As part of my "to-do" list today, I went looking for information for my supervisee (I supervise, now!) about NPI's and CAHQ numbers, vaguely remembering a past blog about it, and re-stumbling upon my old ramblings. It seems I have been so busy for the past, hmmm, year? that I have had nothing to say. I think it is an indication of my creativity overall taking a back seat to the effort it takes to progress my career and personal life. I am hoping (knock on wood?) things are beginning to normalize and give me the luxury again. Creativity, unless it is your vocation (which for me robs much of the appeal and inspiration), really is a luxury. My paints, drawings, pastels, charcoals, papers and sketchbooks and canvases have been tightly sealed awaiting some extra energy or attended to passion. I guess my blog is also a part of that.
My past year of "busy" has given me many positive changes. In acronyms I have left and IOP/PHP and moved to an OMHC. In translation, I left working for the hospital and now work for an outpatient clinic. It sounds less exciting, but it is actually a greater clinical variety and professional challenge, and something I enjoy much more than all the politicking of working for a hospital. My population served and so professional capacities have grown from past work focused with pregnant substance abusers, to now include adults, children, men and women of all diagnoses. I have seen such a variety of life: from political refugees to war veterans, foster children to children with autism, divorcees to single parents, people grieving for lost pets to others grieving for losses more traumatic in nature, people with medical or developmental problems that make them non-verbal to others who hear voices around them all the time. I run groups, but only with a topic I choose and attendees that want to be there.
I work closer to home now and actually have a house instead of an apartment for the first time in a decade, and can look over my lake from my bedroom. I come home to the same stinky white dog, but now also to a husband. I have stopped seeing a therapist and my own symptoms seem to be in mental health remission. I learn every day more about home repair from my house, more about love and relationships from my husband, more about life and gratitude from my patients.
And so the stage is set for my new introspections: from the outside through her large office windows, we see a tired but happy looking young, but now slightly older therapist, as evidenced by the crinkles starting to form at her eyes when she smiles. Her eyes are, of course, still blue, but wiser and more self-assured. The expression is calm and confident: the kind that says, "Everything you are saying and feeling is important, and don't worry, I've heard worse." She sits attentively facing her patient, a sad looking, older man who is talking slowly while staring at the wall. She says something to him. He lifts his head, nods, and squares his shoulders...
Wednesday, April 3, 2013
Monday, February 20, 2012
You're an *!&@^#%!! Charlie Brown
I tend to arrive to the hospital around 730am each morning to have time to answer phone calls, emails, and check in with my fellow therapists before beginning the day. Sometimes we talk about our lives and sometimes we are putting out fires the patients have proverbially set already that day. Today I was listening to one of my coworker's political rants.
This particular coworker tends to take small amounts of information to feel fully informed, and promptly steps up on his soapbox and rant. I find this completely annoying, to say the least. Today's tirade was about 30 minutes he had watched of a documentary about "Freakonomics." Apparently this is a book put together by an author and economist, which, more succinctly than he put it, is about correlation not equaling causation. Any good grad student knows this rule since the beginning of their first statistics class. My coworker was convinced it meant that just because we think crime decreases with the increasing number of police officers, doesn't mean that the reality isn't that there were just fewer criminals born because abortion was legalized twenty years before. (Don't worry; the silliness of this bold opinion is where I am going with this.)
I have another coworker who firmly believes that (in my words, not hers) the more you enable a patient, the more you are helping them. This is a bit harsh to say in contrast to the goodness of her intentions, but it is accurate also serves to illustrate my point. Both coworkers are completely closed to any sort of outside opinion or feedback. Both workers are convinced and convicted that they are completely and entirely correct in their positions. I actually see this equally in my patients all the time. They are living on the street, homeless, and without any major support of any kind, but cannot seem to see any explanation to their situation other than they were treated unfairly.
There is something to be said for feeling passionately about something. There is something to be said for feeling strongly about and defending your viewpoint or even your worldview. However, I firmly believe, if you aren't at least willing to listen to AND consider other perspectives, you will remain stuck and enclosed in one point of view. We see this in the adamant political fool, the too-tenderhearted therapist, the victim of circumstance patient, and many others. Doctors, lawyers, professors, therapists, children, parents and all of us can fall into the trap of being too stuck on the defense to accept that someone else might feel adamantly different for another completely valid and good reason.
