Tag Archives: family

The Cancellation

Another day, another call or email: a couple whose first appointment was scheduled for later this week has cancelled. They have “found a doctor who takes our insurance.” That would be fine but for one detail: the appointment was for marriage counseling.

This could create a dilemma for the doctor who “takes our insurance,” if the clients turn out to be shopping for marriage/relationship counseling. This is because unless one member of the couple is diagnosed with a mental disorder, and the treatment rendered in those conjoint appointments comprise empirically supported treatments for that disorder, it is probably not covered by their insurance, whether the doctor “takes it” or not. No doubt this will be part of the discussion during their first appointment, when they inform the doctor that the problem is not helping Partner A cope with depression or anxiety (or some other mental disorder diagnosis), but rather some sort of relationship problem. Now, if Partner A is depressed, and the treatment involves communication skills combined with cognitive-behavioral therapy, or another empirically supported form of therapy that can involve the spouse as a coach/partner in healing, that’s excellent and ethical practice; not so for relationship problems.

At least I found out in advance, sparing the mutual aggravation of patients who imagined somehow that their marriage counseling needs are someone else’s financial responsibility and of a psychotherapist who expects to be paid for services.

This sort of retraction prior to a first appointment happens sometimes in my practice. “I found someone who takes my insurance.” This, despite my spending 10-15 minutes on the phone before setting that appointment and providing this information about my practice. I don’t contract with health insurance companies: it’s clearly stated on my website, and I tell people during that first, free, fifteen-minute consult.

Why bother mentioning it? There are ethical issues at hand.

To be perfectly frank: health insurance is for health problems.

It ought not to be used to get a discounted rate, subsidized by every other person paying premiums to that health insurance company, for marriage counseling, or premarital counseling, or vocational counseling, or any other normal, problem-of-living, life phase process.

My website clearly states my position on health insurance: I don’t contract with insurers because the bulk of what I do is not billable. I do not want my work with couples to be tainted by ethically questionable gymnastics in which we justify treating the relationship because it will indirectly help with a mental disorder. I will not label children with a brain disease because their grownups are getting divorced and upsetting the children, resulting in a custody evaluator referring the children to me. I will not participate in diagnosing people when I am concerned it is not in their best interest – a position supported, as it happens, by the American Counseling Association.

So, no, I don’t “take” insurance. Insurance cards are not debit or credit cards, anyhow: there’s no “taking.” There’s submitting paperwork and hoping one is eventually paid, or being denied payment and then having to bill the client, who may have been discharged months ago.

I don’t diagnose people for the sake of billing. If a client meets criteria for a diagnosis, what we’re doing is aimed at treating the symptoms of that diagnosis and, after being provided information about the process, the client chooses to submit the information to his/her insurance company, I will provide the appropriate form for the client to try to be reimbursed.

I work with human beings who are having problems in their lives (provided they are in Florida, where I am dually licensed for mental health counseling, and marriage and family therapy), and who want life to be better. They want better relationships and a hopeful outlook; they wish to live with purpose and meaning.

Those are not mental disorders. They are signs of health and hope.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

A little out of sync…

Intellectually gifted children are a challenge for grownups.

Their ability to learn and apply information may be far ahead of their peers but their emotional and motor skills may be completely normal (read: average and right on schedule). So your highly gifted six-year-old, who can visualize Johnny Depp’s pirate ship but whose little fingers can only manage 5-year-old’s motor skills, will be angry and frustrated to the point of tears over a boat that looks perfectly fine to you. Your gifted twelve year old will, with the emotional fragility of a middle-school-aged heart, grapple with the existential questions peers more often face in college.

This kind of asynchronous development is hard for the child, too…and will continue to be so, until adulthood. It’s easier for adults to find a few intellectual peers with whom to deeply connect. The more gifted the child, the harder this will be, simply because of the mathematical odds. Intellectual giftedness comprises only 2% of the population. Highly gifted persons are less than 1/1000 of the population; for them, the odds of finding someone on par, or, an even happier event, encountering someone sharper in intellectual terms, is slim. It’s important for grownups to be aware of the interior struggles gifted children face and provide opportunities for support, encouragement and sometimes some careful education on why they feel so different from other kids.

Add to this gifted kids’ tendency to need a little less sleep, be a little more bouncy, be in a hurry to learn and do, ask a lot of questions…or, conversely, be very quiet, observant and introverted, and the challenge for parents and teachers becomes clear.

Interested in learning more? There are a lot of resources out there: American Mensa and SENG are two excellent sources of information and support for the gifted child (or grownup) in your life.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

What can it be, besides ADHD?

Your child is bouncy. He doesn’t seem to pay attention; she forgets to follow through on tasks. The book bag is a disaster area; necessary books never seem to make it home; and you regularly have to turn around and go home to pick up shin guards or ballet shoes.

