An Unexpected Gift: Traveling to the International Obsessive Compulsive Foundation Conference

Sometimes I receive unexpected gifts when I am in a place of being open to receive them. I had such an experience on my way to the International Obsessive Compulsive Foundation's annual conference in Chicago. I decided to face my fears and do a little exposure therapy by getting on the L which is the public transport train from O'Hare airport to downtown Chicago. I wasn't sure which train to take but I saw a young man running for the one that's doors were closing so I took a leap of faith, ran after him, and hopped on just as the doors closed. I looked at him and told him I had no idea what I was doing but I knew I was facing my fears. He asked where I was going and we quickly realized we were going to the same conference but for very different reasons. It was a 45 minute ride to downtown. He shared his struggles with severe OCD and how he had not gotten good treatment until he went to Roger's Hospital which specializes in treating OCD. Even there, he found staff who were not understanding to his peers when they were incapacitated by their severe anxiety and unrelenting symptoms. I shared my unwavering commitment and passion for helping those with OCD and yet how I am humbled by this disorder every day. We laughed at the absurdity of the symptoms and the tricks OCD plays. He shared several of his fears including his fear of having schizophrenia. I looked up  and saw a huge advertisement on the wall of the train scrolling, "SCHIZOPHRENIA" . We again laughed at how there are opportunities to do ERP everywhere and sometimes it feels like the universe creates these experience for people with OCD just to give them some practice. I felt his warmth, wisdom, and genuineness throughout our travel. We never stopped talking and actually missed our stop! We laughed and just got off on the next stop, embracing our anxiety and owning our uncertainty. I am so grateful for having met this young man who reminded me of  how challenging OCD can be for people who live with it every day as well as the hope that therapists, researchers, and psychiatrists offer in meeting this challenge head on and offering the latest advancements in treatment for such a debilitating illness.
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For more information about OCD and its treatment go to www.iocdf.org.

Embracing Transitions

It is the middle of June and we are getting ready to celebrate my daughter's graduation. It is a time of reflection, excitement, joy, and gratitude. Unfortunately, many parent's and young adults find this time to be anxiety provoking. Transitions are often difficult due to the uncertainty of what lies ahead. Parents are grieving  what they are losing and the young adults are fearing what they are about to face. The best thing to do is to honor these feelings....create a space for them. If you resist them, try to get them to go away, or push them down, the feelings will only grow and gain power. I often take some deep breaths and open my arms and hands to tell myself that I am listening and I am open to learning from the sadness/fear. It is also helpful to tell your mind the whole story. Anxiety/Sadness tends to only repeat the negative or catastrophic parts of the story. It is your job to balance this story by accepting the uncertainty and possibility of distress but also stating the potential for new, exciting, and interesting experiences to emerge. Keep yourself open and keep the door open for possibilities. This will prevent you from being controlled by anxiety.

Taking Risks

My family had an adventurous vacation. We decided to participate in every action-filled experience we could. This included kayaking, hiking in ankle deep mud, hiking on cliffs, learning  to Stand Up Paddleboard, Zip lining, snorkeling with huge sea turtles, surfing, and jumping 18 feet into a swimming hole in the middle of the jungle. I was excited for each experience until we got there and my anxiety brain told me that it was crazy to do this. My excitement turned to fear before I had any say in it. My heart beat fast. My stomach felt sick. I had to go to the bathroom something fierce (this is something my kids tease me about because I always have to go to the bathroom multiple times when I am anxious). My thoughts would try to convince me not to do some of the things-particularly the high jump into a blue hole that I had no idea what lay beneath. Then I thought of each of you. The hard work you have to do to face your fears every day. The times you have to do things even though you are scared. The self talk you have to do to teach your brain the truth and to convince yourself to take these risks because life is worth living. I was scared but I jumped, zipped, snorkeled, hiked, and was in awe of these massive sea creatures I swam with in the ocean. The most fascinating thing was that once I got over anticipating the potential risks and  got through the first few seconds or  minutes of the experience, my brain stopped feeling fear and really enjoyed the ride.

