Rembrandt van Rijn, The Return of the Prodigal Son. (1668), Hermitage Museum, Saint Petersburg
Rembrandt's “Return of the Prodigal Son,” painted in 1668 toward the end of his life, and now hanging in the Hermitage in St. Petersburg, Russia, is a truly astounding work of sacred art. I haven't seen the original (it is a large painting 8” by 6”), but even the prints convey that which is almost inexpressible.
Others have painted this gospel parable that appears in Luke, chapter 15 many times. Rembrandt’s version stands out, however, from all the others (including James Tisor’s The prodigal son in modern life: the return, painted around 1882, which portrays the son as a wayward sailor returned to his father’s arms on a dock somewhere).
In Rembrandt's version, the father and prodigal son are in that ever-so-soft-and-delicate light of Rembrandt (not the highly intensified and focused light like Caravaggio) against the backdrop of a black surface. The ragged, dirty robes of the son contrast with the father’s ochre tinged with gold robe.
One can move downward from the light on the father’s face to the son’s feet, filthy, with one sandal lying on the floor. The son is almost bald and repellant: he has squandered his inheritance and has even descended so far into degradation that he lived with the pigs.
In another painting of this biblical story Rembrandt caught the prodigal son in the tavern. He painted himself and his wife, Saskia, into the merry-making of wine and song in a raucous pub (of course, Rembrandt as prodigal is wearing a sassy Dutch hat of black felt, with sword dangling at his side).
There are sketches, too, of scenes from the story. Albrecht Durer sketched The prodigal son among the pigs in 1496. This sketch sets the prodigal son smack in the middle of a pig’s trough. These pigs, and their piglets, have the largest snouts I have ever seen. Durer is a matchless wood-cut artist and crafter of sketches.
But it is the father’s features that keep my eyes fixated on the Rembrandt painting, perhaps the way Leonardo Da Vinci’s Mona Lisa still strikes silent awe in our hearts. How could he paint such an enigmatic smile? Rembrandt’s solemn scene of reconciliation paints the father’s look with such utter tenderness, compassion and love.
Part of the way he does this is by the contrasting light on the old man’s eyes: his left shaded with black, the right eye full of light, the head tilted to the left, the arms extending out of the scarlet robe (revealing extraordinarily beautiful undergarments) and hands placed with utmost tenderness on the son’s back (his head, though turned, is resting on his father’s chest).
Rembrandt has caught the moment when the father has just so, so carefully placed his hands on the son. One can almost imagine that this dirty wayward prodigal had just walked in, and the father moves to meet him, with the son falling at his father’s feet. The psychological depth of this painting is remarkable. The son has come home, the feast is about to begin.
But Rembrandt does not forget the elder brother. He is the “good son” who stands at the side to his father’s left, with two figures, barely visible, in between (another stands behind the father). The light is on the elder son’s face. Unlike his brother, he is standing, hands folded, a walking cane in his front. A red cape drapes his shoulders. He doesn’t seem particularly overjoyed.
The universal meaning of this unsurpassable painting is that light flows into the darkness and sin-weariness of the world though compassion that accepted the wounded and humiliated with total encompassing. The father embraces the wayward one without question. In his book, The Return of the Prodigal Son: a story of homecoming (1994), Henri Nouwen, the contemplative priest and spiritual director, discusses his encounter with Rembrandt’s painting. His story began in the fall of 1983 in the village of Trosly, where he had been spending time at L’Arche, the community founded by Jean Vanier for mentally handicapped people.
Henri had been traveling around the United States lecturing and protesting the war in Central America. He was exhausted, restless, and needy. One day he went over to visit Simone Landrien in the community’s documentation centre. He says, “As we spoke, my eyes fell on a large poster pinned on her door. I saw a man in a great red cloak tenderly touching the shoulders of disheveled boy kneeling before him. I could not take my eyes away.
“I felt drawn by the intimacy between the three figures (one, very, very faint), the war red of the man’s cloak, the golden yellow of the boy’s tunic, and the mysterious light engulfing them both. But, most of all, it was the hands—the old man’s hands—as they touched the boy’s shoulders that reached me in a place where I had never been reached before.”
Immediately Nouwen wanted to get a copy—at Simone’s insistence. The picture stayed with him over the years. There is little doubt that for Nouwen, the coming home to a secure and safe place swelled up from his spiritual depths. Three years later, Henri had opportunity to visit the Hermitage in St. Petersburg where he saw the original painting for the first time.
“I was stunned by its majestic beauty. Its size, larger than life; its abundant reds, browns, and yellow, its shadowy recesses and bright foreground, but most of all the light-enveloped embrace of father and son surrounded by four mysterious bystanders, all of this gripped me with an intensity far beyond my anticipation. There had been moments in which I had wondered whether the real painting might disappoint me. The opportunity was true. Its grandeur and splendour made everything recede into the background and held me completely. Coming here was indeed a homecoming.”
Dive deeper into the painting
The painting revealed to Nouwen the deepest yearning of his heart. The story of the prodigal son is the story of a God who goes searching for us and who doesn’t rest until he has found us.
3 phases of the spiritual journey:
1. The younger son.
Practical tips & things to pray about
Recently I posted a video by Esther Perel where she provides a brief guide about communicating about love in this day and age. In the video, Esther discusses the phenomena of ghosting, icing, and simmering. In this post, we’re going to look at these terms, why to stop engaging with them if you’re a culprit, and how to deal with the emotions of being ghosted, iced or simmered.
Rejection has always been a part of the relationship landscape. But are the new trends of ghosting, icing and simmering increasing our acceptance of ambiguous ends? These tactics of maintaining unclear relationships and prolonging break-ups all produce what I refer to as stable ambiguity. When we are stably ambiguous, we're too afraid to be alone, but unwilling to fully engage in building intimacy. This behavior creates a holding pattern that affirms the undefined nature of the relationship, which has a mix of comforting consistency AND the freedom of blurred lines.
Esther says that "we want to have our cake and eat it too. We want to have someone available to cozy-up with when it’s snowing, but if something better comes along, we want the freedom to explore."
In this relationship culture, expectations and trust are constantly questioned. The state of stable ambiguity will undoubtedly create an atmosphere where at least one person experiences a constant cloud of uncertainty, and neither individual feels truly appreciated or nurtured. We do this at the expense of our emotional health, and the emotional health of others.
"Ghosting, icing, and simmering are manifestations of the decline of empathy in our society — the promoting of one’s selfishness, without regard for the consequences of others," says Esther. There is a person on the other end of our text messages (or lack thereof), and the ability to communicate virtually doesn’t give us the right to treat others poorly.
So what is ghosting, icing, and simmering really? Let's take a look.
Ghosting is simple. The other party simply becomes a ghost. They stop responding to calls, texts, or DMs. Typically, ghosting happens once you’ve already met the other person.
If someone just stops responding to your messages within an online dating site and you haven’t met yet, it's probably one of three things:
Do you ghost?
