One of our main activities at LCL is referring lawyers, law students, etc to see behavioral health professionals. In my blog of August 2010, I briefly described the history of efforts to achieve insurance coverage for mental health and addictions treatment that was roughly equivalent to coverage for physical conditions. Laws with this purpose have been known as “mental health parity” laws. [None of this pertains to the more recent health care reform package.]
A major improvement of the Massachusetts parity law of 2000 came in 2009, when alcohol/drug abuse/dependence, as well as eating disorders, PTSD, and autism, were added to the list of diagnoses for which coverage was mandated. These illnesses, like those already included (e.g., major depression, bipolar disorder, schizophrenia, panic disorder), were no longer subject to arbitrary maximums of treatments, and even less severe conditions had to be covered up to 24 outpatient visits a year.
Then, the new federal parity law was to take effect in 2010, apparently bringing all psychiatric diagnoses under the parity umbrella, and applying even to most self-insured plans (which had been excluded from the state law, along with MassHealth and Medicare).
But things have become murkier with the advent of 2010. Some or all of the federal law seemed to be on hold and awaiting feedback until July. And I have not found any finalized word in my own Googling efforts. However, I notice that at least some Massachusetts insurers who post benefit information on line are no longer providing information about treatment maximums (which may suggest that the maximums no longer apply).
The upshot is that the chances that your behavioral health treatment will be covered are probably enhanced with the convergence of the federal and Massachusetts parity laws. But certainly you should be prepared for exceptions, which include plans through employers with 50 or fewer employees, and insurers may still find a way to exclude some conditions. And don’t forget that, if you have an HMO (and even the rare PPO, such as the Harvard Pilgrim plan now available through the state’s GIC program), no services will be covered without pre-authorization. Through the process of pre-authorization, the managed care company will determine how much treatment is “medically necessary.” Even without maximum numbers of visits, the mere fact that you and your treatment provider believe that therapy/counseling is indicated does not mean that the insurer will agree that they should be paying for it.
Although coverage remains as uncertain and ambiguous as ever, the overall trend is toward improvement. And though I wanted you to be an informed consumer, aware of the pitfalls, I certainly do not want you to use these complexities as an excuse to avoid getting the help you need.
Monday, August 9, 2010
Monday, June 7, 2010
Unsolicited Advice to Lawyers with Associates
Since I joined the LCL staff in 1998, I have personally seen 2 or 3 lawyers a year who come in distressed, and often depressed, with regard to their role as associate in a law firm. In some cases, they function as sole underling to a seasoned veteran who has taken them into an otherwise solo or small practice. In other cases, they are making a big income with a giant and prestigious firm. In either situation, the associates that I see (who are, of course, self-selecting to come to LCL) are struggling to keep their heads above water.
They complain that they feel swamped with work demands, but ill-equipped to do a good job. The more senior attorneys to whom they answer are quick to point out the associates’ errors, but mostly unavailable to provide guidance. (In some cases, their “door is always open,” but on most given occasions they are too busy.) In a small practice, the associate is sometimes in the predicament of having to try to juggle many different kinds of cases at once, all of them with little previous experience, further reducing their chances of attaining mastery. They have little or no say about how they are to spend their time or how a case is to be addressed (i.e., the senior attorney expects that it will be handled just as s/he would have done). Many of these individuals were highly successful in law school and now feel much less competent, humbled if not humiliated.
Some of these associates blame the seemingly uncaring boss to whom they answer. Others blame themselves. Either way, as their mood declines, so does their productivity. They respond by working more hours. As their home lives or social lives deteriorate, their lives become less balanced and they are less able to function in a healthy way. Eventually, they either make it through this “rite of passage,” gradually master the needed skills, and re-achieve personal equilibrium, or they leave the firm. In some firms, large and small, the turnover rate is high.
From a psychologist’s point of view (and these thoughts are influenced by the writings of Dr. Martin Seligman, father of “positive psychology,” who has addressed himself to depression-promoting aspects of the lives of lawyers), if someone running a law firm wanted to keep the firm’s associate(s) happier and more productive, and to retain more of these newer lawyers for a longer period once they have learned the ropes, one might do some of the following:
• Provide actual mentoring, not just oversight. Take some time, even one uninterrupted hour a week, focused entirely on the associate’s questions, concerns, and ideas. The time you invest will likely pay for itself in the associate’s increased productivity, flowing not only from the concrete information and advice that you can provide, but also from his or her increased effort in response to sensing your support and interest.
• People are generally more productive (and happier) according to Seligman and others, not to mention common sense, when empowered to have a say in what they do (what he calls “decision latitude). That suggests that your associate will do better if there is some discussion about what s/he will do and how, and if the associate has a voice and choice in determining how their time will be spent. That is likely to include a chance to master certain kinds of tasks before plunging into others.
• Different associates are likely to have different strengths, based not only on past experience/learning but even more on personality and native talents. You can utilize a win-win strategy by noticing and capitalizing on their particular strengths, increasing their sense of efficacy and optimizing their contribution to the firm.
My sense is that such efforts will pay off in productivity, retention, interpersonal atmosphere, decreased conflict, etc. Meantime, LCL remains a consultative resource for those (at any level of the hierarchy) who find their work environments a source of stress and dysfunction.
