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.

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.

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.
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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 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.
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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.

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.

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 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.

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.
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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.

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.

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:

• Report any bullying you may witness a child being subjected to on the basis of their sexual identity.
• Establish a safe place for LGBTQ youth to discuss their problems and identity openly in a school near you, either by calling your school to confirm that a safe place has already been created, or advocating for one yourself.
• Share this post along with a “Safe Space” graphic on your social networking sites to make it known that you will not condemn a child for coming out to you!

Celebrating a thriving LGBTQ community during the month of June is just one way of ensuring LGBTQ youth feel comfortable being themselves. Ensuring that LGBTQ youth can be proud of their identities helps to prevent the perpetuation of stigma, thereby improving their mental health and well-being.

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 characteristics of a victim attitude include:

• Hopelessness
• Powerfulessness
• A belief he or she is unable to care for themselves
• Feels broke and unfixable
• Feels stuck or persecuted
• Lacks accountability for their circumstances
• Doesn’t question his or her own responses to life 
• Wants to be saved or rescued by someone else
• Wants others to treat them gently or carefully
• Finds it difficult to make decisions

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A Victim says things like:

• “Life is against me”
• “This always happens to me”
• “Nothing can help me”
• “Poor me”
• “It’s not my fault”
• “Yes, but…”
  
  

The characteristics of a rescuer include:

• Wants to solve other peoples’ problems, instead of looking at their own issues and challenges
• Neglects their own needs
• Keeps the victim dependent 
• Overly protective
• Needs to be needed
• Feels guilty or worthless if they are unable to help
• Often burdened, overworked, and may be at the edge of exhaustion
• The martyr, enabler, co-dependent

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A rescuer says things like:

• “Let me help you”
• “I can do it for you”
• “If they just listened to me, they’d feel better”
• “I would love to help”

The characteristics of a persecutor include:

• Blames others
• Frustrated
• Self righteous
• Critical
• Controlling
• Authoritative
• Angry
• Manipulative
• Over-powering

A persecutor says things like: 

• “It’s all you’re fault”
• “You’re wrong, I’m right”
• “I know best”

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.

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.

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.

To move from victim to creator take these steps:

• Take responsibility for your thoughts, feelings, and actions.
  
• Think like a problem solver and use your creative imagination.
  
• Take actions that will achieve your desires outcomes.
  
• Instead of looking for someone to save you, learn to take care of yourself.
  
• Focus on what you want instead of what you don’t want. 
  
• Ask empowering questions like: “What do I want?” and “What steps can I take to get what I want?” 
  
• Look at what’s going right in your life.  You can do this by practicing gratitude each day, reviewing your accomplishments often, and appreciating the goodness in life.
  

To move from rescuer to coach, take these steps:

• Be helpful and supportive by acting like a teacher or a coach instead of a rescuer or a fixer.
  
• Help people learn to solve their own problems instead of solving problems for them.
  
• Encourage self-responsibility rather than dependency.
  
• Set boundaries on the amount of time you’ll listen and provide support.
  
• Ask empowering questions like:  “What would you like to see happen in this situation?” or “What can you do to change this?”
  
• Trust that the other person can solve their own problems.
  

To move from persecutor to challenger, take these steps:

• Challenge people but don’t blame, criticize, or oppress them.
• Be firm but fair in your interactions.
• Ask for what you want, be clear but not punishing.
• Address the consequences of their actions and set boundaries.
• Ask questions like, “What do you think you react so strongly in this situation?” or “What would happen if you challenged the belief you can’t take care of yourself?”

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.

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).

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.

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
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.
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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.

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.
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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.

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.

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.

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.

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.
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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.

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.

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.
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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.

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.
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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.
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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.

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.

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.
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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.

According to the American Psychological Association (APA), millennials experience more stress and are less able to manage it than any other generation. In fact, more than half of millennials report that they have laid awake at night over the past month due to stress.

It's not surprising that millennials are more stressed than older Americans. The APA reports that 12% of millennials have a diagnosed anxiety disorder — almost twice the percentage of their boomer counterparts. Non-clinically, the BDA Morneau Shepell white paper found that 30% of working millennials have general anxiety, while a 2014 American College Health Association (ACHA) realized that 60% of college students live with anxiety.

