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Adoption Academy this Monday

At the airport on our way to an adoption conference in Portland in 2008.

On our way to an adoption conference in Portland in 2008. The moving sidewalk at the airport during a layover was her favorite part.

My daughter and I will be sitting on the Adoption Academy panel this Monday hosted by The National Center for Adoption Law & Policy and Nationwide Children’s Hospital. I will be there to encourage my daughter and hopefully she’ll be doing most of the talking when it’s our turn to share.

The Adoption Academy is a great (and inexpensive!) opportunity for prospective adoptive parents to get an overview of many different kinds of adoption to better understand what way of building their families might be right for them.

Because I was asked to speak as an adoptive parent (not as a professional specializing in adoption) I asked them if my daughter could come with my support instead. I did this because a few months ago when I was on my way out to another speaking engagement my daughter (who is 10 as of this writing) said, “Why don’t they ask me? After all, I am the adopted one!”

She had a good point.

We adoptive parents tend to seek each other out for information and support and sometimes that’s appropriate but if we don’t widen our cultural view we run into the danger of assuming that our vantage point is the only one or the most right one.

Fortunately there are more and more opportunities for us to hear from the other players in adoption. Publications like Gazillion Voices, events like the Ohio Birthparent Group‘s All Adoption peer support meeting (every second Tuesday in my office at 7pm), and the blogs of first parents and adoptees allow us to listen and learn, giving us the chance to be better, more inclusive, more understanding parents.

What we’ll hear isn’t always easy and we won’t always agree with what is said. But the experience will give us a better understanding of adoption in all of its complicated nuances, which will make us better parents to our own adopted kids.

I’ve been dragging my daughter to adoption conferences since she was in diapers and so she has been fortunate to hear from adult adoptees, birth parents and other adoptive parents and she has been chomping at the bit to add her own voice to the discussion. Over the weekend we’ll be practicing and playacting some of the questions she might get so she can think about how she wants to respond. Right now she knows that the message she is most anxious to impart is that there doesn’t need to be competition between adoptive parents and birth parents.

“It’s all family,” she explained, trying to decide how she wanted to articulate this.

There’s a strong possibility that my daughter will want to take a step back from participating in events like this as she edges closer to her teens and I will support her in that, too, but as long as she wants to share her story and her experiences, I want to help her do that.

So we’ll be seeing you Monday. It ought to be a good time.

 

The Myths of Good Parents

GOODWe do not raise children to go out into the world and be perfect and build perfect relationships with perfect people. That would be impossible. We raise children to be good enough to build good enough relationships with other good enough people. Therefore, good parents are, by definition, not perfect. It’s our imperfections — deftly handled — that will help our children to grow up and handle other people’s imperfections with compassion, understanding and good boundaries.

With that in mind, these are some of the pervading myths of good parents.

Myth: Good Parents Don’t Get Angry.

Actually good parents do get angry. Sometimes they even yell and stomp around. But good parents work hard to manage their anger appropriately, apologize when they handle it inappropriately and work to get help if their anger feels out of control or truly scary. Good parents need to know that their children are going to deal with people who get angry (otherwise known as: everybody) for their entire lives. They also know that their children are learning how to handle their own anger so they learn to see the everyday challenges of living as learning opportunities for all of us.

Myth: Good Parents Always Enjoy Their Kids.

No. they don’t because the children of good parents are not always enjoyable. ‘Nuff said.

Myth: Good Parents Have it All Figured Out.

Actually good parents get that this parenting thing is a process and it’s changing all the dang time as kids move from one developmental stage to another. Good parents may feel great about parenting a 3-year old and absolutely lousy about parenting a 13-year old or vice versa because those are totally different kinds of parenting, which take a totally different skill set. Good parents get help (books, friends, therapists) when they feel stuck and most good parents will eventually feel stuck because parenting is hard.

Myth: Good Parents are Fair.

