Beth Keeney

The Drive Is Worth It

by Dennis Crandell, LCSW, LCAC
Vice President for Adult Behavioral Services

 

Editor’s Note: This post was written by the author in an email to his staff before a staff appreciation event.  It is being shared with permission.

 

Recently I spoke to an acquaintance, Julie, in the small town near where I live.  Julie and I discussed local events and the conversation soon turned to my current employment.  When I noted I drive to Jeffersonville everyday, 60 miles away, she said in mild astonishment “I hope it is worth it!” 

 

Well I began to think to myself, is it worth it? 

 

I come to this place each day to have the privilege of being a part of a group of dedicated people who serve persons who suffer with mental illness.  And I think, there is no more a noble a cause. 

 

Those who provide deliverance from the effects of mental illness are truly noble; you are a noble bunch.  Society in general does not understand how much they should appreciate you. 

 

Mental illnesses are a group of the most potentially devastating maladies.  They can change the very essence of what it is to be human, they affect the brain.  That organ we use to test reality, to think, to communicate, to feel, to experience emotion, to love, to bond, to participate in human relationships and to navigate the complexities of society.  And as a group you help alleviate the suffering of mental illness. 

 

Each and every one of you, are integral to the success of our clients, and to LifeSpring as an agency.  You all, are either directly or indirectly, purveyors of deliverance, providers of relief, from the devastating effects of mental illness.  Each day you go about your duties in the betterment of life for the individual and as a result for the improvement of the community at large.  What you do every day, is too often unsung, it is hid in the cloak of confidentiality and of ignorance and stigma of the larger society.  What you do well is often not heralded as it should.  But you are appreciated, by me, and more importantly by our clients and their families. 

 

I have been impressed with the professionalism, intellect and energy of the Adult Behavioral Services group.  Initially I was impressed at how smart you all were by how nice you treated me!  But what followed was a real appreciation of how well our clients are treated.  And that is the real testament to your intellect and your compassion and understanding of those we serve. 

 

I make the drive here each day eagerly.  I am proud to have this opportunity to be a part of this system of care.  I appreciate all of you and what you do each day. 

 

So, yes, Julie it is worth the drive! 

What to Expect When You Visit

 

Very often we get questions about what to expect when you come to LifeSpring. Every patient is different. However, this article should give some idea of what to expect when you want to become a patient of LifeSpring.

 

When you call to make your first appointment at LifeSpring, you will be provided an ADMINISTRATIVE INTAKE appointment. This usually happens within the first few days of your call.

 

At the ADMINISTRATIVE INTAKE appointment, you will work one on one with a support staff member who will go through the intake process and paperwork with you. You will learn about LifeSpring’s policies and will have the opportunity to ask questions. The day after your ADMINISTRATIVE INTAKE, you will call back and schedule your first CLINICAL APPOINTMENT.

 

THE ADMINISTRATIVE INTAKE

To your ADMINISTRATIVE INTAKE, be sure to bring your picture ID and your insurance card if you have one.

 

Financial assistance is available to those who do not have insurance. In order to receive financial assistance in the form of our sliding fee scale, you will need to show that you are an Indiana resident and we will need to verify your household income. The sliding fee scale at LifeSpring is based on total household income and total people in the household. Your household is the total number of people living in your permanent housing unit. If you are staying with friends or family temporarily, they do not count towards your household. If you are living there permanently, their income does count.

 

In order to utilize the sliding fee scale, we will need the following information:

 

Proof of Indiana Residency which is established by one of the following:

  1. Valid driver’s license with your current address (OR)
  2. Valid picture ID with your current address (OR)
  3. Recent paycheck stub with your current address (OR)
  4. A letter or ID card from a homeless services agency (OR)
  5. A letter from a probation or parole officer establishing your address (OR)
  6. Two utility bills or service credits with current address
    1. Cell phone bill
    2. Cable bill
    3. Electric or utility bill
    4. Credit card bill
    5. Loan payment bill or statement
    6. Junk Mail is not acceptable

 

Proof of Income

 

Sliding fee scales are based on total household income and the number of people living in the household. You will need to bring one of the following:

  1. Two most recent paycheck stubs (or disability statements) for all adult members of the household who are supporting you (OR)
  2. Last two months of your bank statements showing your disability check deposits or other household income and any other household income (OR)
  3. Letter from Social Security stating the monthly amount of your disability income and any other household income (OR)
  4. Last year’s tax return

 

Please note: If you have no way to prove your income or address, call to talk with our staff about your situation. We can help you find a solution.

