I was recently asked if I believed that people could change.  In a word?  Yes.

People will change.  The question is more, “Will a person make a meaningful change?” that brings about increased meaning and satisfaction in their life.  We people are generally motivated by a “what’s in it for us” perspective.  The trick is finding what that is.  This is not a “once and for all” destination, but a journey through life as the particulars may change throughout the lifespan.

When a person is able to see the benefit in a certain change or they experience circumstances that are undesirable, they generally are willing to expend some effort to make a change.  

From a spiritual standpoint, the closer one is to God and following His Word, the more satisfaction and meaning they will experience.

From a psychological standpoint, the more one recognizes their self-worth (see blog 06/03/2012) and uses it purposefully, the more satisfaction and meaning they will experience.

From a social standpoint, the more one understands and accepts their place in the world (whatever that looks like given one’s own preferences and values), the more satisfaction and meaning they will experience.  

Carl Rogers: “… the individual has within himself or herself vast resources for self-understanding, for altering his or her self-concept, attitudes and self-directed behavior - and that these resources can be tapped…."  

If I thought people could not change, I most certainly could not do this work.

People can and will change!  If you want to make a change, a safe environment and an understanding therapist may be a venue to begin that process.

There are many points of transition that come along in our lives.  Some are welcome where some not so much so!  Some we initiate where some just come our way.  In any case, transitions are inevitable.

That first day of school. Changing schools.  Getting a new teacher.  Moving to another town. Falling and breaking an arm.  Going to Middle School.  Getting into a club or organization where you may not know many people.  Trying out for a sports team – getting chosen, not getting chosen.  Going to High School.  Having a girlfriend or boyfriend – then losing a girlfriend or boyfriend.  Having a friend move away.  Grandparent dies.  Being elected as Class President or Captain of your team.  Going to college.  Getting a job.  Getting married.  Having children.  Losing a job.  Going back to school.  Getting another job.  Having grandchildren.  Retiring.

Life is full of transition!  This is a point of transition in my life where I am leaving state service where I have worked for over 31 years and now am planning to concentrate on my private practice.  I will officially begin that journey January 6, 2014.  It is not without some pain that I make this decision, but it is with great enthusiasm and anticipation (see blog of 12/24/12) that I make this transition – and I do see it more as a transition than “retirement”!  The timing finally seems right.

We can fight changes in our life or we can address them with the confidence that no matter our circumstance that we will survive and may even learn something along the way.  It largely depends on our attitude.  Use your self-worth (see blog of 06/03/12).  Consider your situation and make a choice with the knowledge that you can always make another, if things do not go as planned (see blog of 07/04/13).  Accepting that not every aspect may be to your liking will go a long way, but count your blessings.  You will feel better!

Today is Christmas Day and I write this as I await everyone else in the house to awake.  The timing was right for Jesus’ birth and what a transition that was for Mary and Joseph, but more importantly, the world.  The impact of His birth continues throughout history bringing peace and goodwill to mankind.  The World needed a Savior, He is Christ the Lord.  Glory and thanks be to God!

Our beliefs and conclusions about things/ events have a strong influence on our emotional and behavioral reaction.  We all have preferences related to:
1.     approval, acceptance, love
2.     achievement, success, performance
3.     comfort.

Having the preference is not a problem; but when we demand that we have what we
want relative to these, we are likely to create an emotional disturbance for ourselves and may find ourselves behaving in a self-defeating manner.  For instance: If those closest to me do not provide me the approval in the way I desire; people at the office do not recognize the good work that I am doing or I am inconvenienced by my vehicle
breaking down – I could quickly find myself angry.  I could brood or worse.  I could say cutting, unkind things to those closest to me or purposefully “slack” at work as though I have this authority to punish and straighten them out.  

Accepting that people are not always going to behave the way we like and that the world is not always going to provide us the level of comfort we desire will go a long way to
avoiding unhealthy anger.  We have the legitimate authority to ask for or work to get what we want, but no one owes it to us.  As a matter of fact, we may not get what we think we deserve even having worked for a thing. 
People are fallible and do not always act fairly or morally.  Healthy anger would motivate us to ask for what we want, take legitimate
action to change circumstances or to accept what we cannot change.

