The Longwood Counseling Center
The Longwood Counseling Center
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We have structured this blog by building each post off concepts introduced in the previous posts. This means that jumping ahead may be great for specific information, but you may miss out on some parts of the concept. Feel free to read it however you want! (The memes are for fun)
The Power of Private-Pay - 01/22/25
TLDR: Health insurance can be useful if you break a bone, but has many issues when it comes to mental health.
Private health insurance may be the default in the United States, but does it work? Does it help you? Does it have your needs in mind?
The short answer is kind-of, and sometimes not at all. Ultimately, insurance companies exist to make a profit, and they make money by charging you more than you get, on average.
Here's a quick list of the most useful benefits of private pay mental healthcare instead of health insurance:
Privacy: Insurance requires a diagnosis on day 1. That means that we are required to provide them with your personal and private information, personal health information (PHI), and a mental disorder which fits your symptoms based on very little conversation. A one hour session really flies by during counseling -- often for our client's, too! I generally advise against needless diagnosis for multiple reasons, which I will get into in more detail below, but the biggest reason is that this becomes part of your permanent health record and can limit you from certain careers and can be used against you in court.
Freedom: Choose who you want to see, and how long or often you want to see them. No visitation limits or referral requirements.
Better Care: Insurance companies require that providers use 'cost-efficient' treatment plans and techniques. This means that many individuals with their own unique issues get funneled into the same treatment style. This goes completely against contemporary therapy philosophy. To quote Irvin Yalom, "The therapist must strive to create a new therapy for each client."
Stability: With private pay, your insurance company will never send you a retroactive bill. You won't have to worry about copys vs coinsurance, or maximum out of pocket vs deductible. In short, way less crazy-making.
Diagnoses: The pros and cons of labeling unique experiences - 01/29/25
TLDR: Diagnoses & labels are good for science, but may not be useful for most individuals seeking the reality of their unique situation or trying to think creativity. Just try googling any symptom of any disease and you'll see what I mean.
Many people come in wanting a diagnosis. This is understandable. It's what I wanted when I first came to therapy as well. I think I wanted to know that my situation was not normal. I also wanted to know which kind of not-normal it was. Like many others, I thought a label would help me fix my problems. Looking back, I was lucky enough to go to a good therapist who danced around the question artfully when I asked, "Do I fall into anything diagnosable?" She responded by telling me that what I was dealing with could be overcome with the right tools and the right way of thinking. The way out was through.
This is not to say that diagnoses aren't useful. The DSM is built upon categorizing people's symptoms into labels and categories based on similar experiences, and it is -- sometimes -- a profoundly useful instrument of the trade. It is also constantly being worked on and compared to the ICD, which offers a slightly different view on many symptoms. The DSM has yet to include C-PTSD and is currently undergoing a revision to its section on personality disorders, which will likely have huge implications for American psychotherapy and mental health care.
A diagnosis can help understand what else a clinician should examine, and how to treat particular issues. Scientific research would not be possible without the concept of diagnosis. At the same time, a diagnosis doesn't mean that you have every symptom. It doesn't connote a life-long affliction. It really doesn't mean that anything about your life is different than before you were diagnosed.
Language is imperfect. This is one of my favorite -isms. I use idioms and metaphor often, partly because they help simplify complex ideas and partly because they can mean many different things. In this case, what I mean is that we think more creatively about something before we have a word for it. The word itself constrains our thought process, which can make it more efficient, but also can lead us astray from the reality of the situation. Sometimes this can lead to us moving faster in an incorrect direction.
Complex Post Traumatic Stress Disorder (C-PTSD): How the World of Therapy May Get Shook - 02/01/25
TLDR: We put bold in this one (see below), start there if you don't want the intro.
Interesting things are happening in the cutting edge of psychotherapy. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) came out in 2013. It added severity specifiers and reorganized diseases from a "multi-axial system" to just giving things categories: anxiety disorders, depressive disorders, OCD, trauma, etc. The changes seemed pretty common sense.
The DSM revisions have typically come out faster than the last, and the last one (DSM IV) lasted 14 years. If you're doing the math here, we're in a different world than 2013. There's been a lot of research, society is ever-evolving, and the news only gets faster. The therapy community is expecting a new DSM by 2027 or 2028, roughly 14 years since the DSM-5. Here's the interesting part: Revising the DSM is a big deal, generally speaking. This is a therapist's encyclopedia of current, research-based understanding of these disorders. There are rumors about the next release date, but nothing concrete from the APA.