Living with OCD

My phone has been ringing off the hook with people who are desperate to get treatment for OCD. There are a few reasons for their desperation.  First, the symptoms can be severe and create much suffering personally and in their relationships. Second,  people often are misdiagnosed and mistreated once they get to a therapist which leaves them feeling hopeless and helpless.  Finally, there are not enough therapists trained to treat OCD using evidenced based treatment, which is Exposure and Response Prevention. Consequently, people often have to travel great distances once they find a well trained therapist. I want you to know there is HOPE.  OCD is treatable. The treatment is actually simple but very difficult to do because it goes against what your brain is telling you. I tell kids to treat OCD like it's a bully, telling them awful things about themselves because it has figured out what matters most to them. Once you face the bully and call it exactly that; allow yourself to feel the anxiety without doing anything about it; and, most importantly, do the opposite of what the bully says (agree with the fear, contaminate yourself, hug your child while holding those awful thoughts, be uncertain....), OCD will begin to dissipate. See, OCD has no power as long as you don't believe it and refuse to do what it says. Even if you find yourself believing it, if you do the opposite, you will gain insight into how it is lying to you. You just have to take that leap of faith, be really courageous, and get to the other side. I am humbled by the clients I have the opportunity to care for who have OCD. They are the most courageous people I know. Come check out our support group on the first Thursday of each month from 6:30pm -7:30 pm to find out how to be on the path to recovery from OCD.

Pratical Advice for obtaining quality mental health care when money is tight.

Wednesday, December 17, 2014

Thanks to mental health parity, many more people have access to psychotherapy than in the past. But two great barriers to treatment remain. The first is shame, as the stigma of mental illness still prevents many from seeking professional help. The second is cost, because even when people have health insurance, the expense of co-pays and high deductibles can be too much when money is tight.

For some people, the predicament of needing mental health treatment, but not being able to afford it is doubly shameful, and so they never seek the care they need.

But I’m here to tell you there are ways to obtain high-quality therapy for little or no cost, and people should never let shame get in the way of wellness. Here are some tips for talking to mental health providers about cost concerns, as well as suggestions for ways you can get free or discounted care.

1. Know that it is OK to talk about cost. 
First and foremost, understand that cost is not a taboo subject. Money is a reality for both providers and patients, and people should feel comfortable discussing their ability to pay with therapists.

If you have concerns about cost, be direct and honest with your provider. When you first call to make an appointment, say, “This is the insurance I have, do you take that insurance? If I can’t make my co-payment, then what do you do? What do you offer for people who don’t have resources to pay your fee?”

Granted, talking about your ability (or inability) to pay may not be your favorite topic; but it is far better to have the conversation than avoid seeking care. People must shift their thinking to recognize that long-term wellness outweighs the brief discomfort of a conversation about cost. It’s about leaning into that discomfort and believing, “I deserve this.”

2. If a therapist won’t work with you on cost, find one who will.
If you ask a therapist about reduced-cost care and get an unsatisfactory answer, don’t take that “no” for your final answer. Just because one therapist won’t work with you on cost doesn’t mean that’s how all mental health facilities function. Ask the therapist if he or she has any recommendations for where you could receive free or low-cost care. Very rarely will a therapist just turn someone away with no guidance or referral.

And if you get a rude response when you ask about cost, he or she is probably not a provider you want to work with anyway.

3. Tap community resources.
If you are having trouble affording traditional psychotherapy, there are some low-cost alternatives that might meet your needs. For example, I offer a free support group to OCD patients and a $15 therapy group for patients with anxiety. I don’t bill insurance and everyone who comes pays just $15. A lot of other therapists provide similar free or reduced-cost support and therapy groups, so be sure to ask.

If you live near a university, call the graduate psychology department and ask if they have a counseling center for people in the community. These centers are typically staffed by graduate students who are learning to provide therapy, and the care is usually excellent and free or very-low cost.

In every community, there are crisis care services (usually provided by the local health department) for people facing a mental health crisis. Specially-trained support staff will help you over the phone, and may even come to your home to help you through the crisis. Often, services include connecting people to affordable, appropriate care, and this can be a valuable resource for people who don’t know where to turn for assistance.

Finally, for people who are self-pay, some providers offer a sliding-fee scale. A sliding scale allows people to pay based on their personal income and what they can afford.

4. Explore what’s available through your employer. 
Some people have an employee assistance plan (EAP) through their work. An EAP is an employer-paid benefit that is separate from your medical plan. It is designed to help employees through challenging situations. Typically, employees can access counseling through the EAP for no cost. As the EAP is designed to provide short-term assistance, there is usually a limit (ranging from three to eight) to the number of free counseling sessions.

If you are not sure if you have an EAP plan, call the 800 number of the back of your insurance card or call the HR department.

5. Seek quality care.
Free or low-cost care does not mean inferior care. Even if you don’t have the resources to pay for therapy, you deserve quality care. Don’t limit yourself to finding a therapist who can provide reduced-cost care; be sure you find a therapist who can provide the right care at free or reduced cost.

I encourage patients to interview potential therapists. Describe your symptoms and ask, “Do you feel like you can help me? How would you help me? What is the evidence-based treatment for my condition? Do you have training in this type of treatment? ” For further guidance, the Anxiety and Depression Association of American provides a comprehensive list of questions to ask when choosing a provider for yourself and for your child.