Beliefs/ Thoughts That Predispose People to Anger
1.  How awful and terrible that you treat me like this!
2.  I can’t stand your irresponsible behavior!
3.  You should not/ must not treat me like that!
4.  Because you behave as you should not/ must not, you are a non-person and deserve severe punishment!
5.  How awful for you to have treated me unfairly!
6.  I can’t stand your treating me in such an unjust manner!
7.  You must not behave that way toward me!
8.  Because you have treated me in such a manner, you are a terrible person deserving of nothing good in life and I wish all manner of harm to come upon you.
9.  How awful things have turned out so badly for me!
10. I can’t stand that things turned out this way!
11. Things should not happen this way, and so terribly inconvenience me!
12. Nothing ever works out the way I want it to!  Life is always unfair to me - as it shouldn’t be!

These beliefs/ thoughts are largely not true.  I may not like it, but I can stand it and it is survivable.  Things may even be objectively bad, but they never become too bad.   Situations may be hard, but never become too hard to survive, cope or overcome.

In Summary:
1.  Accept that the world and other people and even yourself are not going to always come through for you and may even down right try to do you in.  Accept that the goals of others may conflict with yours. Accept that circumstances will not always be to your liking.
2.  Do what is in your legitimate power to change the situation.
3.  Take responsibility for your life by making choices that have the potential to benefit you (exercise your self-worth).
4.  Recognize that the more energy that you spend being angry, the less energy you have for #2 and #3.

Anger is a primitive emotion that has a survival benefit and purpose.  The response is rather automatic once our minds conclude that we are in danger - we go into “fight or flight” mode.  This, of course, is protective.

In our current culture, does this anger response still serve a legitimate purpose?  YES!  There is still danger, but too often our anger becomes misplaced when we raise the level of importance of things beyond what is reasonable.  For example, the violence among fans at sporting events or my yelling at the TV when LSU loses to Ole Miss!

There are still social issues and human behaviors that would be better changed (ex: child abuse, discrimination, etc.) and to do so
means having some passion for action.  Without our having a response in opposition or in support of alternative beliefs/behaviors, many good causes would go unnoticed/ unaddressed.  ANGER serves a purpose and that is it motivates to action to right what one thinks is wrong.

The key for this segment is that there is healthy anger and unhealthy anger – the level of emotional energy adequate to address the
wrong within our legitimate authority vs. the level of emotional energy that motivates a response to the wrong that exceeds our legitimate authority.  To illustrate: (1) law enforcement has legitimate authority to enforce the law, but does not have legitimate authority to do it in a way that uses more force than necessary and (2) a parent can discipline their child legitimately, but does not have legitimate authority to
discipline someone else’s child or to discipline their own in a harmful manner.  One final example and point: I may not like a particular law or political climate, but my legitimate authority to address it rests within the bounds of our legal system and process for changing laws.  If I spend a great deal of emotional energy just being angry, lashing out at others around me, refusing to be happy in any situation, can do nothing but complain about my displeasure, etc., then I am likely to do myself harm (personally, physically and interpersonally) by being unhealthily angry.  On the other hand, maybe I use that energy to run for office or speak to groups of people at appointed times in order to influence thinking while being able to manage that emotional energy such that I can appropriately enjoy and engage in other meaningful
activities.

We have no business getting angrier than is necessary to do something within our legitimate authority and power about wrongs we perceive.  Accepting what we do not have the power to change does not mean that we like it or that we are just giving up.  We can be
displeased, disappointed and/or agitated while we seek to find a solution, but govern/ redirect that emotional energy to engage in other areas of life where we find pleasure, satisfaction and/or meaning.  We are going to get angry! So, let’s do it constructively!

“Anger is not good or bad; it depends on your reaction to it.” 
 
I submit that this view will get you into trouble, but it is essentially what many of us are taught in that we are to control our angry behavior and even turn the other cheek.  A display of anger is considered bad manners at the very least and usually is embarrassing or creates more trouble for us.