They complain that they feel swamped with work demands, but ill-equipped to do a good job. The more senior attorneys to whom they answer are quick to point out the associates’ errors, but mostly unavailable to provide guidance. (In some cases, their “door is always open,” but on most given occasions they are too busy.) In a small practice, the associate is sometimes in the predicament of having to try to juggle many different kinds of cases at once, all of them with little previous experience, further reducing their chances of attaining mastery. They have little or no say about how they are to spend their time or how a case is to be addressed (i.e., the senior attorney expects that it will be handled just as s/he would have done). Many of these individuals were highly successful in law school and now feel much less competent, humbled if not humiliated.
Some of these associates blame the seemingly uncaring boss to whom they answer. Others blame themselves. Either way, as their mood declines, so does their productivity. They respond by working more hours. As their home lives or social lives deteriorate, their lives become less balanced and they are less able to function in a healthy way. Eventually, they either make it through this “rite of passage,” gradually master the needed skills, and re-achieve personal equilibrium, or they leave the firm. In some firms, large and small, the turnover rate is high.
From a psychologist’s point of view (and these thoughts are influenced by the writings of Dr. Martin Seligman, father of “positive psychology,” who has addressed himself to depression-promoting aspects of the lives of lawyers), if someone running a law firm wanted to keep the firm’s associate(s) happier and more productive, and to retain more of these newer lawyers for a longer period once they have learned the ropes, one might do some of the following:
• Provide actual mentoring, not just oversight. Take some time, even one uninterrupted hour a week, focused entirely on the associate’s questions, concerns, and ideas. The time you invest will likely pay for itself in the associate’s increased productivity, flowing not only from the concrete information and advice that you can provide, but also from his or her increased effort in response to sensing your support and interest.
• People are generally more productive (and happier) according to Seligman and others, not to mention common sense, when empowered to have a say in what they do (what he calls “decision latitude). That suggests that your associate will do better if there is some discussion about what s/he will do and how, and if the associate has a voice and choice in determining how their time will be spent. That is likely to include a chance to master certain kinds of tasks before plunging into others.
• Different associates are likely to have different strengths, based not only on past experience/learning but even more on personality and native talents. You can utilize a win-win strategy by noticing and capitalizing on their particular strengths, increasing their sense of efficacy and optimizing their contribution to the firm.
My sense is that such efforts will pay off in productivity, retention, interpersonal atmosphere, decreased conflict, etc. Meantime, LCL remains a consultative resource for those (at any level of the hierarchy) who find their work environments a source of stress and dysfunction.
Thursday, March 4, 2010
Integrity Among Lawyers (and Others)
[The following thoughts arose out of discussions of some of the struggles endured by members of the LCL Solo Practitioners Forum that I facilitate.]
There is no greater delight than to be conscious of sincerity on self-examination. (Mencius)
- A legal task took less time than you expected. Although ample funds are sitting in the client funds account, you bill only for time actually spent.
- A practice that is profitable but ultimately irresponsible has gained momentum in the law firm that employs you. To the extent that it is improper, responsibility for it is spread across the whole firm, including those in positions of greater power than yours. Despite that, and the fact that raising the issue may have a negative impact on how the partners view you, you speak up.
- You find yourself burning the midnight oil, putting an inordinate amount of effort and diligence into a family law case on behalf of a client who you know will probably never pay you; but you do it anyhow, even though you wish you’d never met this client.
- You find that you can board a Green Line train to work from a rear door by merely waving any card, and you watch others do so and take their seats. You bother to walk to the front of the train and pay the $2, by which time no seats are left.
- A fellow lawyer, you observe clearly by her behavior in his office and in court, is in rough shape, not firing on all cylinders. Though you hate to intrude into someone else’s business, you can see that she is on a path toward harming clients and her own career. You express your concern and offer to go with her to LCL for a confidential assessment, knowing full well that the suggestion may well elicit an angry, defensive reactio
Nothing is at last sacred but the integrity of your own mind. (Ralph Waldo Emerson)
Issues of integrity arise (whether or not consciously acknowledged) in all our lives every day – perhaps even more so in the lives of lawyers, who on the one hand sometimes find themselves representing the interests of the dishonest and vile, and on the other hand operate within an intricate foundation of laws that would seem to require an honorable respect in order to remain standing.
Fear of discovery, punishment, humiliation, etc. is, of course, a major help in making responsible choices in the face of all the short-term rewards of cheating. That’s a major raison d’être for institutions such as the auditing wing of the IRS, or the Office of Bar Counsel. But it has not stopped the Bernie Madoffs or Bernie Keriks of the world (no offense to people named Bernie), or those who ignored construction standards in the Big Dig, or those scientists and pharmaceutical companies who publish only studies supporting their (profitable) propositions and ignore contradictory evidence, or … well, you know all of this. And the fact that so many people, so much of the time, ignore social values and go for quick profit (even your personal trainer who demands to be paid in cash) makes it all too easy to rationalize doing the same.
But there is an upside to behaving ethically, responsibly, and maintaining personal integrity. You go about your life without fear of being “caught.” You do not carry the burden of guilt, or go to great lengths to escape awareness of that guilt. To the extent that “what goes around comes around,” you are ready for what comes around. Your friends and associates come to trust you, and with reason. Your knees don’t shake if you get a letter from the BBO (at least not as much as some other lawyers’ knees). If you believe that the purpose of life is to amass the most money or fame in the shortest time, you may be disappointed. But, as they say, you can look at yourself in the mirror. Your clients, coworkers, bosses, and friends may never notice, may never thank you. But inside, where it counts, integrity must be its own reward.
