I get this question a lot, and the answer is one of those yes/no situations. First, the yes part: I am a preferred provider with Uniform Medical Plan, and I also can be reimbursed up to 80% by Group Health Options. (But it has to be Options!) In both cases, the client is responsible for the part of the fee not covered by insurance. I also am a provider in the Wellspring Family Services network, so if your employer offers that EAP as part of your benefit package, you can have a few sessions with me that are completely paid by Wellspring. (After they’re done, you would then have the opportunity to continue seeing me out of pocket.)

If you are covered by another insurer, there may still be a chance that your sessions with me are partially covered. It depends on your specific plan. I’ve worked with a few clients who paid me out of pocket, then filed claims with their insurer and received partial reimbursement. If this is possible in your case, then you would need to do it this way: 1) pay me the fee; 2) then file your claim. I’ve found that if I file the claim as an out-of-network provider, reimbursement doesn’t happen.

The “no” part: couples counseling is not covered by any insurer I know of, with the sole exception of Wellspring. This means that even if you have insurance with Uniform, I can’t bill them for couples sessions. If you’re an individual client of mine and we decide to invite your partner in for a session or two, then I would only be able to bill that to insurance if the work we’re doing still focuses on your individual issue. If it’s a true couple problem, then for those few sessions I would ask you to pay out of pocket. To not do so would be, alas, insurance fraud. (I personally think they should cover couples counseling, since I believe it’s helpful and I also think that a person’s relationship has a lot to do with their emotional health and life functioning. But…I don’t make the insurance rules.)

Finally, a recommendation: consider not using your insurance and paying out of pocket. There are several advantages to this:
1) All of your information will be kept confidential. No third-party onlookers will know that you’ve even seen a counselor.
2) I won’t have to diagnose you with a mental disorder. We’ll be able to let your chart reflect who you are, pure and simple. (And even if you have one of the ‘mental disorders,’ like ADD or anxiety, it won’t be a matter of record.) Plus, we’ll have absolute freedom to structure your sessions exactly how we want.
3) In my many years of experience with clients—and as a client myself—I’ve learned that out-of-pocket clients are more invested in their work, tend to get better results, and enjoy the satisfaction of putting their hard-earned money to good use.

It’s up to you. But if those three points sound convincing to you, think about paying out of pocket. And it helps to put it in perspective: therapy is expensive, yes. But how much do you spend per month on your cell phone? Or your cable? Maybe therapy would be money very well spent!

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Like all of their workshops, this Gottman workshop is stuffed with great ideas, sound research, and keen insights. One of my favorites is their work on the concept of “turning toward,” that is, turning toward your partner as a way of being, a stance, a habit. For example, you see that your partner is upset, and rather than “giving her space” (which often enough is a way to avoid her, dressed up as being respectful of her), you lean in and simply say, “You look upset, babe. What’s the matter?” If you’re cultivating the habit of “turning toward,” you’ll begin to recognize thousands of opportunities to do this in your daily life with your partner. If you miss too many of them—or simply don’t recognize them—your relationship begins to erode.

For more on this from my own perspective, see what I said recently about curiosity.

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Today I’m attending a workshop of John and Julie Gottman that’s all about trust and betrayal in relationships. I’ll let you know what they’re working on these days, and new insights they’ve found. For now, I’ll share a quotation from John Gottman that I love: “Altruism is a highly adaptive norm across all mammalian species.” LOL. Watch this space for more!

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One of my goals in the next year (or two) is to write an abecedary. An abecedary can take many forms, but for my purposes it would be a small book with 26 chapters. Each chapter would be an essay on concepts I use with clients in therapy, one for each letter of the alphabet. A is for attitude, perhaps: how does your attitude determine your mood, the quality of your relationship, etc.? L is for listening (I’m in favor of listening, and it’s more than you might think it is). You get the idea.

