Tuesday, January 30, 2007


Did you see the lead article in the Sunday NY Times Magazine? It was about nutrition, by Michael Pollan. His position is that we should eat food. Just food, without additives, supplements, enrichments, reformulations, re-engineered, or processed. If you eat moderate amounts of plain food, the better you will be. He makes a case that getting nutrients is not the same as getting nutrition.

Now, I know there are people out there who know more about this than I do, but I like his basic idea: keep it simple, stick to the basics ( I read another book about that)

That is what I am trying to get people to do when they come to me for treatment. I want them to live their life, in real direct form. I don't want them to live it in their brains, or through chemicals, or magical routines, or special thought processes or mystical beliefs.

I want them to live with thoughts, emotions and behaviors. I want them to think about what they are doing and feel what they are feeling. I want them to see that what has been done to them, and how they have reacted, has brought them to where they are now, and that what they do now will determine where they will be soon.

It's tough work, but it's not magic.

Yet, I see how difficult that can be. Today, was one of those days when I just rattled off appointments. 9, 10, 11, 12, 1, 3, 4, 5. All kinds of shapes and sizes. But what I came away with today was how difficult it becomes once you fall behind.

You know, you have one of those days when you come home, throw the bills on the pile, open a beer and watch TV and just don't (can't) give a shit. But then those days become weeks and then months. The bills are piled up, the laundry is piled up, the dishes are piled up, the dust is piled up, the car registration is run out, the parking tickets are unpaid, your license gets suspended,and you don't have the money.

You would,(I no longer am) be amazed how many people fall into this. How many houses are falling down inside, even if the lawn is mowed. How many tables are piled high with ten years of US Magazine and losing lottery tickets.

Mostly, these people feel neglected and rejected and that if no one else cares, why the hell should they. It's sad.

But once the mess begins, no one is coming to the rescue. Well, maybe once or twice the family will come. But then they seem to vanish. It is very difficult to carry along someone who won't at least respond; get up and move.

You've got to start with the basics and stick with it. As the teacher said when he was asked by his student, now that he had come to the school, where should he look to learn the great insights. The teacher asked if he had eaten. When the student responded that he had, the teacher said: "then wash your bowl."

Monday, January 29, 2007

Answer the question

Thanks, for asking. Thanks for answering. You guys are really cool out there. I enjoy all of the exchanges. Sometimes I wish I didn't see 35 clients a week so we could just sit here and talk.

But, ever since psychotherapy was able to be covered by medical insurance payments, which began in the late 1970s, it has been necessary to give everyone a diagnosis if you wanted the insurance company to pay the bill. That gave a strong impetus to the idea that this mental stuff is medical; so it must be disease.

Then, drug companies began to enter the picture in a big way, and they pushed the idea hard, that if you are anxious, depressed, upset, wild, shy, angry, oppositional, or plain old obnoxious, then they had a pill for it, so it really must be a disease.

We also had more technologies that could show what was going on in the brain when someone became anxious or depressed or any of those things. That made it all seem like it is physiological.

Of course it is, at that level. That's reductionism. Everything we do, feel, think, imagine, feel, shows up in our brains and our bodies because that's who we are.

But, here's a nice extreme example. You walk into the bedroom and your girl is in bed with your buddy. You have a reaction. You are surprised, stunned, angry, hurt, confused, and even unhappy.

Your brain is full of chemicals and electrical charges running up and back. It runs through your entire body, your muscles, your heart, your lungs, the whole deal.

So, what do you treat? Do you seek a tranquilizer to stop all the chemicals? Will that make it better? Is what is happening a disease?

Now, I agree that's an extreme situation. But what if you failed a test, or dropped the ball, or lost your job. And then you lost another one, and couldn't pay the rent, and your car broke,and you kid got sick.

What about more damaging things such as your parents were abusive, or your uncle molested you, or your husband beat you regularly?

Those things cause long-term chemical imbalances in the brain. Is that a disease?

Now, sometimes, taking pills can be a necessary step in getting your brain back into balance. Sometimes it just calms you down. Sometimes a pill stops you in your tracks, you can hardly think and you get fat.

Also, some people really do have bad brains. Those brains, because of injuries, some congenital defect or toxins, don't work right.