People who are “into you” don’t “just get the hint” when you stop responding. In some cases, they actually worry. If you’re someone that ghosts others, consider stepping up a little and treating people with a bit more respect. Everyone wants to be respected. You’re not going to be respected if you don’t respect to others. That’s just the way the world works.
Have you been ghosted?
Being the victim of a ghoul sucks. Plain and simple. Many ghostees live in within the gray area between anger and worry. Particularly if they really liked the ghost.
But, it’s not you. That didn’t help, did it? But the reality is, is that someone who can’t send you a message letting you down isn’t someone you want to be with in the first place. How far do you want to go with someone unable to take responsibility for their own decisions?
A client of mine recently came in to their session in tears because the person that they had been seeing for last two months finally reached out to them a week after they left them a voicemail, saying they'd gotten busy. My client hadn't been ghosted. They'd been iced.
Icing is when someone suddenly behaves very cool towards you. Their responses become sporadic and will become increasingly more generic than specific. Trying to make plans will yield responses like “let me get back to you.”
Do you put people on ice?
Stop. Really, people are not toys. It’s OK to call it like it is. Keep a good friend vs. just being a jerk.
If you're prone to icing people, try; this instead: So, here’s the thing: I like you. I like that you _____, and you would probably be great to be friends with.
Warning: If they agree to be friends, make the next four or five connections be group interactions. Test that friendship is going to work. Constant advances aren’t OK. Maintain your agreed upon boundaries.
Have you been put on ice?
I guess the good news with icing is that the other person is kinda into you. They do like you. Otherwise, they’d ghost. But chances are, they aren’t so sure whether the like you like you. That’s worth a little bit of effort, right? So that's why you're on ice.
Icing is weird. People do get busy. But if someone wants to spend time with you, they make the time. At very least, an “I wish I could see you, but I’m booked” text will fill the space and help take the edge off.
Dealing with icing takes a bit of commitment. Give yourself a strategy and stick to it. Set boundaries and limits. A strategy that I teach my clients is 2/4. I recommend that they reach out twice, four days apart. So, if my client reaches out to someone – phone, text, email, DM – and they don’t respond in four days AND they really like them, call and ask a hard “when can we get together again?” But, that’s it.
If my client is truly being put on ice, their second call is going to go to VM. If their crush answers, chances are icing isn’t what’s going on – something else is.
If that second call is met with something other than a “let’s get together x,” most likely it's not worth continued pursuit.
Simmering is the worst. It is literally putting a relationship on the back burner and letting it sit there. And you're in the pot. You're plan B. They're really looking for x but, if the can't find it, maybe they'll settle for you.
Do you let people simmer?
If you’re a simmerer, just say you’re not interested. Maybe you kind of are, but do everyone a favor, just say you’re not. If you’re not interested right now and have the courage to state it, you might have the chance with the person later if you become interested, because you were honest before. But, if you simmer someone, you’re just being a jerk. Even if you believe you have good intentions.
Are you on the back burner?
When you’re being simmered, you have to be the strong one. That puts you in the awful position of having to bail on someone you actually like.
But, here’s the thing: you’re only around for their ego. Even if things would escalate to a relationship, chances are, you’re only arm candy for their ego.
Don’t tell the simmerer, but the reality is quite simple: they’re just not ready for an adult relationship. In an adult relationship, you like someone and you want to give it a shot… or you’re not willing to give it a shot. For some reason or another, simmerers just aren’t willing or ready to give it a shot. And that's okay, but you don't need to stick around until they are ready.
Ghosting, icing, and simmering are manifestations of the decline of empathy in our society — the promoting of one’s selfishness, without regard for the consequences of others. There is a person on the other end of our text messages (or lack thereof), and the ability to communicate virtually doesn’t give us the right to treat others poorly. (Esther Perel)
I encourage you to end relationships respectfully and conclusively, however brief they may be. Act with kindness and integrity. This gives both people the chance to enter into their next relationship with more experience and a clear head, rather than filled with disappointment and insecurity.
Ideas to incorporate into a final conversation:
Of course, couples living in the realm of stable ambiguity don’t always end in a breakup. Sometimes this state is the training wheels period needed for one or both parties to realize they want something more. This is normal for a brief, beginning phase, but not as the defining mode of a relationship.
Many people stay in self-defeating relationships too long because they are they are afraid that they'll be alone or that they are responsible for the happiness of their partner. They may say they want out—but they end up staying. Other people may actually be successful in leaving the relationship but inevitably repeat the same or similar self-destructive pattern in a new relationship. The adrenaline rush that they experience when they feel passionate toward someone can be addictive. For many people, the reason behind excessive emotional reliance on a partner is co-dependency—a tendency to put other's needs before their own.
Recently, I asked a client this question: "What is it that stops you from getting what you want out of a relationship?" Her answer was: "It's too hard to go through a breakup and to be alone." My response went something like this: "Maybe it's time to examine your fears and the ways you might be self-sabotaging." I often realize that my clients aren't always aware that they may be excessively dependent on their partner to feel good about themselves.
So what can you do if you are paralyzed by fear or unable to risk leaving a relationship that is unhealthy for you? The first thing that you need to do is acknowledge it. Fear doesn't go away by itself—you must stare it in the face—it tends to morph into something else. If you sometimes find that you sabotage your own needs in relationships, there could be many reasons. However, codependency symptoms are common for people who grew up in a dysfunctional home—especially if you took on the role of a caretaker.
According to codependency expert Darlene Lancer, most American families are dysfunctional—so you're in the majority if you grew up in one. She writes, "Researchers also found that codependent symptoms got worse if left untreated. The good news is that they're reversible."
Fear doesn't go away by itself—you must stare it in the face—it tends to morph into something else.
As strange as it may sound, for many of us, conflict in relationships is comfortable because pain is what we know. For those people for whom this is true, the fear of getting hurt emotionally may cause them to flee a healthy relationship or engage in some form of self-protective behavior by staying in an unhealthy one. Dealing with an unavailable, distant, or inappropriate partner is their wheelhouse. A partner who wants nothing more than to be with them and make them a top priority is a foreign concept.
Do you find yourself falling into one or more of these codependent relationship patterns?
Nothing erodes self-esteem quicker than an unhealthy relationship. Many [people] remain in dysfunctional marriages because they are convinced that this is what they deserve.
Many of the people with whom I work describe themselves as independent, loyal and conscientious. These individuals are hardworking, trustworthy, and self-reliant—and pride themselves on these traits. They often feel self-assured and autonomous—confident they can take care of themselves while others can't. The truth is that in spite of these wonderful characteristics, many of these people find themselves being attracted to troubled, distant, or moody partners at some point in their lives.
I sat down for a session with Jessica* one afternoon. An outgoing and lively twenty-something, she has found herself in an on and off again relationship for seven years with a guy she just can't seem to successfully break away from. Over the course of my time working with her, I have learned that Jessica never wants to be responsible for a relationship ending. And when her partner, Jackson*, doesn't treat her well, or devalues her love, she wonders why she wasn't worth fighting for. Jessica dreams of a boyfriend who offers her love, security, and respect. But she says whenever she runs across a man who could potentially give her those things, she isn't attracted to him. All she knows is the cycle of inadequacy and mistrust.
