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Running on Empty

“Without the ability to assert ourselves, we will have difficulty living with integrity and self-respect. Sacrificing our rights usually trains others to mistreat us. By standing up for our rights, we should we respect ourselves and thus win the respect of others.”
~Rollo May, Power and Innocence

     Has this ever happened to you? Trying to squeeze one more trip out of those last few drops of fuel is, for some people, a wonderful hobby! They know EXACTLY how far that gauge can move before the car is actually out of gas.

     In a former life, I worked in an autoshop, and saw cars come in with complaints of decreased performance, chugging, or not even starting. Turns out, many cars have their fuel pump located inside the gas tank. This does several things: the gas keeps the pump from overheating, there’s less contamination, and there’s less chance of exposure to air rusting out the fuel pump. This also means that, if you constantly run your tank low, you risk overheating your pump, clogging the filter with sediment from the tank (usually that stuff just sinks to the bottom and doesn’t bother the pump), and shortening the overall lifespan with added stress.

     We’re much more complex than cars, but there are certainly some similarities! Do you have warning lights that let you know when you’re running low? Do you find that trying to squeeze out “one more trip” when physical, emotional, or psychological resources are drained is shortening your lifespan? Does it inhibit your performance?

     Then find ways to refill! Make sure you are taking care of you! Sometimes it only takes a few minutes of rest, relaxation, meditation, or conversation. Whatever it is, don’t put it off until after you do one more thing!

     If you’re struggling to find a way to fill-up, give us a call! One of our therapists can work with you and your family to ensure you see finding ways to fully engage in life!

888.631.EXFT (3938)

Running on E
(c) 2018, Nathan D. Croy
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Embrace The Trauma

“Anxiety is freedom’s possibility…”
~The Concept of Anxiety by Soren Kierkegaard
     I’m horrible at golf. I am my own hazard. It’s bad. However, I really enjoy it! Playing reminds me of spending time with my dad and I’ve found it to be relaxing. When I was beginning, my father would stand behind me and offer helpful critiques on my swing. 
    During a particularly horrendous game, the first four hits had immediately veered right as soon as my club made contact. I was frustrated. It made no sense to me why the ball wasn’t going where I was aiming! So, on the fifth hole, I lined my shot up to go far left of the green. It made sense that, if my shots went to the right, then I’d aim left and they’d go where I wanted!
     Standing behind me, my father piped up and pointed out that I was putting a foursome in some real jeopardy based on how I was lined up. I explained my reasoning of “ball goes right; aim left”. He chuckled and offered some advice, “We don’t change our game to match our mistakes; we fix our mistakes.”
     Many people who have experienced trauma tend to change their life to avoid future trauma. If they have been in an abusive relationship, they may decide all intimacy is potentially hurtful and not worth the risk. If they have been in a car accident, then they may decide leaving home is no longer worth the risk. They begin to change their life to match their trauma, instead of addressing the trauma. 
     This empowers the trauma and minimizes the power in the person. Changing our lives to match the trauma only serves to keep us stuck in the trauma. There is an increase in anxiety when we begin to think of confronting the trauma. This can be uncomfortable, scary, and is absolutely necessary. There are various therapeutic and psychiatric means of addressing trauma to facilitate freeing ourselves from past experiences and to begin embracing the possibilities life has to offer. If you discover you aren’t free to engage in healthy interactions with people because of your past, consider contacting a professional to help you confront those fears and get your life back!
    Don’t change your game to match a bad experience, change the experience!
Golf
(c) Nathan D. Croy, 2018

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An Open Letter to Kansas BSRB

