Family Therapy

When it comes to family therapy, there’s this idea that each person in a family impacts the whole family. Usually, this looks like individual family members taking on specific roles. I vividly recall taking on the role of “responsible older sibling” while my sister took on the role of “the baby.” These roles are not stagnant. Family members often shift their roles, sometimes “responsible older sibling” becomes “teenage rebel.” Sometimes these roles change based on situation. “The baby” may turn into “annoying younger sibling” when the parents aren’t around. Parents take on roles within the family unit, too. I’m thinking of the very common “fun parent” and “mean parent.” But there are many more.

When one person within the family unit changes the way they do things, the rest of the family unit pushes back. Think about how an older sibling’s behaviors change when a new baby comes into the family. The older child might want to be held or fed “like a baby” or even have some potty training regressions. They might “act out” and say things like “I hate the baby. Take him back!” Or they might go the opposite direction and try to parent the baby themselves. Change is hard.

I see this in familiy therapy when a parent begins to implement a new strategy for dealing with a child’s inappropriate behavior. I always warn the parent that “things will get worse before they get better.” I can’t tell you how many times I’ve heard “We tried that, but it didn’t work.” Of course it didn’t work. The kid is used to things being a certain way, and trying to change the way things are is new territory and it can be pretty scary.

Let’s look at an example

Nine year old boy is refusing to do his homework, his chores, or even to take a bath. His parents have tried EVERYTHING! They’ve taken away his electronics, took him out of football, grounded him to his room for days, even stopped letting him play outside with friends. Nothing works. Then in a family therapy session their son’s new therapist suggests that they try a radical new approach of no more punishments. Clearly, this new therapist is a quack! The therapist politely suggests: what you’ve been doing hasn’t worked, so why not try something new?

So the therapist goes through the plan with the parents, helps the parents practice the new way of responding to the child when he’s refusing to do what he’s been asked to do, and vehemently reminds the parents that “things will get worse before they get better.” The parents have a conversation with Little Jonny and his older sister Susan and explain that things are not working and something has to change, so they will be trying this new parenting approach that Jonny’s therapist suggested. They explain to Jonny and Susan that they’re going to be using “logical consequences” whenever possible and talk about what that looks like.

Then, they begin. Like every other day, Jonny refuses to do his chore after dinner, but this time instead of sending Jonny to his room, Jonny’s dad says “Man, it’s too bad that you don’t want to do your chore tonight. I was hoping we could all watch the new Marvel movie tonight, but now that I’m doing my chores AND Jonny’s chores, we just won’t have time to watch it before bed.” Jonny does nothing, and his dad does both their chores. This continues for the rest of the week. Each day, Jonny’s parents express their disappointment and regret that Jonny didn’t do his chores because it means they have to do double chores. Susan watches Jonny refuse to do his chores and not get into trouble, and she keeps telling her parents how unfair it is that she has to do her chores but Jonny doesn’t.

The next week, Susan begins to refuse to do her chores. Again, the parents stick with the technique and simply tell Susan that they’re disappointed because now they have to do all the chores. The parents spend the entire evening cleaning up after dinner. They come into the next family therapy session ready to quit this technique. It’s clearly not working! The therapist reminds them that “things will get worse before they get better.” The parents agree to continue for two more weeks.

Over the weekend, the parents casually comment that they’re so glad that the house is clean. They take pride in keeping a clean home, but it’s too bad that they can’t invite friends over because they’re just too tired from all the chores they’ve been doing all week. The parents regretfully inform Susan and Jonny that they can’t take them to the mall or the park because they’ve got other things to catch up on that they didn’t have time to do during the week.

The next week, Susan does her chores. Jonny still refuses. The parents continue to express their disappointment and regret when he refuses. However, on Sunday Jonny announces to his parents and Susan that he is going to do his chores this week. The parents are shocked, but they very carefully say, in a casual way, “I think that sounds like a good idea” and “Sure, honey.”

Let’s explore this example

When the parents tell Jonny or Susan that they don’t have time to do one thing or another, they are very careful to say it in a very objective, matter-of-fact way without placing blame. This is very important because saying “I can’t shoot hoops with you tonight because Jonny didn’t do his chore” would likely make Jonny defensive which would make him even less likely to cooperate. Instead, they focus on showing the kids how important it is for everyone in the family to work together to keep the house clean and highlight the consequences of not working together. And Jonny reaches his decision to do his chores on his own.

This really does sound like a radical idea, but it works when done correctly. It does not work, however, when done incorrectly. I know from experience. It is very hard to keep blame out of your voice when telling your child that you can’t do something you really wanted to do because they didn’t do what they were supposed to do.

Notice how Susan pushed against the parents’ new way of doing things? At first she complained, then she also stopped doing her chore. This happens when kids experience something different. But they are usually pretty resilient and will pick up on the new way of doing things. Problems arise when the parents give up too soon or when one parent has trouble with things changing. Imagine in this scenario if Jonny’s parents stopped the intervention when Susan stopped doing her chores. What if Jonny’s dad was on board with the new techniques but Jonny’s mom was adamant that it would not work. Would the techniques introduced in Jonny’s family therapy sessions work in these situations? Probably not.

