Hope is the Cure

Fear keeps us stuck in situations in which we are unhappy; fear that things can even change, or fear of what that change might look like. Perhaps we are struggling with depression or anxiety, and we don't believe that things can get better. Maybe we are unhappy in our relationship, but we don't address it for fear of what may happen. Many people feel stuck in jobs in which they are unhappy, but fear of loss of income prevents us from looking for a better way. Many of the people I work with struggle with gender identity issues but are, understandably, fearful of what making changes will bring.

In all of these situations, we lack the hope that things can get better. Change is hard. We are afraid of what that change will look like. What if things do change but nothing gets better? We may not be aware of it, but fear clouds hope for so many people. Let me give an example from my own life in which fear kept me stuck without hope that things can get better.

Before I was doing my private practice full time I had a job, but was very unhappy. I was working for an agency as a psychologist, but my work wasn't fulfilling and there were a number of issues that I felt powerless to change. I knew that I wanted to have a private practice, but I didn't know how to make that happen. I had significant financial responsibilities, and didn't think I had the financial resources to consider making changes. I had bills to pay, and making sure I was able to do that kept me stuck in unhappiness.

Then I unexpectedly lost my job. I immediately started looking for another job, because I thought that was my only good option. I was fearful of financial consequences and didn't have the hope that I could make private practice work. I did start building my private practice (at the time it was already established but was very small) in order to have some income, but my focus was on finding another job based on my belief that was the only way I would have financial security.

I never did find another job in the way I thought I needed. During the time I was looking, my private practice was building, and shockingly I was able to pay all of my bills. Yes, my finances were very tight, but everything got paid.

There wasn't a single moment when I realized that private practice was all I needed. No ah-ha moment, no instant where suddenly I knew it would work. However, over time my fear of financial insecurity was replaced by the hope that I could really do this. I was working from home so that I wouldn't have all of the financial obligations associated with maintaining an office elsewhere. Even when I started to realize that the private practice was really working, I still thought working from home was a temporary thing until I could afford a "real" office. It's now a year and a half later, and I'm still working from my home office. I am as financially secure as I was when I was working for someone else. I'm also amazingly more happy than I was when I had a boss and a paycheck every two weeks.

I didn't have the confidence that I could do it on my own. This fear of failure kept me stuck. In my case it wasn't by choice that I depended on my private practice, it was by necessity when I suddenly found myself without a "real" job. I can now say that losing my job was the best thing that could have happened. I wouldn't have attempted to go out on my own - fear made me believe I couldn't do it. But somewhere in there hope took root and Hiestand Psychological Services is all I need. Having a home office is fairly unusual, but I realized it really works. So many of my clients comment that they love the home setting an opposed to a commercial office. And having my pets around also significantly adds to the work I do in ways I couldn't have even imagined.

What are you afraid of? Where in your life is hope clouded by fear? Know that change can happen, even if we aren't sure what that change will look like. I wouldn't have a job if people or situations couldn't change. When we find that hope, even if it is just a spark, we can go on to make significant changes in our lives for the better. Fear is a disease; hope is its only cure.

Insurance Update

When I started my private practice almost 2 years ago, I didn't fool with getting on insurance panels - I knew it would be a headache and decided to just use a sliding scale. However, when I went full-time with the practice, I knew I needed to go ahead and get on some insurance panels. I started the process months ago, and it has definitely been a headache. Here is where things stand.

Magellan: I have a contract and am finalizing a few details, but basically ready to bill.

Cigna: I have a contract but before I can start billing they have to check my credentials. They say it won't be more than a month (I'm not holding my breath).

Blue Cross Blue Shield: I have submitted all the documentation that I am aware of and am waiting on a decision. I do think this decision will be favorable, but don't know how much longer it will take.

Humana: They denied my initial application, but I appealed it and I think they are going to offer me a contract. Again, not sure of the timeline.

Aetna: I have submitted the initial application but haven't heard anything from them.

United: Initially they stated they are not contracting with any more psychologists in this area. I have appealed it but haven't gotten an answer.

Amerigroup: Will submit my initial application once I have a Medicaid number - they require that before they will consider an application.

Medicare: I have submitted all the paperwork and am waiting on the answer.

Medicaid: I have submitted all the paperwork here as well, so just waiting.

At the moment I think this covers it. As contracts become real I will notify folks.

Religion and Psychotherapy

We live in a time where religion/spirituality is sometimes seen as not belonging. We are likely aware of the frequent disagreement about the role of religion in our government. Controversies around laws with religious content are very common at the moment. However, this isn't primarily a political blog, it is a blog about psychology. Another question we sometimes have to deal with is the role of religion/spirituality in the therapy room.

To be completely transparent, I am a Christian. I was raised in the United Methodist Church, and I continue to identify with that denomination today. Recently I have also been incorporating some additional spirituality into my life, meditation practices that could be considered more a part of Buddhist thought. Thus, religion and spirituality are important parts of my personal life.

As important as religion and spirituality are to me personally, when I am working with a client, my beliefs are not relevant. Early in my work with an individual I will ask them about their personal religious/spiritual beliefs. If they do have beliefs that are important in their life, I need to know so that our work can include their beliefs (as relevant). If they don't have specific beliefs, then our work won't include a spiritual component.