Not only does anxiety harm our wellbeing, but it affects our productivity. The ACHA assessment found that the top two tolls on students' academic performance were stress and anxiety. Two-thirds of millennials interviewed by BDA report that declining work performance to be related to anxiety.

Sources of millennial anxiety may include a difficult job market and student debt as well as psychological causes, such as ambition addiction, career crisis and choice-overload. Even our day-to-day behaviors can create anxiety. Here are eight common habits that cause stress and compromise our potential.

Bad Sleep Habits
Poor sleep may be the most prevalent contributor to anxiety. A study by UC Berkeley found that lack of sleep "may play a key role in ramping up the brain regions that contribute to excessive worrying." Common causes of poor sleep include going to bed at inconsistent times, not making sleep a priority, and spending time on the phone or laptop right before bed.

Mental health professionals suggest that you form a long, boring nighttime routine that is technology free, and that you keep a journal by your bed to write down thoughts that keep you awake. Exercise during the day is also helpful to tire your body.

Skipping Meals
Eating regularly not only regulates your metabolism and insulin levels but also our mental stability. “Waiting too long to eat or missing out on breakfast may lead to unsteady blood sugar levels, which can cause anxiety-like sensations, including shakiness, dizziness, confusion, and difficulty speaking. Dehydration has a similar effect. Because food and water are biological needs, anxiety naturally follows hunger and thirst.

It's important to eat meals regularly. Try to keep things like granola bars or nuts in your desk drawer. Bring a water bottle to work and sip it throughout the day. Have a glass of water right upon waking and right before you go to bed.

Drinking Coffee
Drinking coffee makes us more alert and, in many cases, helps us perform better on short-term tasks. However, it can also make people jittery, irritable and nervous, especially if they’re already predisposed to anxiety. Sensitivity to caffeine is, in fact, heightened in people with panic disorder and social phobia, and caffeine can provoke panic attacks in some individuals. Caffeine is also diuretic, which can cause dehydration—an anxiety trigger established above. 

Try to wean off coffee by switching to just one cup a day, decaf or black tea. If you feel more calm and in control after a couple weeks without it, commit to quitting it altogether.

Sitting
America’s surge of anxiety symptoms parallels our increasingly sedentary lifestyles. But, until a recent review by BMC Public Health, it wasn't clear whether the two were actually linked. After lengthy process, researchers found that the risk of anxiety risk increases as sedentary behavior increases—and, specifically, sitting time spikes one’s likelihood of experiencing anxiety. 

If you work at a desk all day, you’re not doomed. Get up and walk around every ninety minutes. Offset your sitting time with regular exercise, which halves your risk of anxiety and depression.

Your Phone
A 2014 study by Baylor University found that American students spend an average of nine hours a day on their phone. Of course, technology vastly improves our lives in so many ways. But too much of it makes us anxious. Screen-based entertainment increases central nervous system arousal, which can amplify anxiety. Social media is similarly associated with low moods and depression. 

Next time you’re waiting or have nothing to do, leave your phone in your pocket or purse. Stop utilizing it as a means of alleviating boredom and instead use it consciously as needed for its useful functions.

Always being "on the clock"
According to data from FORBES’ @Work State of Mind Project, millennials become anxious and irritated when work intrudes on their personal lives. But our bad work-life balance is our own choosing. BDA’s assessment explains, “Millennials do not believe that productivity should be measured by the number of hours worked at the office, but by the output of the work performed. They view work as a ‘thing’ and not a ‘place.’” Even after we leave the office, we’re still at work. 

We can still be ambitious, work long hours and impress our bosses without sacrificing psychological health and personal boundaries. Schedule a defined, consistent time at night to stop working. When time’s up, mark that task complete and go take care of yourself.

Netflix and Chill
You may think snuggling up on the couch and watching a movie will help you unwind, but research disproves this trend. In one study, participants felt more depressed and anxious after watching just two hours of TV than those who didn’t. Another study found that those with anxiety and depression spend significantly more time on the computer and watching television. While resting reduces anxiety short-term, research reveals that its effect is short lived, particularly compared with exercise. 

