disappearing, consumers & insurance companies are looking for ways to get in and out of therapy quickly by strategically targeting specific problems. As an old school psychodynamic, existential and humanistic therapist I am impressed with emerging theories of psychological thought called "Post Modern Therapy."

Post Modern includes theoretical orientations such as Solution Focused and Narrative. New lingo includes "externalizing the problem," "strength based" and "resiliency." Most of this work focuses on identifying the problem in a non-judgmental supportive forum, helping the client become aware of their inner resources and strategize solutions to the problem. Although post modern therapy lends well to long-term work it tends to be short-term and highly focused. Insurance companies and clients like these therapies because less sessions mean less out of pocket expense as well as a quicker return to wellness.

Lake Mary Counseling Center is happy to help clients achieve their goals in the shortest possible time.

7 reasons to choose Collaborative Profesionals

If you and your spouse are considering divorce, a new alternative to the usual adversarial approach is collaborative divorce law. This is an area of family law that trains attorneys to negotiate, compromise and create a friendlier environment. It is an effective, new way to end a marriage without the acrimony, anger and resentment of many divorces.

There are seven main benefits to collaborative divorce law, but for it to work both spouses must be committed to working together to have an amicable divorce.

The Advantages

1. You each have more control over the outcome. You can voice your opinions and know that you will be heard.

2. You get to agree to settlement issues based on compromise and fair play instead of having a judge make the final decisions that affect your lives

3. It is less expensive than litigation. Attorney fees and court costs can add up quickly.

4. The process takes less time than litigation because you chose the time and place you meet instead of dealing with the timetable of busy divorce courts.

5. There is far less stress and anxiety involved because you are playing a more active role in the divorce.

6. The goal is to reach a settlement before anyone files papers in divorce court. Once a couple accepts a settlement, then a legally binding agreement is written and once signed by both parties the papers are filed in court for the approval of a judge.

7. You know that you worked together to make life easier for everyone. This is especially important if children are involved.

The Disadvantages

1. None

More and more attorneys, mental health professionals and accountants are involved in collaborative divorce law. If a marriage has come to an end, this is a far better solution for all involved.

Why use Collaborative Divorce?

Educating the public on the vital need to avoid litigation in most family matters is part of the mission of the Lake Mary Counseling Center. Alternative dispute resolution is the best choice for families, children and pocketbooks.

In the next few weeks I will post some information about Collaborative Divorce.

Please feel free to post a response or contact us directly for more information on this progressive new way to settle a divorce.

Why would you use collaborative divorce? If you have a family it is the better approach to take, that’s why. Collaborative divorce is an effective way where each side in the divorce is able to reach a fair solution and resolve differences. With collaborative divorce, it is more a question about if you’re going to treat the divorce like a sensible adult or not.

Collaborative divorce addresses more than just the legal issues. It looks at the grand scale pictures – looking out for the emotional issues as well. Court, battling out who is going to get what – this is something no child should ever have to be a part of. Kids shouldn’t have to see their mother and father showing such a display of hostility towards one another. It is inconsiderate, unfair, and unkind to them.

Even though you are leaving someone, you are working together to get what best works for everyone else. Use it if you care about your loved ones. Use it if you want to set an example for your children, despite the fact that you are getting divorced.

However, collaborative divorce is not for everyone or every situation. It requires that those involved be committed to working with and not against the other party in order to achieve results.

Collaborative divorce and its participants are committed to creating a process that is safe and that does not cause further harm to the participants and the families involved.

Collaborative divorce results in a negotiated settlement that is reached without the costs and conflict that accompany traditional methods. The atmosphere of collaborative divorce is respectful and much less stressful than traditional litigation. Collaborative divorce provides the parties with an agreement that is designed by the parties, with the assistance of their collaborative divorce lawyers.

Why are we so concerned about what generation you come from?

Normative history-graded influences are common to people of a particular generation within a specific society. Due to historical circumstances, a wide-sweeping occurrence, such as the Vietnam War, greatly affects each generation a particular society in a great, but unique way. For example, the younger generation’s members were drafted and exposed to the horrors of war while the older generation debated to the political and economic implications upon the country. These events became normative when the event was unavoidable, discounting extreme circumstances, and held a lasting and gradable effect on a significant amount of at least one generation with the society.