But, IMHP, those case are much less frequent than we are being led to believe. And we are being led to believe that by people who are making money from products and services based on those beliefs. We believe it more because it seems like "science," and it seems to offer an easy solution.

Changing your life is very difficult (I've been doing the same thing, with slight improvements, for thirty years). But it's your life and your responsibility.

But, it isn't of course, because everything you do is determined by how your physical being has already interacted with all you have experienced.

But, you can alter that by adding the experience of new thoughts, by bringing new thoughts right into your own head.

But, how can you do that unless you have learned about it? That had to come from somewhere.

I guess just from reading this bog.

Saturday, January 27, 2007

Not just the weather

It's gray and cold up here in the great Northeast.

I am gray and old. Not much I can do about that. Dye my hair?

Physically healthy? Today I am, yesterday I had that stomach thing that everyone shared.

Mentally healthy? Now that's an interesting question.

Yesterday I was reading about Behavioral Activation It's a treatment for depression. On the website of Dr. Christopher Martell, who devised this treatment, he states that he doesn't think that depression is a disease, like, say diabetes. Well, I never thought it was either, at least not more than 10% of the time. People don't just catch depression the way I did that stomach thing yesterday. It comes from having a rotten life, and not knowing how, or not being able to change it. You end up feeling powerless, worthless, and useless. When those feelings last for a while, your are what we call, depressed.

But, to me, that doesn't mean you are unhealthy. Often, being depressed is the only response you can have. Why some people are not totally immobilized is what amazes me.

One of my favorite clients, let's call her Amy, comes to see me about once a month, if she can make it. She has very bad knees, a broken foot that has healed badly and a degenerative bone disease that causes her back and hips to crumble. It takes her about three minutes to walk into my office from the waiting room. She is fifty-six years-old. She has had cancer in her forties, and last year a heart attack. She takes so many medications that her digestive system is a mess.

Amy was raised by a father who terrorized both her and her mother. He was demanding, abusive and overbearing. If Amy reacted too slowly he would take out his gun and fire it over her head. Well, he only did that three or four times.

When she was about seventeen she thought she would turn him into the police. But she didn't bother, because her father was the judge.

She was married twice. The first time she got pregnant and then her father set out to kill her. He would have but her mother hid her in a different state. The first husband was a kid who was lost and a drinker so the marriage fell apart. Ten years later, Amy met a man who had been in high school with her and had always wanted to be with her. They married and had five marvelous years together. Then he died of cancer.

And last year, Amy, who now was living alone, befriended a seventy year-old man and cooked suppers for him and cheered him up. He fell in love with her. She told him she was complimented but no thanks. He came back, tanked up on Viagra, and threw this mostly crippled woman on the bed and tried to rape her.

Stuff happens.

Now, Amy is depressed. But when she comes to see me, she worries about me. She is actually very funny, and has a real will to live and carry on. She gets discouraged. She lives with a lot of pain. She tries, as long as her energy hold out.

But I would call her healthy. Her depression is not a disease.

Thursday, January 25, 2007

sreaming, yelling, etc.

What a week, huh?

I don't know what is happening where you are, but up here the sky is falling. All this screaming, yelling, fighting, crying, pushing, shoving, dramatic melt-down kind of stuff.

I have one friend in the hospital and another waiting to start chemo. A relative is going through a divorce and another friend just had a murder where he works. My aunt died. And my wife is on the condo board! You can imagine what that does to her.

And then there are also my clients.

I had four in high crisis mode this week. Interpersonal and intra-psychic conflicts abound. The phone calls, and now even emails come pouring in. "Help I've fallen and I can't get up!"

Yes you can. Here, sit up, now put your hand here, now balance, now stand up. See, there you are, upright.

That's what I've learned after doing this for thirty years. Be patient, stay calm, breathe, balance. Most of the time, things get better. Most of the time. It works much better for psychological stuff than physical stuff. Breathing deeply will not cure cancer. Thinking good thoughts won't stop bad cells from multiplying, you need protons and drugs for that. Thinking good thoughts may save a marriage, or avoid a personal melt-down. But that takes some dsscipling and re-training.