Author Allison Pescosolido writes, "Nothing erodes self-esteem quicker than an unhealthy relationship. Many [people] remain in dysfunctional marriages because they are convinced that this is what they deserve." In some cases, there is no need to end the relationship. In my work and life, I have learned that relationships can heal if people change. But in order to heal from an unhealthy pattern of codependency, it's important to regain control of your thoughts and make your needs a priority.
Steps to reclaiming healthy love in your life:
Take a moment to consider that you might be attached to the feeling that being in love brings pain. If so, you might be self-sabotaging your chances of having a healthy relationship where you can get your needs met. Your fear of being alone or taking a risk, for example, may be preventing you from finding the love and happiness you deserve. Maybe you're blocking out the opportunity to love someone who can meet you half way. Author Karen McMahon writes, "By focusing on your healing and personal growth you will energetically transform your life and begin to attract others (friends, bosses, companions) who are your emotional equals."
*Names have been changed to protect privacy
Recently, I had the opportunity to listen to a talk given by Mark McMinn on the subject of integrating the concept of grace into his counseling sessions and the impact of its message on the clients with whom we work in relationship. Listening to this message by McMinn helped me reconnect with grace in my own life. Here are a few of my reflections.
I have identified as a Christian for nearly all of my life, but I'm not sure if I always truly understood what the concept of grace means. I’m certain that I heard sermons about it, read about it in the Bible, and heard other people talk about their experience of grace, but for the most part, I was ignorant as to how it affected me. It wasn’t until I read The Ragamuffin Gospel by Brennan Manning that the true message of grace sunk in. I learned that no matter what I did, no matter what mistakes I made, no matter how many times I failed, I could rest in the love that God had for me and know that it was enough.
McMinn talked about grace in this way: Grace is a free gift of love, forgiveness, and God’s favor with no strings attached. It is above and beyond all we could ever want or need. There is no hidden agenda or any way we could pay God back for the grace we receive. It isn’t contingent on how we respond. It is unconditional and is given to us before we decide to receive it. It doesn’t make sense. It changes us.
Grace is a free gift of love, forgiveness, and God's favor with no strings attached.
Grace is believing that I am enough.
I often struggle with what I call my "enoughness." "Am I enough" is a common question we face, and we often answer this question one way or the other based on what we see in our lives. But grace shows us that our actions cannot add to or detract from our fundamental worth and value. If I am going to experience grace for myself and extend it to my clients, I must rest in the truth that we each have individual and inherent worth and value, and that because of that, we are enough.
With grace, we can practice acceptance.
If you were to speak with any number of my clients, they would tell you that I often talk to them about the surprising freedom that comes as we take stock of our circumstances and give ourselves grace for how we are handling them. Often we are plagued by the “tyranny of the shoulds,” where we wonder about how we “should” be facing a certain circumstance, or we worry over how our circumstances are not working out as they “should.” However, the energy spent on “shoulding” all over ourselves :) and others simply increases our distress. As a therapist, one of my goals is accept and love you in the middle of your circumstance, offering you grace when you aren’t able to offer it to yourself, with the hope that you will learn the path to offering grace to yourself.
Our values are important.
Just because we are able to accept our circumstance, it doesn't mean that we are waving a white flag in defeat. Accepting our circumstances doesn’t magically fix them. What it does is provide clarity on what actions we can take to move toward our values. In the urgency of the day-to-day, we can lose sight of the things most important to us. If you make a list of all the things you value and compare it to your current schedule, you would likely find inconsistencies. Identifying and reminding yourself of your values and choosing to act in accordance to them even amidst chaotic circumstances allows you to experience peace.
Accepting our circumstances doesn't magically fix them.
Treatment is very different with a grace mindset.
Manning, the author of the Ragamuffin Gospel, suffered from a lifelong pull toward alcoholism. Alcoholism and addictions of any kind are driven by shame: as the addict feels shame in their life, they will choose to medicate or run away from that shame with addictive behaviors. However, addressing shame with grace removes the fuel for the fire of addiction.
Resist shame by befriending the thoughts that are plaguing you. Accept them, normalize them, and allow them to be there while also making decisions based on your values. Imagine a sex addict feeling the urge to view pornography. In the moment when he or she feels that urge, they may experience shame and “should” all over themselves, which will lead to medicating that shame with the most effective tool that is available to them – acting out their addiction. With an approach of grace, however, the person can choose to normalize their urges (“Of course I’m wanting to view pornography, I’m an addict and there’s a chemical imbalance in my brain.”) and then choose to act in a way that is in alignment with their values (“Sobriety is important to me, so I’m going to choose to call my sponsor instead.”)
Grace is humbling.
Grace offers us the opportunity to admit that we really don't have it all together. Over the years, McMinn named that he had adapted his counseling style from one focused more on concrete thoughts and emotions (cognitive behavioral therapy) to a method that involved more mindful awareness and acceptance of the present state of circumstances (acceptance and commitment therapy). He even wrote a book about the first style of therapy that he admitted to his audience was not in alignment with what he currently practices. Grace gives us the humility to adapt and change our response.
We develop empathy as we connect with our personal brokenness. Accepting grace requires us to admit that we are human, that we’ve failed or done wrong or made a mistake. It makes it easier to forgive others when we see how broken we are ourselves. Imagine the difference this could make in marriage if couples extended grace to themselves and to one another. Imagine the effect this forgiveness could have.
Grace gives us the humility to adapt and change our response.
Most of my work as a psychotherapist consists of helping individuals and couples work through very difficult relationship challenges, and nearly everyday, I have a person sitting across from me in tears expressing frustration, hurt and anger. They often say something like: "He said I am sorry, but it’s at least the tenth time! I don’t know what to do. I am told that it’s my Christian duty to forgive, and the Lord knows I’ve tried. But each time I forgive him, he changes for a little while and then returns to the same behavior. I have a gut feeling I am handling things the wrong way. He never really changes, and I just get angrier. What should I do? Sometimes we hesitate to forgive because we think it must automatically include reconciliation, but in reality these are two separate processes, and one does not always lead to the other.
One person can forgive; it takes two to reconcile
The capacity to forgive does not depend on anyone else's behavior or permission. The person who is being forgiven can continue to be cruel, thoughtless, and relentlessly set agains the person who is trying to forgive. But he or she cannot for me to offer or withhold forgiveness.
