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Barriers to Mental Health Treatment

Friday, December 13th, 2013

Recently I was asked, “It’s obvious that all of us are touched by mental illness – in ourselves, our families, or people we know. Why don’t we all demand that mental illness be funded for treatment just like biological illness?”

My clients have been speaking to this for decades – why didn’t they seek out treatment, demand treatment coverage from their health insurance company, demand their workplace purchase insurance that covered mental health treatment?

Their comments go in many different directions. First, some barriers expressed in my office by individuals that have opinions (but not enough information) about mental illness:

Mental illness is actually a moral issue: “I was angered that the pastor in church preached for gun control after recent rampage shooting ‘rather than for family values, as the Pope just did, which would have prevented that shooting.’

Mental illness is actually a financial issue: “(I am resentful) that mental health parity law now demands coverage of mental health illnesses ‘because that comes directly out of my profit margin’ to my employees.

Mental illness is actually a religious failing: “(family member) doesn’t need counseling – she needs Jesus!”

Then there are the barriers of ‘scale.’ There isn’t a “we” to demand that mental health treatment be funded. There are small fragmented coalitions or individuals that speak out, but no powerful lobbyists.

Next we have structural legal and profit barriers. Mental health treatment fees paid to service providers were set in 1989 when “managed care” health laws were passed. These fees REMAIN IN PLACE and have not risen due to inflation or competition, from which health insurance law exempted companies in 1947. That means your psychotherapist (counselor, social worker, psychologist, psychiatrist) has not has a raise in salary in twenty-four years. According to the Bureau of Labor and Statistics[i] that $60 per hour fee set in 1989 now has the buying power of $31.86.

And a paper from 2010 [ii], if accurate, cites an important structural legal loophole for insurance companies. Quote:

“In mental health, there is a double layer of administration and profit—after 20% of premium dollars are used for administration and profit, the remaining mental health funds are transferred to a MBHC [managed behavioral health care] entity. Some of these are independent entities, and some are subsidiaries of their insurance company. All of the funds transferred to the MBHC are recorded as a medical expense, but in reality, these are profit-making entities with large administrative expenses. The administration and profit of MBHC entities is hidden from the publicly reported medical loss ratios.”

It appears that significant money intended for mental health treatment is ‘siphoned off’ to administrative costs and to profit the insurance company.

There are other barriers. Again, quoting my clients:

Social norms: In many urban and rural neighborhoods, mental illness is a social norm: “we didn’t think much of it, all the husbands in the neighborhood beat their wives and kids”.

Shame: “I was ashamed of my thoughts, feelings, behaviors about being mentally ill. It was just so humiliating to be unable to get out of bed and function like everyone else.”

Fear: “Everyone in the neighborhood feared his father, who was alternately nice and then really enraged. No one would deal with him”

Political ideologies: “I have the right to (own unlimited firearms, raise my children as I will, treat my neighbors with disdain).”

Social ideologies: “Those addicted to drugs should be locked into prisons for extended periods of time.”

Psychophobia: A term I have coined to express the blanket rejection of the psychological, the inner life, the observable facts of repeated behavior-emotion-cognition and their consequences. When a President of the United States faced a crisis regarding infidelity, whom did he call? Tony Robbins, an untrained, unlicensed motivational speaker. In wide circles outside of urban and rural American cities, it’s easy to find a man like I did in Montana. He asked me, ‘what do you do for a living?’ “Psychotherapy,” I answered. His face froze in a rage as he barked out the question-accusation, “… PSYCHO????……” I changed the topic to how the trout fishing was that day for him on the Yellowstone River.

What can be done? These barriers can be addressed, through public health education and political change, one at a time.

A simple law could be passed with these effects:

  • cut the extra-profitability away from managed care institutions and push those funds to the treatment of the insured
  • allow the insured citizen to hire any licensed behavioral health professional as their psychotherapist (i.e. to go “out of their panel” of contracted providers), by combining their insurance coverage and their own financial resources
  • provide for a vast educational effort, not unlike for obesity or smoking or rape other proven tragic health problems in America, to bring the American public current, empirical information about mental health, its forms and its treatments
  • prohibit price fixing and collusion among health insurance companies in setting fees for mental health treatment
  • mandate that ‘up front deductibles’ (where the insured has to pay a lump sum first before their coverage for therapy begins) be declared illegal

Carlton F. “Perk” Clark is a licensed clinical social worker, practicing psychotherapy and organizational development in Tucson since 1975. Feedback: perkclark@yahoo.com

# # #

  1. [i] Bureau of Labor and Statistics, retrieved August 13, 2013 from http://www.bls.gov/data/inflation_calculator.htm
  2. [ii] Miller, I. (2010) Underfunding Mental Health Services—Disparity 2.0: Isn’t It Time for Real Reform? Retrieved August 12, 2013, from www.ivanjmiller.com/disparity_action.html.