How important is age in your mental health?

"Age is becoming an irrelevant factor in our modern society." The “age” being referred to in the quote is most likely referring to chronological age, the number years a person has lived since their birth-date. According to Botwinick in 1978, life-span experts believe that chronological is not very relevant in understanding a person’s biological, psychological, and social age. The three prong system in determining development, rather than simply stating a number, states an individual’s biological health, psychological capacity, and the expected social roles of a person. Life-span expert Bernice Neugarten concurs with this understanding of an irrelevant chronological scale, but acknowledges that some social markers such as getting married, still occur at relative chronological ranges.

Questions for LGBT clients might ask in selecting a therapist:

* Are you licensed? How many years have you been practicing?

* I have been feeling (anxious, tense, depressed, etc.). What kind of experience do you have in this area?

* What are your areas of expertise for example, working with children, families, the LGBT community?

* What kind of treatments do you use, and have they been proven effective for dealing with my kind of problems?

* What are your fees? (Fees are usually based on a 45- or 50-minute session.) Do you have a sliding scale fee policy?

* What types of insurance do you accept? Will you bill my insurance company directly? Many insurance companies provide coverage for mental health services. Check with your insurance company to see if these services are covered and for limitations which apply, and how you may obtain these benefits.

* Is the therapist in your preferred provider network?

* How is payment to be made (weekly, monthly, etc.)?

* Does the therapist have experience treating people with problems similar to yours?

* How often should you meet with the therapist?

* How long are the sessions?

* How available will he or she be to you during emergencies at odd hours or during weekends?

* Does the therapist treat other LGBT clients?

* What are the therapist's views about whether being LGBT is a problem?

* If the therapist is not a psychiatrist, is the therapist affiliated with one in case there is a need for medication or hospitalization?

Is porn addictive

from WebMD

I copied this article which explains the debate. Porn addiction or compulsion still needs treatment.

Psychologists debate whether people can have an addiction to pornography.
By Martin F. Downs
WebMD Feature
Reviewed by Louise Chang, MD

In November 2004, a panel of experts testified before a Senate subcommittee that a product which millions of Americans consume is dangerously addictive. They were talking about pornography.

The effects of porn on the brain were called "toxic" and compared to cocaine. One psychologist claimed "prolonged exposure to pornography stimulates a preference for depictions of group sex, sadomasochistic practices, and sexual contact with animals."

Compulsion or Addiction

The difference between describing the behavior as a compulsion or an addiction is subtle, but important.

Erick Janssen, PhD, a researcher at the Kinsey Institute, criticizes the use of the term addiction when talking about porn because he says it merely describes certain people's behavior as being addiction-like, but treating them as addicts may not help them.

Many people may diagnose themselves as porn addicts after reading popular books on the subject, he says. But mental health professionals have no standard criteria to diagnose porn addiction.

Mary Anne Layden, PhD, a psychologist at the University of Pennsylvania, was one of the witnesses at the Senate hearing on pornography addiction. She says the same criteria used to diagnose problems like pathological gambling and substance abuse can be applied to problematic porn use.

"The therapists who treat pornography addicts say they behave just like any other addicts," she tells WebMD.

One of the key features of addiction, she says, is the development of a tolerance to the addictive substance. In the way that drug addicts need increasingly larger doses to get high, she thinks porn addicts need to see more and more extreme material to feel the same level of excitement they first experienced.

"Most of the addicts will say, well, here's the stuff I would never look at, it's so disgusting I would never look at it, whatever that is -- sex with kids, sex with animals, sex involving feces," she says. "At some point they often cross over."

Janssen disputes that people who look at porn typically progress in such a way. "There is absolutely no evidence to support that," he tells WebMD.

What questions should I ask when looking for an alcohol treatment program?