I don’t have all the chapters worked out, but I’m pretty sure I’ll have a good time with chapter three. C is for courage. I’ve written about this before. It takes courage to pursue the relationship you really want, to take your career in a new direction, to confront yourself—and then your partner—about a problem, or about your deepest wish. It certainly takes courage to draw close emotionally to someone who really matters to you, and who (by virtue of being human) is capable of harming or grieving you.

But I also want C to stand for curiosity. Curiosity may have killed the cat, but the lack of curiosity has killed many relationships. If you have the foresight—and the humility—to try to look at the world through your partner’s eyes, you might be less upset by what’s going on with your partner, and feel more free to take action. I like to say that when a couple is shouting at the top of their lungs, they are expressing zero curiosity about the other. No wonder they’re at each other’s throats. I’ve noticed that in any of the hundreds of friendships, working relationships, and other relationships I’ve had over the years, my own curiosity has opened up a lot of opportunities for growth and intimacy.

And yet, I also want C to stand for creativity! I want to talk about the importance of play in relationships, and playfulness in your thinking and behaving throughout your life. Can you recognize your own absurdity and laugh at yourself? If not, I don’t like your chances for happiness. And the happiest couples I’ve worked with have been the ones who allow for delightful creativity, spontaneity, and playfulness in their relationship…even if there’s also been a lot of hurt feelings and hard times.

Lots of people assume that in Therapyland, C stands for communication. Maybe. But I think the three words above are more of a challenge for most people than communication skills. In any case, chapter three is going to be a snap!

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Lately I’ve been acquainting myself with an uncomfortable feeling: I’ve been going to workout classes at my health club and feeling incompetent.

Pathetic, even! The kickboxing class was challenging, invigorating…and mystifying. I’m a good verbal learner—I know how to read, write, and think my way through a problem—but I’m not a good visual learner. I can’t watch you do the kickboxing routine perfectly and quickly imitate your moves. Step aerobics: same thing. I kept at it—I stayed till the bitter end, dammit!—but I had to stay close to one particular move that I could do, and just keep doing it while the instructor taught to the top of the class. Spin class is much easier on the self-esteem, if not the body: I can’t humiliate myself too much when riding a stationary bike. Coming up: aquafit, so I’ll have a chance to look the fool and be half naked all at the same time!

Why am I doing this? Of course I want to get in shape, and there’s no better time for that than these long summer days, especially since I finished up a ton of work projects last month and have a lot more time. I always feel better when I’m at fighting weight, which is a very personal measurement, as I’m sure you know. We all tend to like a certain weight, a certain feeling, a certain look. I’m not far away from it, but I have to work at it.

But I’m also doing it because I think it’s healthy to do things one isn’t good at. As a therapist, I have to be highly competent in my job: I’m working with human beings in vulnerable, complicated situations in their lives. I have to be tip top! But step class? That’s a perfect opportunity to get used to the feeling of incompetence. I say this not because it’s fun or virtuous to feel silly or make a fool of yourself, but because it teaches you that you will spend your life getting better at things, so it’s good to cultivate a healthy humility about it. I’m always learning, and there’s a time in the trajectory of learning when the learner feels incompetent.

Which brings me to the work I do with clients. I often wonder (sometimes aloud, sometimes not…depends!) whether certain clients are highly uncomfortable with feeling incompetent. None of us likes the feeling, but some of us are deeply uncomfortable with it. So when they discover their incompetence at, say, relationship skills, they get resistant, distant, frustrated, even furious. Their partner has to drag them to counseling, and they sit there, arms folded, fending off the feeling that they’re just not that good at all this relationshippy-talky stuff. So I invite them to, well, look at it the way you’d look at a step aerobics class. (Unless you happen to be excellent at that!) Embrace your incompetence. Realize you’ve got a lot to learn, and everyone has been in this position. Take a deep breath, and start asking questions—of me, of your partner, and (most importantly) of yourself. What do you want to know? What do you want to learn? It’ll be hard to find out until you accept the fact that you’re not too good at this. (Yet!)