After thirty years, I've become good at that. Or maybe I'm just too passive

Monday, January 22, 2007

Laura's play

Laura has been staying home, trying to avoid contact with the guy who has been plaguing her and driving her crazy. But then she hears from a friend that this guy has been already contacting other women on one of the local dating websites.

This sets her off in a fury. As I discussed in the last post this jealousy emotion must have its roots in some kind of adaptive behavior, perhaps of not having to waste precious resources on other people's children or something, but in today's highly communicative society it quickly leads to trouble.

Laura's response was to put her picture up on the same site. Under the picture she writes that she has just broken-up with a scum-bag and that she feels the best way to get over him is to have a very quick sexual encounter with a stranger. She wrote that she thinks doing that would cure her of thinking about him, and that the stranger would not be expected to stick around, or have any other responsibilities.

Within four hours she had 215 concerned, sensitive men volunteering to help her get over her lost relationship.

It's nice to know people care.

At this time Laura has not yet chosen the lucky winner. She may be re-thinking the idea.

Sunday, January 21, 2007

Variations on the theme

Thanks to everyone who has responded to the posts about Laura. Right now she is still headed in the right direction, saying the right things. As all of you seem to know, it takes a long time.

Last week I saw Victoria (not her real name)for the second time. She is younger than Laura,just a couple of years out of college, has a pretty good job, and is a pretty confident woman. But men confuse the hell out of her.

Her own family had some difficulties, but not the overwhelming kind that I often see. He father has gone through several bouts of a real major depression when would just shut down for months. He lost jobs, stayed in bed, looked awful But he kept on trying. He would rally and be moderately OK for a couple of years before crashing again.

Victoria was very frightened by this, and by seeing all that her mother had to do to keep the family going. So now, any time a man has a problem, she is gone. But once she is gone, she feels somewhat compelled to stay friends with them, and try to fix them.

But, that's not what I want to get into here. What I want to talk about is her most recent case of jealously. Victoria kept in touch with one guy, and was helping him put up a profile on-line. She stumbled into his email account -- he said it was fine, they were friends now, there were not secrets. But then she found an email from a woman that was sent while they were still trying to be a couple.

She flipped out. got jealous, felt betrayed.

He was stunned. It was nothing. He didn't remember this woman, and anyway why put so much rage into a relationship that was already over.

She didn't know. Couldn't explain it.

To me, it's an insight into how primitive we all really are. As Willie S. said a few hundred years ago: "Hell hath no fury as a woman scorned." True it is. And doubly so for men, who set out with guns and knives when they feel betrayed.

This sex thing is pretty powerful stuff for humans. In the rest of the animal kingdom it's a pretty mixed picture. Some animals mate for life and get really depressed when the partner is gone. Other creatures seem to get it wherever they can.

Maybe with us it has to do with how much effort it takes to raise a child. Maybe it just has to do with the need to get your rocks off consistently. But it is surely there, and, as The Greeks made very clear, people are ruled by their passions. That has not changed much in 3000 years. Technology and birth-control have only made it more confusing.

I will let you know how Laura does.

I will see how Victoria does.

Somebody put holes in L's boots and the water is coming in. "Why would somebody want to do that?"

Friday, January 19, 2007

Update: Laura dumps him

You've all been waiting for the next installment, so here it is.

I saw Laura this week and she came alone. She said that she has been totally free of all mind-altering substances, except caffeine, for six days. That means no alcohol, no nicotine, no Atavan, no Xanex,and no pot. Nothing.

She is also free of him. She gave him the challenge of joining her in not drinking. At first he said that he thought that was s stupid idea, but when he realized she wasn't going to see him unless he stopped, he agreed. (all this was done by email). But by the time he agreed she was sober enough to realize that he wouldn't be able to stick with it, even if he meant it.

So now, Laura has pulled it together. She dragged her son back into the house and threw out all his pot and all of his bongs. Together they are ripping up carpets and repainting walls. She is re-feathering her nest.

Done, done, done. Everything is over. She is beginning again. She is not even putting a profile on-line. She will just be by herself for... well, how long isn't clear.

If you see Laura, you will know immediately that she has designed herself to attract attention from men (not artificially, like the other woman I mentioned). If she is going to stay alone, she will have to work at it. The only time she has been without a man, or two, since fifth grade, was when her parents put her in a convent school to end the affair she was having with her English teacher. (He was one of those who encouraged her to write).