 

When residence and income have been verified, we use the below sliding fee scale to determine what fee discount you are eligible for.

 

2015 Fee Schedule

This verification must be completed every six months.

 

Administrative Intake Checklist

 

THE CLINICAL APPOINTMENT

 

After your ADMINISTRATIVE INTAKE, you will call to schedule a CLINICAL APPOINTMENT.  During the CLINICAL APPOINTMENT, you will meet one on one with a therapist who will talk to you about your unique situation and what you hope to get out of treatment.

 

Together with your therapist, you will develop a Treatment Plan, which will include your goals for treatment, and the specific combination of services which will provide you with the best opportunity to reach those goals.  Your participation in all recommended services will provide the best possible outcome.  Recommended services could include any combination of the following:

  • Individual or Group Therapy
  • Case Management Services
  • Primary Care Services
  • Psychiatric or Nursing Services

 

Your therapist and other staff will also help you arrange any necessary follow up appointments.

DSM-V: Psychiatry’s New Bible

Last May the American Psychiatric Association (APA)   published the latest version of its diagnostic and statistical manual, the DSM-5. While some mental health professionals are already using it, many are holding off until October 1, 2014 when the United States adopts the 10th edition of the International Classification of Disease (ICD-10-CM) as the nation’s standard medical coding system.  The ICD-10 and the DSM-5 are compatible and share the same numbering system.

This new manual is a far cry from the slim amber-covered booklet that I was given when I first started working in the field of mental health in the early 1970’s. The Diagnostic and Statistical Manual of Mental Disorders-II (DSM-II) I used then was just the second revision of this best-selling manual and it was published in 1968. It contained a list of all the common psychiatric diagnoses along with a very short paragraph describing each one. These descriptions were very general and loaded with Freudian terminology and theoretical references. My favorite diagnosis back then was something called “Inadequate Personality”. I was told that this diagnosis, which is now long-gone, was used to describe people who no matter how hard they try, just can’t seem to succeed. These were folks like Charlie Brown, in the Charles Schultz comic strip Peanuts who seem to have “endless determination and hope, but who are ultimately dominated by his insecurities and a permanent case of bad luck”.

The DSMs evolved from the definitions use when collecting state hospital statistics and a World War II army publication classifying mental disorders.  Since the original DSM was published in 1952, there have been six major revisions.

The DSM has always been thought of as mental health’s most authoritative source. It was developed so that professionals could agree on what they were talking about in regards to research, diagnosis, prognosis and treatment of various kinds of mental disorders. There have been several rival systems, but none have posed a serious threat to the DSM, which has probably maintained its eminence because of its widespread use in insurance billing.

The DSM-II that I used contained 182 disorders and was 134 pages long.  The new DSM-5 is the size of a dictionary and has well over 300 distinct diagnoses. Over the years the DSMs have created a very financially successful cottage industry within APA, with the special hard-covered, soft back, on-line, and pocket-sized editions, to say nothing of all the accompanying commentaries.

Debate over the DSM-5 has been especially contentious with criticism coming from both inside and outside the DSM community.  It was hardly released before Thomas R. Insel, the Director of the National Institute of Mental Health, issued a statement that hi agency would no longer fund research projects that rely exclusively on DSM diagnostic criteria, due to its poor validity. This bombshell was followed by extensive disparagements from Duke University psychiatrist Allen Frances, an insider who was the chairman of the APA’s last DSM taskforce.

Francis says that the release of the DSM-5 represented, “the saddest moment in [his] 45 year career of studying, practicing, and teaching psychiatry.” He claims that APA has approved a “deeply flawed DSM-5“ which contains changes that are “clearly unsafe and scientifically unsound”. He advises clinicians to just ignore the changes that make no sense.  Francis has published two books describing the inadequacies of the DMS-5, the last one entitled, Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. While the title smacks of conspiracy theory, the work describes the controversial political processes involved in making the DSM and points out   how a scientific best-seller can impact what treatments and medications ultimately will receive insurance reimbursement.

Therapist Gary Greenberg’s book wonderfully entitled, The Book of Woe: The DSM and the Unmaking of Psychiatry, describes how in his opinion the “DSM-5 turns suffering into a commodity, and the APA into its own biggest beneficiary”.