Well, what can it be, besides ADHD – the psychiatric diagnosis of Attention Deficit/Hyperactivity Disorder, diagnosed off a checklist and sometimes suspected of being over-diagnosed?

The symptoms associated with ADHD can be due to a wide variety of issues; here are a few:

  1. Stress at home or in the environment. If you are having marital or other family difficulties, your child is stressed – whether you know it or not. Research indicates that a, adults are pretty lousy of telling when children are anxious or worried and b, the children of adults with marital problems, when tested in research studies, have high levels of stress chemistry metabolites in their urine.
  2. Maybe it’s not at home; maybe it’s the environment. Live in a noisy and/or high crime neighborhood? Is your child bullied or afraid of being bullied at school? Sources of ongoing stress will interfere with the parts of the brain that are important to focus, attention and memory.
  3. Insufficient sleep. Is your school-age child getting 9 or 10 hours of quality rest per night? Falling sleep by television, computer, or with a cell phone close at hand? These will all interfere with quality and quantity of sleep.
  4. What are overtired kids like? You know what you do when you’re driving late at night and you are too tired to be driving – so you bounce in the seat, sing too loudly and pretend having the windows open will magically keep you alert? Yeah, well…meet the 3rd grade kid who is up too late because of football or soccer practice a few times a week and fidgets around looking dazed in class.
  5. Insufficient exercise. The recommendation for children is two hours of physical activity a day – real activity, not standing-around-hoping-coach-lets-me-play-this time activity.
  6. Boredom. Brains + boredom = either shutting down and not trying at all OR driving grownups and other kids bonkers. Look out for the introverted or shy child who may shut down and go into dreamland; a lot of gifted children are very introverted and self-contained, and unlikely to be overtly disruptive. They simply tune out.
  7. Frustration. A child who is having difficulty – perhaps an undiagnosed or insufficiently supported learning disability – will often give up and stop trying. Remember that children personalize things; if they are struggling and the grownups act like they “should” be able to “get it,” the child assumes the adults know best and that the child must be flawed/”stupid” etc.
  8. Your (or some other involved grownup’s) inconsistency. If you flipflop on rules, fail to follow through, and run an unpredictable life for yourself and your child, it’s not fair to look at the child who seems scattered or (more likely) is gambling on this being one of those times when you are too stressed or preoccupied and let things slide, and blame the child.

You’ll notice that none of these issues can be blamed on the child. These are all grownups-need-to-pay-attention flags, not “naughty kid” flags. So, before you assume your child has a brain disorder, rule out the many factors that we grownups often unwittingly inflict on children and see if, with a few months of more consistent attention to these risk factors, your child’s behavior and morale improve.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

 

What are you waiting for?

The American Association for Marriage and Family Therapy asserts that the typical couple coming in for counseling has had difficulties for over five years…which makes me wonder, what are they waiting for?

There are a lot of seemingly perfectly sensible reasons to postpone counseling when things start to go awry:

“It’s expensive.” This is true; counseling does cost money and relationship counseling is an out-of-pocket expense. Still, most therapists are cheaper than two retainers, two divorce attorneys, a mediator, a parent coordinator, etc…

“I don’t want to be told what to do.” Well, a good therapist isn’t just going to tell you what to do. A therapist is going to be asking a lot of questions, having you fill out a lot of questionnaires, and trying to develop a very clear picture of your relationship’s specific strengths and the particular types of problems each of you identify. That way, research-recommended approaches can be matched to the problem(s) of the particular couple.

Fear. Don’t a lot of people fear that it’s going to be like that old Simpsons episode, where, after Marge vents for hours, the therapist turns to Homer and says something to the effect of, “I’ve never said this before, but it really is all your fault.” That’s not what happens in real life.

Shame. So many people suffer with shame over the difficulties they are having. Marital difficulties feel like a failure. Yet, if marital problems were some rare, shameful thing, why are there so many marital therapists? We have our own doctoral programs, professional licensure, and organizations. Beyond that, other non-specialists in the mental health professions also offer couples counseling.   Shame can be overcome by getting help and feeling less alone in the suffering.

The Ostrich. Just try to ignore it and hope it goes away: the addiction, the affair, the endless disputes about parenting or money or values and ethics. Some things, ignored, will go away: a minor cold, a pimple, a minor aggravation of the day. Other things, though, just fester and turn into a nasty emotional infection: resentment, trauma, guilt, hurt.

If your relationship is suffering from feelings of distance and disconnect, or seems to be a vortex of repetitive arguments, counseling could be very effective. Often, five or six appointments, spread out over four to six months, can make a world of difference when both parties are willing to work at changing patterns of behavior and experimenting with new ways of interacting.

It’s important to find a counselor who is a good fit. Call a few of us; talk for a few minutes; get a sense of style and see who seems like a good fit for the two of you.