The reality is, each of us have the power to forgive anything but that doesn’t mean that a person is willing to forgive anything or that the act of forgiveness will be easy. And sometimes a wrong is so heinous that it can take the rest of one's life to forgive completely. But the possibility is there. The capacity to forgive does not depend on anyone else’s behavior or permission. The person who is being forgiven can continue to be cruel, thoughtless, and relentlessly set against the person who is trying to forgive. But he or she cannot force me to offer or withhold forgiveness. From my perspective, forgiveness is a spiritual act, which means that, ultimately, I rely on God’s grace to accomplish it. In fact, my own faults and weaknesses will get in the way of my ability to forgive, especially in some situations. But whatever I’m lacking, God can supply. At times my need for God’s assistance is acute, but when I choose to forgive, my effort does not rely on any other person.
Reconciliation is a multiple-person process. When one person reconciles with another person, both of them must first ask and/or offer forgiveness. But it has to go further than that. Both people have to choose to do whatever it takes to restore the relationship. One person might be completely willing, but if the other person is not willing, reconciliation isn't possible. This means that I can forgive someone for damaging our friendship, but maybe I don’t feel safe enough to resume the friendship. Reconciliation might happen later, but for now I will forgive and leave it at that. Or I might forgive and be ready to reconcile, but the other person no longer desires the relationship. Or the other person can forgive me but not want to reconcile; or the other person forgives me but I don’t want to reconcile. It’s worth recognizing here that some damage occurs in relationships that are out of balance to begin with, such as the friendship in which one person is needy and the other one always comes to the rescue. In these cases, reconciliation—if it should happen at all—will require a complete reconstruction and that only after one or both people have dealt with their individual issues. Reconciliation can be long and painful and messy, but it can also be well worth all the strife if the relationship is truly restored. Sometimes restored relationships are stronger than they were before they fell apart.
Forgiveness is an interior discipline; reconciliation is an outward process
Forgiveness is a private and ongoing discipline of mind, heart, and soul. Actually, forgiveness is one aspect of an overall posture toward others and life itself. If I am judgmental and vindictive in general, forgiveness will be an awkward and difficult change of direction for me. If I hope to forgive specific wrongs others commit against me, then I should be practicing everyday to look at others with openness and compassion, to be slow to place blame and to resist seeking revenge. And I can even practice forgiveness without anyone else knowing what is happening inside me. I may be super hurt at something another person said, and I know that before I confront that person in any way, I need to choose forgiveness. I might silently work on forgiveness—in my prayer, meditation, talks with a counselor —for days or weeks without talking directly to the person whose words hurt me. In some cases, I might go through that private process, realize that the wrong wasn’t as blatant or as intentional as I first thought, and then get over it completely without the other person ever knowing about my struggle.
Forgiveness is a private and ongoing discipline of mind, heart, and soul.
Reconciliation, on the other hand, is not private because it must include at least one other person. When I’m working on reconciliation, of course I do my own interior work, but I must also cooperate with the larger work that involves others’ personal difficulties and needs. I may feel a burning desire to have a discussion immediately and try to restore the relationship, but the other person has a lot going on—dealing with her teenager, pressures at work, or health problems—and she simply cannot enter such a heavy conversation yet. My loved one may want to reconcile now and move back home, but I know that until she has received professional help for her substance abuse or mental-health problems, such a move would be a mistake and likely result not in reconciliation but a bigger mess. Reconciliation is as complicated as the people involved, and it can require more time and patience than forgiveness because of all the moving pieces. Another big factor in reconciliation is the inclusion—or, intrusion—of other friends and family members. Additional people can provide strength, encouragement, and wisdom. They can also provide more opportunities for argument, miscommunication, and flawed strategies.
A few things the LGBTQ and mental health communities want everyone to understand this Pride Month and beyond
During Pride Month, events and parades across the country celebrate how far the LGBTQA+ community has come in fighting for the right to simply be themselves — and love whomever they want to love — freely. But Pride Month is also a time to reflect on the challenges people in the LGBTQA+ community still face, with politicians pushing laws that hinder their right to exist in public spaces or make it legal to discriminate based on sexual orientation or gender identity. On top of this, lack of acceptance and bullying can have dire psychological consequences.
According to The Trevor Project, lesbian, gay and bi adolescents and adults have two to six times higher rates of reported suicide attempts compared to adolescent and adult straight populations. The National Alliance on Mental Illness also states that folks in the LGBTQA+ community are almost three times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. There’s no doubt that discrimination and societal pressures play a part in this.
There’s also the uncomfortable fact that being gay was actually listed as a mental illness in the Diagnostic and Statistical Manual (DSM) until 1973. Now, those who are gay and living with a diagnosed mental illness have a different set of challenges — while someone may be supportive of your sexuality, they might hold hurtful beliefs about people who live with depression. Another person may get what it means to have bipolar but think a person’s asexuality is “all in their head.” Likewise, while some see their mental illness as part of their identity — perhaps similar to their sexuality — others see their illness as something separate from themselves, unlike their sexual orientation. And neither is wrong.
Here are some things that I've heard from LGBTQ people about the intersection between mental illness and sexuality, and what they wish people understood.
1. “Just because I have a mental illness doesn’t mean I’m confused about my sexuality. A person’s sexuality is not caused by mental illness nor is it a mental illness in itself.”
2. “My queerness and my neurodivergence are inseparable, and that’s OK. I’m not a bad example for the cause because of it.”
3. “My mental illness (MI) did not cause me to be bisexual nor did being bisexual cause me to have mental illness. My identification as bisexual stands alone from my illnesses, and I believe firmly I would still have been bisexual had I not developed MI as a result of the traumas in my early life. I want people to understand it not part of a personality disorder or a reaction to trauma. It is in my genetic makeup as much as my eye color and my skin tone.”
4. “My sexuality and mental illness aren’t the same nor are they interchangeable. I will always be apart of the LGBTQ+ community and I will always live with the effects of my mental illness. I just wish you guys wouldn’t tiptoe around me when it comes to such subjects like depression and PTSD because it is so degrading and hurtful, and I get that you don’t wish to trigger me, but instead of avoiding it — talk to me about it and find out about my experience. Find out about my triggers and find out about me too.”
5. “I wish I connect with more people in the LGBTQA+ community, but having social anxiety makes that super hard. I’d love to reach out and meet more like-minded and similar people, but I can only manage to do so much (most of my friendships are long-distance/online). And finding safe spaces nearby to meet people is also a huge struggle as well.”
6. “People outside the community understood that labels don’t define who we are, but stigma damages us more than they realize — as someone who has fought to accept both her mental illness and her asexuality, people telling me ‘it’s just a phase’ or ‘you’ll get over it’ or ‘you just haven’t met the right person yet’ doesn’t help me accept myself one single bit.”
7. “Just because I was abused by a man (step-dad) does not mean that is why I’m a lesbian. My PTSD has nothing to do with my sexuality. I liked women before the trauma. What really bugs me the most is that some people think that an LGBTQA+ person owes an explanation of their sexuality. No one should ever have to explain to anyone their sexuality.”
8. “Wish they would understand how hard the LGBTQ community gets bullied, picked on and verbally abused by others and how it affects them in many different ways… we are just normal people trying to live our life as any other people and just want to be accepted for who we are, not what we are stereotyped as.”