One of the first major public criticisms of the DMS-5 came from advocates in the Autism treatment community.  The clinical criteria for when a child can be diagnosed with autism has been tightened considerably and there has been estimates that these narrower criteria might   reduce the number of children who meet the new standards by anywhere from 10% to 50%. Results from a new government study, just published  in late January,  found that about 19%  of 8-year-olds previously diagnosed with an autistic  disorder no longer  meet the updated criteria.  Advocates understandably are afraid that this might lead to the disqualification and expulsion of   children from much needed school and other services.

Francis, Greenberg, and others critics are especially concerned about how DSM-5 pathologizes everyday experiences. One of the more contentious issues in the new DSM-5 involves the elimination of what had historically been called the “bereavement exclusion”.

In the old DSM people who had lost a love one and were grieving were excluded from being diagnosed with Major Depressive Disorder (MDD), because it was thought that giving such a diagnosis would mistakenly define the normal grieving process   as a major psychiatric disorder. The DSM-5, however summarily ends this exclusion and allows the MDD diagnosis to be given to people in the process of mourning a love one.

The framers of the DSM-5 mood disorders section believe that while depression and grief may overlap, they are not the same and can be clinically distinguished.  Also the maintain that such  grief and MDD can co-exist, just as MDD can coexist with other major life losses such as   a job loss,   being assaulted,  or experiencing a major disaster, such as a flood, tornado, or hurricane.   In their opinion, the bereavement exclusion often kept people with legitimate depressive disorders from getting the help they needed.

The DSM-5 has also been criticized for blurring the lines between other normal processes and psychiatric illnesses. Francis is  concerned that in  using the  DSM-5 criteria everyday  temper tantrums   might be  diagnosed as  Disruptive Mood Dysregulation Disorder,  simple overeating could be  diagnosed as a Binge Eating Disorder, and  even common place worries  might be viewed  as a case of Generalized Anxiety Disorder. He believes that even very small changes in such definitions can have negative unintended consequences such creating millions of new patients. In another example, changes in the criteria for the substance abuse disorders, for example,   may result in first-time abusers being placed into the same category as hard-core addicts.

According to Scientific American writer Ferris Jabr, the DSM-5 may have   an even more fundamental flaw.  Despite all of the tremendous advances in neuroscience, according to Jabr, the DSM-5 says virtually nothing about the biology of mental disorders. It was expected that the new manual would take a decidedly biological direction and incorporated the latest and greatest research in genetics and brain sciences.  In all fairness sophisticated biological markers are included as part of the diagnostic criteria for some sleep disorders, although this may seem like a token inclusion to most neuroscience researchers.

Personally I don’t like how the chapters have been reorganized and how the childhood disorders are scattered all about. It’s hard to find a lot of things. I was also quite surprised by some of the features and diagnoses that have been eliminated such as the multi-axial system, the Global Assessment of Functioning (GAF), and the subtypes of schizophrenic (such as paranoid, disorganized, or catatonic).

My wife Diane and I have completed two training on the DSM-5- one online and the other in person and we are gradually getting familiar with it.  Trying to keep up with all these changes could make you feel like an inadequate personality, if there ever was such a thing.

Originally published in the Southern Indiana News Tribune

How to Build a Better New Year’s Resolution

How many New Year’s have you resolved to lose weight, quit smoking, spend less, or exercise more? Research shows that most people make the same resolution for at least five years before they achieve even six months of success. While about 40 percent managed to continue for six months, over a quarter of all resolutions are abandoned within the first week.

 

People make the same resolution an average of ten times and even all these failures don’t reduce future plans for self-change. Over 60 percent make the same resolution year after year. As you might suspect, behaviors with an addictive quality are the most difficult to change. Relapse rates for these behaviors are extremely high (around 50 percent to 95 percent).

 

The main reason for failure is having very unrealistic expectations. Like the children in Garrison Keillor’s fictional Lake Wobegon, we all believe we are “above average.” People routinely overestimate their abilities, including the amount and rate of self-change they can achieve. In one study 60 percent of adolescents and 47 percent of adults believed that they could smoke for “just a few years” and then easily quit. Self-change is just much harder and takes much longer than most of us realize.

 

Also we tend to greatly overestimate the benefits obtained from the change. For example, many overweight people believe in what has been called “the power of thinness.” Not only will you lose weight, but you will also be vastly more attractive, popular, successful, and of course happy. The Duchess of Windsor once said that a woman can never be too rich or too thin and today popular culture icons have carried this shallow ideology to the extreme. While such anticipated benefits can motivate future attempts at change, when they are not immediately forthcoming, people are deeply discouraged.