It fascinates me that anyone (but so many people!) can be so sure that they've got it right, that they assume that any digression from their theory is wrong. All or nothing thinking, as my therapist frequently accuses me of. For those of you not entrenched in psychobabble like us mental health professionals, we call this a cognitive distortion, or "stinkin thinkin." It is a maladaptive thought pattern that leads us around in circles, or towards bad decisions and bad emotions.
Bottom line, whether or not you are one hundred percent correct and everyone else is wrong, that the earth does revolve around the sun, perhaps that crazy woman in the corner may also be right when she mumbles that the sun is just a star. Even if she is not, could we not open our minds to more possibilities by at least considering it? After all, Charlie Brown couldn't have always been the victim; he must have been an !@#*%$$!! to somebody.
This particular coworker tends to take small amounts of information to feel fully informed, and promptly steps up on his soapbox and rant. I find this completely annoying, to say the least. Today's tirade was about 30 minutes he had watched of a documentary about "Freakonomics." Apparently this is a book put together by an author and economist, which, more succinctly than he put it, is about correlation not equaling causation. Any good grad student knows this rule since the beginning of their first statistics class. My coworker was convinced it meant that just because we think crime decreases with the increasing number of police officers, doesn't mean that the reality isn't that there were just fewer criminals born because abortion was legalized twenty years before. (Don't worry; the silliness of this bold opinion is where I am going with this.)
I have another coworker who firmly believes that (in my words, not hers) the more you enable a patient, the more you are helping them. This is a bit harsh to say in contrast to the goodness of her intentions, but it is accurate also serves to illustrate my point. Both coworkers are completely closed to any sort of outside opinion or feedback. Both workers are convinced and convicted that they are completely and entirely correct in their positions. I actually see this equally in my patients all the time. They are living on the street, homeless, and without any major support of any kind, but cannot seem to see any explanation to their situation other than they were treated unfairly.
There is something to be said for feeling passionately about something. There is something to be said for feeling strongly about and defending your viewpoint or even your worldview. However, I firmly believe, if you aren't at least willing to listen to AND consider other perspectives, you will remain stuck and enclosed in one point of view. We see this in the adamant political fool, the too-tenderhearted therapist, the victim of circumstance patient, and many others. Doctors, lawyers, professors, therapists, children, parents and all of us can fall into the trap of being too stuck on the defense to accept that someone else might feel adamantly different for another completely valid and good reason.
It fascinates me that anyone (but so many people!) can be so sure that they've got it right, that they assume that any digression from their theory is wrong. All or nothing thinking, as my therapist frequently accuses me of. For those of you not entrenched in psychobabble like us mental health professionals, we call this a cognitive distortion, or "stinkin thinkin." It is a maladaptive thought pattern that leads us around in circles, or towards bad decisions and bad emotions.
Bottom line, whether or not you are one hundred percent correct and everyone else is wrong, that the earth does revolve around the sun, perhaps that crazy woman in the corner may also be right when she mumbles that the sun is just a star. Even if she is not, could we not open our minds to more possibilities by at least considering it? After all, Charlie Brown couldn't have always been the victim; he must have been an !@#*%$$!! to somebody.
Wednesday, October 12, 2011
A Public Service Announcement for Would-Be Private Practitioners
Just on the off chance that anyone comes accross this and needs this information, let me save you what amounted to about 3 hours of research. There is apparently no easily accessible place online where all this vital information is availible together.
If you are considering a mental health private practice, there are some logistics to consider before jumping in. Amongst these of course is how to obtain financial reimbursement for services. In order to be paid for your hard work in private practice you essentially need three numbers. These numbers can take up to 3 months to apply and be approved for so this should be a FIRST STEP in working towards a private practice. Why won't anybody tell you this!? I got the information through extensive phone calls to insurance companies, grilling other professionals, emailing professional organizations and career centers and lots of googling. Ladies and gentlemen, the research shows:
For private practice billing and insurance reimbursement you basically need three separate numbers:
In order to bill in private practice on sliding scale or fee for service (without in insurance reimbursement) you need to apply for a small business id at:
http://www.irs.gov/businesses/small/article/0,,id=98350,00.html
In order to bill for state (Medicare or Medicaid) reimbursement, you need an NPI#. More information available at:
https://nppes.cms.hhs.gov/NPPES/Welcome.do
In order to bill private insurance companies, you need a CAQH# which in turn each individual private insurance company has to approve for reimbursement (i.e. once you have the CAQH, you use it to apply one at a time to private insurance companies you want to use for reimbursement- you would do this online at each private insurance company’s website). More information available at:
http://caqh.org/ucd_health_participating.php
Just in case this spares some other poor soul all the frustration and confusion of obtaining BASIC information. Geez.