I would bet that she will successfully get rid of this guy. No more bouncing up and back (and up and down) with him.

Has she learned anything? Will the next relationship be different? Once she understands why she is attracted to losers will it help change her behavior?

Again, we will have to wait and see.

There will be another chapter. That's the great part of this business; there always is. It's not like a novel that comes to a nice ending, because in life, there is always the next day, even when there isn't much of a plot.

Wednesday, January 17, 2007


"You can be ANYTHING you want to be, if you just put your mind to it."

That maxim is the basis of over 45,000 self-help books. What they don't tell you is that it is only half the story.


J (not his real initial) is a 20 year-old college student who is majoring in computer science. He hopes to design computer games. He already spends many hours playing these games, so much so that his grades in his programming courses are mediocre at best.

Now, it may be true, or at least possible, for J to stop playing games and study hard and get to be such a good programmer that he can get whatever job he wants. But then, as he almost had the insight to say, he wouldn't be J. A major part of being J is being a slacker who is kool and doesn't just do what he is told.

So, does he want to be a game designer?

B (not her real initial either) wants to get married. She has planned six different versions of her wedding. She loves the idea of getting married, being a princess, and living happily ever after. "Is that too much to ask for?"

It is, if you can't keep a relationship going past the second month. If you think being in love means that someone will come through the door and just adore the wonderful you, while you eat Wendy's, watch soap operas and read Bride Magazine.

You see, I often explain. If you really want to be something you have to give other things up. That's the part they don't tell you. Often, what that means, is that becoming that something isn't worth the trade-off. You won't really still be you, when you become that.

I once saw a woman, smart, social, perky, who decided that this was America, and what she wanted was to become rich. Not just have money, but be rich: rich-rich.

As she talked about she saw what she had to do. She gave up both her boyfriends. She transfer to a business college. She decided on the best business that she could go into fast. She joined an office, she worked 70 hours a week, she bought the office. She hired people to run it. She bought three other offices of the same kind of business. She lured people from other offices to work for her. If they didn't work out she politely let them go. That included her brother and mother. She was constantly contacting people, taking people to lunch, writing cards to people, making phone calls, making deals, making better deals.

Her recreation was going over the books.

Family, friends, lovers, parties, camping, cooking, shopping, all dropped away. She worked and she went to the gym. She was no longer the person she was before.

You know what, she was happy. She came back to tell me that, and to ask if I needed any of what she sold. She really didn't know what she was going to do with the money, but the numbers in her accounts were very large. She thought of it as the American game of life, and she was winning.

The intereting spin-off of that is that this is a small city. In the year since I last saw that woman I have seen four other cases of people who knew her and wanted to be like her, or in some cases they wanted their spouse to be like her.

They wanted they money. They wanted to have the money so they could spend it. They wanted to still be the people they were, and make the money she made. That wasn't working. The trade-offs were not worth it.

They were all just as smart, and maybe just as energetic, but they weren't willing to pay the price.

I am not saing they were weak or wrong or not good at it. In fact, I think they realized that for them, it wasn't worth it.

That's what they don't tell you in the self-help books. Make sure that what you want is worth the price of getting there, or else you won't get there.

Monday, January 15, 2007

MLK and us

It was MLK's birthday today. It's a national holiday. I took the day off. I can, I run my own business. I respect what he did and what he still stands for.

I take a slightly different stance however. MLK said that all people are equal. I'm for that. He kind of implied that all people are equally important and each person is special. That's where we differ.

Basically, I feel that we are all united by our insignificance. For this I refer you to that Carl Sagan poster. The one that shows that vast blackness of the universe with earth being a tiny blue dot in the corner. We, each of us, is a much, much even more tiny dot down here on earth.

For many of the clients I have seen the basis of their difficulties is their own exaggerated sense of importance. They somehow felt that the world, and those there in it, should take better care of them, or give greater recognition of their achievements, or bless them and keep them, just because they exist. This is especially true now in our "celebrity culture."

Everyone wants to be a star. Most of the stars are idiots. You put up something clever on YouTube. That's good. I'll watch it and smile. You are reading my blog. Thanks.