This above all; to thine own self be true. (William Shakespeare)
Saturday, January 30, 2010
The Many Demands of Solo Practice
The other day I was telling a colleague about the lives of the lawyers who attend our monthly Solo Practitioners Forum. In the process, he and I both realized that running a solo practice requires a surprisingly long list of skills. Some of them are:
· Legal/Intellectual – this goes without saying, and calls upon much of what you learned in law school and in subsequent reading and continuing education, but no one can know it all. A major problem arises when lawyers, not recognizing their limits, fail to ask for guidance from someone who knows more about a particular subject.
· Accounting – unless you have paid staff, you have to log your time spent, bill your clients, and keep track of where your accounts stand. I can’t tell you how many lawyers I have met who are months behind in billing. For some of them, it’s because they are uncomfortable asking for money, especially from clients they know are far from well off. (Naturally, this is easier when someone else asks on your behalf.) They may feel a degree of shame for billing for services that were, perhaps, not delivered in a timely fashion. Or they may just have a brain that is allergic to columns, rows, and figures.
· Marketing – there may have been a time when just being a competent lawyer would eventually create enough word-of-mouth referrals, but that is no longer enough. Aside from CPCS as a ready source of (low-paying) referrals, the solo practitioner must figure out ways to get business. For most, it’s uncomfortable and oh-so-avoidable to contact people asking them to send business your way, or, for example, to do public speaking or spend a bunch of money on ads.
· Interpersonal – a slew of interpersonal skills are required to know how to deal with a variety of clients with different personalities, not to mention legal adversaries, judges, clerks, etc. – each of whom calls for a different approach. It helps to be able to read body language, discern unspoken agendas or expectations, etc., and to consciously manage your own reactions to individuals who “press your buttons.” Some practices call for evolved skills in negotiation or persuasion. And some clients behave in ways that require diplomacy in the form of clear limit-setting so as to avoid burning out or losing your temper.
· Organizational – in order to make a living, any lawyer has to be relatively efficient and productive. Most clients would not care to pay for your hours spent in reverie, even if you are finding parallels between their case and your readings of Proust, never mind Facebook. So you need to schedule yourself, keep yourself motivated, keep on top of deadlines, and prioritize tasks by importance, urgency, etc. Those who work at law firms have others around, and to whom they answer, to notice if their noses veer from the grindstone, or if they are putting undue work into matters that don’t demand it, or if they are taking too long to get back to clients, but those in solo practice must be their own overseers.
I’m sure that there is much more, but it becomes obvious how many skills and tasks must be juggled in order to carry on a solo practice. In order to thrive, and stay out of trouble, it is important to be aware of how you are doing on each dimension – few people could be adept at all of these functions. Identifying real deficits in any of these areas calls for action, such as delegating some tasks or getting further training or coaching for yourself. Those who attend our Solo Practitioners Forum use the opportunity to clarify, vent, brainstorm, and seek solutions. But that group is not always the right option for the lawyers who come to us for assessment; sometimes the thing that helps most is a referral to, for example, an organizational coach, mentor, or counselor. We also frequently refer to the Law Office Management Assistance Program (LOMAP), which is funded by LCL. It makes sense for practitioners to make use of such resources when you realize just how demanding and multifaceted a job they face.
· Legal/Intellectual – this goes without saying, and calls upon much of what you learned in law school and in subsequent reading and continuing education, but no one can know it all. A major problem arises when lawyers, not recognizing their limits, fail to ask for guidance from someone who knows more about a particular subject.
· Accounting – unless you have paid staff, you have to log your time spent, bill your clients, and keep track of where your accounts stand. I can’t tell you how many lawyers I have met who are months behind in billing. For some of them, it’s because they are uncomfortable asking for money, especially from clients they know are far from well off. (Naturally, this is easier when someone else asks on your behalf.) They may feel a degree of shame for billing for services that were, perhaps, not delivered in a timely fashion. Or they may just have a brain that is allergic to columns, rows, and figures.
· Marketing – there may have been a time when just being a competent lawyer would eventually create enough word-of-mouth referrals, but that is no longer enough. Aside from CPCS as a ready source of (low-paying) referrals, the solo practitioner must figure out ways to get business. For most, it’s uncomfortable and oh-so-avoidable to contact people asking them to send business your way, or, for example, to do public speaking or spend a bunch of money on ads.
· Interpersonal – a slew of interpersonal skills are required to know how to deal with a variety of clients with different personalities, not to mention legal adversaries, judges, clerks, etc. – each of whom calls for a different approach. It helps to be able to read body language, discern unspoken agendas or expectations, etc., and to consciously manage your own reactions to individuals who “press your buttons.” Some practices call for evolved skills in negotiation or persuasion. And some clients behave in ways that require diplomacy in the form of clear limit-setting so as to avoid burning out or losing your temper.