If you are considering a mental health private practice, there are some logistics to consider before jumping in. Amongst these of course is how to obtain financial reimbursement for services. In order to be paid for your hard work in private practice you essentially need three numbers. These numbers can take up to 3 months to apply and be approved for so this should be a FIRST STEP in working towards a private practice. Why won't anybody tell you this!? I got the information through extensive phone calls to insurance companies, grilling other professionals, emailing professional organizations and career centers and lots of googling. Ladies and gentlemen, the research shows:
For private practice billing and insurance reimbursement you basically need three separate numbers:
In order to bill in private practice on sliding scale or fee for service (without in insurance reimbursement) you need to apply for a small business id at:
http://www.irs.gov/businesses/small/article/0,,id=98350,00.html
In order to bill for state (Medicare or Medicaid) reimbursement, you need an NPI#. More information available at:
https://nppes.cms.hhs.gov/NPPES/Welcome.do
In order to bill private insurance companies, you need a CAQH# which in turn each individual private insurance company has to approve for reimbursement (i.e. once you have the CAQH, you use it to apply one at a time to private insurance companies you want to use for reimbursement- you would do this online at each private insurance company’s website). More information available at:
http://caqh.org/ucd_health_participating.php
Just in case this spares some other poor soul all the frustration and confusion of obtaining BASIC information. Geez.
Monday, June 27, 2011
Feeling Put-Upon
GRRRRRRRR DEFinately feeling a certain kind of way today. Feeling very much PUT UPON by others.
Ever ask yourself (albeit selfishly) "why don't I ever spend any time doing what I want? Why am I constantly doing things that make me unhappy that others want me to do!?" FEELING that way today!!$%#!
AMONGST the people making me feel put upon are people I spend the most blood sweat and tears trying to help, make right or reconcile with. I don't understand, and I believe I forever won't, why people PURPOSELY make things EXCEEDINGLY difficult FOR THEMSELVES. KNOWINGLY. When the options are A-relax, or B- get crazy; they opt for B EVERY TIME.
Ever have something come along and just take the wind out of your sails? Suddenly everything gets 100% harder. Depression and the death of a pt will do that to you. Add to that this exasperation and exhaustion of being put upon and try to stay afloat. Try to keep your social life afloat. Your personal life. Your family life. EX-AS-PER-ATED. Just plain ANGRY!!!??$?$$$@@@!!!!
So here is my personal recommendation, world. Next time you have options to either, A-relax, or B- get crazy, go against the gut and choose A. Sit down with a nice cold beverage and inhale, exhale; inhale, exhale....
HONESTLY!!!!!
Ever ask yourself (albeit selfishly) "why don't I ever spend any time doing what I want? Why am I constantly doing things that make me unhappy that others want me to do!?" FEELING that way today!!$%#!
AMONGST the people making me feel put upon are people I spend the most blood sweat and tears trying to help, make right or reconcile with. I don't understand, and I believe I forever won't, why people PURPOSELY make things EXCEEDINGLY difficult FOR THEMSELVES. KNOWINGLY. When the options are A-relax, or B- get crazy; they opt for B EVERY TIME.
Ever have something come along and just take the wind out of your sails? Suddenly everything gets 100% harder. Depression and the death of a pt will do that to you. Add to that this exasperation and exhaustion of being put upon and try to stay afloat. Try to keep your social life afloat. Your personal life. Your family life. EX-AS-PER-ATED. Just plain ANGRY!!!??$?$$$@@@!!!!
So here is my personal recommendation, world. Next time you have options to either, A-relax, or B- get crazy, go against the gut and choose A. Sit down with a nice cold beverage and inhale, exhale; inhale, exhale....
HONESTLY!!!!!
Tuesday, March 8, 2011
Thank God for Running and Puppies
I have been thinking often at work what things in life the women I work with who are chemical dependent replace with drugs. When do we get our natural "high"? What are they missing or giving up for the chemical fix? I don't mean lifestyle. That's a given. I mean what are our moments of natural high that they instead strive to acheive with drugs?