Try to do anything but watch TV when you’re done with work. Go on a walk, grab drinks, knit, work, draw, write, sit in your room and look at the wall, call your mom, actually cook dinner, build something, play a sport.

Hanging Out with Anxious People
Maybe you feel like you’ve found someone you can vent to who understands you, but studies show that ruminating on anxiety often makes it worse. Furthermore, participating in “intergroup anxiety” increases one’s anxious behaviors. 

Try to seek out people who level your mood. After you hang out with someone, check in with yourself and ask if you feel stable and well—or if you're hyped up and on edge. It’s easy to spend less time with certain people once you’ve decided they’re not great for your health.

If the annoyance, pain and performance impairment of day-to-day anxiety isn’t enough to quit these bad habits, maybe this is: According to Harvard Medical School, anxiety is implicated in heart disease, migraines, chronic respiratory disorders and gastrointestinal conditions.

Despite your youth, chronic anxiety is not sustainable. By switching out these daily practices, you can improve your mood and your life one habit at a time.

In my practice, when I meet with someone in their 20s it’s rare that they won't mention “anxiety” as the reason that they're coming in to see me. The topic of "anxiety" is normal, every day conversation for these young people — which is scary, but it's the reality of our current culture. With social media breeding comparison on overdrive, being overloaded with information, and attempting to keep up with the Jones', it’s no wonder we’re all feeling a bit… anxious.

From sleep issues to stresses about jobs, anxiety is an unpleasant thing to deal with, but the good news is that there are absolutely things that can help. Continue reading for the major causes of millennial anxiety and ways around each type.

FOMO
FOMO, meaning "Fear of Missing Out," began as some fun lingo but it is increasingly becoming associated with some serious anxiety that can be anything but fun.

Simply opening your Facebook and Instagram feed can immediately cause feelings of FOMO to rise to the surface. Whether you're wishing that you are on that fancy trip your friends are on or bummed that you missed a party that you weren't invited to, FOMO is real.

How to deal with FOMO:
Try to get to the root of your FOMO. Categorize the times when you feel it the hardest. If it surrounds travel, set goals and start saving for your next trip or book a weekend get away. Do you experience FOMO because you believe that you don't have many friends? Become proactive and sign up for a community sports league or volunteer with an organization whose mission you align with.

It's important to take note of what your FOMO is telling you and make changes around whatever area you're missing out on. It's also a good idea to log off of social media for a bit.

​Not Prioritizing Sleep
Even though more senior generations like to assume that the millennial generation is lazy, it's actually true that the younger set is, on the whole, very hard working. Young adults have lived a life that is 24/7. This often means staying up until 1 a.m. to hit a deadline or texting every person back before being able to put the phone down.

The constant priority for everything that is happening in life takes a toll on sleep. This is not good.

How to prioritize sleep
If you notice that you're not getting seven to nine hours of sleep per night, it's important to make a change. Start to say no to events or working late if it's getting in the way of rest.

Creating a nighttime routine is a great idea to help you wind down. Put your phone on airplane mode, take a warm bath, drink herbal tea and get into bed with an analog book at least nine hours before your alarm goes off.

Being the next Big Boss
Career anxiety may be the biggest source of anxiety for people in their 20s. While pushing to be the next break out star is great, it also leaves you feeling less than if we're not successful at starting our own business or rising to the top immediately. And of course there's the anxiety that presents itself when you don't know what you want to do with your life. Individuals in their 20s were born into a constant rat race that pushes people to be the best or more inventive than the rest. The internal and external pressure to have things figured out right out of college is exhausting.

How to deal
If you're feeling a lull in motivation but like your job, it's probably time that you take a break. Use your vacation (or sick...) days and take a break from the cubical for a few days. Even if all it means is that you get to catch up on your doctor's appointments and chores around the apartment. The time away from the desk will reboot your energy.

If you're anxious about what to pursue, take some time to attend a workshop or conference that you're interested in. Put yourself around inspiring people to gain more information and get things brewing.

Grab a cup of coffee with someone you respect and pick their brain. The act of talking to friends who feel this pressure can also help because you will realize that you're not alone.