Nope, good parents try to be just but they are not always strictly fair. That might mean different bedtimes, different chore expectations or different privileges for different kids. Sure, sometimes good parents take the easy way out and just buy everyone the same pack of gum — no arguing! — and other times they wearily wade into explaining yet again that just because your sister gets to go to a birthday party doesn’t mean that you get to go to Kroger’s to pick out a cupcake. Good parents learn to withstand tears and sorrow with sympathy but without giving in. Sometimes they don’t because, remember, good parents are imperfect.

Myth: Good Parents are Patient.

In fact, sometimes good parents are patient and sometimes they’re not. Sometimes good parents don’t have the energy to be patient or they’re having bad days. Good parents learn to bring this experience to build empathy with their own impatient kids.

Myth: Good Parents Have Clean Houses, Lots of Home-Cooked Meals and Amazing Holiday Traditions.

Ummm, sometimes? Sometimes not. Good parents do some things really well and other things not so great. Good parents may be terrific softball coaches with filthy kitchens. Good parents may know how to make a mean pot roast but can’t make cookies to save their lives. Good parents don’t always remember to buy pumpkins in time for Halloween or advent calendars in time for Christmas. Good parents don’t always have money for the tooth fairy. Good parents sometimes don’t notice their kids have grown out of their tennis shoes until they notice them limping across the playground. Good parents forget to pack the diaper bag.

Myth: Good Parents are Confident.

Sure, sometimes good parents look at a parenting challenge and say smugly to themselves, “Yeah, I got this.” But lots of other times good parents lie in their beds wondering if that decision they made about homework or screen time or dessert was the right one after all. They work hard to model the great grand work of self improvement, understanding and relationships. They live complex lives that sometimes create challenges they hoped their children would never have to face — divorce or death or depression. They struggle and worry and fret. They move forward because they have to, not always because they’re sure.

Myth: Good Parents are Consistent.

This is one of the things every parenting book says: Be Consistent. And it’s true that consistency will save you a lot of trouble in the long run. If you always say no to the candy aisle in the grocery check out line your kid won’t necessarily stop asking (or whining) but they’ll learn that when you say no, you mean it, which will come in handy when they’re teenagers. But sometimes the candy seems like a good idea because you’ve got such a headache that you’ll say yes to anything to get them to shut up. Good parents sometimes make short term decisions just to cope because life is like that.

Myth: Good Parents are Born, Not Made.

No way. Most of us have to work hard — ongoing — to be good parents just like we have to work on our skills to do anything else well (play tennis, bake yeast breads, create killer TED-inspired presentations, etc.). Good parents sometimes get tired of all of the self-growth and effort that being a good parent takes, particularly when they look at the 2-year old wailing on the floor or contemplate the disaster-area of an 11-year old’s room or note that the 16-year old is missing curfew. Then those good parents reach out to friends for a night out or call a therapist for help or reread How to Talk So Kids Will Listen again. Sheesh, says the good parent to herself, when am I gonna get it? But the good parent keeps trying.

Pregnancy and Infant Loss Awareness Month

pregnancy-infant-loss-remembrance-day-300x218October is Pregnancy and Infant Loss Awareness month and October 15th is Pregnancy and Infant Loss Awareness Day. On the 15th many families who are living with loss will light a candle at 7pm their time to create a “wave of light” in remembrance of their babies.

At Kobacker House at 800 McConnell Drive, Columbus Ohio 43214, they are hosting a Pregnancy and Infant Loss Art Wall exhibit. The building is open 24/7 and the art will be on the wall on the main floor, just outside of the family kitchen as you walk toward the in-patient unit. The exhibit will be up through the end of October.

They are also hosting two events later this month:

Mourning Walk in the Afternoon, Sunday, October 19, 2pm. This exercise of remembrance will be a reflective, meditative and guided walk on Peggy’s Path surrounding the Kobacker House. The approximate distance is 3/4 mile and involves some hilly paved terrain so please wear comfortable shoes.
Instructor: Sarah Phillips, LISW-S
Location: Kobacker House
Register by phone: (614) 533.6060

Healing Drumming Circle, Sunday, October 26th, 2pm. For thousands of years, drumming has been a part of almost every culture. This ancient ritual remains alive today. Studies reveal that drumming can accelerate physical and emotional healing, boost the immune system, and have a calming effect. Children are welcome. No experience required. Drums will be provided or you may bring your own.
Instructor: Sarah Phillips, LISW-S
Location: Kobacker House
Register by phone: (614) 533.6060