When we or others behaviorally display anger we generally think of that as having “lost control”, so we do our best to retreat into civilized behavior, but the anger remains and is then internally destructive and may eventually be overtly manifested when the pressure “blows the lid off”.  The controlling of behavior is not such a bad thing, but trying to keep the lid on or ignoring the underlying anger can be.

This internal anger can not only eat away at our psychological well-being, but our physical well-being. If we do not resolve the anger, we may stay in a state of constant preparedness which can eventually have an adverse physiological affect in the form of hypertension, heart problems, ulcers, stroke, etc.

Cromie, William J. Anger Can Break Your Heart: A Hostile Heart Is a Vulnerable Heart, Harvard News Office, 2006.
In this news report, they note a study of 1305 men with an average age of 62 that indicated that angrier men had a three-fold increased  risk of heart disease and another study of 1055 medical students over a period of 36 years that indicated a six-fold increased risk of having a heart attack by 55 for those with anger problems.

I will discuss more about anger in future Counselor's Corner spots where we will learn more about how to make anger work for you and how to be less vulnerable to these potential emotional, social and physiological negative consequences.  It really is more than just controlling the overt behavioral reaction.  Stay tuned!

We tend to want “certainty” in our lives.  We want to know that the car is going to start.  We want to know what we are going to be doing on the weekend.  We want to know we will have enough money to pay our bills or to be able to retire.  We want to know where we are going to go to college, what will be our major and what we will do when we graduate.  The list can go on and on.

“Certainty” is just not within our grasp.  As much as we think we know what is going to happen or that “everything is going to be alright”, we really don’t.  Ironically, I am not promoting anxiety with this little thought, but want to encourage acceptance, personal responsibility and confidence that we can tolerate much more than we give ourselves credit.

“Certainty” is not all that! As I was thinking about this, I just did a Google search for “uncertainty” and found several articles on “The Uncertainty Principle” (way above my head!), but it would seem that scientists are not even able to be as “certain” as they would like.  It turns out that we are not able to know where a thing is and where it is going at the same time and that by observing a thing we change that which we are observing; thus, contaminating the experiment to a degree.  Anyway, enough of that.  The point is no matter how much we would like “certainty” it is not happening!

The quest for “certainty” is a major source of anxiety.  We would be wise to simply take a deep breath, relax and take a moment to be mindful of ourselves and appreciate our existence.   Embrace “uncertainty” with the perspective that it adds variety to the world and it
affords you another opportunity to consider life’s priorities and make another choice about how you will respond in the face of the new reality. Accept that we can affect our circumstances to a degree by making good choices: work hard, love others well, be kind, take care of yourself (physically, mentally and spiritually), forgive, laugh, …….. but, we will never control our circumstances to the point of certainty.

This is not to ignore that there are many things that were once uncertain that we may have thought was certain can be very painful, but thinking we can do enough to totally avoid those things in our lives is rather naïve.  As you go through this day, be aware of just how many things are “uncertain” and how much we really live by faith out of necessity.  So, let’s persevere, keep our priorities in focus no matter what life brings us and live in faith on purpose.  Carpe Diem!

http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/07/low-income-patients-say-er-is-better-than-primary-care.html

Low-Income Patients Say ER is Better Than Primary Care

New RWJF Clinical Scholar research helps debunk commonly-held myths about frequent emergency room use.

·        Published: 7/9/2013

One of the drivers of high health care costs in the United States is the use of emergency rooms (ER) for preventable conditions by patients who generally come from the most vulnerable populations. Estimated to cost as much as $30.8 billion a year in a recent Health Affairs study, avoidable ER use is a primary target for experts seeking to reduce health care costs.

To achieve this goal and “generate system-wide savings, experts need to listen to patients and address their concerns about the cost, quality and accessibility of outpatient care,” said Shreya Kangovi, MD, a Robert Wood Johnson (RWJF) Clinical Scholar (2010-2012) supported in part by the U.S. Department of Veterans Affairs.