“As long as he denies his own agency, real change is unlikely because his attention will be directed toward changing his environment rather than himself.” 
― Irvin D. Yalom, The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients
Dear Board Members, 
     The Behavioral Sciences Regulatory Board (BSRB) for marriage and family therapists in Kansas has failed to legislate concrete regulations regarding telehealth/telemedicine. At this time, your unofficial stance is to defer to the regulations set forward by HIPAA. While these regulations are helpful guidelines, there are certain factors which impact MFT’s differently than other providers. Telehealth is not only here to stay, research suggests it will only grow larger in the coming years. It is estimated 7 million patients will use telehealth by 2018; this is up from 350k in 2013. Forty-two states have passed legislation regarding the use of telehealth. Twenty-nine states have passed laws requiring health plans to cover telehealth services. Telehealth is NOT going away. The “wait and see” approach is having direct impacts on therapist malpractice risk, income, and patient care.
     The reluctance of the BSRB to pass statutes guiding therapists on appropriate implementation, training, and understanding of telehealth will directly impact our ability to ethically and legally treat patients. Without regulations requiring HIPAA compliant telehealth services, therapists are open to lawsuits and accidental breaches of patient confidentiality. Without these regulations, MFT’s are not restricted to operating within the state(s) where they are licensed, which puts an undue burden on other states and therapists to complete due diligence. Without these regulations, there is no baseline by which all MFT’s can be held accountable, and this puts practitioners at risk for inadvertent malpractice. If there are no regulations regarding additional malpractice coverage to address the practice of telehealth, most providers will be unaware this should be purchased. 
     In 2015, the Board noted that Kansas was “not interested in being part of the “telepsychology compact”.” This was supposed to be discussed in the next meeting, as it was clear nearly 3 years ago that the ubiquity of internet access and technology would make telehealth a meaningful option for more people than ever before. However, no legislation has been created or, as near as I can tell, suggested. This can impact MFT’s ability to bill insurance companies. The Department for Health and Human Services Centers for Medicaid and Medicare Services (CMS) has outlined the requirements to bill for telehealth services. It is feasible that, without consistent definitions of terms, an MFT could bill for what the MFT considers telehealth, while it may not meet the criteria for CMS. There is an additional hindrance to patients covered by KanCare. KanCare has addressed telehealth, but our governing body has failed to do this. 
     The lack of these regulations will directly impact patient care. I have had a patient contact me and request I provide family therapy via telehealth for themselves and a family member living in another state. I declined as I was not licensed in the other state and they did not provide reciprocity. This patient contacted me after finding a therapist who would help and expressed frustration and anger at the incongruence within the profession. Patients entering college may travel out of state but not change residency; where do we stand on providing therapeutic support when there is no reciprocity offered by the other state? What about military personnel living overseas with the ability to participate in family therapy while deployed? 
     While regulations would not ensure complete congruence throughout all MFT practitioners, it will provide those who are compliant a reference source for patients. This is a critical step in maintaining cohesiveness within our profession and our ability to educate patients on our ethical requirements. 
     My suggestion is to create requirements which meet these criteria:
  1. Meet HIPAA guideline
  2. Establish specific criteria for HIPAA compliant software without making specific recommendations
  3. Require a telehealth component to our required ethics training
  4. Suggested malpractice coverage rates
  5. Requirement regarding participation in telehealth/text/phone therapy as it relates to participating in commercial providers (i.e. Talkspace)
  6. Clear regulations for providing telehealth therapy across state lines; particularly in regards to patients in college and the military
  7. Clear regulations on providing telehealth therapy for therapists living outside Kansas; will we offer case specific licensure at a reduced rate?
While there will be many cases not completely covered by your regulations, we must have a starting point. I urge the Board to begin addressing these issues in the next meeting. Please take steps to decrease our professional risk, increase our ethical practice, and protect our patients. We can no longer expect our environment to change. In our profession, we must be congruent and ask of ourselves the same thing we ask of our patients: To embrace our agency and begin changing what we can without externalizing our responsibility.

   Therapists, if you agree it is imperative the BSRB craft and implement regulations regarding MFT’s providing telehealth, please contact the board.

Sincerely,

Nathan D. Croy, MA, LCMFT

HIPAA HELP!
Nathan D. Croy, (C) 2017
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The Fantastical Poison

“If you do not express your own original ideas, if you do not listen to your own being, you will have betrayed yourself.” -Rollo May
 
 
     Fantasy is thinking about what should be. Creativity is thinking about what could be. Neither is inherently destructive or unhealthy. However, fantasy can become poisonous when it usurps reality.
     Many of my clients require encouragement to implement creativity: to experiences their lives as they could be! Creativity is at the core of the miracle question and can be a very healthy skill to develop. Goal setting in this way often requires solitude and meditation. To imagine our life as it could be, and begin to think about what is required to make real what’s possible, is crucial to healthy growth. Being able to identify concrete benchmarks helps families and individuals plot their growth and internalize success.
     Fantasy, however, can be incredibly destructive. When clients begin to envision what should be, to the exclusion of what is, imagination becomes an escape. Instead of seeking brief respite through solitude, clients become emotionally, mentally, and socially isolated while perseverating on a world which does not exist. Rather than focus on what is possible, fantasy poisons what already exists, and reality becomes an affront to an internalized sense of entitlement.
     This process of fantasy fosters resentment toward resources the client or family already have. When services, providers, family, friends, or therapists seek to support the client poisoned by their fantasy, the client reacts as if their very life is under attack. In truth, this is the experience! The fantasy they have worked so hard to construct is threatened to evaporate the moment they agree with anyone. Even if the fantastic client is presented with their fantasy, it rarely, if ever, aligns with what should have been. In these moments, the client feels a tremendous sense of betrayal and abandonment. Their defense mechanisms kick into high gear, and a new, complex, perfect, fantasy is constructed to protect them from the onslaught of reality.
 
Treatment
     The client suffering with fantasy or delusions can be very resistant to treatment. Existentially, treatment will focus on the powerlessness a client feels when faced with reality. The initial steps of therapy require joining with the client and validating their desire to be in control of their world. After all, who does not want to be in control of their life? Therapists must be careful to only validate the sense of frustration rather than the fantasy.
     By identifying the need, rather than the want, treatment encourages a client to use their creative in healthy, positive ways. The Socratic dialogue is particularly beneficial in helping identify the needs a client believes will be met when their fantasy arrives. The miracle question, while beneficial for creative clients, can serve to foster additional avoidance in clients hyperfocused on fantasy and, as such, should be used with caution.
     Once needs are identified, treatment will use dereflection to facilitate identification of meeting needs rather than wants. Once this occurs, it may be useful to address the loss or the fantasy with interventions aimed at mourning. This can help solidify the new direction clients are going in.
     Do not shy away from the fantasy. Clients will cling tenaciously to these ideals if they feel threatened, isolated, or rejected. These fantasies are probably the closest and most loyal companions ever had by your client. Respect the mourning process as new, more healthy options, are gently offered. If the client accepts, they will require a great deal of patience and encouragement as they progress on this new path.
 
Mirror
(c) Nathan D. Croy, 2016