What I Know: PTSD, as listed in the DSM-5-TR (the most recent DSM-5 version), lists symptoms such as re-experiencing traumatic events, avoiding reminders, and hypervigilance. The ICD-11 released in 2019 and made a huge change by adding C-PTSD, or Complex Post Traumatic Stress Disorder (though the term has been used much longer -- since 1988, by Harvard psychiatrist Dr. Judith Herman). Criteria for C-PTSD consist of "disturbances in self-organization," which includes fluctuating moods, negative self-concept, and relationship issues.
Moving forward, we can expect updates to personality disorders. While no one knows the exact cause of personality disorders, and "genetics, neurological differences, and environmental factors" are listed as possible contributors, the biggest cause is Trauma. The addition of C-PTSD may shake up our perspective on it and other disorders. Trauma can have intense and varied impacts on a person's mood, thought process, and behavior. It can make people depressed, or angry. It can create OCD & personality disorders. Where would C-PTSD fall in this hierarchy?
Quick Debrief: This isn't to say that all disorders are caused by trauma or that trauma can cause all disorders. Many disorders are very hereditary, we don't know everything, and epigenetics is a newer concept in the collective consciousness.
That being said, don't forget to factor in politics, unknown discoveries that happen in science nearly everyday, what your senator had for breakfast, or if they slept well. We can't read minds or tell the future, and the world is rife with misinformation, even as new empirical discoveries are made at an increasing rate.
Disagree peacefully with acceptance - 02/08/25
TLDR: Use radical acceptance and empathy to become a super-human.
The world feels like it's moving faster than ever. It technically is, but I mean that figuratively.
It feels like we have more to do, less time to do it, and more surprises along the way than ever. The opinions of others feel further from our own truths. Americans, especially, are more divided than ever.
The way out is through. The way through is with acceptance and empathy. Because the reality is, it involves others.
Between the media, friends/peers, and the internet, there is a lot of information out there, and a lot of it is contradictory, exaggerated, or just flat-out wrong. No one is immune from hearing flawed information. And no one is immune from believing it, especially when its faster than ever and is designed to make us addicted to it. That includes you, sometimes. This requires a pretty radical acceptance.
Radical Acceptance is actually an official psychology thing—part of my favorite evidence-based practice, Dialectical Behavior Therapy (DBT). Developed in the 1970s and '80s by Psychologist Marsha Linehan. Developed to treat suicidality and borderline personality disorder, DBT contains skills that can be useful for anyone wanting to better themselves, grow, or heal. One such skill is radical acceptance. Like many DBT skills, it's easy to understand while being potentially difficult to master.
Here are some key components of Radical Acceptance:
Accepting reality: Acknowledge the present moment, without judgment. Harder than it sounds, we all have blind-spots.
Let go of control: It sometimes feels like we are expected to be "in-control" of every second of our lives, but this isn't humanly possible. Do yourself a favor and put that down for a second.
Remind yourself of the facts of the present situation. What would a robot say happened?
Feel it: physically and emotionally. Bodily sensations and emotions happen faster than we can think, and have a large influence on how we think.
Look both ways: How would you react if you did accept this reality? And what if you did not? Make a list of behaviors for each outcome.
This is a brief summary of radical acceptance, which is only one of many DBT Skills and should be learned in context with the principal concepts of DBT: Mindfulness, Emotional Regulation, Distress Tolerance, and Interpersonal Effectiveness.
I also mentioned empathy, and radical acceptance gives us a glimpse into empathy.
From the Greek for "feeling-in," empathy means truly feeling like another person is feeling.
I often say, "Everything has a spectrum." Mostly to help describe the subjectivity of thoughts/feelings and individually lived experiences. The nuance in life. Sometimes we get locked in dichotomous thought: If it's not this, then it's that. Empathy has a spectrum, too. Women are typically higher in empathy than men and it can change over time. Empathy is a multidimensional construct based on individual and societal factors.
Use radical forgiveness, grow your empathy, and navigate the world with a little more understanding and less stress. Become better, even.
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My lawyer made me say: this blog is for informational and educational purposes and is not a substitute for mental health therapy services. Reading this blog does not establish a therapist-client relationship. If you're in need of mental health services, please reach out to a licensed mental health professional.
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