Kangovi’s new study reports that current approaches to getting patients from low-socioeconomic groups to seek preventive and primary care in physicians’ offices or accountable care organizations instead of hospitals are often ineffective.

“Our findings suggest that these efforts could backfire by making hospitals even more attractive to these patients. We also debunk the notion that people from these groups abuse the emergency room for no reason and need to be taught how to use it properly.”

Insurance Status is Not the Key

Working from literature that shows ER usage patterns are not necessarily linked solely to insurancestatus, Kangovi explained that she “wanted to find a way to address the ongoing disparities” she saw in her patient population. “To do so, I designed the study so that we could talk with patients whose voices are seldom heard in policy discussions.”

Kangovi and her team conducted one-on-one interviews with 64 patients, ages 18-to-64, from two urban Pennsylvania hospitals. Forty of them met the criteria to be included in the study. They were uninsured or insured by Medicaid. The respondents, who were 90 percent African American, also lived in one of five Philadelphia zip codes where more than 30 percent of the residents had incomes below the poverty level.

The results were published in the July Health Affairs cover story “Understanding Why Patients of Low Socioeconomic Status Prefer Hospitals Over Ambulatory Care.”

“We asked them: ‘What are some of the reasons you might prefer to come to the emergency room rather than your primary care doctor’s office or clinic?’” Kangovi said. “The interviews were conducted by a community health worker who was a member of their community, so there was more of a trusting relationship.”

Study respondents (both the insured and uninsured) explained that they consciously chose the ER because the care was cheaper, the quality of care was seemingly better, transportation options were more readily accessible, and, in some cases, the hospital offered more respite than a physician’s office.

Excessive Barriers to Primary Care

“As a physician, I found the results very disturbing. We discovered that our system is just riddled with barriers to primary care,” Kangovi said. Patient voices taken from study interviews tell the story best:

·        Convenience. “You must call on the same day to set up a [primary] care appointment … whenever they can fit you in.” This open-access scheduling resulted in people taking days off from work and still being unable to see a doctor. It also made it impossible for many to access transportation covered by Medicaid because the transport arrangements had to made 72 hours in advance. Late hospital hours also made care more available.  

·        Cost. “I don’t have a co-pay in the ER, but my primary [physician] may send me to two or three specialists and sometimes there is a co-pay for them. Plus there’s time off from work to go to several appointments.”

·        Quality. “The [primary care doctor] never treated me or my husband aggressively to get blood pressure under control. I went to the hospital and they had it under control in four days. The [physician] had three years.” This patient was one of many who expressed far more trust in the quality of hospital care.

Shelter from the Storm

In order to better understand study participants’ needs, Kangovi sorted them into two groups—those with five or more acute care episodes a month (group A) and those with less than five acute episodes a month (group B).

“The patients in group A had often gone through extraordinary trauma and were more likely to say that a traumatic event set off a cycle of social dysfunction, mental illness, and disability that drove their repeated hospital visits,” Kangovi explained.

“The group B patients were most often highly functional caregivers for social networks strained by poverty and illness. These people often put off caring for themselves. Both groups had extremely eloquent and valid reasons for avoiding preventive care, waiting to get sick and choosing emergency care,” she added.

Creating a National Model for Change

Acknowledging that this research has some limitations, such as the small size of the study sample, Kangovi intends to encourage other researchers to focus on vulnerable patients.

“I used the health services research training I gained as a Clinical Scholar, as well as the incredible support I received from my Clinical Scholar program mentors including my co-authors David Grande, MD, MPA, and Judith Long, MD, to address problems I saw from a public health and eventual policy perspective,” Kangovi said. “We plan to disseminate the study strategy.”

“We learned that the patients are the experts in the flaws in our health care system and the people we need to listen to,” Kangovi advised. “You hear the term ‘patient-centered care,’ well you have to talk to patients to create that care. Right now, they are telling us that we are creating a maze of hoops and hurdles that are driving them out of primary care and into the hospital.”

My goal for this blog is not so much to describe decision making models or processes, because there is much about those available with a simple browser search.  My goal is to simply call attention to a common mistake that people often make when decisions don’t turn out the way you would have liked. That mistake is judging one’s self to be unable to make good decisions.