Kobacker House also has an ongoing monthly support group for parents who have lost a baby before, during or within the first year after birth.  The next meeting is November 7th at 7pm and there is no cost. Call for more dates and times: (614) 566-4509

Mount Carmel hosts a Pregnancy & Infant Loss Care Line hosted by chaplains who are specially trained “to provide spiritual and emotional encouragement and support to patients and their families from all faiths and cultural traditions.” The number is:  614-234-5999

They are also taking registrations for their upcoming Coping with Loss Educational Series. “A three-session forum designed for grieving parents and their families who would like to learn more about the normal grief process and how to effectively heal. The meetings include guidance and teaching from trained grief facilitators on practical ways to live with loss and find hope in life.”

To learn more or to register, call 614-234-5999 or e-mail infantloss@mchs.com.

Finally the SID Network of Ohio has a resource page for families struggling with the loss of a baby to SIDS. They have a support group but it may not be meeting again this year. To find out more, contact the Sudden Infant Death Network at 800-477-7437 or by e-mail: Leslie@SIDSOhio.org

For those of you who are grieving, you are in my thoughts. I hope you are able to reach out to find the comfort and support that you need and deserve.

 

 

Why is therapy so expensive?

girlallowance-insideThere’s no getting around the fact that therapy can be expensive. Sure, you may pay less than you would for a hair cut and color or just a little more than you would for a massage, but most people don’t get their hair cut as often as they’re likely to go to therapy. I mean a dye job lasts what, six weeks? And most people see their counselors about four times a month.

The reasons therapy costs so much are:

  1. Schooling. In order to offer psychotherapy, your counselor needs an advanced graduate degree. Generally Counselors, marriage & family therapists and social workers need a masters and psychologists need a PhD.
  2. Licensing fees. Ongoing expenses include paying for our license and certifications as well as our professional memberships in organizations like the American Counseling Association or the National Association of Social Workers.
  3. Continuing education. Therapists need to have continued training to be sure we’re up on the latest research and that we’re staying abreast of what our professional ethics and the law require of us. States vary in their demands and the costs of training differs a lot, too, but most of us sink a few hundred a year into making sure we’re up to date. If we have other certifications — in, for example, hypnotherapy — we will need to take classes to maintain that certification, too.
  4. Insurance. We pay for professional liability insurance the same way that doctors do (fortunately our costs are a lot less). Most of us need the insurance to maintain our licenses.
  5. Rent and utilities. Even if we’re not in practice for ourselves, part of our income goes to keeping the office open and the lights on. Bigger cities, naturally, charge bigger rents and thus more expensive therapy. For those of us in private practice, rent is likely our biggest expense (I know it’s mine).
  6. Phones. Some therapists also pay for an answering service.
  7. The cost of doing paperwork. Those of us who take insurance (I do not) generally negotiate rates with each contracted insurance company. So you pay your co-pay and the clinician bills the insurance company for the rest of the rate initially agreed upon (and this is usually something the insurance company dictates; therapists can either agree or not). The paperwork required for insurance eats up a lot of time. Insurance companies differ in what they require and when and keeping track of it, submitting the billing, following up on payment (because insurance companies don’t always pay in a timely manner) and going back to the client if there’s something sticky takes up a great deal of office time, which could go to seeing clients so therapists bundle that time into their fees. Some of us farm these tasks out and pay a biller, which also obviously adds to the cost of therapy. For those of us who don’t take insurance, the paperwork demands are a lot less but ethically and legally we are required to keep certain documentation up-to-date. After a session with a client, we have to write up the session and again, our pay for this is bundled into the fee we charge the client. Note: Those of us who take insurance generally charge more than those of us who don’t because of the cost of doing business with the insurance company but most of us end up making about the same amount. People who take insurance spend more time on maintaining paperwork and those of us who don’t spend more time on marketing (since insurance companies do much of the marketing for you, giving your information to consumers who use their plan). A full-time therapist (i.e., someone who works a 40-hour week) isn’t seeing clients for all of those forty hours. Some of those hours are doing paperwork, getting training, meeting with supervisors or getting peer support, marketing, talking to insurance companies, printing out worksheets for the next session, reading research, calling to coordinate care with other providers, following up with clients who missed appointments or have questions or emergencies; etc.. Client fees have to also cover the invisible work of being a therapist.
  8. Miscellaneous supplies and fees. Therapist need to print out worksheets and forms, keep our furniture in reasonably good shape (and replace broken down chairs and sofas), maintain a working supply of pens and paper, and Kleenex. Most of us also need to pay for a web site and/or for inclusion in membership directories so clients know how to find us. If we work with kids, toys and art supplies need to be available and in good repair. Then of course there’s stuff like bank fees, the cut the credit card company takes, etc.