Be bold. Push past shame and fear; challenge your inner ostrich. Then start to feel happy again.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Toxic Myths, revisited

A lot of people ask about toxic myths: what does that mean? Why “myths?” (I’d like to say, well, buy the book, and sometimes do).

The toxic myths are examples of lies dressed up as truths. Our culture is seething with them, but in Toxic Mythology, I only addressed a few.

For example, consider the myth that people can compartmentalize their lives. Someone can, within this myth, be an absolute scoundrel in their personal life but supposedly be capable of being completely trustworthy and honorable in their public/vocational role.   Conversely, they can (per the myth, at least) be a sociopath in their professional life but be kind, tender and good in private.

So…if you buy this myth, you have to be willing to:

Vote for someone who swears to uphold a particular principle while having a personal and/or professional life littered with betrayals and a habit of acting on expediency, not principle;

Believe your child who promises she didn’t really cheat on that exam or plagiarize on the paper (despite the software evidence) after same child was grounded for “borrowing” money out of your wallet without permission.

Keep on an employee whom you overhear lie to customers because you haven’t caught that employee lying to you.

Convince yourself that your gossipy acquaintance never, ever would talk about YOU behind your back.

Does any of that sound reasonable? Of course not; these are, however, the toxic myth in action. Our culture tells us that it’s perfectly reasonable to believe that compartmentalization of character is possible and (further) that we should be “judgmental.” That’s another myth for another day.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Mental Health, Well-Being, and Responsibility

More about personal responsibility in regards to mental health and well-being…

Have you noticed how often people talk about things they do as if they were events that happened. It’s as if “stuff happened,” and they were just hapless victims of circumstances. Note, I am talking about the things people actually DO – not things that really do happen to them.

“I got to work (or class, or church, or wherever) late.” A more accurate description would be, “I decided to do (some category of activity) rather than leave on time.” Maybe it was staying in bed, maybe it was “one more chore,” but the person decided to do something and thus the lateness.

Someone complains, “I woke up with a hangover,” when, of course, the reality is, “I decided to drink to a point where I knew I would feel lousy today but last night it seemed like a really good idea.”

“The (whatever task – homework, a chore, etc.) didn’t get done.” What really happened? The person decided to do something else, or a whole bunch of something elses, rather than that pesky task.

So, one way to improve one’s well-being is to simply start taking responsibility for choices. I might decide to have a brownie ice cream sundae for breakfast, and if so, I should say I am deciding to have this instead of scrambled egg whites with cheese. The brownie sundae, in all its wonderful deliciousness, will not just happen to me by accident, without warning.

I can decide to sit and stew about something that bothers me or I can decide to try to focus on some other activity and decide that I will figure out what to do about a particular problem when I’m in a better frame of mind. I get to decide; an hour spent stewing is something I can choose, or maybe I can choose to do something else instead.

You can decide to be in a relationship with someone who is toxic and mean, or not.

You can decide whether to seek help in parenting strategies, or throw up your hands in despair, or try the consequence-of-the-week approach except for when you’re too tired to argue.

You can decide whether to join a grief support group or suffer in silence and loneliness.

The act of owning a decision gives a greater sense of control, because if you decided one thing today, you might decide something else in five minutes, or tomorrow, or next week. If stuff just happens to you, you have no control, and thus must sit around being helpless, hoping for better luck next time.

Luck is an iffy plan.

It would be better to decide.

 

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Letting Children be Children

Is having a healthy, happy childhood a good thing? Is it important to have that foundation in order to be a productive, healthy and happy adult? All of us would agree that, “Well, duh. Of course.” Well, of course…yet, around the world, it seems that the short-lived glorification of childhood as a separate, sacred stage of life (in many ways a 20th century movement) is crumbling away.

In some European nations, 14 year olds have attained the age of consent to sexual activity with adults. Here in the US, they aren’t expected to remember their homework and thus teachers must dutifully post assignments on a school website so parents can check. For the record: 14 year olds can remember homework. Try breaking a promise about a privilege and see how good their memory actually is. The same child, however, is not capable of informed consent. They are not equipped to really understand long-term consequences due to brain development.

In the Netherlands, a 12 year old who is seriously ill – and consider that here, an awful lot of parents don’t expect 12 year old children to do chores or remember their own shin guards for soccer – can petition a judge to be euthanized due to illness. Their parents get to choose whether to grant permission up until age 16. That means that a 17 year old can petition to be medically killed. The same child might not be able to follow through on a college admission essay, or otherwise exhibit normal responsibility, but somehow their request to die ought to be treated as a perfectly normal legal procedure.

In our own country, about 9% of children have been diagnosed with ADHD and are being treated with medications, most often powerful stimulant medications – a rate that dwarfs much of Europe’s less-than-1% rate for medicating children.