Most providers are willing to have a 10-minute conversation with you about this. If someone gets defensive about this sort of questioning, move on. You deserve to be treated with respect and have your questions answered. Even if it takes four phone calls to find the right therapist, it’s worth it. And you deserve it.

Helping Our Children Be Balanced and Successful

Wednesday, April 15, 2015

The Wall Street Journal published an article recently on helping your young adult get good mental health treatment in high school and college http://www.wsj.com/articles/good-mental-health-away-from-home-starts-before-college-1428944477. This is an important article for two reasons: First, rarely does a newspaper print a consumer driven article that has great information from both a consumer and a top notch clinician. Second: Successfully sending our children out into the world of college or the work force has increasingly become a difficult task both for parents and kids. There are many aspects to this new challenge. The expectations we place on our children to be competitive can create burn out before they even get to college. The shear number of advanced placement classes, number of volunteer hours,  and the in school and out of school activities they are expected to participate in all contribute to these kids having increased mental health issues including anxiety and depression. This article shows that there is help. Helping our children be balanced means teaching them to notice when they have taken on too much, teaching them to speak up to teachers and coaches about their needs and struggles and honoring them when they do speak. Creating spaces for them where they can quiet their bodies and minds helps to create life long habits that promote well being. Making sure they have enough time to help around the house and participate in family activities.  If your child does develop mental health symptoms, provide them support. This may mean that you need to seek professional help. This article shows that evidenced based therapies, like cognitive behavioral therapy, can make a big difference in a short period of time when everyone is invested. Our children are our future. Let's help them learn early, how to care for their mind, body, and spirit so they can go forward to use their gifts and talents in a way that lights them up and lights up the world!

Being Purposeful in Facing Your Fears

I have a friend who was recently attacked by a dog. This has been a traumatic experience for her and has developed into a fear of walking near dogs. We have walked every week together for over 2 years, whether it's 10 below or 90 and humid. This attack has changed her experience on our walks from noticing people, trees, and the beautiful snow flakes to being hypervigilant to any potential run- in with a dog. It's been interesting to watch her fear take over our walks and grow exponentially with every avoidance move she makes. I finally asked her if I could help her so that she could take back her walks and change her experience with dogs. Thankfully she was open as she was painfully aware of how skiddish she had become. I told her that she had to teach her brain the difference between danger and discomfort. Danger is when something is actually happening (like when she was being bitten) and discomfort is when we fear something might happen (every walk we take). I asked her to start being purposeful about walking next me when a dog was on the street, on the side where the dog is. I explained that every time she moves away from a dog or purposefully avoids walking down a street where a dog is, she teaches her brain to be scared of discomfort, of streets, of walking. In order to enjoy her walks again, she will have to choose roads with dogs so that she purposefully creates an opportunity to practice feeling discomfort and being courageous. The woods was particularly beautiful today, people and dogs were out in force. My friend took a deep breath and practiced walking toward the dogs, instead of away. She got stronger with each encounter and I watched her confidence grow. By the end of our walk in the woods, we were noticing the beautiful flowers again, sharing family stories, and smiling.

Being Curious

When working with my anxious clients, I often have them become an observer of their anxiety. This helps them to bring to me the facts about their symptoms, thoughts and behaviors connected to their anxiety rather than just their fears. However, it does something else. It helps them become unattached to anxiety and takes them away from judging themselves (this is so scary, I can't do this, I must be weak because this is so awful) to acceptance (This is anxiety., I know what this feels like., Just because I think it doesn't make it real.).  For some, this might sound a lot like mindfulness. Well it is! Being mindful allows us to slow down our response to stressful events, observe our experience, and then allow our wise mind to decide what to do next. I often ask my clients what they did when they realized their anxiety was being triggered. (note the correct answer is nothing!). It can be very difficult to change our automatic responses to what feels like a dangerous experience. So one approach that can be very helpful is to be curious. Curiosity creates a different kind of energy. It is kind of pleasant. It makes me smile. If I have a child that is afraid of bees, I can easily get them to move towards a bee just by asking them to be curious about the bee. What does it actually look like? What is it doing right now? Why do you think it's doing that? So the next time you find yourself triggered with a stressful event (you will know because you will feel an emotion rising up), be curious about it. Ask it what it would like you to know? Observe your automatic thoughts. Don't do anything until your wise mind can catch up. Here is a TED talk that might be helpful: http://www.ted.com/talks/judson_brewer_a_simple_way_to_break_a_bad_habit?language=en