The federal government's Substance Abuse and Mental Health Services Administration (SAMHSA) has a list of 12 questions people should consider when selecting a treatment program:

1. Does the program accept your insurance, and if not will they work out an affordable payment plan?
2. Is the program run by trained professionals who are state-accredited or licensed?
3. Is the facility clean, organized, and well-run?
4. Does the program cover the full range of individual needs from medical through vocational and legal?
5. Does the program address sexual orientation and disabilities and provide age, gender, and culturally appropriate treatment services?
6. Is long-term aftercare encouraged, provided, and maintained?
7. Is the treatment plan continuously assessed to ensure it meets changing needs?
8. Are there strategies to engage and keep the individual in longer-term treatment, which increases the chance of success?
9. Is there counseling and other behavioral therapies that enhance the ability to function in the family and community?
10. Is medication, if appropriate, part of the treatment?
11. Is there ongoing monitoring of possible relapse to help the person return to abstinence?
12. Are there services or referrals offered to family members to ensure they understand the process and support the individual in recovery?

What are the different kinds of rehab for alcohol abuse?

We at the Lake Mary Counseling Center asked to evaluate a person and recommend treatment for alcohol programs. A request can come from the patient, a friend, relative, employer, school, and the courts.

Howard Sherman LCSW is trained and certified as a Substance Abuse Professional by the Department of Transportation for evaluation and monitoring of treatment for those holding comercial driving permits such as truck drivers, school bus drivers, fedex drivers, pilots, and comercail boat and ferry captions/

There are many choices of treatment plans and each recommendation is made after a thorough evolution of a persons history, medical and social situation and legal issues.

Some of the programs available:

Hospital- or medical-clinic-based programs. These programs offer both alcohol detox and alcohol rehab on an inpatient basis in specialized units. They are less common than they used to be, primarily because of changes in insurance.

Residential rehab programs. These programs can last from a month to more than a year and take place in a residential environment. Often the treatment is divided into a series of stages that the person goes through. For instance, in the beginning, a patient's contact with others, including friends and family, on the outside is strictly limited. The idea is to develop a primary relationship with the other residents who are also recovering from alcoholism. Eventually, the person will be allowed more contact with people outside the residential community and may even go back to work or school, returning home to the treatment facility each day.

Partial hospitalization or day treatment. These programs provide four to eight hours of treatment a day at a hospital or clinic to people who live at home. They typically run for three months and work best for people with supportive family and a stable home environment.

Outpatient programs. These are run at hospitals, health clinics, community mental health clinics, counselor's offices, and residential facilities with outpatient clinics. Attendance requirements vary, and many of them are run in the evenings and on weekends to allow people to be able to continue to work.

Intensive outpatient programs. These programs require nine to 20 hours of treatment activities per week and run for two months to one year. They work best for people who are motivated to participate and who have supportive families and friends.

What do I do after detox and rehab-

Here at Lake Mary Counseling Center we are often asked to provide follow up services for people completing an intense program.

Many times arrangements are made while you are still in the rehab program and an initial appointments can be made for individual and family sessions before you are discharged. These sessions are typically arranged as part of your discharge plan.

Experts emphasize that it's important to consider someone who has had a problem with alcohol dependence and is now sober to always be in recovery. No alcohol treatment program can guarantee a person will not relapse and begin drinking again. To help prevent relapse, people who have gone through treatment for alcoholism will periodically meet with a counselor or a group. The purpose is to assess how well the person is managing and to offer help in dealing with the challenges of daily living without alcohol.

People ask me what happens if I go to rehab!

Exactly what happens in an alcohol rehab program depends on what kind of program it is -- for instance, whether it's a live-in program or an outpatient one. But there are certain elements that are common to all.

Initial assessment. When a person is first admitted to an alcohol rehab program, that person receives a thorough clinical assessment. The assessment is then used to help determine the best approach to treatment. It is also used to help develop the treatment plan.

During the initial assessment a counselor will ask questions about:

* The amount of alcohol a person drinks
* How long the person has been using alcohol
* Cultural issues around the use of alcohol
* The effect alcohol has had on the person's life
* Medical history
* Current medical problems or needs
* Medications being taken
* Mental health or behavioral issues
* Family and social issues and needs
* Legal and financial issues the person is confronting
* Educational background and needs
* Current living situation
* Home environment
* Employment history, stability, problems, and needs
* Previous experience with rehab or attempts to quit using alcohol

If it's determined during the initial assessment that there are urgent medical issues that need to be addressed or that the person needs a detox program, the person will be referred to a doctor who will oversee this part of the person's care.