Not knowing how to relax
We’re so anxious, the thought of relaxation even stresses us out. But this is really about how we’re relaxing, and that’s usually through binge watching, which research shows actually can have the opposite effect. Watching TV and spending hours scrolling through social feeds might be to blame.

How to relax
Force yourself to truly take a break - even if that means you become a little bored. Think back to the times when you've felt the most relaxed and go back to that place.

Find the practices that truly leave you feeling relaxed and renewed and incorporate them into your weekly routine. Maybe you'll even take the step to turn off your phone for one day a week and block out any new information from clouding your head. It's uncomfortable at the start, but you'll feel your anxiety decrease within a few hours

Hitting Milestones by a Certain Age
Many 20-somethings need to feel like they've reached a certain level of success by a certain age. If that age is reached and our careers or personal life still seems “mediocre,” cue the anxiety.

This is likely due to the fact that while times are changing and people are doing things later in life, millenials were brought up by a generation much different. The parents of 20-somethings got married young and they didn’t go back to school, and that’s likely weighing in on where you're *supposed* to be — or where you thought you'd be by age 30 as a kid.

How to deal
Instead of setting up your life to reach specific milestones by certain ages, let life take the course it was meant to take on its own. That idea is way easier said than done, but be careful to settle for a job or a partner all because you're turning 30 next year and you have to have those things before then. Set goals for things you can control, but really try not to attach an age to the goal. Do what feels right for you—no matter what your friends or parents have done.

Most importantly, take care of yourself! No matter the type of anxiety, there's usually one thing in common: we all need to step away from our phones and tune into ourselves instead. Move slower, create real human communication, take breaks, journal, meditate, go to therapy. Do what you need to do to feel good personally.

For a while now, science has shown that anxious people tend to to be more intelligent. Now we are finding that there is a link between anxiety and being more creative. In my work with artists, I find that many of them feel anxiety even if the symptoms vary from one person to another. It's not uncommon to learn that creative people, like artists, musicians, dancers, and writers live with mental health challenges like anxiety.

Painter Vincent van Gogh suffered throughout his life, as he explained in a letter to his brother: “I am unable to describe exactly what is the matter with me. Now and then there are horrible fits of anxiety, apparently without cause, or otherwise a feeling of emptiness and fatigue in the head … at times I have attacks of melancholy and of atrocious remorse.”

Artist Edvard Munch, painter of the famous painting "The Scream" suffered from anxiety and hallucinations throughout his life. In fact, that painting came to him as a vision while he was trembling with anxiety. He wrote in his diary: “My fear of life is necessary to me, as is my illness. They are indistinguishable from me, and their destruction would destroy my art.”

Grateful Dead’s Jerry Garcia said that music is “something that escapes between frenzies, between anxiety attacks.” It's known that some artist capitalize on their neurotic view of the world to fuel their creative ambitions. I imagine you know some people in your own life who fit the description of an anxious artist. Or maybe you're channeling your own anxiety into artwork.

Throughout history, social scientists have supposed that there may be a link between anxiety and creativity. For a long time this hypothesis was based upon anecdotal evidence alone, but today there is a growing body of research that suggests there actually is a link between creativity and mental illness.

What the science tells us

One of the first key studies, which found that creative people had an unusually high number of mood disorders, reviewed individuals in creative fields such as literature and the arts. Researchers in Sweden’s Karolinska Institute followed more than one million Swedes and their relatives using a registry of psychiatric patients. The patients demonstrated conditions such as anxiety, depression, or schizophrenia. The study revealed that people working in creative fields, including dancers, photographers and authors, were eight percent more likely to live with bipolar disorder. Writers alone were 121 percent more likely to suffer from the condition. Researchers also found that people in creative positions were more likely to have relatives with schizophrenia or bipolar disorder, which shows that there may be a genetic trigger for both creativity and mental illness.

In 1987, Dr. Nancy Andreason from the University of Iowa found that a sample of creative writers had significantly higher levels of bipolar disorder than a control group. Andreason also noted that a writers' first-degree relatives, meaning their parents, siblings, or child, were more likely to suffer from mental illness. In 1994 a study looked at 60 female writers' mental health. The results of that study revealed that writers had a significantly higher rate of depression, mania, panic attacks, or generalized anxiety as compared to the study's control group. A 2004 survey by psychologist Erika Lauronen found that of 13 published studies, all but one supported a connection between mental illness and creativity.