· Organizational – in order to make a living, any lawyer has to be relatively efficient and productive. Most clients would not care to pay for your hours spent in reverie, even if you are finding parallels between their case and your readings of Proust, never mind Facebook. So you need to schedule yourself, keep yourself motivated, keep on top of deadlines, and prioritize tasks by importance, urgency, etc. Those who work at law firms have others around, and to whom they answer, to notice if their noses veer from the grindstone, or if they are putting undue work into matters that don’t demand it, or if they are taking too long to get back to clients, but those in solo practice must be their own overseers.
I’m sure that there is much more, but it becomes obvious how many skills and tasks must be juggled in order to carry on a solo practice. In order to thrive, and stay out of trouble, it is important to be aware of how you are doing on each dimension – few people could be adept at all of these functions. Identifying real deficits in any of these areas calls for action, such as delegating some tasks or getting further training or coaching for yourself. Those who attend our Solo Practitioners Forum use the opportunity to clarify, vent, brainstorm, and seek solutions. But that group is not always the right option for the lawyers who come to us for assessment; sometimes the thing that helps most is a referral to, for example, an organizational coach, mentor, or counselor. We also frequently refer to the Law Office Management Assistance Program (LOMAP), which is funded by LCL. It makes sense for practitioners to make use of such resources when you realize just how demanding and multifaceted a job they face.
Monday, January 4, 2010
Universal Coverage? Not Exactly
On occasion, the “universal” health coverage system initiated in Massachusetts during the Romney administration and sustained in the Patrick years has been pointed to as a model of what might be accomplished on a national scale. As the various kinds of “public options” seem to be fading away, it looks even more similar – adding a requirement for all citizens to arrange coverage, without any substantial renovation in the system (e.g., there is clearly no appetite for adopting the kinds of systems found in most other countries, even though many of them reportedly offer better care at much lower expense). It is quite understandable that the idea of losing our familiar forms of medical coverage triggers anxiety in most of us. The Massachusetts plan does have a kind of “public option,” but it has not made coverage truly universal. The problem, and I am not claiming to have the answer on its solution, is that many citizens, having no way to pay for the mandated coverage, continue to go without it. [Let me be clear that I am taking no political side here, since there are clearly drawbacks in any approach that has been proposed – my concern is strictly for those who need care that they cannot get.]
Personally, I was very pleased when the Massachusetts plan came along, because I had been able to present few treatment options to lawyers who came to LCL (or others who consulted with me elsewhere) in need of therapy or medication but with no means to pay for it. Publically subsidized clinics and mental health centers had long since become unable to offer truly low-cost services (probably since the end of the Dukakis administration), so the main option remaining was to refer people to community-oriented hospitals drawing upon a statewide “free care pool.”
Little did I suspect that I would be faced with a significantly larger number of uninsured lawyers after the advent of “universal” coverage here in the Bay State – and virtually nowhere to send them (since the free care pool subsequently diminished or disappeared).
I don’t think that the advent of expanded coverage itself could have caused an increase in numbers of uninsured middle class citizens – that must be a reflection of the economy – and I’m sure it has reduced the number of uninsured citizens in dire poverty. [I don’t have evidence that the trend toward more uninsured even extends beyond lawyers who come to LCL, but there was no mistaking it among those I saw there.] Aside from imposing state income tax penalties on those without coverage, the new Massachusetts plan brought about two main changes in coverage options: (1) private insurers began making some more affordable plans directly available to consumers and (2) the state began offering its Medicaid plan, MassHealth, to a significantly expanded group of residents, under the name of Commonwealth Care.
But consider the case of an LCL client (or other citizen) with a spouse, 2 kids, and a combined family income of $70,000. The private insurers have developed stripped down plans, with less extensive coverage resulting in lower premiums for young adults -but not much lower for those who have reached middle age. So, what about the public option, Commonwealth Care? In order to qualify for Commonwealth Care (the application is somewhat cumbersome and processing takes well over a month), your income must be less than 300% of Federal Poverty Guidelines. For our hypothetical lawyer/consumer with a household of 4, that means under $66,168 – and he will still have to pay about $1200 a year in premiums. In order to get the least comprehensive plan and not pay premiums, the annual family (of 4) income would have to be under $33,084. An individual (family of one) would have to make less than $16,260 to receive fully subsidized coverage. (That individual can get Commonwealth Care with an income of under $33,084, but would be paying premiums.) Of course, just like private insurance, the plan also requires co-pays for office visits and prescription drugs (with an annual cap on out-of-pocket expenses).
Thus, more than one lawyer seeing me at LCL has demonstrated that, since s/he makes too much money to qualify for Commonwealth Care, there is no way to afford health insurance without giving up, say, food, the house, or the car. They can better afford the tax penalty. Certainly, hospitals will not throw them out on the street if they require emergency care. But for less urgent services, and certainly for most LCL referrals, consumers are on their own – “free care” is apparently difficult or impossible to come by. As the state’s coffers empty, the capacity to subsidize coverage may further erode. At LCL, we do what we can to help, but too often it is simply not possible to arrange the kind of treatment to which we would refer any of our insured clients. This may be the best that can be realistically expected in this place and time, but it is not “universal” care.