Living in the South, religion (Christianity) is a very visible part of the landscape. We don't have to go far to see multiple churches of varying denominations. However, there are folks who are not interested in religion, possibly because it has never been a part of their life, and possibly because they have been hurt by the religious beliefs of others. For these individuals it is inappropriate to expect psychotherapy to include religion; it is unethical for a therapist to try to include religious beliefs when the client does not want that.

Religious beliefs/spirituality are very personal endeavors. If you are contemplating therapy and want religion to be included, make that known to the therapist. If you do not want religious thought to inform your therapy, make that known as well. It is appropriate for you to ask your therapist how they utilize religion in the therapy room, and if their response isn't comfortable for you, then that therapist is not a good fit for you.

Am I my mental illness?

Most of the folks I work with meet the criteria for one or more mental illnesses; I meet the criteria of one (Major Depressive Disorder). For some folks it's a temporary thing - you are feeling sad/depressed, but it is linked to something that you will deal with, and then you will no longer meet the criteria. This is especially common for things such as depression and anxiety. For others, your mental illness is something you are going to live with for much of your life. You will learn ways to cope with it, you will be able to effectively manage it, but it is going to be something you will have to address on and off, possibly for the rest of your life.

For those of us who do live with mental illness long term, it can become very easy to identify with our mental illness. I could think about myself as a depressed person, but that isn't accurate most of the time. Yes, there are times when I have to actively manage depression, times when I experience depression, times when I suppose I am a depressed person. But it would be unhealthy for me to incorporate depression into my sense of self. I live WITH depression, but I AM NOT depression. While it may be a part of my life, it does not define me.

If I identify with depression, I am giving depression power and control in my life that it doesn't deserve. By making depression part of my sense of self, I am guaranteeing that it will play a prominent role in my life. I don't want depression to play a prominent role in my life. I accept it is a part, but I do not accept that it is who I am.

For a long time now, I have used a visualization for my depression. This is what my depression looks like:

except the creature is all green, not purple. It is a ghastly obnoxious dancing green dinosaur. It is not of me. It is a separate entity that at times I have to attend to. Sometimes it is much harder to do this, to maintain the distance needed to control the beast. I have lived with it for over 30 years now, but it will never be me. Barney the Depression Dinosaur, you will never get to be me.

Couples Counseling

Couples counseling. Couples start counseling for different reasons and at different times in their relationships. Often, they wait until things get really bad before they start counseling, and that reduces the chances that counseling will be effective. It is far better to start therapy before things get too bad for the best chance of working things through.

Sometimes couples start therapy as more of a preventative measure. They start therapy when there aren't any significant concerns, and so use it to deal with things as soon as they come up. That way issues don't usually get too serious before they are working through them. This is a really nice way to stay on track with your partner.

A third option is pre-marital therapy. This is counseling done prior to getting married during which potential issues can be identified and discussed. The state of Tennessee offers a significant discount on the fee for the marriage license to couples who have done acceptable pre-marital counseling, and I am able to do this work. It requires at least four hours of therapy, so isn't a huge commitment, and can be a really nice way to be prepared for some of the challenges that often arise in marriages. Good relationships do take work, but doing that work can help us maintain healthy and fulfilling relationships.

Never give up on someone with a mental illness...

Never give up on someone with a mental illness. When "i" is replaced by "we", illness becomes wellness.
-Shannon L. Alder

Can Politics and Hope coexist for LGBT Americans?

Politics. I tend to not discuss politics too much. Well, that used to be the case, but recently politics have become much more important and personal to many of us. I know that many of us are really struggling with things that have been done (immigration, healthcare) and things that we are afraid might be done. I'm with many of you in worrying about what steps might be taken that will prove harmful to us as LGBT folks. I want to be comforted knowing that the executive order preventing discrimination in government is going to be left in place. However, I am very aware that so many other things could - and very well will - happen.

I wish I could tell you that things are going to be okay. I do believe that our lives are going to be made more difficult, both by the federal government and by the Tennessee legislature. Even so, I know that our community is far more organized than we have ever been before. I know that we have more allies than we have ever had before. I know that the majority of the general population approves of gay marriage. I believe that they can make our lives harder for a while, but I don't believe they take back the progress we have made, not permanently anyway. In the past I haven't been especially politically active, but I am planning to go to Nashville to speak out as a psychologist against any bills they try to pass against us. I'm not the only person who is now far more politically aware and active than I used to be. Together we will fight back against whatever they try to put in place, and even if it takes a little time, I truly believe that we will prevail.
Like many of us sometimes I feel very afraid, very uncertain about our futures as LGBT Americans. There are days it is harder for me to hold onto this hope, but I have seen what we have accomplished so far so I know we will continue to overcome. I'm not telling you not to worry. I am telling you to be ready to stand up and fight, and if we do this, we will reclaim any progress lost and continue to march ahead. That is what we will do as LGBT Americans.

My ad on Psych Today

You can visit my page at Psychology Today:
https://therapists.psychologytoday.com/rms/prof_detail.php?profid=311392&sid=1485113618.6495_10129&name=Hiestand&search=Hiestand&ref=1&tr=ResultsName