I think I am in another cycle of my depression. God knows I have lived with my old friend long enough to know the disease well. Once symptoms fearful and desperate, now I recognize the lack of energy, motivation and enjoyment as like trying to run through water, slowing me down. I cuddle up with a good book more, I enjoy long hot showers, I pull out my puzzle books and buy my favorite doughnuts. I excuse myself to hunker down as long as I am fulfilling (somehow!) my other basic responsibilities.
I got to work today at 630am. I had so much to do and was getting so behind, as every waking moment at work I have a patient in my office, paperwork tends to just pile up and wait. This morning, sitting on my butterfly rug on my floor pillow with a laptop and my files and papers across the floor, I forced myself through typing and typing and typing of notes, records, documentation. Since I came in so early, I left at 4pm instead of the usual 430pm (a whole half hour-yippee!!) This meant I would get home before the sun went down. To me this means one and only one thing: I get to run around my lake before dark.
Anyone who has been depressed for any reason can tell you that depression is crippling. It overtakes you so you literally can barely do anything except curl up and wait it out, hoping you do nothing destructive. Often it gets so bad that your mind becomes paralyzed for thought and you cannot keep a single thing in your spiraling mind. Its like trying to tread water in a whirlpool. Your best saving grace, other than medications I suppose, is to have a couple coping mechanisms that you can always turn to, that always work. Of these I have just one.
When my mind is paralyzed and my body depressed, I know only to do one thing. Lace up my running shoes, flick on my ipod, and start running. Though metaphorical and healthy, the literal focusing on nothing but physical sensation and breathing calms and centers my soul. Doing this outside with the sky over my head is my zen: there is nothing like it in all this world. When I am running I have nothing in my mind but calm focus and simple purpose to keep moving forward. Working through the physical pain of my muscles and lungs cures some of the emotional ache, and the simplicity of the exercise (just breathe and keep moving) grounds and centers me. Eventually, the endorphins get pumping and my measly, tiny amounts of dopamine and seratonin get their lazy butts to work. I smile. I feel happy.
Today when I was running around my lake feeling my muscles work up a hill and straining to keep my breath even with my stride I thought, "this is the first time I have felt happy all day." It is not necessarily that my depression makes me miserable all day anymore. I have learned to cope beyond that point. However, no matter what I try, running is the only thing that brings back the "happy." Otherwise, it's just numbness, spiraling and paralysis. It is my natural high. My addiction, I suppose, for my body and mind crave it now and want nothing else for relief of the depression.
Well, almost nothing else. I have to make a little plug for my sweet sweet puppy. Though I could go on about the therapeutic benefits of animals, suffice it to say that there is something very special about never having to go through anything alone. No matter how mopey or grumpy I feel, I always have a little white bundle of fur at my side who couldn't be more thrilled in the world to be there.
Thank you, God, for my beautiful runs and my little puppy.
I think I am in another cycle of my depression. God knows I have lived with my old friend long enough to know the disease well. Once symptoms fearful and desperate, now I recognize the lack of energy, motivation and enjoyment as like trying to run through water, slowing me down. I cuddle up with a good book more, I enjoy long hot showers, I pull out my puzzle books and buy my favorite doughnuts. I excuse myself to hunker down as long as I am fulfilling (somehow!) my other basic responsibilities.
I got to work today at 630am. I had so much to do and was getting so behind, as every waking moment at work I have a patient in my office, paperwork tends to just pile up and wait. This morning, sitting on my butterfly rug on my floor pillow with a laptop and my files and papers across the floor, I forced myself through typing and typing and typing of notes, records, documentation. Since I came in so early, I left at 4pm instead of the usual 430pm (a whole half hour-yippee!!) This meant I would get home before the sun went down. To me this means one and only one thing: I get to run around my lake before dark.
Anyone who has been depressed for any reason can tell you that depression is crippling. It overtakes you so you literally can barely do anything except curl up and wait it out, hoping you do nothing destructive. Often it gets so bad that your mind becomes paralyzed for thought and you cannot keep a single thing in your spiraling mind. Its like trying to tread water in a whirlpool. Your best saving grace, other than medications I suppose, is to have a couple coping mechanisms that you can always turn to, that always work. Of these I have just one.