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Are you thinking about getting some counseling? Good idea! And if so, I suggest you stop wondering whether you need it, and definitely stop asking the question, “Are things bad enough that I need to go to counseling?”

I work alongside a couple of massage therapists in my little office complex, and sometimes I envy them. I envy how their field is understood by most people: anyone can say, “Oh, I had a massage today, and then I got a haircut, and the sun’s out, so…a great day!” But rarely will you hear someone say, “I set up a counseling appointment to work on my emotional-regulation problems, and to finally face the fact that I’m not being very mature in my relationship.” No, most people won’t say that, even though it would be a remarkably mature thing to say!

So that’s why most people look at counseling as a last-ditch effort to pull their little airplane out of its fiery plunge, or see it as something you do if—unless you get some counseling—your life or relationship is about to collapse.

I started seeing a therapist myself in May 2006, which is one of the reasons why I had enough confidence to leave a great job here and start my own private practice. I knew that I needed someone to help me get a better handle on myself, my goals, and some of the ordinary neurotic software that was still running in my very normal human mind. I wasn’t about to lose my partner, or my job. I wasn’t becoming self-destructive, and certainly wasn’t within a thousand miles of feeling suicidal. But I knew I needed a hand. I still see her, and these days we work on who I am, what kind of relationship I want to keep cultivating with my partner, how my beliefs and attitudes affect how I run my business, and so on. There’s always something to explore.

And often enough I feel like I’ve just had a massage when I leave her office. Take it from me: you aren’t “psycho” if you’re seeking counseling. If you’re taking this step, you’re probably one of the most mature and courageous people you know.

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I risk hypocrisy by posting this, but I want to talk about the importance of rest and relaxation. I’ll admit up front that I’m a son of hardworking Midwestern parents, and I’ve taken their life lessons to heart. This means that I don’t really start relaxing on a vacation until perhaps the third or fourth day, and even then it’s hard to really let go of all the different concerns and issues that preoccupy me in my profession. But I keep working on this, and one way I do it is by meditating on the activities (or lack thereof) of other mammals.

Think about it: You don’t have to be a dog or cat companion to know that once the other (non-human) mammals on this planet have fed themselves, relieved their sexual needs, provided reasonable security, and found shelter, they just … lie around. If I surprise my dogs by coming home in the middle of the day, I find them snoozing. What is it about humans that we can’t just let it go on a regular basis?

I suggest that we post pictures around us that remind us of the restful wisdom of other mammals. This is one of the reasons I like to take pictures of my dogs at rest. It reminds me to get over myself and plan for weekly times of R&R. Ideally, we would all unplug at least one full day per week. If you’re feeling stressed and exhausted, stop for a moment and recognize that the non-human mammals around you, well, they think it’s odd that you’re not napping!

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First, sorry for the long blog silence: I was a trainer at a week-long conference, then on vacation. At the conference—which was about organizational development—we talked a lot about three possible reasons why change doesn’t happen in organizations: dissatisfaction isn’t high enough, the people don’t have a strong enough vision, or there isn’t enough awareness of the first steps they need to make for change to happen.

Naturally, I thought about this in my work with clients (and, as it happens, in my own personal goal-setting). Here’s how you can apply it to yourself and your relationship:

1. Is change not happening because you’re not dissatisfied enough? As much as you might be upset about the state of your relationship, your health, or your career, you might also feel comfortable with the overall state of things, and therefore unwilling to change. An obvious example of this is the frustration people suffer around weight loss: it’s hard to not eat the French fries because as much as you want to look and feel better, you’re not so dissatisfied with how you look and feel that you’re willing to push the plate away from you.

2. Do you lack a strong vision of the future you want? I got some good advice when I started my private practice a few years ago: I was told to envision my ideal client, the person (or persons) with whom I most want to work. I’m not everyone’s therapist, and not everyone is my client, so to design my business successfully, I had to clarify my vision.