Development of a plan. Following the assessment and provision of medical care, the person will be assigned a counselor or case manager. Together they will work out a detailed treatment plan. The plan will identify problems, goals, and details about how to address the problems and reach the goals. That plan will be carried out by a team of trained individuals that can include a social worker, counselor, doctors, nurses, psychologist, psychiatrist, or other professional.

Group and individual counseling. Counseling is an integral part of the treatment for alcoholism. Counseling gives the individual in rehab tools to accomplish important goals:

* Overcome denial
* Recognize problems
* Become motivated to solve problems
* Address mental health issues such as depression or anxiety disorders
* Change behavior
* Re-establish healthy connections with family and friends
* Build new friendships with people who don't use alcohol
* Create a recovery lifestyle

Individual assignments. Throughout the rehabilitation process, the patients will be given material to read and tapes and videos to listen to and watch, asked to write about their experiences or their responses to treatment, and new behaviors to try.

Education about substance use disorders. Often people who have a substance use disorder like alcoholism are in a state of denial. They actually believe the way they drink is normal. In order to progress in recovery they need to confront the fact that they do have a problem with alcohol and acknowledge the dangers that problem presents.

Life skills training. When someone who has been dependent on alcohol goes into recovery, he or she may need training in these areas: managing anger, stress, or frustration; employment skills; goal setting; spending leisure time; developing social and communication skills; and managing money and time.

Relapse prevention training. It's important that the person recovering from alcoholism learn to recognize situations that can trigger a relapse and how to avoid them.

Orientation to self-help groups. Most alcohol rehab programs require participants to join a self-help group after the program ends for help in continuing on the path of recovery. Taking part in a self-help group is not considered part of treatment, but rather an essential part of maintenance.

Most people are familiar with 12-step programs like Alcoholics Anonymous, which has been highly successful at helping people stay sober. But there are people who don't like the 12-step approach for a variety of reasons, including its spiritual or religious overtones. So most rehab programs include orientation to other programs such as SMART, which uses cognitive methods to help people stay sober, Women for Sobriety, which is a support program for women that focuses on issues that are specific to women in recovery, and Moderation Management, which is a program for people who want to moderate their drinking rather than stop. Moderation Management does recommend abstinence for people who aren't successful at moderation.

In addition to the above elements, many programs also include treatment for mental disorders.

Medications are also sometimes used to help with staying sober, such as disulfiram (Antabuse), which causes unpleasant side effects if a person drinks while taking it, or naltrexone (Vivitrol, ReVia), which reduces the craving for alcohol.

Rape is not Mental Illness! Its a crime

The task force overseeing development of the new DSM-V has rejected “coercive paraphilia” as an official diagnosis — maintaining rape strictly as a criminal issue and not a mental disorder.

The issue has been debated before and there were arguments in favor of including it in the diagnostic manual’s new edition, due out in May 2013. In fact, this is the fourth time in a row that the task force rejected rape as a mental illness, according to an opinion piece in Psychiatric Times by Allen Frances.

“Rapists need to receive longer prison sentences, not psychiatric hospitalizations that are constitutionally quite questionable,” said Frances, professor emeritus at the Duke University School of Medicine.

Civil rights advocates apparently fear people convicted of rape will be forced into psychiatric facilities after serving their prison sentences where they could be held indefinitely.

“While such continued psychiatric incarceration makes sense from a public safety standpoint, misusing psychiatric diagnosis has grave risks that greatly outweigh the gain,” Frances wrote. “Mislabeling rape as mental disorder in SVP cases allows a form of double jeopardy, constitutes a civil rights violation, and is an unconstitutional deprivation of due process.”

New health law, will emplyers drop coverage

Will reform law encourage employers to drop health plans?


The debate continues over what the health insurance landscape will lool like after the bulk of the provisions associated with the 2010 Affordable Care Act go into effect in 2014.

It’s a big issue and not just because of the 2012 election. There are signs that major changes lay ahead for consumers and health care providers alike. Making adjustments to your practice will be the key to flourishing in the new environment.

The feeling in Washington is that despite Republican opposition, and GOP attempts in the House to withhold funding for portions of the reform program, the Affordable Care Act is a train too big to stop at this point. That’s what we heard last week from Laura Groshong, a clinical social worker from Seattle and director of government relations for the Clinical Social Work Association. She had just returned from Washington.