Psychologically and physically, children aren’t miniature adults, as was so often the view in the past, due to the physically challenging, dangerous life most humans lived over much of history. They need love, secure boundaries, and guidance in learning to make good choices as they mature. Where these needs are unmet, adult dysfunction, emotional distress and physical illnesses are apt to follow.

They definitely don’t need to make life-or-death decisions, or be exploited by bad adults, or otherwise be treated with an expectation that they are fully rational, insightful grownups.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

 

Review: The Collapse of Parenting: How We Hurt Our Kids When We Treat Them Like Grownups, by Leonard Sax, M.D., Ph.D.

A friend recommended this book and this past weekend I read a large portion of it. It’s aimed at parents and others who are directly involved in raising children, and cites some pretty striking research about the negative outcomes of giving children more freedom and flexibility than they can handle. Children being given the control over their lives that ought to be reserved for responsible adults are far more likely to develop anxiety, depression and obesity; they have less attachment to their families and adults in general, and are more likely to turn to peers for advice. Their peers, of course, are not apt to know any more than them about making wise choices about life.

It’s a conundrum for some: after all, kids have to learn how to make choices, but they can’t handle the full variety of options that many parents want to give them. Learning how to present a narrow, fair range of choices is, apparently, a challenge for parents who are desperate to be liked. This craving for their children’s approval underlies a lot of dysfunctional, but seemingly well-intended, parenting. I described a parent’s style as a “democracy” (the children are school age) and the parent took it as a compliment…as if being democratic with children, where no one is really in charge and knows best, was a good plan.

Do kids need choices? Absolutely. Do they need – or can they even handle – the full range of options that an adult might handle? Absolutely not.

For parents, teachers, grandparents and others who work with children, this book is a friendly, accessible but thoroughly footnoted guide.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Decisions, decisions!

Choices are good, right? Until they’re bad.

Too many choices becomes overwhelming. We can see the results of seemingly endless choices and information when we, or someone we know, gets lost in hours/days/weeks-long process of sorting through online reviews and information in the attempt to make a decision that might have been made over a dinner conversation twenty years ago. Grownups have problems with this, and yet so many parents inflict too many choices on their children.

It’s important for children to learn to make choices and endure the consequences in small, safe, age-appropriate doses. It’s also important for children to feel like the grownups are running the show. Offering opportunities to make choices – within defined parameters – and then sticking with those choices, are great learning experiences for children.

Consider asking a five-year-old:

“Would you like applesauce or yogurt for a snack?” versus, “What would you like for snack?”

What are the odds the child isn’t going to go for fruit or low-fat dairy and will instead choose something the parent wasn’t planning to provide? With so many modern parents afraid of upsetting their children and overly eager to have their children’s approval, children are left without anyone big and safe to place limits around their world. Temper tantrums, anxiety, and entitlement are often the results.

Children benefit from parameters and calm grownups being in charge. A calm, in-charge grownup can offer safe, appropriate opportunities to learn decision-making skills and learn to live with the consequences.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Way 31/Day 31: Make it a great year: Ask for feedback…and use it

Some of us remember former NYC Mayor Ed Koch, who would famously ask, “How am I doing?” and get loud feedback from everyday people nearby. That seems useful for someone who is a public servant. For most of us, just randomly asking strangers how we’re doing seems more irrational than reasonable.

We all have people close to us, though, who do have a sense of how we’re doing, and perhaps more than we do. “Jane” thinks she’s doing fine, and managing well, but her husband “Joe” sees that she is frazzled, irritable, and apt to burst into tears of helpless frustration every couple of days. Meanwhile, “Joe” thinks his Ironman training is going fantastically – and doesn’t realize that he is nodding off mid-conversation, grouchy and distracted during what little time he does find for family. The conversation is likely to become pretty unpleasant, very quickly, if they decide to sit down and tell each other what they need to do differently or what seems “wrong with you.”

It’s hard to do, but asking someone for honest feedback – someone whom you can trust to describe what they observe without slamming you or criticizing you – can be a real insight into how we seem to be doing. It’s information, after all, and, if you trust the source, it merits careful reflection – not immediate rejection. If Jane comments, gently, on Joe’s tendency to be exhausted and grouchy, he might tend to imagine he’s hearing a death-knell for his Ironman dream. No, he’s hearing that something about the balance of training, work, and home life is leading to his being so tired that the people who love him miss his (awake, ungrouchy) presence. How can he get some of that back for all of them, including himself? If Joe expresses concern about Jane’s seeming awfully stressed out these days, she is apt to hear still more criticism and feel defensive, when she’s really hearing concern.

Find one, or two, or three, people whose feedback you can trust to be in your best interest and fairly accurate…and at least take it into consideration. Better yet, sincerely try it on and see if it fits, and if so…use it.

Make it a great year!

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.