More recently, in 2015, a study that was published in the journal of Natural Neuroscience found that genetic factors that raise the risk of bipolar disorder and schizophrenia are found more often amongst people who are in creative professions. Creative people were, on average, 25 percent more likely to carry the gene than less creative professionals like farmers, manual laborers, and salespeople. The scientists point out that to be creative, people need to think differently, and this may be genetic.

Imagination

Imagination is the main reason for the connection between anxiety and creativity is imagination. The difference lies in the fact that the same brain that conjures up inventive artwork can also get stuck in repetitive thoughts and unpleasant worries. These individuals use their imagination to visualize something before it happens, whether it's their artwork or an issue (real or otherwise) that scares them and causes them concern and panic. People with both traits tend to overthink and over-analyze nearly everything, this can increase anxiety. However, dwelling on one's fears may be the root of creativity and problem solving. A double-edged sword, right?

There are still some people who question the direct link between anxiety and creativity. The research does tend to be limited because it is difficult to define what "creativity" is and replicate it for study. People will argue that while a correlation may exist between these two traits, one does not necessarily cause the other. For sure, there are plenty of people who are creative who don't battle anxiety or other mental health issues.

What does this mean for you, a creative person?

So, what should you do if you're an anxious creative type? Of course it's always a good idea to get professional help from a therapist who can work with you to evaluate what is actually going on and formulate a plan of action...and then walk with you through that plan. Once we learn what is actually going on, we can begin to gain tools and start using the imagination in a helpful way to minimize anxiety. It turns out that some artists are able to channel their anxiety in the right places to their benefit. Creativity comes from expression, and some of the most powerful forms of expression result from our struggle.

​Here are some ways to transform anxiety into creativity.

1. Identify what you are feeling.
Name the feelings: You’re scared. You’re anxious. You have creative anxiety. Ask yourself what is behind the feelings: You’re afraid of failing. You’re afraid of succeeding. You’re afraid of producing terrible work. Then, make a list of all the things that might be standing in your way, creating the feelings. When you name your feelings and what is holding you back, they become easier to face. Getting them outside of your head and onto paper makes them tangible. When they are outside of you it is possible to see how you might deal with them and how they are not as big as the internal feeling makes them out to be.

2. Consider why you're doing this (creating) in the first place.
My guess is that you didn't start creating things because you felt that you should. People do lots of things because they feel like they should, but they don't become writers, painters, sculptors, and dancers because they should. That doesn't happen because there is a lot of risk involved in creating. There's not much security in being an artist, so no wonder why it scares you. No wonder you experience anxiety. You're going to make something no one's ever made before. A brand new thing. That's inherently risky. And what's more, it's something that goes straight to the core of who you are. Creating art reveals your deepest self and it's going to be reaching out to the deepest self of others. That's also risky. But isn't that why you do it? The things that scare you are precisely the things that compel you to make art in the first place. They scare you because you need them, they are a big deal, and there's no certainty that you will be successful. But that is what makes the whole process valuable. You don't have to make art. You're not doing it because you should. You're doing it because you want to. Keep that in mind the next time you are afraid to get to work. You started this because you want to.

3. Lower your expectations of yourself.
Stop being so hard on yourself. Creators want so much to make something good, useful, and beautiful. Artists have grand visions and they want to make those visions come to life. They strive for it to come to fruition and wonder why what they produce never matches up to the dream in their head. There is often a disconnect between what you want to be able to do and what you can do. You have to become okay with your limits. It's also important to become comfortable with failure. We learn through failure, so it's okay to produce crap sometimes. The only thing that matters is the making.

4. Remember what it felt like to make art as a kid.
Remember when you drew monsters with crayons as a little kid? Wasn't that great? Wasn't it the best feeling in the world? Hold on to that feeling. Call upon it every time you sit down to work. Be a kid artist.

5. Calm yourself before beginning.
If you don't already have a daily mindfulness practice, I suggest developing one. Yoga, breathing exercises, and body scans can be helpful to help you remain grounded and focused as you begin your work.