If you live in Massachusetts and currently lack health insurance, here is how to find out what you’re eligible for: Get on the internet (at the library if you don’t have it at home), and go to www.mahealthconnector.org. Click “Individuals and Families” or “Young Adults,” whichever applies, fill in the requested information (e.g., family size, income), and you will be led to either the opportunity to apply for Commonwealth Care or to a selection of private health plans, with information on their costs and benefits. If you are still left in the cold…. Well, let’s see what happens on a nationwide level…….
Personally, I was very pleased when the Massachusetts plan came along, because I had been able to present few treatment options to lawyers who came to LCL (or others who consulted with me elsewhere) in need of therapy or medication but with no means to pay for it. Publically subsidized clinics and mental health centers had long since become unable to offer truly low-cost services (probably since the end of the Dukakis administration), so the main option remaining was to refer people to community-oriented hospitals drawing upon a statewide “free care pool.”
Little did I suspect that I would be faced with a significantly larger number of uninsured lawyers after the advent of “universal” coverage here in the Bay State – and virtually nowhere to send them (since the free care pool subsequently diminished or disappeared).
I don’t think that the advent of expanded coverage itself could have caused an increase in numbers of uninsured middle class citizens – that must be a reflection of the economy – and I’m sure it has reduced the number of uninsured citizens in dire poverty. [I don’t have evidence that the trend toward more uninsured even extends beyond lawyers who come to LCL, but there was no mistaking it among those I saw there.] Aside from imposing state income tax penalties on those without coverage, the new Massachusetts plan brought about two main changes in coverage options: (1) private insurers began making some more affordable plans directly available to consumers and (2) the state began offering its Medicaid plan, MassHealth, to a significantly expanded group of residents, under the name of Commonwealth Care.
But consider the case of an LCL client (or other citizen) with a spouse, 2 kids, and a combined family income of $70,000. The private insurers have developed stripped down plans, with less extensive coverage resulting in lower premiums for young adults -but not much lower for those who have reached middle age. So, what about the public option, Commonwealth Care? In order to qualify for Commonwealth Care (the application is somewhat cumbersome and processing takes well over a month), your income must be less than 300% of Federal Poverty Guidelines. For our hypothetical lawyer/consumer with a household of 4, that means under $66,168 – and he will still have to pay about $1200 a year in premiums. In order to get the least comprehensive plan and not pay premiums, the annual family (of 4) income would have to be under $33,084. An individual (family of one) would have to make less than $16,260 to receive fully subsidized coverage. (That individual can get Commonwealth Care with an income of under $33,084, but would be paying premiums.) Of course, just like private insurance, the plan also requires co-pays for office visits and prescription drugs (with an annual cap on out-of-pocket expenses).
Thus, more than one lawyer seeing me at LCL has demonstrated that, since s/he makes too much money to qualify for Commonwealth Care, there is no way to afford health insurance without giving up, say, food, the house, or the car. They can better afford the tax penalty. Certainly, hospitals will not throw them out on the street if they require emergency care. But for less urgent services, and certainly for most LCL referrals, consumers are on their own – “free care” is apparently difficult or impossible to come by. As the state’s coffers empty, the capacity to subsidize coverage may further erode. At LCL, we do what we can to help, but too often it is simply not possible to arrange the kind of treatment to which we would refer any of our insured clients. This may be the best that can be realistically expected in this place and time, but it is not “universal” care.
If you live in Massachusetts and currently lack health insurance, here is how to find out what you’re eligible for: Get on the internet (at the library if you don’t have it at home), and go to www.mahealthconnector.org. Click “Individuals and Families” or “Young Adults,” whichever applies, fill in the requested information (e.g., family size, income), and you will be led to either the opportunity to apply for Commonwealth Care or to a selection of private health plans, with information on their costs and benefits. If you are still left in the cold…. Well, let’s see what happens on a nationwide level…….
Friday, December 11, 2009
Taking on Depression: The Bottom Line: No Laughing Matter
The need to make a change in order to overcome depression has been the theme of this series. The mind, heart/feelings, and body are the 3-in-1, highly reciprocal triumvirate of the human personality. Change the mind, and the emotions and body respond. Change the body, and the mind and emotions respond. Change the feelings, and the body and mind respond. Therefore, when it comes to depression, there may be a variety of access points to begin to leverage change.
If you are someone who struggles with mild to moderate depression, you may find the strategies described in this series very useful, enlightening, and effective. If you have a persistent moderate depression, and experience difficulty implementing and/or benefitting from these approaches, you should consider “hiring” a good therapist to help you support and focus your efforts to change. In some cases, the use of medication for a period of time can help you get some traction to the point that self-reinforcing behaviors begin to “take,” and for many the need for medication diminishes.
Depression is no laughing matter and should be addressed as early as possible, preventing a more severe decline in mood. A long-standing, severe and entrenched depression is often best addressed as a medical problem, and anti-depressant medication is often necessary, perhaps for an extended period. In such cases, symptom reduction via medication can make it possible to make better use of psychotherapy to address deeper needs, wounds, beliefs, and losses.
Fundamental to these deeper sources of depression are troublesome undercurrent human emotions such as fear and anger. When, despite the discomfort associated with them, fear and anger are consciously experienced and acknowledged, i.e., when you “own” them, as some say, they have less power over you, and offer useful information about your personal experience. You are then able to respond, rather than react, with constructive, responsible, decision-making concerning the situations/conditions that evoked them. In so doing, you are no longer victim; you reclaim and exercise your power.