So many people feeling sorry for themselves. Yes, some of you have been screwed. Some have been given a very bad hand to play with. For those, I will try to give you a break, or a push, or even a couple of dollars. But many of you are just wallowing in it, wasting your time, wasting mine; and I'm getting paid to listen.
Spare me the drama.

We are each very important. I believe in that. But mostly we are important to ourselves, and then to a few people around us. Perhaps we make their lives better, cheerier, or more comfortable. If we do, that's great. That's what it's all about. But that's all there is.

But the world can, and will, get along without any and all of us. In fact, the universe can, and eventually will, get along without out little blue dot. So, don't take it all so seriously. Get on with your life. Take advantage of being alive for the short time you are with us. Be nice to those around you. Do something fun and creative. Whistle a happy tune.

Really, who do you think is important? The President? That's a good one.
Raise your hand if you think he's an asshole.

I see a lot of hands.

MLK, he made a difference. They shot him in the head.

Saturday, January 13, 2007

Two Things

Sometimes, as a therapist, I run into an awkward moment. A few weeks ago I saw an old patient returned. I had not seen her for about two years. She had first seen me about eight years ago when she had panic attacks, and again six years ago when she was beginning a new business. She was smart and fun. She came from a crazy family that haunted and degraded her, but she was making great strides in overcoming all that.

But when she appeared for her appointment she was wearing a slick new windbreaker that she ostentatiously took off, revealing a brightly colored V-neck T-shirt. Things were her were clearly different. But how, as a therapist, do I say anything? or should I?

So I didn't say anything at our first meeting.

Eventually, the subject matter came around to how men have been flocking around her more than usual. So I said "Well, you are a bit different, aren't you?"

But she wouldn't be helpful and just answer. She had to say "How do you mean that?"
So I had to say "You've been enhanced, did't you?" Then she said: "You like them don't you?"

"Sure," I said, " I'm not that old."

Which leads me to


It's not a good sign for your marriage if you wife goes an invests in a new pair of tits. I've been through this about four times now, and each time, within six months, she was gone with some guy in a Mercedes.

I know one ex-husband who demanded the cost back as part of the divorce settlement. I think he got it.

Thursday, January 11, 2007

The Big Question

Here it its. This is really the question that you're all waiting for. There have been about 16000 books, +/- written about this. Now, as I age slowly, but not enough to not notice or not care, I can spot the problem within seconds for meeting a new client.

The question: Why do so many really attractive, smart, capable women, take-up with and then stay with, and then return to, such obvious losers.

As I said, this is not a new question. But it remains a major supplier of my business.

Today's example is Laura.

Going into this we knew that Laura has brought some problems of her own. They would more than fill a book, and I won't do that here mostly because she is already doing it herself. I am not sure if she has a publisher but she has told me that her writing professor wants to help her get it published. Knowing what I do know about Laure, and really, I know more than anyone as I have seen her on and off for ten years, I believe that if she is honest and explicit, that her book covers will melt.

Anyway, after a couple of early marriages Laura put together a solid career, taking in and tossing out guys every couple of years, as none of them were up to her standards. But now, she hooks up with a charming, semi-successful but on his way down, manipulative alcoholic. Their relationship began about a year and a half ago, and since then her life has been a mess.

He calls her, she leave work, they drink, they screw, they fight, they break-up. She won't talk to him, He begs her, he haunts her, she refuses. He calls again, and again. She gives in. She leaves work, they drink, they fight, they screw. He won't talk to her. He leaves town. She calls him. She begs him. He refuses. She doesn't get out of bed. Her kid cuts school. She cries. He comes back. She runs to him. They screw, they drink, they fight. He leaves. She smashes his car window. He calls the cops. They arrest her. He bails her out. They get back together, they drink, they screw, they fight.

Now she is frantic, crazed, drunk, ends up in the hospital. The doctors explain to her that she needs to stop this cycle. He is not good for her. She agrees. She gets out of the hospital. Stays sober. Stays away from him.

Two days later she calls me up. She is better off without him. she says. She thinks she that if she saw him again they would drink and fight, but...

Maybe if they stay sober and come to see me together I can help make it all work.

What are the odds of that?

I'll let you know what happens. I feel the prospects for success with them are about as good as they are for Bush sending more troops into Iraq.

