The Recession and Mental Health Care

The recession has kept people who need care out of therapy.

That was the consensus of a small group of private practice therapists I met with Monday. We are a interesting and somewhat diverse group of folks: three licensed psychologists, three LMFTs and a social worker. Each of us has an individual private practice in the southwest Twin Cities, and we meet every month or so in each others’ offices for support, case consultation and resource sharing.

As our meeting was coming to a close, one of us looked around and said, “I think people are coming to therapy less often, and when they do come, they are worse.” All of us agreed. We are seeing that in our new clients: more severe symptoms of anxiety and depression; people who need medication taking themselves off and showing up in therapy; couples who might have been helped out of their patterns two years ago, making appointments like a “Hail Mary” touchdown attempt and often not even showing up to their first session.

Stereotypes of psychotherapy, widespread in the American culture, already do enough to keep people away from getting the care they need. The same kind of fear of the unknown (people avoiding their annual mammograms or other preventative exams) keeps them from seeing therapists. People fear that therapy is all about dredging up past pain, and they would rather avoid it. Or they believe that they should be able to “get over it,” whatever it is, themselves. To be fair, therapy isn’t all about the past, but it takes long looks back in order to understand the present, so the stereotype is partially accurate. What isn’t true is that it’s a waste of time, or it never works, or that its a huge money drain.

That last part, about the money, is what we’ve noticed about this recession as providers. People have lost their jobs, or are afraid they will. That anxiety alone makes us more conservative, and hunker down, and save money, and stop doing anything new. The added anxiety about what may happen to health care and insurance in the current political debate stops even more people from reaching out.

One thing I know for certain, though: nothing matters if you feel like you are losing your mind. The mind you count on to talk to others, to do your job, to care for your children, to connect with your family and friends. Actually, good overall health is dependent on mental health. If you are so afraid you can’t leave your house, or so despondent you can’t get your kids off to school in the morning, it matters little if you have low cholesterol.

Psychotherapists live with the fact that we are the lowest paid professionals in our health care system. We struggle to overcome the giant obstacles to care placed in our way by costs and stereotypes, by stigma and shame. What we wish for is for people to seek help before they are desperate, before they decide to leave their spouses, before they think often about suicide, before they start to think that they can’t get any better. Life can be so much easier with good, quality care and a compassionate professional guiding you along.

If you need help, please reach out. And if you know someone who does, ask them to help themselves. Today.

This is What I Do it For

After three years of private practice, I’m beginning to anticipate its natural rhythms.

There are some months that I have a steady schedule, and the phone rings with some regularity with requests for information and appointments. These months tend to follow the school calendar and extend into early summer. And then there are weeks that the phone stops ringing, current clients miss appointments and don’t return my phone calls, and the calendar starts to have big holes in it. These weeks coincide with major religious and national holidays, and the last weeks before Labor Day.

I now understand why therapists have traditionally taken the whole month of August off. Remember Bill Murray and Richard Dreyfuss in the 1991 comedy, “What About Bob?” (The busy New York City doctor rents a home in New Hampshire for the whole month of August only to be followed there by his newest, most eager patient, Bob.)

So while I have some unwelcome time on my hands, I have been reading. And I have been seeing some of my long term clients. And this is what I have seen: healing. While I can’t give you details, I hope it is enough to tell you that just today, I saw a client who had a difficult mental disorder that was controlling her life a year and a half ago. She told me today that she is really feeling “her normal self,” the self she remembers before the disorder took over. I smiled through her session.

The same thing happened last week, as a couple client told me that they had “completely changed” the way they moved in their relationship. Wow. We talked about what they were doing differently, and what they had learned. I remembered what it was like for them when we began. And I smiled, and congratulated them on their hard work.

That kind of healing of emotions, mind, spirit and behavior is what I have experienced in therapy as a client, and what I strive for with each new client who comes to me for help. It doesn’t always work, for a wide number of reasons. But when it does, I have to tell you: it’s joyful for me. This is what I do it for.

Returning

It’s been awhile since I was up north, to Duluth and beyond. I’m going to visit today.

I worked in northern Wisconsin for 12 years as a pastor of three different parishes. I loved many of the people I served, but none more than the friend I am going to see. We have held ourselves together through teenagers (hers), a wedding (mine), work system nightmares (both), cancer, deaths and funerals, births (my children, her grandchildren) chronic health problems, educational endeavors (both of us), aging and the general pressures of time and distance. We love looking at the world together, and from quite different points of view. We are blessed to have found each other and to have remained friends for over two decades. 

Who in your life is the same kind of gift of God, a similar lens through which you see yourself and the world more gracefully, more lightly than you do alone?

Give thanks to God for them. Cherish your relationship enough to go out of your way to stay connected. Oulu is out of the way. But I’ll be there, returning, remembering. More whole, more myself. Trusting the same for her.

Fear and What’s Possible

Today is 9/11. The bells toll, and the wars continue.

In an email from our school district, we have been informed that the H1N1 virus is up and running. Several children have tested positive, and we are all encouraged to be alert and aware. NPR reported this morning that a single vaccination (instead of two) may be all that is needed to immunize adults, allowing more vaccinations to go to more people this fall.

In listening to the media coverage of this story, I’ve learned that in an average year, fully 36,000 people die from the seasonal flu virus. That’s an average of 720 people per state. Do you know any of them? The predictions for this winter imagine up to 90,000 deaths from H1N1. That would be an average of 1800 deaths per state. The primary difference being many of those deaths are predicted to be our healthy, robust children.

I want to be ready. I will get my family immunized. But in the meanwhile, in the midst of the preparations, I have been wondering: what’s the difference between fear and vigilance?

We are washing our hands. We are covering our sneezes. We have a strategy for taking time from work. But I worry that all our worry makes us feel less strong, and more vulnerable. Less confident, and more anxious. Some preparation is the soul of wisdom. Thinking ahead is what keeps us resilient.

But too much hand wringing about what we cannot ultimately control just hurts the hands and stalls the mind. It puts our life on hold, waiting for the worst. A worst that may not come, and if it comes, is still never far from the grace of God.