9. “My mental illness does not cause my sexuality. I have PTSD and depression, and I am asexual. The trauma was not the cause, I just so happen to have both of these as part of my life. Period.”
10. “I’m not ‘just confused’ because I’m non-binary. But my sexuality and gender do impact my mental health. Minority stress is real, and it has a real effect on well-being.”
11. “It’s hard to find other LGBTQ people when you have social anxiety disorder and aren’t out to anyone. I’ve found the community has an intimidating reputation, and social anxiety makes it doubly so.”
12. “We deserve to be included.”
13. “Bisexuality is part of my identity. Depression is not.”
14. “I’m not depressed because of my sexual identity, nor am I queer because I’m depressed. I wish society would stop trying to pathologize my attraction to people.”
15. “Being an outcast in both communities is very lonesome and tiring.”
16. “I am not broken in any sense of the word. But I am 100 percent valid.”
17. “I wish people understood that I like girls all the time, not only when my mood is manic.”
18. “I’m pansexual, and I wish other people understood, regardless of my sexual orientation, I am still a person. A person with a debilitating mental illness who needs love and support. If you cannot support me then step aside.”
19. “Being bipolar doesn’t make me bisexual, and I’m fully capable of having a proper romantic relationship (and I’ve been in one for almost three years).”
20. “We are this way, and we are proud of it, so please give us support.”
If you or someone you know needs help, visit this suicide prevention resources page.
If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741. Head here for a list of crisis centers around the world.
Thanks to The Mighty for compiling some of the content for this post.
The month of June is LGBTQ Pride month in honor of the 1969 Stonewall riots, which were the tipping point for the Gay Liberation Movement in the U.S. 45 years later, the LGBTQ community has made huge strides towards equality in America, and has helped reduce stigma and advocate for equality for LGBTQ Americans. However, there are many unfinished battles—including the high rates of mental health issues among LGBTQ youth due to bullying, lack of acceptance within their communities, and difficulty receiving appropriate treatment. While 1 in 4 Americans will face a mental health issue in their lifetime, LGBTQ youth face unique risks to their mental health and well-being. Research suggests that LGBTQ youth are likely to be at higher risk of depression, anxiety, and substance use disorders. According to the National Alliance of Mental Illness (NAMI) “the reason for these disparities is most likely related to the societal stigma and resulting prejudice and discrimination that [LGBTQ] face on a regular basis, from society at large, but also from family members, peers, co-workers, and classmates.” Stigma and discrimination can have serious effects on young people—including missing school for fear of bullying, homelessness, and suicide. In order to prevent such outcomes, mental health providers and advocates for youth must understand and be sensitive to the specific needs of the LGBTQ community.
Addressing the unique needs of LGBTQ youth
In recent years, projects like “It Gets Better” and “Day of Silence” has pushed discussion of suicide awareness and mental health problems among the LGBTQ population to the foreground. Gay, Lesbian, & Straight Education Network (GLSEN) has done a fantastic job putting together the “Safe Space Campaign,” encouraging educators to create a safe space for LGBTQ students and their allies to get together speak their mind about their problems. Dialogue about the unique difficulties LGBTQ persons face on a day-to-day basis has increased, but that does not change the fact that LGBTQ youth still find it difficult to speak to other adults about their problems for fear of being bullied or treated differently. Here are some ways that you can help create safe spaces for these vulnerable youth:
Is it even possible to have a healthy relationship? For most people, relationships aren’t easy. Too often they’re ruled by unconscious patterns and fraught with drama, disappointment, and distress.
Sometimes we move on from one partner only to find yourself embroiled in hauntingly familiar styles of dysfunctional interaction yet again with the next partner. Maybe you even carry the same patterns into everyday interactions with family, friends, and colleagues.
Let’s look at one classic explanation of what goes wrong in relationships and how to counteract it. The “drama triangle” refers to a model of social interaction and conflict developed by Dr. Steven Karpman in 1968. It identifies three roles commonly and often unconsciously played out in relationships: Victim, Rescuer, and Persecutor.
Let’s take a peek at the characteristics of each role, and the suffering that occurs in these stressful interactions. Then we’ll check out the “empowerment dynamic,” the way out of the Drama Triangle.
The drama triangle refers to a model of social interaction and conflict developed by Dr. Steven Karpman in 1968. It identifies three roles commonly and often unconsciously played out in relationships: Victim, Rescuer, and Persecutor.
Characteristics of a Victim
The characteristics of a victim attitude include:
A Victim says things like:
Characteristics of a Rescuer
The characteristics of a rescuer include:
A rescuer says things like:
Characteristics of a Persecutor
The characteristics of a persecutor include:
A persecutor says things like:
Obviously, these three roles need each other. If you function in one of these roles, you’ll try to draw someone into a corresponding role on the Drama Triangle. Or if you’re not in one of these roles, you may find someone else is trying to pull you into one of them.
These three roles need each other. If you function in one of these roles, you'll try to draw someone into a corresponding role on the Drama Triangle.
The Drama Triangle creates pain
Most people operate from one primary or habitual role when they’re involved in a Drama Triangle. They typically embrace this role as their identity in life.
But we also move between roles. For example, a victim can become a persecutor or a rescuer can move into the victim role. You might even move between roles in a single conversation.
When you interact from a position on the Drama Triangle, you reenact and reinforce painful beliefs and patterns that keep you from living a conscious, authentic, and fulfilled life.
So how do you move out of the Drama Triangle? Let’s take a look at the Empowerment Dynamic.
When you interact from a position on the Drama Triangle, you reenact and reinforce painful beliefs and patterns that keep you from living a conscious, authentic, and fulfilled life.
How do you get out of the Drama Triangle?
The Empowerment Dynamic was developed by David Emerald to help people move out of the Drama Triangle. It identifies three empowered roles: Creator, Coach, and Challenger.
Below are some of the actions you can take to move from a dysfunctional role in the Drama Triangle into an empowered one. You’ll have to take these actions again and again to create new modes of healthy interaction.
Victim ---> Creator
To move from victim to creator take these steps:
Rescuer ---> Coach
To move from rescuer to coach, take these steps:
Persecutor ---> Challenger
To move from persecutor to challenger, take these steps:
Another empowered model, the Winner’s Triangle, was developed by Acey Choy in 1990. It recommends alternative ways of being to counteract the roles on the Drama Triangle: vulnerable and outcome oriented instead of victim, caring instead of rescuer, and assertive instead of persecutor.
Are you ready to get out of the Drama Triangle?
Acting out a role in the Drama Triangle only leads to pain, suffering, anger, and resentment for everyone involved. While you might get your needs meet on the short term or feel gratified temporarily, triangle dynamics never bring lasting happiness.
No matter how embedded you are in a particular role, you can learn to act in more empowered ways through self-awareness and making alternative choices.
It’s not necessarily easy because we’ve practice and reinforced these patterns so many times. You need to give it your all. Take time to study the Drama Triangle and the Empowerment Dynamic. Journal about your reactions and and the role you see yourself playing. Make your own program to practice the skills for your corresponding role in the Empowerment Dynamic, one at a time.