Let’s review

It’s easy to see this kind of resistance in this example of a hetero- nuclear family, but it exists in all family structures. Maybe someone in the family is recovering from addiction. Perhaps someone in the family is trying to overcome depression or anxiety. Maybe the parents are going through a separation or divorce. Orthere’s been a significant loss in the family. Whatever the circumstances, when one person within a family unit is making changes in their own lives, it can have an impact on the entire family.

Change is hard. It takes time and often meets resistence. However, change is possible with commitment and consistency. Family therapy provides the support the family needs to stick to these changes.

Ready to get started?

If teletherapy sounds like it might be right for you, please reach out to schedule your free fifteen-minute consultation by calling 662-200-4210 or clicking the “schedule an appointment” button.

Paying for Therapy

Last time I wrote about the benefits of choosing teletherapy or virtual therapy over traditional in-person therapy. In this post, I want provide reasons you may want to pay for therapy out of pocket instead of through your health insurance. This can seem overwhelming when considering the cost of therapy, but the inconsistencies and restrictions that come with health insurance make the cost worth it in many cases. Therapists give lots of thought and consideration before making this decision for their practice. Ultimately, I decided to not accept insurance because I want my client’s to have complete control over their therapy options.

Our heathcare sytem is broken

In many cases, your employer is the one who determines which insurance options are available to you, and you are then subjected to limited options for in-network providers (such as therapists or primary care physicians) and limited coverage that you have very little control over. Every year during open enrollment you learn whether your employer has decided to keep the same insurance options or to change them. Or maybe you’re faced with a whole new insurance plan because you’ve made a change in employment. These changes in plans are often inconsistent with the healthcare providers and coverage you’ve gotten used to working with, so you find yourself searching for new providers and figuring out new treatment options. This can be frustrating and even detrimental to progress when you’ve been working with the same therapist for several months and have to stop seeing them because of a change in insurance coverage.

It’s expensive.

You’re also responsible for paying the monthly premiums for these healthcare plans and other out-of-pocket expenses like co-pays and deductibles. (It seems like one of my milestones of reaching adulthood was finally understanding concepts like “premiums” and “deductibles.”) Sometimes you’re fortunate enough to have an insurance plan where you can make your monthly payments AND meet your deductible without creating any financial hardship. Often, folx find themselves paying a good portion of their paychecks toward health insurance then unable afford the co-pay to see the doctor or therapist, especially if they have multiple dependents on their healthcare plan. Having a high monthly premium or copay can keep people from utilizing therapy services.

It’s restrictive.

You’re also limited to the treatments and services approved by your health insurance plan. In theory this would protect the consumer from inappropriate or ineffective medications and treatments, but in reality it restricts a provider’s ability to meet the consumer’s needs. Health insurance puts restrictions on what type of mental health problems they cover, what types of treatments they cover, and time frames for those treatments. These kinds of limitations cannot meet the complex needs of people who do not fit into neat little boxes. When you pay for therapy yourself, you don’t have to worry about all these restrictions.

It’s inconvenient.

So what happens when the insurance plan your employer offers is too expensive or does not provide the access to care that meets your personal needs? It’s very difficult to obtain health insurance through other means when your company offers it to its employees. I once had a job that was based in another state so the closest in-network provider was 90 minutes away, and the out of network costs were outrageous. I declined the health insurance thinking I could be added to my spouse’s insurance through their job… Nope. It wasn’t an option since my employer OFFERED health insurance. I thought I could enroll through the healthcare marketplace… Nope. Again, I was not eligible due to my company OFFERING health insurance. I ended up having to pay a fine for not having healthcare coverage that year. It is important to be able to make your own choices about what kind of treatment you’d like to receive.

What if you’re uninsured or underinsured?

What if you’re unemployed? Working part-time? Working as a contractor or another job that doesn’t provide insurance (like cleaning houses or babysitting)? Again, it seems like people in these situations have very few options. Many people in these situations simply go uninsured and *hope* they don’t need to go to the doctor. In 2018, the percentage of uninsured non-elderly individuals in Mississippi was 14.5% (compared to the national average of 10.4%). That’s 351,794 individuals in Mississippi without healthcare coverage. https://www.kff.org/statedata/election-state-fact-sheets/mississippi

Pay for therapy yourself.

My goal is simply to provide quality therapy services in a way that gives my clients the power to prioritize mental health. I believe that every person has the right to make their own choices about their mental health care, including what problems they want to address, whether they want a formal diagnosis on their health records, and what treatment options may be right for them. I am able to give my clients this power by choosing to not work with insurance companies.

You have the power to prioritize your mental health.

Many of the issues with health insurance are related to affordability. A $70 co-pay is much more affordable than a $140 therapy session. When that is your only option, you have to do what you have to do. There are many excellent therapists in-network with major insurance companies in the state of Mississippi. If you choose to go this route, contact your insurance company for a list of in-network providers. However, if you want control over your mental health care (and can afford it) then paying for therapy services yourself may be the best option for you.

*If you do not have health insurance and want to pay for therapy out of pocket at a sliding-fee rate, you can apply to become a member of Open Path Collective at https://openpathcollective.org/

**Most therapists have a limited number of sliding-fee rate clients and you may have to go on a waitlist or spend more time looking for a therapist who can accept you as a sliding-fee client.

Ready to get started?

If teletherapy sounds like it might be right for you, please reach out to schedule your free fifteen-minute consultation by calling 662-200-4210 or clicking the “schedule an appointment” button.