After all of these expenses are taken from our hourly rate the rest goes toward our salary. Part-time and contract workers at agencies and practices as well as those in private practice for themselves also have to pay taxes (about a third of their income), health insurance and retirement (not to mention banking for sick or vacation days) out of that what they take in.

And that’s why therapy costs so darn much.

There are options to make therapy more affordable:

  • Use your insurance. Not all insurance plans offers mental health benefits and not all insurance plans that do make it more affordable. (Plans with high deductibles may take a lot of time and money before you see any savings.) You will need to find a therapist who takes your insurance and then you will need to receive a mental health diagnosis that your insurance company will cover. Once you get that diagnosis, your insurance company will need to approve the treatment plan your therapist gives. All of this sounds very complicated but therapists who take insurance generally understand how to make it work for you. Make sure you are clear about what the diagnosis and treatment plan mean and what exactly will become part of your health record. Also note that most insurance plans do not cover couple or family counseling and may not cover certain diagnoses. Sometimes you won’t find this out until your bill gets denied so take some time to make sure it all makes sense to you and your therapist.
  • Use your Health Savings or Health Spending Account. If you have a HSA card, see if it will cover counseling and if your therapist is able to charge HSA cards. Most of the time these plans will only need you to submit a monthly or quarterly receipt but check first to see.
  • Seek out a practice or agency that uses a sliding scale. Sliding scales tend to be needs based and different therapists and practices require different documentation; some will want proof of income and others will not. Not all therapists will advertise their sliding scale so if there’s someone you’d really like to see and you’re not sure if a sliding scale is available, call and ask.
  • Explore group therapy. Groups tend to be much less expensive than individual therapy (that’s one reason I decided to create the Parenting Challenging Children group — it’s a more affordable way for parents to get help) and research shows they can be be just as effective. I especially like groups because I feel that community can be incredibly healing for those of us who feel isolated in our struggles.
  • Seek out a publicly funded agency since they often have more generous sliding scales. Depending on your income, using a county agency (in Central Ohio those are agencies funded by the ADAMH board, a list of which you can find here) may allow you to pay very little and sometimes nothing for counseling. Because they receive outside grants to fund mental health support for underserved clients they can subsidize their services. There may be a wait list and depending on where you live, it may be long but check in regularly since cancellations do happen and sometimes the intake person can get you in more quickly than originally promised. (Sometimes if you call in the morning they may have a last minute slot open up in the afternoon.)
  • See your therapist less often. While meeting every week may be ideal (it’s easier to create and stick to change when you can devote an hour each week to working on it), you can go every other week or even less often if your therapist agrees.
  • See an intern at the practice. Not all agencies or practices hire interns but those that do sometimes charge less since those practitioners have less experience. Interns are supervised by other counselors with specialized supervisory training although what this means will depend on the practice. If you’re using this option, ask them what this will mean exactly so you know what you’re agreeing to. (Note: Research shows that new therapists can be just as effective as more experienced therapists in part because newbies have lots of enthusiasm, which can make up for their lack of real world experience.)
  • Do the work. Counseling is not a race and how long it takes will depend a lot on individual factors but the more energy you put into therapy, the more you’ll get out of it, the more quickly you can create change and the sooner you’ll be leaving therapy. This means showing up for appointments (and avoiding the no-show fees! another way to cut costs), being honest with your therapist and reflecting on what you’ve learned between appointments.