Tuesday, January 09, 2007

two news

Two news stories merged together in my mind as I drove home from work.

I was listening to NPR on Monday night and I heard about a embryo bank that was open in San Antonio. The woman who runs it was describing how she buys eggs from women, and harvests them, as it's now called. Then she buys sperm from sperm-banks over the internet. Then she sends them to NY where a clinic puts them together in a petri dish and they mate and form an embryo, which, if handled correctly can turn into a baby.

The purpose of all this is to sell the embryos to couple who cannot conceive a child, but who, I guess can carry the embryo, for find someone who can. They implant it, and nine months later a child is born.

All kinds of questions that arise here, about who owns what and when? What to do when it doesn't work? Who are the real parents? Who can have the baby? Who can have the baby for whom? There is all that vague kind of ethical stuff that will remain five to ten years behind the technology. By the time the courts decide what they think is legal these babies could be in high school.

That's all fine with me. Have a baby if you want to. If a couple wants it that much I hope they take good care of the child. There is no guarantee of that, but the chances are no worse than they way things are done now.

But, the night before this I was reading an article in the NY Times Magazine about using drugs to help athletes, and how many athletes will and do take anything they can to give them an edge, especially if many many dollars are riding on it. A throw-away point in the article is that the military is helping to develop these drugs so that they can develop an uber-soldier. On researcher said they were working on a "metabolically enhanced dominant soldier. who could run at Olympic speeds for 15 minutes on one breath, or develop a pain vaccine that would block pain and inflammation for 30 days, or a drug that will allow a soldier to fight for a week without sleep."

The big fear, and there are probably already novels about this, is that these two ideas will merge, and that the army will get their own embryos and breed there own soldiers from birth. They will be specially bred and enhanced, and probably psychologically programed in unquestioned loyalty, and fascist thinking. They will protect "us" from "them" which would be fine, maybe, if I was sure I would be one of the "us", but I'm pretty sure I wouldn't be.

The really scary part is that this idea is quite old. Plato favored such a scheme to protect Athens, and wrote about it in The Republic. But now we have the technology.

If I have thought of this, you can be sure the people who are looking for soldiers to go to Iraq have already made plans. Maybe some of the kids are already five years old.

If the war ends they could all go to the NFL (or maybe they have).

Sunday, January 07, 2007

Begin again

And now the opposite, another week is about to begin. Sunday night has always been a time for me to reorient my head and prepare. It must have begun in Jr. High when I would stay up late and listen to Jean Sheppard (anyone remember him?)

This week will be busy. Almost all of the folks who said they would call to make an appointment after the holidays have called. There are others too, who have found their way to my voicemail, though very varied and complex networks that often surprise me. Only four of the thirty-six appointments are in the midst of a real major crises, although about nineteen think they are.

But, I think about my own life, and how much things have led me here, or how much I have chosen to make it that way. Probably because of what I do, I have learned to see things coming, and thus to avoid the worst of them. Sometimes, looking back, I wonder if I have chosen to avoid too much. There are risks I didn't take, that maybe I could have. Yet, my head is still attached, most of my body and mind work pretty well, and we are certainly not starving. My kids are healthy and doing very well, my wife is charming, and certainly still entertaining. I do spend too much time with people who are boring. I have cut down on that, but it still seems to force itself on me.

But, as much as I can, I try to believe that I have some control over what is going on. I am actively making choices. The options that I have to choose from do not always include my first choice -- I should be getting at least 3X an hour than what I do -- but all real choices involve trade-offs: You can work, or you can play. You can make money or spend it. You can have another drink, or avoid insulting your neighbor. You can stay up late, or wake up energized. You can do your homework, or fake it and hope for the best. You can seduce your neighbor's wife, or keep peace in the marriage.

There are all kinds of good things on each side of the either/or dilemma. Short-term or long-term gains? Can you really choose, or just rationalize?

Friday, January 05, 2007

the weeks's flotsam

Survived the first week of the new year. Wish I could say that things went smoothly, but hey, that's the nature of the business.

I did pick up a nice glimpse of "the way people live today." I heard it second hand. One of client's told me about her sister-in-law. She feels that the sister-in-law has a problem and wants to get her to come and see me.