One of the issues to be addressed in psychotherapy may be what I call an unconscious commitment to depression. Sufferers of long-term depression may be quite aware that they are depressed, may even be quite aware of many of the root causes, but they may be quite unaware that their depression has become a part of their identity, that they are unwittingly clinging to it, trapped by their grief, and by their vulnerabilities and fears of a fuller engagement in life with all its surprises, disappointments, and responsibilities. When this is the case, they may refer to their depression as “my depression,” see themselves as defined by their depression, and anticipate feeling quite lost without it. They may doubt their capacity to even imagine feeling truly good, truly alive. No wonder depression can be, for some, so insidious and tenacious!
Depression can have an insidious affect on loved ones as well, as the sufferer of long-term depression may also unwittingly hold and subtly communicate an expectation that others understand and be complicit with their limitations. However, for others to take responsibility for, or somehow participate in the depression, only serves to generate guilt and resentments that tend to feed and “spread” the depression. The challenge for family members and friends is to offer compassionate acceptance and support without infantilizing or buying into the loved one’s incapacitation, and to insist that the depressed person obtain treatment. To curtail their own enjoyment of life in any way, or succumb to guilt for being happy or having fun when their loved one may be miserable is a type of co-dependent behavior that serves no one, especially not the depressed person. It is therefore important that family and friends take care of themselves and allow themselves as full a ration of fun and enjoyment as possible.
There ought to be no shame in suffering from depression, and no stigma for seeking help. Depression is part of the human experience, and severe depression is now recognized as a treatable medical condition. Combination therapy that may include medication, psychotherapy, and use of techniques such as those offered in this series are generally quite successful and offer the participant valid hope for change and the prospect of becoming more happily and gratefully engaged again in life.
When you take on depression, you are taking on a challenge; the longer and deeper the depression, the greater the challenge. Whether you struggle with a low grade, a moderate, or a severe depression, you can overcome it with persistence, determination and patience. Strive for progress, slow steady progress, and take it one day at a time, employing at least one strategy every day, starting as early in the day as possible. Keeping it in the day, so to speak, can help free you from the failures or regrets of the past (and we all have them) and protects you from anxieties about the future.
For many, overcoming depression, whether accomplished through self-help strategies or with professional help, is a learning, letting go, and self-acceptance process: learning how to be happy, letting go of (or becoming reconciled with) those conditions or parts of yourself that have held you back, and embracing yourself with compassion and humor.
If you are someone who struggles with mild to moderate depression, you may find the strategies described in this series very useful, enlightening, and effective. If you have a persistent moderate depression, and experience difficulty implementing and/or benefitting from these approaches, you should consider “hiring” a good therapist to help you support and focus your efforts to change. In some cases, the use of medication for a period of time can help you get some traction to the point that self-reinforcing behaviors begin to “take,” and for many the need for medication diminishes.
Depression is no laughing matter and should be addressed as early as possible, preventing a more severe decline in mood. A long-standing, severe and entrenched depression is often best addressed as a medical problem, and anti-depressant medication is often necessary, perhaps for an extended period. In such cases, symptom reduction via medication can make it possible to make better use of psychotherapy to address deeper needs, wounds, beliefs, and losses.
Fundamental to these deeper sources of depression are troublesome undercurrent human emotions such as fear and anger. When, despite the discomfort associated with them, fear and anger are consciously experienced and acknowledged, i.e., when you “own” them, as some say, they have less power over you, and offer useful information about your personal experience. You are then able to respond, rather than react, with constructive, responsible, decision-making concerning the situations/conditions that evoked them. In so doing, you are no longer victim; you reclaim and exercise your power.
One of the issues to be addressed in psychotherapy may be what I call an unconscious commitment to depression. Sufferers of long-term depression may be quite aware that they are depressed, may even be quite aware of many of the root causes, but they may be quite unaware that their depression has become a part of their identity, that they are unwittingly clinging to it, trapped by their grief, and by their vulnerabilities and fears of a fuller engagement in life with all its surprises, disappointments, and responsibilities. When this is the case, they may refer to their depression as “my depression,” see themselves as defined by their depression, and anticipate feeling quite lost without it. They may doubt their capacity to even imagine feeling truly good, truly alive. No wonder depression can be, for some, so insidious and tenacious!
Depression can have an insidious affect on loved ones as well, as the sufferer of long-term depression may also unwittingly hold and subtly communicate an expectation that others understand and be complicit with their limitations. However, for others to take responsibility for, or somehow participate in the depression, only serves to generate guilt and resentments that tend to feed and “spread” the depression. The challenge for family members and friends is to offer compassionate acceptance and support without infantilizing or buying into the loved one’s incapacitation, and to insist that the depressed person obtain treatment. To curtail their own enjoyment of life in any way, or succumb to guilt for being happy or having fun when their loved one may be miserable is a type of co-dependent behavior that serves no one, especially not the depressed person. It is therefore important that family and friends take care of themselves and allow themselves as full a ration of fun and enjoyment as possible.
There ought to be no shame in suffering from depression, and no stigma for seeking help. Depression is part of the human experience, and severe depression is now recognized as a treatable medical condition. Combination therapy that may include medication, psychotherapy, and use of techniques such as those offered in this series are generally quite successful and offer the participant valid hope for change and the prospect of becoming more happily and gratefully engaged again in life.