Self Awareness

Monday, December 2nd, 2013

The town doctor in The Plague by Albert Camus defines the good man as he ‘who has the fewest lapses of attention’. Maurice Nicoll, PhD states in his six-volume series on The Psychological Commentaries on the Teaching of Gurdjieff and Ouspensky that ‘it all begins with self-awareness.’

If you are considering meeting with a psychological professional (psychotherapist, counselor, etc.) it will benefit you to understand that you are not ‘going to the dentist.’

At the dentist, you relax, sit back, PASSIVELY engage the treatment, and pay for your visit. The pain, we hope, is soon gone.

At these psychological types of meetings however, you will be asked to ACTIVELY engage in the treatment (and pay for your visit). The pain will continue and you will wonder when the ‘dentist’ will make it go away. But your active engagement is the crucial first-step to your gaining the strength that you are seeking.

Your active practice of self-observation is crucial to your research on your painful experiences and increasing your psychological skills. You must learn to begin working with the pain-creating activities that you bring with you. And your first tool in working with that is “self-observation.”

Yes, I know: “I am self-aware at all times and have free will” you would tell me. But there are a series of experiments that you will be asked to carry out, and in these experiments you will be able to test that self-assessment, under real-world conditions, to see just how persistent your awareness is and what you can do with it.

Just today I challenged a client with me to notice how he was drinking from his water bottle (which hand, etc.) here in the office. I urged him to be repeatedly aware of that small act here in the next hour and to change the pattern of drinking in just any small way every time he did it. He agreed.

Predictably (in my experience) he forgot the challenge about five minutes later and drank in his characteristic way for some time. Later I brought this to his attention and he laughed, recognizing that he’d ‘forgotten himself,’ was unaware of that which he was to be watching for, did the behavior in a fully conditioned and unaware way, as he always has.

Whether you and your therapist are studying thoughts, emotions, behavior, core beliefs, deep personal history, organizational behavior or the larger world, it is crucial that you understand the role you must actively play in this project. Without your commitment to repeatedly practicing self-observation, you’ll miss out on a thousand moments that can aid your progress and help build the strength that you are seeking. This isn’t something that the therapeutic person can do for you: you can’t purchase this from a weekend seminar or from a self-help book, or from all the prayers that you repeat. And it isn’t ‘navel gazing’ or ‘narcissism’ or ‘egotistical’ – in fact it is a corrective for all those.

You begin by making this commitment to repeatedly observe yourself without judgment or criticism or guidance or changing anything.  You start with just body posture and sensations, and then gradually expand to thoughts, emotions, reactions to others. You’ll be astonished at how much of you is conditioned, mechanical, un-free, predictable, habituated, manifested without choice or awareness. Some of that mechanical nature is wonderful: you remember how to drive the car without having to relearn it.

Some of that conditioned behavior is horrific.  It ruins marriages and children and organizations and sleep and friendships and nation-states.

And you can begin to do something about all that — if you are willing to practice ‘being the person with the fewest lapses of attention.’

 

 

 

Emotional Support: Seven Skills

Monday, December 2nd, 2013

Often I’m working with a man whose partner complains that he is not “emotionally supportive.” This complaint has very little meaning to him, and his critic is commonly unable to define it, much less demonstrate it.

This is essentially what I present to these men and women, and in this sequence:

Emotions are physical events, must be observed first in the body:  sensed, identified, and named simply in one of the seven classic emotional words:  angry, sadness, enjoyment, love, surprise, disgust, shame. [1] They are organic physical “events,” not things. Emotions as events must be ‘worked with, explored, tolerated, shaped, expressed, contained, experienced, accepted, metabolized.’  They cannot be ‘let go, gotten-past, dropped’ as can material things.

Thus skill one is to be practicing self-observation episodically during your day, and night. This involves literally turning your attention to your own posture, tone of voice, reactions, thoughts and emotions in an aware non-critical way. Doing this, one suddenly notices ‘an emotion is in me now, driving certain thoughts, reactions.’   (Example: an emotion of fear and the thought ‘that dark spot looks like a mountain lion!’)