 

Anther cause for failure is that many people frame their goals negatively — don’t overeat, don’t gamble, don’t drink, don’t spend, etc. Each individual breach of the prohibition is seen as another failure, which can rapidly lead to a total collapse of the change effort. You have a much better chance reaching your goals if they are couched in positive terms over a longer term.

 

When asked why they didn’t succeed, people usually misinterpret their failures. Typically they blame external factors like, “I was on the wrong diet” or “It just wasn’t a good time to start.” They also blame themselves for lack of will power. They believe minor adjustments can lead to success the next time-like picking a better diet or just trying harder. Since most individuals try to do way too much, it is important to redefine success in terms of modest and realistic goals.

 

Another major factor contributing to self-change failure is that most people are not at the stage where they are really ready to change. Dr. James O. Prochaska from the University of Rhode Island has worked decades researching self-change and has identified five basic stages:

  1. Precontemplation: You have no intention to change your behavior in the foreseeable future. People in this stage lack awareness even about the need to change. They may, however, “wish” to change and often make resolutions without any plans whatsoever.
  2. Contemplation: You are aware that a problem exists and are seriously thinking about changing, but have not made a commitment to action. People often get stuck in this stage.
  3. Preparation: You make up your mind and start planning. You intend to take action in the next month and have a definite plan in mind.
  4. Action: You actually modify your behavior, experiences, or environment in order to achieve self-change.
  5. Maintenance: This where you work to prevent relapse. Most people do not maintain their gains on their first attempt. With smoking, successful quitters made three to four attempts before they achieved long-term success. Most of us move through these stages in a spiral pattern. Typically we progress from contemplation to preparation to action to maintenance, and then relapse. During relapse, we often return to an earlier stage. However, each time we recycle, we learn from our mistakes and can try something different the next time around.

 

So this year if you really want to change, level with yourself and decide what stage you are at, then select some modest goal that can help you progress to the next stage.

 

For example, if you are still in the precontemplation stage, don’t try make some large impossible change. Instead commit to becoming more aware of the problem and how it affects you and your environment. Read about it, talk to others (friends, family and professionals), see films and try to fully experience and express your feelings regarding the issue.

If you are in the contemplation stage consider making a careful and comprehensive written cost-benefit analysis of the problem, listing all the pros and cons. Fully assess how and what you think and feel about the problem. What needs does it meet, are these needs still relevant, and are there other ways to meet them?

 

If you are in the preparation stage, this is the time for a resolution. Candid discussions with others, self- help groups, and counseling can help you decide and commit to a course of action in this stage.

 

Finally in the action and maintenance stages, you can benefit most from acquiring techniques to facilitate change, such as establishing self-rewards and learning how to relax or be more assertive. Developing alternatives for problem behaviors, finding sources of social support, and avoiding situations that lead to problem behaviors are other important strategies than you can learn more about through reading, counseling, or attending self-help groups.

 

So this year don’t set yourself up for failure. Know your readiness to change and strive to make those small achievable steps that lead to success.

 

by Terry L. Stawar, EdD
Based on a Column that appeared  in the Southern Indiana News Tribune

It Must Have Been Something I Ate

            The late Senator Daniel Patrick Moynihan, once said, “Everyone is entitled to his own opinion, but not his own facts.”  Of course, teasing out the difference between facts and opinions is a murky business at best. Residing between fact and opinion is the realm of the theory. A theory is a set of ideas that is intended to explain certain phenomena.  Milton Dawes from the Institute of General Semantics says, “We couldn’t stay alive without our ‘theories’. In a world where we don’t know all about anyone or anything, we have to have ‘theories’, whether we are aware of our ‘theorizing’ or not.”   

            Back in the 1950’s American psychologist George Kelly developed a theory of personality, called “the psychology of personal constructs”.  Kelly believed that humans are biologically programmed to establish some kind of order within their personal experience.  They do this by constantly creating and testing hypotheses. Kelley said,   “Every man is, in his own particular way, a scientist.”. Generally we try to improve the accuracy of our theories so that we can better predict what is going to happen to us. Many of our theories are unstated, because they were formed before we had the use of language.  

Kelley believed that in order to understand other people, one must learn their system of theories, especially the core ones, which are often difficult to change.  Our personal theories are usually about ourselves, other people, and the world in which we live.

A variety of cognitive biases and “lazy thinking” can result in erroneous theories. Cognitive biases are common, but maladaptive, ways of thinking that lead us to over or underestimate certain things. For example, people overestimate their ability to show restraint in the face of temptation and underestimate the influence or strength of their feelings. We also tend to overestimated the value of our own possessions, while underestimating the value of the possessions of other people. According to Harvard psychologist Dan Gilbert, “Lazy Thinking” is when we make judgments based upon an irrelevant, past experience a situation also referred to as a false equivalency.  