Chances are, you’ll return to and play out your former role in the Drama Triangle again and again. But every time you act from an empowered place, you build your capacity to interact in healthier and happier ways. Gradually, your relationships will feel more satisfying, you won’t feel so powerless, and you’ll be able to avoid toxic relationships that would only draw you back into the Drama Triangle.
Your Turn: Which role on the Drama Triangle feels most familiar to you? What emotions come up when you see this? How do you notice when you’re in a self-defeating role and how do you get out of it? I would love to hear from you in the comments.
A while back I wrote a brief post about the benefits of abstaining from the use of your health insurance when seeking mental health treatment. I decided that it'd be a good idea to go into a little more depth on the topic of why you shouldn't use your insurance for counseling and therapy. It never fails that I receive inquiries multiple times a week from folks asking if I take their insurance. The simple answer is "no" I do not and I do my very best to educate them about why in the short window of time that I have them on the phone.
When a potential client is willing to have a short chat about the pros and cons of using insurance for mental health treatment, those individuals tend to recognize the benefits of not using their insurance and proceed with scheduling an appointment with me. However, those who are only looking to use their insurance often decline and let me know that they will call other clinicians to try to use their insurance. These same individuals often call back, though this usually occurs weeks later after they realize that most providers who take insurance are booked out for months. This can be very frustrating for individuals who have finally made the courageous decision to seek professional help as there is usually a notable amount of immediacy to get in for an appointment (because of this, I make it a priority to keep several new client appointment slots open in my weekly schedule).
SOME PATIENTS ARE SURPRISED TO LEARN THAT THEIR INSURANCE DOESN’T COVER THERAPY, OR ONLY COVERS A FEW SESSIONS, OR REQUIRES A HIGH CO-PAY OR DEDUCTIBLE.
Before utilizing your benefits, I encourage you to investigate all options and arrive at an informed decision regarding your health care. You can always decide to use your benefits, but you can’t reverse many of the negative consequences after using them. Considering the frequency that people contact me about this, I want to share some insight as to why you should not use your medical insurance for mental health treatment.
Required diagnosis of a mental illness
The rule is that insurance companies only pay for services that are considered “medically necessary” (more on this below). This means that in order to utilize your medical insurance for mental health treatment, you must be diagnosed with a mental illness or disorder. Additionally, the clinician has to prove that your mental health condition is affecting your health and overall functioning on a daily basis.
The problem is that many of life’s difficulties, and the reasons why people seek mental health treatment, are not mental illness disorders and are not diagnosable. When this is the case, your medical insurance is not going to cover the treatment. Insurance will not cover “I am having a hard time” or “I am grieving a loss.” Many of the patients that I see do not have a diagnosable disorder, so any intentions they had of ever using their medical insurance (in-network or not) to cover treatment becomes irrelevant.
You may be thinking, “so just diagnose me,” but equally important is that any ethical therapist will not simply diagnose you for the sake of using your insurance for treatment. While you may initially disregard the importance of this, this is a very good thing.
(Note: Any therapist who will falsely diagnose you for the sake of using insurance is committing fraud, is unethical, and you should turn around and walk out the door. These are indications that the clinician is not concerned about the integrity of their practice and the quality of care provided, which will become more clear in terms of your interactions and the effectiveness of treatment if you were to continue seeing them.)
Couples therapy is an excellent example of where this often becomes an issue. Some insurance companies claim to provide coverage for couples therapy, however there is much more that goes into this. Insurance is billed using two pieces of information: the type and length of the session (e.g., individual therapy 30/45/60 minutes) and the mental illness diagnosis (the basis of medical necessity). The problem is that there is no procedural code explicitly for couples or marital therapy. In fact, the exact code is listed as “Family Psychotherapy with patient present.” This means the identified patient is the person whose insurance is being billed, has a diagnosed mental illness, and the understanding is that your partner is present as a support to you in treatment.
There is a "V-code," listed as “Counseling for Marital and Partner Problems,” however, this is a code that is typically rejected by insurance companies for not being medically necessary. The equivalent would be trying to get your medical insurance to cover a face-lift or botox for anti-aging. It’s just not going to happen. As far as insurance companies are concerned, couples therapy may be great, but just like a face lift, it is not medically necessary.
So when an insurance company says they cover couples therapy, what they really mean is that, you, the identified patient who has a diagnosed mental illness disorder, is permitted to have your partner present in the room while you receive treatment for a diagnosed mental illness. And the therapy is supposed to be addressing the disorder. The problem again lies in that many couples seeking therapy do not meet criteria for a diagnosable mental illness. To further that, it is insignificant if your partner does in fact meet criteria for mental illness unless they use their own health insurance and are the identified patient.
MOST OF THE TIME, COUPLES THERAPY ENDS UP NOT BEING COVERED BY MEDICAL INSURANCE.
This is the term used by medical insurance to describe procedures or treatments they believe must occur, or if not, the person may suffer insurmountable consequences. A large goal of the insurance company is to contain costs, and one big way of doing this is by only providing coverage for services that fit into their matrix and which they deem “necessary.” Medical necessity is extremely important to insurance companies as they will only pay for services they agree must occur, and they will stop paying as soon as possible.
As described above, the first component of medical necessity is having a diagnosable mental illness. Without a reimbursable diagnosis, insurance companies already view the therapy as unnecessary, and will not provide coverage. This rules out a large portion of insured patients who are looking to work on coping, managing stressors, relationship problems, grieving, or life coaching. Second, the illness must be causing significant functional impairment. Without these factors present, it is likely the insurance company will deny your claim.
Your treatment will become a pre-existing condition on your record
Any documented mental health treatment that is filed through your insurance will go on your permanent medical record. This can have a significant impact on your future ability to secure any health insurance coverage at all; if you are able to obtain insurance with this on your record, your insurance premium, deductible, and co-pays are likely to be much higher. Given the current state of affairs in the United States with regard to health insurance coverage, this concern is applicable to every person who possesses health insurance and is thinking of using their health insurance for mental health treatment.
IS IT WORTH IT TO YOU TO POTENTIALLY LOSE THE ABILITY TO OBTAIN QUALITY AND AFFORDABLE HEALTH INSURANCE, OR ANY INSURANCE AT ALL, BECAUSE YOU WANT TO FILE YOUR THERAPY EXPENSES THROUGH YOUR INSURANCE?
Loss of confidentiality
One of the biggest concerns about using insurance for mental health treatment is the possibility of losing confidentiality. When your insurance is billed, not only do they require a diagnosis, but they gather information about the type of treatment you are receiving and whether you have improved or not (this is important to them because their goal is stop paying as quickly as possible). The insurer can also audit your records at any time they wish, which means they have full access to any details your therapist has, including information the therapist intentionally did not include in the claim submitted to the insurance company. Any and all information, including progress notes, which can include details about what occurred during the therapy session, is technically open to the claims specialist.