Skill two is to assume that you long-ago learned styles of responding to your own emotions and thoughts: ignore and suppress them? deny and pretend a composed state? Ignore your experience and tend to the other’s needs?  blast your feelings out quickly into the universe? This is learning (conditioning, training) that takes place in childhood, the location of our earliest emotions and thoughts and the significant others that respond (or not) to us.

Skill three is to observe the impact and the limitations of that conditioning – back there in childhood, and here now, in a more grown up life. In your adult present, real-time events are demonstrating how you react when your emotions arise, or emotions from some other human arise.

Skill four involves practicing, by trial and error, how to both support and deny yourself the skill of expressing what you feel when you feel it.

The first step of skill four starts by REVERSING the pervasive blaming talk in the street that “you piss me off,” “I feel abused,” “l feel disrespected.” Blaming, personal or political or international, is crippling us.

Language that takes ownership for what I feel simply describes who I am and what I want.  It takes lots of practice to say, ‘This is frustrating for me – could we focus on just one part of this first?’

The second step of skill four is to practice “dis-identifying” from your frustration, being a disinterested witness to your experience. Here you are  “supporting” your right to feel suddenly resentful and yet simultaneously just watch as it rises, stays agitated, passes, subsides, dissipates, as all emotions do. This commitment to spending more seconds observing non-reactively your inner emotional weather is crucial.

The third step of skill four is to practice labeling an emotion of yours, first silently, then to another person. Another version of this is to label your emotion silently.

Skill five is to practice identifying implied emotional states in others. You can see this in faces on television, on the street, in the workplace, in your social life. You can learn to read it vividly in short social media or texting comments, easily training yourself to extrapolate ‘what he was feeling’ as he wrote that, or ‘what she was feeling’ when she responded to that.

Skill six is to describe your observation, and to have it confirmed or corrected by the other person. “You sound sad about that.” Friend: “I’m not sad, I’m angry.” You say this out loud to other people and begin to deal with their responses to someone who can see and name their emotional experiences. It helps to begin this with “insignificant others,” casual acquaintances, vendors, people you have little connection with. Clue: many people will resent your doing of this.

Skill seven is actually offering “emotional support.” If you can see or if your friend can acknowledge that she’s angry today, you can be accepting, curious about that, allow her to feel that way:  just listen. You listen only and with determination. You do not advise her, talk her out of it, tell her it will get better or she shouldn’t feel that way. Emotional support is a quiet conscious accepting presence towards an emotional experience that you or the other reports.

The advanced portion of this training is to learn to tell your demented mother, your drunken friend, your hallucinating sister, your aggressive-deceptive boss or your paranoid neighbor that their experience is indeed “frightening” or such for you. In other words, their behavior, triggered by so many influences or produced by internet propaganda or data distortion, does generate emotion in you also.

That emotion is real, in the present, and a fact of life. It’s as real as a hamburger.

In this way, humans produce and maintain emotionally supportive bonds with one another. We have this unique capacity to enjoy a more-intimate and more-accepting style of communicating about the way we experience life, and death.  Thus we move towards the prior fact of connectedness and commonality that all the Traditions document, and away from the seeming separateness and overt blaming that are fulcrums many use to shift power and resources in their own narcissistic direction.


[1] Goleman, D. (1994). Emotional Intelligence. New York:  Bantam Books, p. 289.

Why Bother?

Saturday, January 14th, 2012

Why Bother?[1]

Why bother to begin this work on yourself? Others have been motivated by these kinds of observations that you yourself might make on your own present life:

  • You make the same mistakes again and again, with painful consequences, and cannot seem to interrupt the mistakes
  • You believe you are entitled to certain treatment or success or health that does not in fact often come your way
  • You are genuinely unhappy, or suffering even, about various elements in your world
  • You experience quite a bit of fear about your life, the life of the world itself, and with what you see in the daily news
  • You experience too much helplessness, life just happening to you, without any genuine sense that you can make a difference in yours or others
  • You read cryptic references in religious or psychological literature that allude to a better life, but you cannot decipher them; or there is reference to dramatic success in human functioning in various methods, but you attempt them and find they do not work for you that way
  • You meet certain people who seem more alert and aware than you, perhaps more empathic, understanding, wise even, and you wonder if ‘that is just them’ or if they perhaps are drawing from some well that you too could drink from
  • You don’t have any real standards (other than financial and consumer-possession ones) from which to ascertain how far you have come as a human being
  • You give a kind of lip-service to “worshipping God,” perhaps even believing you are “born again;” you participate with  your religion but do not really feel deeply yoked to it, and see little from your efforts
  • You have an opinion about yourself, ‘I’m fine, thank you,’ but others do not share it; (this attitude of yours is likely one of the biggest obstacles to actual inner development)
  • You have the sense that you are not what you think you are: you overestimate yourself, and lie to yourself about this, constantly
  • You truly believe that ‘others’ make you the way you are (“you make me angry”), that others are primarily to blame for the paucity of results you’ve achieved from your effort in traffic or career or love
  • You were told, or read, that if you learned to observe yourself, without prejudice, repeatedly and objectively, that this would give birth the truth inside yourself, a kind of truth which can grow
  • You do not know how to actually see things in yourself that you did not see before, nor what to do with these things

 

What will further your efforts?

  • Learning how to observe yourself, over and over, without judgement or condemnation, you will encounter a deepening desire to develop yourself….

 

[1] Inspired by “Talk by Gurdjieff, September 1941”, provided by Richard Lefevre, personal communication, January 13, 2007

 

Defining Transpersonal Psychology

Monday, May 30th, 2011

This is an email exchange from August, 2000 between myself and Charles Tart, PhD. Charlie is one of the better-known educators in the field of transpersonal psychology and offered at that time a strong definition of the field of study.  I was working as an adjunct professor at the University of Arizona Department of Psychology in the fall semester, and had begun teaching an undergraduate course that I’d composed on the topic.

 


Re: tp research (Perk Clark , 08/30/00 1:10 PM)
To: Charles Tart

 

Charlie…

I’m teaching a class year at a local university (The Psychology of Religion and Spirituality: I suggest that I am actually teaching ‘the psychology IN religion and spirituality’.)I’m employing lots of transpersonal psychology material. I have hatched this idea of trying to interest the university (which has both psychology and medicine components) in the deliberate construction of a transpersonal psychology track that would seriously contribute to research in the area. If you might name a few vitally-needed tp areas that could benefit from such research… what would they be??!!!


Re: tp research (“Charles T. Tart” , Tue 5:00 PM)
To: perk@azstarnet.com

 

Dear Perk, 5 September 2000

Glad you’re teaching the course and have possibilities open! But you’re asking some big questions! As an answer, I’m going to pass on a discussion of TP that was just circulated among the core faculty of ITP, and you might also look at the ITP website (www.itp.edu).

With best wishes,
Charley


This article appeared in GUIDANCE AND COUNSELLING, vol 15, Number3, Spring 2000, p. 3-8. GUIDANCE AND COUNSELLING is published by the Guidance Centre, 5201 Dufferin Street, North York, Ontario M3H 5T8, Canada.Subscription price is $40 per year; single issues are $10 each, payable in advance.Orders originating outside Canada, add $12 per subscription. I reprint it here with their permission.

 

This was a special issue of GUIDANCE AND COUNSELLING on Transpersonal Psychology guest-edited by Bud McClure, Barbara Carter, andMichael Franklin.John Davis, Ph.D.Department of Psychology Metropolitan State College of Denvercopyright 2000, John V. Davis

WE KEEP ASKING OURSELVES,WHAT IS TRANSPERSONAL PSYCHOLOGY

Part One: INTRODUCTION

Transpersonal psychology stands at the interface of psychology and spirituality. It is the field of psychology which integrates psychological concepts, theories, and methods with the subject matter and practices of the spiritual disciplines. Its interests include spiritual experiences, mystical states of consciousness, mindfulness and meditative practices, shamanic states, ritual, the overlap of spiritual experiences with disturbed states such as psychosis and depression, and the transpersonal dimensions of interpersonal relationships, service, and encounters with the natural world.

The core concept in Transpersonal Psychology is non-duality, the recognition that each part (e.g., each person) is fundamentally and ultimately a part of the whole (the cosmos). As obvious as this might sound, it has radical implications for psychological systems founded on the premises of mechanism, atomism, reductionism, and separateness. From this insight come two other central insights: the intrinsic health and basic goodness of the whole and each of its parts, and the validity of self-transcendence from the conditional and conditioned personality to a sense of identity which is deeper, broader, and more unified with the whole (Lajoie and Shapiro, 1992; Scotton, Chinen, and Battista, 1996; Walsh and Vaughan, 1993a).