It seems that the woman in question is very anxious about several things, one of them is an exaggerated fear about her safety. Therefore, in order not to get mugged, she doesn't carry cash. She uses her credit card for all her purchases.

That wouldn't be a bad thing, maybe she wants to collect the miles, but really, it is a bad thing because her credit isn't very good. Therefore her interest is high, and she makes things worse by often paying the bills late. What makes it even worse is that when she pays the bills late, she goes over her allowed credit line. Then, EACH time she charges something there is an EXTRA $25 charge, on top of the $35 late fee, and the 29% interest charge.

That means that when she goes to get gas, she pays $30 for the gas and a $25 surcharge. Then she goes to buy lunch and pays $12 for lunch, and a $25 surcharge. Then she charges her haircut, or groceries, or bottle of wine. She, or her husband, my client's brother, pays about $1000 a month on surcharges, and has been for the last SIX months! Even a second-grader would figure out that there could be a better way. But it continues; and they both seem to go along with it.

Perhaps she will make an appointment and I will get to understand what is really going one. I'll make sure she pays with cash.

Just another good time here in America.

Wednesday, January 03, 2007

New Year of health Care

We start another new year, and once again we have to deal with the changing landscape of which corporations are trying to make money by limiting our services, confusing our clients, or creating obstacles for us to work.

From about 1985 until 2002 new companies kept emerging and branching off. HMOs, PPOs, and other big health care corps began to close the market. Then carve out "mental health companies" began to sub-contract with those. Companies such as UBH Magellan, and Options among many others, sold their services to the big general health care corps.

Over the last five years, as if finally became clear that managing mental health care was not saving any money, the companies began to cannibalize each other. They would buy up one another, or sub-contract with someone else, or merge, or sub-sub-contract. Each time they did this they would change the rules of operation. Surveys of patient health are now getting more popular, and re-authorizations every four sessions is fading out. But that is only true with some companies, and it is not true of the same companies that it was last year.

So in addition to working with A/s panic attacks, B's divorce, C's drinking, D's Drugging, the death of F's father, G's court case, H's feelings of worthlessness, I's rejection by her new lover, J's rejection of her new lover, K's total isolation and, of course, the holes they put in L's boots! I have to figure out for whom I have to request sessions, to whom the request goes, where the bill goes, how much they will pay, how much the client pays, and mainly, why it has to be like this.

Until the American people realize they are paying a lot of money so that many people who do sales and marketing can get rich, while access to and the actual providing health care becomes scarce and difficult, we will continue to become a sicker and poorer nation.

The main priority of America has always been to make money. The price we all pay to join that lottery has become very dear.

Tuesday, January 02, 2007

New Year 1

I began the new year with the cold that my wife gave me at Christmas. It seemed to fit me well, so it has hung around for a while.

What is always a part of the profession is that we deal with people whose lives are always in flux, if not in totally crisis. At the end of last week I had prepared my new appointment book. It was all neat and uncluttered, smooth and clear. Every hour had one name written neatly in the box. Tuesday, Jan. 2, listed eight appointments.

I had thirteen messages waiting for me at 8:47. Two people were still sick from New Year's Eve. One was just out of the emergency room. One had missed the return flight from California. One had to suddenly fly to California. Three people who said they would call in the new year were already calling.

By 9 AM I had crossed out five appointments and written in six new ones.

My eleven o'clock was one of the ones that canceled so I thought I had a moment to get everything up on the computer for this year, but a woman walked in. She is someone who lives around the corner and for two years now she just walks into the office. If I am with someone she changes the station on the radio in the waiting-room, and that way I know she was there. She is a friendly, loud, impulsive woman who usually works two jobs, but she quit one in November over a slight disagreement.

She fling herself ove a chair and ee had a discussion about why she should return to that job/ I said she should because she needs the money, she was good at it, she left for a dumb reason, and they want her back. She won't go back only because she is vain and stubborn.

After half an hour I had pointed this out to her clearly. I am not always so directive, but I know that all of those things are true.

She smiled, picked up the head of the frog-puzzle that sits on my coffee table, threw it at me, laughed, told me I was cute, and walked out.

I am not that cute, but she will probably go back to the job next week. She won't tell me she did so for another month, and then she will act surprised that I didn't know.

In this second job she uses her advanced degree, which is a Ph.D. in psychology.