The average insurance claim passes through 14 people while it is being processed. These people are able to view information about your treatment including your diagnosis, treatment plans, progress notes, as well as any other information pertinent to them approving your claim. These details should be private, but are open to anyone with access when you use your health insurance. Confidentiality is also often lost when your information is being faxed to anyone in the health care industry who ever requires access to it, which often occurs while claims are being processed.
While you may not care about this, if you a hold a high security clearance for a job, are seeking a military or federal job, a political position, an aviation position or any other job that requires health-care checks (many institutions are now screening out employees who may be unstable or cost too much money in mental health treatment and lost work days) or have other reasons you want your information to remain confidential, this is important to know. Additionally, children often have an even more difficult time when given a diagnosis, as their diagnosis follows them for much longer and can impact school, college, and be a barrier to pursuing certain careers. If your child’s condition warrants a diagnosis, you may want to have some say over how that diagnosis functions in their life – you may want to keep all treatment private.
LOSS OF CONFIDENTIALITY MEANS LOSS OF CONTROL OVER YOUR INFORMATION, WHO GETS IT, AND HOW THEY USE IT.
Long wait times for appointments.
If you are a new patient using a in-network provider through your insurance, it is very likely you will have to wait a significant period of time before getting in for your first session. Clients, as well as my colleagues and other professionals in the mental health industry, have told me they were told anywhere from two to four months before being able to get in for a first appointment. This is totally unacceptable.
If you have ever sought therapy before, or are currently seeking it now, you know what a big decision this can be. Typically, you have already tried to manage the problem in some way on your own – be it an external situation or an internal psychological issue. Maybe you have read some self-help articles, sought advice from friends and family, tried to ride it out and allow “time to heal,” but finally realized you needed something more. To then hear that you must wait another two to four months before you can attend an intake session is both disappointing and potentially harmful.
Though in some particular situations (such as relationship break-ups) it is true that time is one of the biggest components for healing, in many others (particularly with traumatic events) time only leads to more severe symptoms and internal psychological distress. As with anything else, the best results and less difficult path to healing comes when problems are caught and treated early.
THE EARLIER YOU CAN TREAT A PROBLEM, THE BETTER.
You are not seeing a specialist.
When a clinician accepts insurance, they by nature of their contract with the insurance company cannot specialize. The clinician can note the areas where they prefer to practice, and likewise advertise this to insured consumers, but they cannot turn away a potential client simply based on the person not being their ideal client so long as they have an opening and take that individual’s insurance.
For example, I specialize in treating relationship concerns in couples, betrayal trauma, and issues that artists and creative, highly sensitive people face. If I were contracted with insurance companies to provide services, I would be able to advertise that I have a focus on these areas, but that is the extent of my being able to specialize. I would be required to see any and all patients who contacted me, so long as I accepted their insurance and had an opening. I could not turn down patients on the basis of them seeking treatment in an area outside my “specialities.” If that were the case, then by nature I would not be able to specialize as I would be required to see every type of person and problem who walked through my door.
The problem with this is comparable to going to a family practitioner when you really need to see a neurologist. Sure, the family practitioner has medical training and can probably identify from a more general standpoint what may be going on, and they may be able to provide general treatments, but they do not have advanced training or experience in treating your precise problem. This is akin to seeing specialists for mental health treatment. This is also precisely the saying “jack of all trades, but master of none.” Just like you would seek a specialist to get the best care and outcomes for a physical medical concern, it is equally as important to seek a specialist for psychological concerns.
So, you ask, what about scope of practice? This is an ethical concept!, and has nothing to do with the contract signed between the therapist and the insurance company. Insurance companies are not concerned with specialities or scope of practice, and that is because their stance is a licensed mental health professional is qualified to see mental health concerns (which, in fact, they are, but this does not mean the clinician is specialized in a particular area). To the insurance company, if a provider is a licensed mental health professional, they should be able to manage common mental health concerns just as a family medical practitioner should be able to manage common physical health concerns (but, as we know, sometimes you need more than managing; you need a specialist for advanced techniques and treatments and that is the key difference here). As such, insurance companies are focused on the legalities contained within the signed agreement between the clinician and the insurance company, which typically state they cannot turn a client away so long as there is an opening. No one forces a clinician to sign a contract with an insurance company, so when a clinician makes the decision to do so, they (legally) must comply with the requirements of the contract, which again, means they must take clients if there is an opening, which means they cannot truly specialize.
SPECIALISTS HAVE ADVANCED TRAINING AND EXPERIENCE IN WORKING WITH YOUR CONCERNS. IF YOU USE MEDICAL INSURANCE FOR MENTAL HEALTH TREATMENT, CHANCES ARE YOU AREN'T SEEING A SPECIALIST.
You are not seeing someone with lots of experience
This goes against what we tend to think of, as most medical providers are seen through your medical insurance. However, simply put, mental health treatment is very different. In the mental health field, most experienced and seasoned therapists simply do not take insurance. This is because they don’t have to (and don’t want to, but this blog is focused on the consumer side, so we will not go into specific reasons why providers don’t prefer to take insurance). Logically speaking, experienced and seasoned therapists are specialized and have enough of a following and community reputation that they do not need to acquire patients from insurance mills. New patients are referred to these experienced clinicians by other patients, other medical providers, attorneys, etc. This is not to say that all providers who take insurance are unexperienced, but this is often the case.
Loss of control of treatment
When you see an in-network provider through your insurance, neither you nor the clinician get to decide how you spend your time in treatment. Insurance companies require that a treatment plan be submitted in order to approve the number of sessions and ultimately, they use this to determine how your time in therapy is spent. The number of sessions is determined ahead of time by the claims specialist (a non-mental health professional who you have never met and does not know your plight) and is not based on need.
Attempting to extend the number of covered sessions often proves futile, as the insurance company has a matrix for determining what they believe are the number of sessions needed to correct the problem. The huge difficulty with this is that therapy is not at all predictable, so treatment may very well take longer. Further, their version of correcting the problem often means getting you out of crisis or back to a very minimal level of functioning. Truly effective and thorough therapy requires time, and insurance companies NEVER cover this type of treatment.
Rather than giving you the care that best meets your needs (which in therapy sometimes means deviating from the treatment plan and discussing the terrible interaction you had with your boss yesterday), the therapist is responsible to the insurance company for “completing” your treatment within the pre-determined number of sessions. Bottom line, an in-network therapist works for the insurance company, not for you. This is because of the contract with the insurance company that the therapist is required to uphold. Another common issue is that it can take months for your therapist to get reimbursement, if at all. These delays can interrupt treatment until your therapist is paid by the insurance company (or you) for services rendered.
Your medical record
While many patients come to therapy and do not have a diagnosable mental illness, just as many come to therapy because they do have a diagnosable mental health condition (e.g., major depression, generalized anxiety, bipolar disorder, etc.). For these patients, it comes as no surprise that the therapist would notate their diagnosis in the record, primarily to know what they are treating and then provide effective treatments based on the presenting issues. There is a huge difference, however, between filing insurance claims with this information versus not using your insurance.