Dawes also has said, “In science, theories are put to the test – and they are eventually modified, updated, improved, abandoned…” As such most scientific theories become more accurate over time. According to Dawes, however, “in our everyday ’theorizing’, we seldom ‘think’ of putting our ‘theories’ to the test.”  When we are asked, “How do you know your theory is correct?” We get defensive, try to garner support from others, and work at convincing others of the accuracy of our theories.  We are very creative in using new factors to prove that we were right, rather than critically reassessing our theories.    

We are imperfect scientists and may cling to our pet theories, long after objective evidence would argue for a change. Dawes believes that we often don’t even see our theories as beliefs, but rather as facts. He says, “We live our lives according to, and guided by, our ‘theories’ and many of us would prefer to die, rather than review some of our more strongly held beliefs…”   

Holding theories about ourselves is how we try to make sense out of what we think, feel, and how we behave.  For example, we might believe that we’re acting irritated because we don’t feel well.  In turn we may also have a theory about why we don’t feel well. People create a lot of theories that dealing with health. Many of these notions are based on what we visualize is going on inside our bodies.  For example, when we get sick and run a fever, we might imagine that there is some sort of internal war being waged, with cowardly germs ambushing our heroic white blood cells. 

Gastro-intestinal  and circulatory problems may result in  colorful plumbing imagery completed with leaking  gaskets and stopped-up pipes  As for pain, we might visualize something akin to  old  television commercials.  The classic 1958 commercial for Anacin portrays headache pain as an annoyingly reverberating sound wave, depression as a pounding hammer, and jittery nerves as sparks from an electrical current.  I especially like the recent commercial for a fungicide that depicts the discomfort of Athlete’s Foot  as  flames shooting up between your toes.

Many of our idiosyncratic health theories have to do with eating. If we’re not feeling well,   our first thought is often, “It must have been something that I ate.”  From an evolutionary perspective this makes sense, since finding edible substances and avoiding food poisoning has  such high survival value.  We blame our diet for almost everything, from memory loss to insomnia.  When Ebenezer Scrooge, in  Dicken’s  A Christmas Carol , is  confronted with  Marley’s  ghost,  his  initial theory is diet-related. When Marley’s spirit asks Scrooge , “Why do you doubt your senses?” He replies,  “A slight disorder of the stomach makes them cheat. You may be an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato. There’s more of gravy than of grave about you..” All of  which is just  another way of saying, “It must have been something I ate.”

People also maintain a very large store of personal theories dealing with why other people behave the way they do.  When babies are cranky, for example, based on our experience, we may theorize that they are tired, hungry, or need to be changed.  Sometimes we generalize   from our own motives, making the common mistake of believing that other people are just like us.   More likely, however,  we see  the reasons for  own behavior in a more sympathetic  light,  while in our theories  about other people’s behavior, we may more readily attribute  undesirable motives to them, such as laziness, attention-seeking,  or self-centeredness.  Others often resent our theories and seldom respond positively,  especially if we disclose our theory saying something like, “Do you know what your problem is?”    

Finally, over the course of our lives we develop theories about how the world itself  works, from natural phenomena, such as the weather to man-made artifacts, such as  cars, appliances, and  electricity. These personal theories are important for our overall safety and comfort. Since we cannot see inside most things, we just have to imagine what the internal workings would look like.  For those of us with poor visualization skills, this can be quite difficult.

When electricity was first introduced in people’s homes,  I remember reading about folks who  were afraid  that the electricity would dribble out of the outlet and cost them a fortune– a nice  illustration of a personal theory based on a  false equivalency with the water supply.   

My own theory about how the internal combustion engine  works  comes mainly from  a cartoon  I saw  years ago, when I took   driver’s education in high school. These days I   don’t really believe that the air in the combustion chamber looks like a little fat man who gets squeezed,  when the engine compresses, but I do believe that cars are propelled by a series of tiny explosions and that the gasoline in the engine may resemble a small yellow flame with big eyes and a high squeaky voice.

 

Terry L. Stawar, Ed.D., lives in Georgetown and is the CEO of LifeSpring the local community mental health center in Jeffersonville. He can be reached at tstawar@lifespr.com. Checkout his Welcome to Planet-Terry blog and podcast at www.planetterry.wordpress.com.