The root of the term, transpersonal or “beyond the personal,” reflects this impulse toward that which is more universal than individual or personal identity. Since the root of the word, personal, comes from persona or the masks worn by Greek actors to portray characters, transpersonal means literally “beyond the mask.” These masks both hid the actor and revealed the actor’s role. Following this metaphor, transpersonal psychology seeks to disclose and develop the source and deeper nature of our identities, roles, and self-images. However, it is important that a focus on nonduality, self-transcendence, and intrinsic health not negate the importance of individuality or personalness.

Transpersonal psychology’s orientation is inclusive, valuing and integrating the following: psychological development as well as the spiritual; the personal and the transpersonal; exceptional mental health, ordinary experience, and states of suffering; ordinary and extraordinary states of consciousness; modern Western perspectives, Eastern wisdom, (some) postmodern insights, and worldviews of indigenous traditions; and analytical intellect and contemplative ways of knowing.

Transpersonal psychology is not a religion; it does not present a a belief system or provide an institutional structure. Rather, it is a field of inquiry which includes theory, research, and practice, offering insights based on research and experience and practices for evaluating and confirming or disconfirming its findings. It is scientific in the broader sense of the phenomenological or “human” sciences (Braud and Anderson, 1998; Davis, 1996; Giorgi, 1970). Overlaps between psychology and spirituality have been present in both psychology (e.g., William James, Jung, Maslow) and in the spiritual traditions (which have their own rich views of development, cognition, social interactions, emotional and behavioral suffering, and methods of healing).

A core practice for transpersonal psychology includes meditation, mindfulness, contemplation, and phenomenological inquiry. Comparing the role of meditation in transpersonal psychology to the role of dreams in psychoanalysis, Walsh and Vaughan (1993a) referred to meditation as “the royal road to the transpersonal.” In this broad category, I would include other awareness practices such as Gendlin’s (1982) Focusing technique drawn from phenomenological philosophy and psychotherapy.

While meditation and related practices can be used for self- regulation, relaxation, and pain control or for self-exploration and self-therapy, they have traditionally been used for self- liberation (Shapiro, 1994). Despite their many surface forms, most styles of meditation can be a means of disidentifying from our “masks” or egos and realizing our fundamental nonduality (Goleman and Ram Dass, 1996).

Other practices that are associated with transpersonal psychology include shamanism, lucid dreaming, and psychedelic drugs (Walsh and Vaughan, 1993a). I would add ritual as another important, though less recognized, transpersonal practice. For people in many cultures, ritual is the central means of discovering connections with each other, with communities, with the Earth, and with the cosmos (e.g., Somé, 1998).

Transpersonal psychology has benefits for both psychology and the spiritual disciplines. Psychology can expand toward a fuller and richer accounting of the full range of human experience and potential and incorporate practices that speak more directly to the depth of our nature. The spiritual disciplines can incorporate insights and skills about human development, healing, and growth to deal more skillfully with the psychological issues that arise with spiritual development. It can use these issues as gateways, rather than obstacles, to self-realization.–

Charles T. Tart, Ph.D. Professor, Institute of Transpersonal Psychology, Palo Alto CA ITP Web site: www.itp.edu Fax: (630) 604-3279 Professor Emeritus, Psychology, University of California, Davis e-mail: cttart@ucdavis.eduHome page & archives: http://www.paradigm-sys.com/cttart/ Editor, The Archives of Scientists’ Transcendent Experiences http://psychology.ucdavis.edu/tart/taste/

Welcome!

Monday, May 30th, 2011

This blog is an attempt to speak to both professionals and to consumers who are curious about the topics addressed on this website.

I hope to hear from readers who have contrasting opinions about the materials cited, as well as those who concur with mine and others’ research or experience.  In essence, I am trying to share my own process of the study of these materials, to document many of the sources that seem meaningful to me, and to urge others’ to engage with these materials towards positive personal, professional, and community efforts.

Let me apologize in advance for the slow pace of posts here, as well as for the material that may prove to be less-relevant to you than you would prefer. The errors contained here are my own, and I’ll do my best to correct obvious ones if readers will call them to my attention.

I am convinced that together we can make more progress than in isolation!  In Buddhism they call this the sangha, the community of monks, the assembly, but are in reference to monastic life for progressing on the path to enlightenment.  I don’t have quite that grand an agenda here, but am intent on finding possible connectedness with readers who share these interests, and would hope to connect them to one another as well.

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