 

Teens and Confidentiality in Counseling

teenbackpack-insideParental involvement is a key ingredient in kid client success in therapy. What this looks like will depend on your child and his/her treatment plan, your practical ability to be involved (are you a noncustodial parent? Is your child receiving services at school?) and the therapist. But at the very least, you and your child’s therapist should be communicating regularly.

Depending on the child, the parents and the treatment goals, I include parents in the following ways:

  • Parents attend sessions with their child (this is common with young children and with children who are struggling with attachment);
  • Parents come in for the first or last few minutes of session;
  • Meeting with parents separately before or after the child’s session;
  • Scheduling separate sessions with parents when needed and appropriate;
  • Arranging for phone calls to check in.

I like kid feedback for how parents should be involved, particularly with teenagers who are navigating the developmentally appropriate need to separate along with the necessary support from parents. Sometimes this means helping the teen figure out how they want to talk to parents about something and then inviting parents to session to help mediate a discussion.

I go over confidentiality with parents and teens in session with the understanding that we will all respect the teen’s privacy in the counseling relationship but that the adults will keep her safety paramount in decision-making around what to share. When kids are struggling in a gray area, I always encourage them to invite parents to the discussion but I won’t go over their heads and tell secrets unless I’m concerned for their safety.

Here’s the Ohio ACLU publication about minors and their rights. The part about counseling (this is a PDF file) starts at page 40: Your Health and the Law: A Guide for Teens.

From the file:

A minor who is at least 14 years old can request outpatient care without notifying a parent as long as the treatment does not include medication. However, such care is limited to six sessions or 30 days, whichever comes first. After that, the care must stop or the parents must be informed and must consent in order for treatment to continue. During the first six sessions or 30 days, the parents will not be informed of the treatment unless the teen consents or the care provider feels the minor is likely to harm someone. Still, before the parents can be informed, the care provider must first tell the teen that the parents will be notified.

I have not had a teen call and ask for counseling on her own but I have had other loving adults (relatives or family friends) call me to find out if they can bring the teen to counseling without parental consent. I always explain how the law works and explain that except in cases where parental involvement would be dangerous to the child, it’s really best to have parents be a part of counseling.

There are guidelines around counseling teens and maintaining confidentiality. As a counselor practicing in Ohio, my ethical guidelines come from Ohio’s Counselor, Social Worker, and Marriage and Family Therapist board and my professional organization, the American Counseling Association. Both these entities recognize that teen confidentiality is a gray area. The ACA and their sister organizations for social workers and other therapists regularly publish articles and papers on the topic.
Here’s a handful for you to check out:

As you can see, there are not definitive answers because these topics are complex and so very individual. How I might, for example, handle it if a client tells me s/he is sexually active will depend on many things including but not limited to:

  • Why the teen is in counseling in the first place;
  • With whom they are being sexually active (is it consensual? Is it legal?);
  • How old the teen is (there’s a big difference between a 13 year old and a 17 year old);
  • The family’s values around sexual activity;
  • The circumstances surrounding the sexual activity (are there pressing concerns about safety?).

My first priority is always first and foremost safety but I recognize my ideas about safety may be different than the families. For example, say I learn that a 17-year old after careful consideration and planning decides to access birth control and have sex with her long-term partner. Perhaps she comes from a strict, conservative family whose religious beliefs condemn premarital sex. I am unlikely to break confidentiality under those circumstances.

I say this to encourage parents to talk to their teen’s counselor to make sure that they understand each other. If you want a counselor who would break confidentiality then I’m not the right person to work with your teen. It’s best we all know this ahead of time.

That said, I do not ever encourage teens to lie and I do not side with them against parents.

Finally, when confronted with a sticky situation I seek supervision, meaning I go to my peers and my mentors to get feedback when I’m not sure. While maintaining confidentiality about the individual and the family, I ask for help and document these efforts accordingly. It’s dangerous for any therapist to operate in a vacuum and I am fortunate to have great counselors available to me to answer questions and help me examine ethical practice as it applies to the complicated reality that is counseling kids and teens.

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