Simply put, when you don’t use your insurance, this information remains private. When you use your insurance, your mental illness diagnosis, as well as your treatment, becomes part of your permanent medical record. You don’t get to take this information out once treatment is over, or ever.
This can make applying for new health insurance, life insurance, or a new job incredibly difficult as they can require an authorization to release information to view your entire medical record. With the likely changes coming to healthcare as a result of the new administration likely overturning ACA, it is possible that people may once again be denied coverage based on a preexisting condition which includes mental health diagnoses. If you do secure coverage, companies can charge significantly higher premiums because of having ever been treated for a mental illness diagnosis. If you are someone who might ever be unemployed, self-employed, or need to purchase your own benefits, a mental health diagnosis can make the difference between preferred coverage or none at all.
This is often one of the more significant reasons that resonates with patients, and why many who are insured often choose to not use their medical insurance for mental health treatment.
Insurance companies will warn you, “A quote for benefits does not guarantee payment…” This means that despite being told verbally (over the phone) that something is covered and possibly even being given an authorization number, you can still be denied once they review the diagnosis. If you attend therapy sessions under the belief you are using health insurance to cover your visit, and the therapist receives a denial of the claim, you are still responsible for the full payment to your therapist. You can attempt to appeal the claim with your insurance company, but be prepared to go through several levels of appeals, which can take weeks to months – all while your treatment is likely interrupted.
Additionally, you may have a deductible that needs to be met or a particularly high copay. For example, depending on your deductible, you may have to pay $500 or even $5,000 out-of-pocket before your insurance company will begin making payments on claims.
IN ALL OF THESE SCENARIOS YOU ARE STILL PAYING OUT OF POCKET, BUT SINCE THE CLAIM WAS FILED THROUGH YOUR INSURANCE, YOUR PERSONAL HEALTH CARE INFORMATION IS OUT THERE. THIS INCLUDES YOUR DIAGNOSIS, AND POSSIBLY YOUR TREATMENT PLAN AND PROGRESS NOTES.
Unfortunately, medical insurance often becomes a hindrance to obtaining timely and effective mental health treatment. The biggest, and most sincere, suggestion I can offer is to simply pay out-of-pocket. You are putting the power back in your own hands in terms of finding the right therapist, choosing one who specializes in your particular problem area, and one who is likely very experienced. You are also in full control of the length of treatment and how often you attend therapy sessions. And, your record remains private.
Another possible solution is to use pre-tax dollars, such as by using your Health Savings or Flexible Spending Accounts to pay for therapy. These accounts typically come in the form of a credit card with major credit logos.
Also, unbeknownst to many, visits to your psychologist or psychiatrist can be tax deductible when paying out-of-pocket (however, this same rule does not apply to mental health counselor or social worker visits unless you are receiving psychoanalysis). This link to the IRS shows all available tax deductible medical expenses.
You can also work with an out-of-network provider, which is something I often do with my patients. This means you pay the therapist directly but submit a statement to your insurance for direct reimbursement. However, the statement you submit (called a superbill) still must contain a mental illness diagnosis and the type and length of session attended. This option does not resolve issues concerning confidentiality and your medical record, but allows you to maintain more control of your treatment than when using an in-network provider. You will want to call your insurance company ahead of time to confirm they will reimburse you.
Thanks to Tampa Therapy for some content on this post.
We all experience pain in life. Heartache, loss, disappointment. Suffering is a part of the human condition.
When you're in the depths of pain, it can be hard to see how you will ever recover from the experience. The idea that you will one day be grateful for your disappointment and hurt seems unimaginable.
Yet, we always have a choice. Even in our pain we have a choice to make. We get to decide whether we will take the opportunity and grow, or whether we will let it consume us.
The intention of saying that we only need to make a choice is not an attempt to to oversimplify; in fact it may be the hardest thing you will ever do.
But your pain may also be the thing that pushes you towards your greatest personal breakthroughs.
This summer, we are pondering how pain in our journey can lead to growth and strength in our lives. Lean in. Plant down. Grow up., the new exhibition at Emerge Wellness, curated by TJ Walsh discovers how we can explore, learn and change our situations so that we can become stronger through our pain. It is our hurt that can crack us open and let the light in. It is our pain that can help move us towards living a more deeply fulfilling life.
There is a psychological concept known as Post-Traumatic Growth. Most people are familiar with its cousin, post-traumatic stress. Post-traumatic growth isn't discussed as frequently, but it is the concept that explains how many of us take our pain and use it as the energy to grow psychologically.
"Post-traumatic growth is not about returning to the same life as it was previously experienced before a period of traumatic suffering; but rather it is about undergoing significant 'life-changing' psychological shifts in thinking and relating to the world, that contribute to a personal process of change, that is deeply meaningful" (Tedeshi & Calhoun, 2004).
Here are 3 things you can do to help you channel your deep pain into an opportunity for your greatest growth:
Explore Your Feelings (Lean in.)
Get in touch with your emotions, and be willing to feel them. To understand why you hurt, you have to dip deep into where the pain is stemming from. You may choose journaling, therapy or coaching - but you need to find some way to really explore and understand your feelings.It is easy to say you are hurt because of heartbreak, but the question is, what part of the heartbreak is really causing you the pain? Is it that you feel like a failure? That you are grieving for a future that no longer exists? Or that you don't feel worthy of love? Express your emotions and work through them until you can find their root cause. Self-reflection and personal understanding is a prerequisite to deeper psychological growth.
Look for the Lesson (Plant down.)
In order to grow from a painful experience, you need to focus your mind on looking for the lesson. This is one way of choosing to have a growth-mindset.
No matter what the situation, you will be able to uncover a lesson if you look hard enough. If you have been faced with an illness, perhaps it can teach you what you need to prioritize in life. If you are recovering from heartbreak, perhaps it can highlight your need to respect yourself more, so that you are not prone to letting other people disrespect you.
Looking for the lesson is about taking your power back. You can't wallow indefinitely in the pain if you are to step up and grow. Once you've identified the root cause of your hurt, you have the power to look for what you can learn from the situation.
Resolve to Change (Grow up.)
Once you can acknowledge what your current situation might have to teach you, you need to resolve to change. Real positive growth must be followed by action. You have to do things differently. This is where your pain can truly turn into your greatest power.
It may be that you reprioritize how you live your life, so that the things that really matter to you play a bigger part. Or you may resolve to focus on truly deep-down loving yourself before you begin to look for another romantic partner. Your actions will always be so personal to you.
Real growth comes from a willingness to change. You need to do things differently and use your pain as the thing that leads you on your path to growth.
It may be useful to have a therapist help you work through these stages. We can accelerate our growth when we work with skilled professionals who can help guide us.
You can turn your pain into power. If you are willing to lean in, plant down and grow up, you will come through the suffering a brighter and stronger person.