There is not one of us whose decisions always turn out as expected or hoped!  There are so many factors that come into play that are unforeseen that it is bound to happen.  You make what you think is a “no-brainer” and the next thing you know, everything is falling apart!  It happens. We don’t want to get so focused on that undesirable outcome that we get distracted from the subsequent decisions that then are to be made.  We need to remember that we are making decisions all the time and all we can do is take our current realities, weigh our options and make a choice that has the potential to benefit us (see blog on Self-Esteem, June 3, 2012).

Sure, let’s learn some of the models and determine when it might be best to make a quick decision, to gather more information, to get group input, or to make a collaborative group decision; but regardless of the outcome – stay diligent and involved or the outcomes will only be less desirable and you may become even more discouraged.

I know it likely sounds rather silly of me to downplay “outcome” when so much of what we do is judged on outcome.  I am not saying outcome is unimportant, but it is not ALL important.  None of us can tell the future, control all the factors, or can research a thing so
thoroughly to come up with a perfect decision; so let’s give up that fantasy right now!  Even when we make a good decision, the outcome may turn out bad.  How can that be, you ask?  Let me give you an example.

Several years ago, I was in the market for a car and wanted one that would be equipped to tow a boat. I did my research and the Chevy Caprice was the winner (many of you will remember these as police cruisers and taxi cabs!).  It was not a sexy car.  Edmund’s described it as “competent”.  Edmund’s liked the V8 engine and that is what I chose.  That engine would get up and go – when it was running, that is.  My mom and dad both owned earlier versions of this vehicle and had very few problems.  My uncle, who owned a Goodyear store and was a master mechanic, recommended the vehicle.  My dad still feels bad about his endorsing this car.  I chose the tan color vs. maroon –
otherwise, the same car.  It had problem after problem.  It was in the shop over and over again.  The decision making process was good and the decision was good.  The outcome was less than desirable and was beyond anyone’s ability to foresee.  My parent’s still have
one of those same Caprices, by the way, and it still runs and tows the boat!

Don’t judge the quality of your decision solely on the outcome!  Take the outcome into consideration, learn about decision making and make the best ones you can make.  You will benefit from that diligence, but when things don’t turn out like you expected just regroup and make another decision!

  There has been much written to give direction when it comes to selecting a therapist (you can do an internet search that will render several sites).  A representative list of questions follows from http://www.dummies.com/how-to/content/how-to-choose-a-mental-health-therapist.html :

·         What mental health licenses and degrees do you hold?
·         What kinds of mental health issues does your practice focus on?
·         How long have you been practicing?
·         What type of therapy to you think will be of most help to me in my particular situation and why?
·         About how long do you think I’ll be in treatment?
·         What are your fees?
·         What types of payment do you accept and when is payment expected?
·         If you accept insurance, what kind?
·         Will you bill my insurance company or do I pay up front?

You may also want to ask for friends or family if they know someone.  Knowing the differences between addiction counselors, social workers, psychologists, licensed professional counselors, marriage and family therapists and psychiatrists would be good information to have (this is easily found by internet search, as well).  Most therapists will have websites or other web-based information available so you can check them out prior to making an appointment.  Your insurance may have a list of preferred or “in-network” providers to help you make a selection.

The main emphasis I want to make today is that the “fit” as you experience it is paramount.

By “fit” I mean that sense of connection with the therapist that you interpret as a valuable partner in your journey of recovery – that process of improving health and wellness where you are living on purpose in your quest to reach your full potential.

Research has indicated that it is your perception of that “fit” that is a very strong predictor of your realizing a positive outcome; therefore, you would do well to find a therapist who is paying attention to what you want and is making the effort to create a collaborative environment.  If you do not think the connection is such that you are having a positive response after 3-4 sessions, you may want to consider changing therapists.  This is no specific reflection on the therapist as not all combinations are an easy fit.  If you do elect to switch to another therapist, please tell your current therapist of your plans.  They will appreciate it.