When you take on depression, you are taking on a challenge; the longer and deeper the depression, the greater the challenge. Whether you struggle with a low grade, a moderate, or a severe depression, you can overcome it with persistence, determination and patience. Strive for progress, slow steady progress, and take it one day at a time, employing at least one strategy every day, starting as early in the day as possible. Keeping it in the day, so to speak, can help free you from the failures or regrets of the past (and we all have them) and protects you from anxieties about the future.
For many, overcoming depression, whether accomplished through self-help strategies or with professional help, is a learning, letting go, and self-acceptance process: learning how to be happy, letting go of (or becoming reconciled with) those conditions or parts of yourself that have held you back, and embracing yourself with compassion and humor.
Thursday, November 19, 2009
Taking On Depression: Part 5: Body Language
Just as you can change the focus of your thoughts (the content of your mind) in order to change your mood, you can also elevate your mood by doing a variety of things with/for your body. The most immediate change you can make may simply be your posture. Most of us prepare ourselves for our reflection in a mirror by making little adjustments before we look. But I dare you to take a candid look at yourself in a full length mirror. What do you see? Do you need to tuck in your tush and your tummy, straighten your back, lift your chest and relax your shoulders, tuck in your chin? Having done so, do you feel even a bit more self-possessed? More dignified? If this is not your usual, commit yourself to making it so, and every time you become aware that you are slumping or slouching, tidy it up. You’ll look better and feel better.
How about your face? Many of us are surprised by what we see when we’re caught by surprise in a mirror. We may see a furrowed brow, grim mouth, tense jaw, protruding chin, or other signs of tension. Many of us do store tension in our faces, so while you’re correcting your posture, put on a happy face, or at least release the tightness around your eyes, your brow, your nose and cheeks, your jaw and mouth. If you’re not smiling at this moment, think a pleasant thought and smile. The way you now feel is your proof that even smiling to yourself can shift your mood. You can give yourself the further enjoyment of smiling at others, including strangers, and watching their mood shift along with yours.
Then there’s the matter of exercise. Everyone knows about endorphins, the body’s natural mood enhancers, which are produced by aerobic exercise. You may know from your own experience that regular exercise is energizing and boosts self-esteem right along with the immune system and general fitness. The endorphins help lift mood, and so does exercising the self-discipline to do something you know is good for you. If you exercise with gratitude for a body that is able to exercise, regardless of your level of fitness, and further, do so mindfully and respectful of your limitations, you ramp up the benefit even further.
So, even simple things that you can do with and for your body can improve your mood. Anthony Robbins, the hugely successful motivational speaker acquired his material from exhaustive research as well as from his own experience overcoming major depression. One self-observation he made is somewhat similar to the “fake-it-‘til-you-make-it” strategy, or acting “as if.” At a time when he saw himself as an utter failure, he realized he immediately felt better by simply carrying and presenting himself as he would if he felt great about himself, i.e., by carrying himself straight and tall, by looking others in the eye, smiling and showing some interest in them, all actions that typically elicited positively reinforcing responses. By taking a shower, donning clean and self-respecting attire, shaving and combing his hair, correcting his posture, and being willing to smile, he came to realize how much power he could exercise over his own life and sense of well-being.
For him, this was the beginning of his implementation of a daily routine of deciding and visualizing what he wanted for that day, including what he wanted to accomplish, how he wanted to interact with others, the attitude and mood he wanted to carry, and how he wanted to respond to annoyances and frustrations. This harkens back to the previous blog addressing what you want. It is obviously helpful, therefore, to engage the mind in a manner that supports what you are doing. So, if you find yourself thinking, “That may work for some people, but not for me,” then transform that thought to something like, “If it works for others, it will certainly work for me, too.”
Any discussion of caring for your body is incomplete without talking about “fuel.” It is common knowledge that a balanced diet low in sugar and fat is good for the brain and body and that both diet and exercise are critical to health maintenance and longevity. We all know the difference between good nutrition and junk food; we’ve been hearing the data and the warnings for years, decades really. You need not be a purist. I, for one, am a believer in the benefit of my daily dose of chocolate (rarely just one square). And I consider a slight excess of carbs to be one source of soul food. But without good nutrition, the amazingly adaptable and most forgiving body will begin to cause you problems and expense far greater than that of providing yourself good nutrition. Yes, it does take effort to budget the necessary time and money, but doing so is, again, self-empowering and helps lift and maintain a good mood.
Well, you may say, I can manage all these things quite comfortably when I’m not depressed. When I’m depressed, it’s more of a struggle to motivate myself and may even feel impossible. It is true that it may feel impossible, but it is not true that it is impossible. It may help to remember that you don’t have to do everything all at once. You can start by just doing one thing, even one very small thing, until it becomes routine, and then add another action. Do not permit yourself to be seduced by the feeling, but stay focused on what you want and what you are going to do, and then put yourself in motion. And don’t indulge in discouragement if results are not stellar at first. Persist and you will get your results.