3. Are you having trouble identifying first steps for change? Maybe you’re frustrated in your career, but you’re stuck because you’ve never been in this particular situation before, and you can’t figure out what to do today and tomorrow to change it. You feel the dull drag of your daily tasks, or the pressure of a difficult boss, and you sit at your desk, thinking, “Now what?”

If any of these three situations is a problem for you, then it’s going to be hard to overcome your natural (and even healthy) resistance to change. In counseling, I’ve worked with clients on all three problems, depending on the situation. (Often enough, the typical person—myself included—is working on at least two of them.) Which one is bogging you down?

And if you want some background on the organizational-development theory behind all this, here it is!

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This week I’m working as one of the trainers in an organizational-development training program for leaders of not-for-profit organizations. When the trainers got together last weekend, we went around the room and said what we do in our “day jobs.” I said that I’m a therapist who works with couples and individuals, and mentioned that I also work with teenagers and their parents on various problems, most notably substance abuse. I added that I found this work highly enjoyable.

Today one of the trainers asked me, “Why is it fun for you to work with teenagers, particularly teenagers who are smoking pot or abusing other drugs?” Aside from the possibility that I’m just weird that way, here’s my answer:

Teens and their parents are a great example of culture clash and its impact on relationships. If the parents (or sole parent) finds herself in a power struggle with her pot-smoking teenage son, I help them work on their relationship first, whether or not the teenager ends up giving up marijuana. If you’re a parent of a young adult, you know full well that there is precious little control you have over many decisions and choices your son or daughter makes. This is particularly true when we’re talking about marijuana, alcohol, and other drugs.

But you do have control (some control, that is) over your relationship with your children. If your teenager is smoking pot, failing classes, breaking curfew (what curfew?!), and generally driving you crazy, you can experiment with the following changes to your approach:

1. Take care of yourself, move at a walking pace, and try not to overreact to your child’s behavior.
2. Notice the behaviors and comments your child is offering–behaviors and comments you like–and respond to them gracefully. Don’t overdo it: teenagers tend to distrust and dislike compliments, even though they need plenty of validation from others; you’ll have to figure out how to support them “under the radar” so that they receive the praise without necessarily knowing they received it.
3. Be a visible part of the good experiences your child is having. Tie all rewards (allowance, privileges, etc.) to specific behaviors your son or daughter has done, and tell them about it. For example, you could say, “I’m giving you this part of your allowance because you came home by 11:00 last night,” or “I’m letting you go camping with your friends because you asked me so respectfully.” Make ordinary, ho-hum statements like this (avoid excessive enthusiasm!) and be consistent. Soon your child will understand that it pays to do what you want!
4. Get in touch with your “philosophy of parenting,” that is, your whole reason for being a parent in the first place. Take time to reflect on your motivations for playing this role, and how you can live out your motivations in your relationship with your child.

This isn’t an exhaustive list, but it’s a good sample of the things I work on when parents and teenage men and women come in for counseling. We don’t always solve every problem, but improved relationships are incredibly powerful.

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If you’ve ever had counseling, you most likely experienced negative or critical thoughts and feelings about your therapist. I’ve worked with fantastic therapists myself, and even they will strike a wrong note, or just say the wrong thing, in our work together. What to do?

Simple: tell the therapist. If you think I’m taking us into a topic or issue that’s not interesting, not helpful, or just plain irritating, let me know. Hard as I try, I’m not perfect and might take us down a path that just isn’t right. Not only is it okay for you to let me know, it’s actually a fundamental dimension of good therapy. It could even be a breakthrough moment for you: by confronting me with your concern about our work together, you gain experience connecting with another person on a difficult and painful topic. It’s a chance to practice courageous and healthy honesty. It’s good for both of us!

Often enough I can sense that we’re off track, and I’ll beat you to the punch. “Are you mad?” I asked a client a few weeks ago. “Yeah,” she said. “Are you mad at me?” “Yes,” she replied. And the conversation that followed was probably one of the most helpful experiences she had in our work together.

So…let me have it!

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