When my mind is paralyzed and my body depressed, I know only to do one thing. Lace up my running shoes, flick on my ipod, and start running. Though metaphorical and healthy, the literal focusing on nothing but physical sensation and breathing calms and centers my soul. Doing this outside with the sky over my head is my zen: there is nothing like it in all this world. When I am running I have nothing in my mind but calm focus and simple purpose to keep moving forward. Working through the physical pain of my muscles and lungs cures some of the emotional ache, and the simplicity of the exercise (just breathe and keep moving) grounds and centers me. Eventually, the endorphins get pumping and my measly, tiny amounts of dopamine and seratonin get their lazy butts to work. I smile. I feel happy.
Today when I was running around my lake feeling my muscles work up a hill and straining to keep my breath even with my stride I thought, "this is the first time I have felt happy all day." It is not necessarily that my depression makes me miserable all day anymore. I have learned to cope beyond that point. However, no matter what I try, running is the only thing that brings back the "happy." Otherwise, it's just numbness, spiraling and paralysis. It is my natural high. My addiction, I suppose, for my body and mind crave it now and want nothing else for relief of the depression.
Well, almost nothing else. I have to make a little plug for my sweet sweet puppy. Though I could go on about the therapeutic benefits of animals, suffice it to say that there is something very special about never having to go through anything alone. No matter how mopey or grumpy I feel, I always have a little white bundle of fur at my side who couldn't be more thrilled in the world to be there.
Thank you, God, for my beautiful runs and my little puppy.
Wednesday, February 9, 2011
My Afternoon off...
Every now and again I get burnt out at work. The patients I have come in cycles- new ones at the beginning of their pregnancy with all their needs and new problems, then these same patients after delivery with the CPS involvement and custody issues. At the peaks of these two cyles, I tend to have my moments of burn-out. Having just finished a CPS/delivery wave, now I am in the new patients, new problems wave. Also, one of the six therapists left, leaving five of us to manage all the patients. My caseload is new, and it is rising.
There are various causes of exhaustion on different days. On Mondays, I have two hours of back-to-back art therapy group that I plan and run. It may sound easy, but it is its own version of chaotic managing needy and unruly patients, keeping a topic relevant to them, following rules like sedation protocols, and making sure my supplies don't disappear. Tuesday, I was feeling emotinoally exhausted; just sad. Sad for the women trying so hard to kick addiction with the odds and a terrible life history up against them. Sad from patient after patient sitting in my office crying and crying. Sad from seeing some women so far gone into their addiction that their prognisis as poor on a good day. Sad sad SAD.
Today I am a mixture of the two. After a patient, a group, clinical rounds and methadone rounds this morning, I asked my supervisor for permission to retreat home for the rest of the afternoon. To relax? Nope. To do three weeks of case notes I have fallen behind on and can't get done at the office because of constant other things to do.
SO here is my afternoon off to recalibrate and recuperate from work: millions of work case notes. SIGH. At least Zorro is here and he doesn't shoot dope, nod out, eat benzos or smoke crack. Or grass. Or snort. Or take pills. You get the idea.
There are various causes of exhaustion on different days. On Mondays, I have two hours of back-to-back art therapy group that I plan and run. It may sound easy, but it is its own version of chaotic managing needy and unruly patients, keeping a topic relevant to them, following rules like sedation protocols, and making sure my supplies don't disappear. Tuesday, I was feeling emotinoally exhausted; just sad. Sad for the women trying so hard to kick addiction with the odds and a terrible life history up against them. Sad from patient after patient sitting in my office crying and crying. Sad from seeing some women so far gone into their addiction that their prognisis as poor on a good day. Sad sad SAD.
Today I am a mixture of the two. After a patient, a group, clinical rounds and methadone rounds this morning, I asked my supervisor for permission to retreat home for the rest of the afternoon. To relax? Nope. To do three weeks of case notes I have fallen behind on and can't get done at the office because of constant other things to do.
SO here is my afternoon off to recalibrate and recuperate from work: millions of work case notes. SIGH. At least Zorro is here and he doesn't shoot dope, nod out, eat benzos or smoke crack. Or grass. Or snort. Or take pills. You get the idea.
Monday, February 7, 2011
The Color Test
| Click'>http://www.colorquiz.com/cgi-bin/results.cgi?do=print_blog&picked1=1,5,4,2,3,0,7,6&picked2=1,5,2,4,3,7,6,0&sex=f&blog_name=Cindy">Click here to read the rest of the results. |
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