Think about this: what impression would you like to create in the mind of someone meeting you for the 1st time, or even for the 1st time today? What do you want the “take away” to be from your encounter with another person today? Do you want it to be productive, useful, pleasant, fun? Do you want to relax and enjoy it and for both of you to walk away from it feeling at least generally positive? Imagine yourself engaged in such an encounter and then play it out in your interactions. If you can imagine it, you can do it, however much practice it may take. If you fear that making changes such as those suggested here will be too “out of character,” too noticeable to others, or evoke comments or compliments, don’t be deterred. In response, you can just smile mysteriously and say that you’re conducting a scientific study.
For some who are battling depression, the thought of having to make such an effort indefinitely may be overwhelming. Do it just for today. “Yesterday’s gone, tomorrow’s but a dream.” Commit to doing something just for today. Changing your behavior, i.e., your posture, your face, your care of your body, your energy, in some small way may produce an initially imperceptible difference, but the momentum builds. The long term results of persistent small changes can be huge.
How about your face? Many of us are surprised by what we see when we’re caught by surprise in a mirror. We may see a furrowed brow, grim mouth, tense jaw, protruding chin, or other signs of tension. Many of us do store tension in our faces, so while you’re correcting your posture, put on a happy face, or at least release the tightness around your eyes, your brow, your nose and cheeks, your jaw and mouth. If you’re not smiling at this moment, think a pleasant thought and smile. The way you now feel is your proof that even smiling to yourself can shift your mood. You can give yourself the further enjoyment of smiling at others, including strangers, and watching their mood shift along with yours.
Then there’s the matter of exercise. Everyone knows about endorphins, the body’s natural mood enhancers, which are produced by aerobic exercise. You may know from your own experience that regular exercise is energizing and boosts self-esteem right along with the immune system and general fitness. The endorphins help lift mood, and so does exercising the self-discipline to do something you know is good for you. If you exercise with gratitude for a body that is able to exercise, regardless of your level of fitness, and further, do so mindfully and respectful of your limitations, you ramp up the benefit even further.
So, even simple things that you can do with and for your body can improve your mood. Anthony Robbins, the hugely successful motivational speaker acquired his material from exhaustive research as well as from his own experience overcoming major depression. One self-observation he made is somewhat similar to the “fake-it-‘til-you-make-it” strategy, or acting “as if.” At a time when he saw himself as an utter failure, he realized he immediately felt better by simply carrying and presenting himself as he would if he felt great about himself, i.e., by carrying himself straight and tall, by looking others in the eye, smiling and showing some interest in them, all actions that typically elicited positively reinforcing responses. By taking a shower, donning clean and self-respecting attire, shaving and combing his hair, correcting his posture, and being willing to smile, he came to realize how much power he could exercise over his own life and sense of well-being.
For him, this was the beginning of his implementation of a daily routine of deciding and visualizing what he wanted for that day, including what he wanted to accomplish, how he wanted to interact with others, the attitude and mood he wanted to carry, and how he wanted to respond to annoyances and frustrations. This harkens back to the previous blog addressing what you want. It is obviously helpful, therefore, to engage the mind in a manner that supports what you are doing. So, if you find yourself thinking, “That may work for some people, but not for me,” then transform that thought to something like, “If it works for others, it will certainly work for me, too.”
Any discussion of caring for your body is incomplete without talking about “fuel.” It is common knowledge that a balanced diet low in sugar and fat is good for the brain and body and that both diet and exercise are critical to health maintenance and longevity. We all know the difference between good nutrition and junk food; we’ve been hearing the data and the warnings for years, decades really. You need not be a purist. I, for one, am a believer in the benefit of my daily dose of chocolate (rarely just one square). And I consider a slight excess of carbs to be one source of soul food. But without good nutrition, the amazingly adaptable and most forgiving body will begin to cause you problems and expense far greater than that of providing yourself good nutrition. Yes, it does take effort to budget the necessary time and money, but doing so is, again, self-empowering and helps lift and maintain a good mood.
Well, you may say, I can manage all these things quite comfortably when I’m not depressed. When I’m depressed, it’s more of a struggle to motivate myself and may even feel impossible. It is true that it may feel impossible, but it is not true that it is impossible. It may help to remember that you don’t have to do everything all at once. You can start by just doing one thing, even one very small thing, until it becomes routine, and then add another action. Do not permit yourself to be seduced by the feeling, but stay focused on what you want and what you are going to do, and then put yourself in motion. And don’t indulge in discouragement if results are not stellar at first. Persist and you will get your results.
Think about this: what impression would you like to create in the mind of someone meeting you for the 1st time, or even for the 1st time today? What do you want the “take away” to be from your encounter with another person today? Do you want it to be productive, useful, pleasant, fun? Do you want to relax and enjoy it and for both of you to walk away from it feeling at least generally positive? Imagine yourself engaged in such an encounter and then play it out in your interactions. If you can imagine it, you can do it, however much practice it may take. If you fear that making changes such as those suggested here will be too “out of character,” too noticeable to others, or evoke comments or compliments, don’t be deterred. In response, you can just smile mysteriously and say that you’re conducting a scientific study.
For some who are battling depression, the thought of having to make such an effort indefinitely may be overwhelming. Do it just for today. “Yesterday’s gone, tomorrow’s but a dream.” Commit to doing something just for today. Changing your behavior, i.e., your posture, your face, your care of your body, your energy, in some small way may produce an initially imperceptible difference, but the momentum builds. The long term results of persistent small changes can be huge.
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