So it’s not surprising that Senate Democrats are challenging a controversial report released earlier this month that contends up to 30% or more of employers will drop employer sponsored insurance (ESI) plans after full implementation in 2014.

The report, by McKinsey & Company, a global management consulting firm, argues: “The shift away from employer-provided health insurance will be vastly greater than expected and will make sense for many companies and lower-income workers alike.”

Their conclusion was based on a survey of 1,300 employers conducted earlier this year. The authors said 30% of employers would either “definitely” or “probably” stop offering ESI plans, and up to 60% will “pursue some alternative to traditional ESI.”

Yesterday, Senate Finance Committee Chairman max Baucus (D-Montana) demanded that McKinsey release its methodology in coming up with that 30% figure. The White House is equally irate.

In the New York Times today, columnist Paul Krugman said McKinsey has refused to disclose how the survey was conducted and suggested that the results were deeply flawed. But it makes sense that if everyone is required to carry health insurance, employers may back away from the benefit.

Even the Congressional Budget Office estimated that 9 million to 11 million would lose ESI but 6 million would be added to ESI rolls. That’s at most a 5 million loss of ESI benefits - and that’s nothing to sniff at, either.

Regardless, many health care providers will be faced with learning the ins and outs of new plans that will be offered to the public, some of them high deductible options. Providers may find that they have to intensify their marketing efforts if more people have to pay out of pocket for care, at least early in the year.

It makes sense that there will have to be some adjustments on both sides of the ledger.

from Psychotherapy of Finance

Stress in the Bank

Bankers are stressed, need services, APA official says


Banking is not the most beloved or trusted profession in the U.S. these days. The 2010 Gallup Poll on most trusted professions showed only 22% of Americans have “a great deal” or “quite a lot” of confidence in banks, a record low.

And although when most people think about banks, they think about large financial institutions that were bailed out during the economic crisis, the public tends to lump all banks, small or large, in together.

As a result, bank employees have been taking it on the chin. Like millions of other Americans, they are suffering from stress, depression and job burnout, says Nancy Molitor, president of Division 42 at the American Psychological Association.

We spoke with Molitor, a Chicago-area psychologist, this week for an article we’re preparing on niche marketing opportunities. She had a lot of good and timely ideas, which we’ll explore in an upcoming issue of Psychotherapy Finances.

One interesting tidbit: One of Molitor’s Chicago colleagues has carved out a mini-niche working with bankers and employees of other financial institutions. “He’s been very busy,” she says, because “they feel very under fire — everybody is sort of seeing them as the bad guy.

“People think they’re making too much money. But they’re doing the job of two or three other people, and they’re actually making less money than they used to make. So they’re very stressed.”

Molitor works with the financial services industry as well and adds: “They’re all very stressed. They don’t feel that the public gets what they do.”

Is there a med for everything?

Behavior treatment for Migraine Headaches!

There seems to be a pharmaceutical remedy for every problem, and they get lots of air time on prime time TV. But many consumers are rightfully wary of such widespread prescriptive solutions and behavioral therapists can sometimes offer them an inexpensive alternative.

Along those lines, the study on migraines released this week should get some media attention. It concluded that behavioral interventions are a cost-effective way to treat the problem because the benefits last indefinitely.

Researchers compared the cost of drug treatment — the assumption was 50 cents per day — to short term behavioral intervention in which the patient sees the therapist a few times and then practices treatment techniques at home.

After six months, the costs were about equal but after one year, the behavioral intervention was $500 cheaper.

“People think behavioral treatment costs a lot,” says Timothy Houle, associate professor of anesthesiology and neurology from Wake Forest University who led the research project. “Now with this study, we know that the costs are actually comparable, if not cheaper, in the long run.”

The interventions included hypnosis, relaxation training, and biofeedback.

“The cost of behavioral treatment is front-loaded,” explained the study’s co-author, Donald Penzien, a professor of psychiatry at the University of Mississippi Medical Center. “You go to a number of treatment sessions but then that’s it. And the benefits last for years.”

The research was published in the June issue of the journal, Headache.