By Lindsey Phillips June 29, 2018
We all have our biases — but just because bias is a universal part of the human experience doesn’t mean it is something we should ever dismiss offhandedly, either in ourselves or others. That’s because bias has serious consequences, and when left unchecked, it can turn into bullying. A 2012 study of California middle and high school students published in the American Journal of Public Health found that 75 percent of all bullying originated from some type of bias against a person’s race, sexual orientation, religion, disability or other personal characteristic.
People often talk about bullying in general terms. But as Annaleise Singh, a professor of counseling and associate dean for the Office of Diversity, Equity and Inclusion at the University of Georgia, points out, “If you look more closely at ‘general bullying,’ what you’ll see is a lot of bias-based bullying.”
SeriaShia Chatters-Smith, an assistant professor of counselor education and coordinator of the clinical mental health counseling in schools and communities program at the Pennsylvania State University, defines bias-based bullying as bullying that is specifically based on an individual’s identifying characteristics, such as race/ethnicity, gender, sexual orientation or weight. For example, adolescents might create Snapchat stories that attack someone on the basis of their race, weight or sexual orientation, and parents or teachers might treat children differently on the basis of their skin color, notes Chatters-Smith, an ACA member who presented on “Bullying Among Diverse Populations” at the ACA 2017 Conference & Expo in San Francisco. Research indicates that individuals of color, particularly black and Hispanic men, are more likely to be identified as being aggressive, she adds.
In her research on transgender people, Singh, who co-founded the Georgia Safe Schools Coalition and founded the Trans Resilience Project, has found that bias-based bullying can be based on appearance, gender expression or gender identity, and it can range from name-calling to physical and sexual harassment and assault.
A four-letter word
When people start talking about someone having a bias, those four letters typically trigger a negative reaction and shut down conversation, which isn’t productive. Thus, Chatters-Smith argues that helping people understand that everyone has biases is crucial to addressing bias-based bullying.
However, this task can be difficult because people often resist closely exploring their own prejudices. Counselors should help clients realize that just because everyone has biases doesn’t mean they are excused from recognizing and addressing their own, Chatters-Smith argues.
Because bias is often an emotionally charged topic, Chatters-Smith finds it helpful to start with a nonthreatening example. After pointing out bias, she asks clients when they first identified something as their favorite color. Most people can’t remember when this color preference started because they were young, Chatters-Smith says. She explains how after someone establishes a color preference, the brain starts to sort things by that color.
“When you see something that is your favorite color, you are more likely to gravitate toward it. You have more positive feelings toward cars that are your favorite color. … And sometimes a car may not be the best-looking car, but because it’s our favorite color, we gravitate toward it. That is bias,” Chatters-Smith explains.
Bias is a kind of sorting process that our brain goes through, she continues. “The experiences that we have with individuals can then cause us to have specific attitudes toward someone, and when we see them, we prejudge that they are going to act or be a certain way because of those experiences. … We do an automatic sort.”
Counselors are not immune to bias either. For example, a counselor might assume that a black male client who is unemployed did something to cause his unemployment, Chatters-Smith says. If this happens, the counselor needs to take a step back and ask why he or she is entertaining that assumption, she continues.
These internalized biases can also have a direct effect on students. For example, Singh says, LGBTQ students will not feel safe reporting bias-based bullying by their peers when they hear educators or school counselors expressing anti-queer or anti-trans views. Educators can also hold bias against students in special education, which may limit the opportunities those students have to learn, she adds.
Singh, an American Counseling Association member and licensed professional clinical counselor in Georgia, finds cognitive behavior therapy (CBT) helpful because challenging irrational thoughts is at the heart of addressing bias-based bullying. Thus, counselors need to ask clients and themselves some CBT-related questions: Where did you learn this thought? What research supports this idea?
Counselors “have to become strong advocates in order to interrupt those beliefs systems because the person enacting them — whether or not they’re conscious [of it] — isn’t going to stop until there’s an advocacy intervention,” Singh says.
After making clients (or educators) aware of bias, counselors can work with them to figure out times that they might have sorted a person into a category before getting to know that person and then brainstorm ways to manage that differently in the future.
Counselors can also benefit from bias-based bullying training. In working with Stand for State, a bystander intervention program at Penn State, Chatters-Smith found that certain questions or situations related to bias would cause the counselors participating in the bias-based education to pause or stumble. “A person who is not educated to know [how to respond] can get really thrown off guard,” she says.
Chatters-Smith knows from experience. Once in a workshop, she mentioned how saying that all Jewish people are good with money is an example of a racially charged joke. One of the participants responded, “But all Jewish people are good with money.”
Chatters-Smith questioned this statement by asking, “Really? All Jewish people? Where does this stereotype come from? Is this a racially based stereotype that is meant in a negative way?”
“One of the most damaging things that can happen in [a] workshop is if a bias educator is perpetuating bias,” Chatters-Smith contends. This experience helped her realize that the trainers themselves needed training to be effective at bias and discrimination education. She is currently developing workshops and a workbook that will allow counselors to practice answering questions and go through specific scenarios related to bias-based bullying to help them gain confidence and knowledge in handling these challenging situations.
Uncovering bias
A counselor’s role is to interrupt the systems of bias-based bullying, Singh argues. This process starts with the intake assessment, which should clearly define what bias-based bullying is and provide examples, she continues.
Counselors need to ask upfront questions about bias and harassment in counseling to let clients know that these issues exist and that they affect mental health, Chatters-Smith says. The best way to know if it is happening is to ask, she adds.
Of course, when assessing clients, counselors can also be alert to signs that bias-based bullying may be occurring. Anxiety or fear of being bullied may cause younger children to wet their beds at certain times of the year (right before school starts, for example) or to avoid public bathrooms, Chatters-Smith notes. She advises school counselors to pay close attention to the dynamics between students in the cafeteria. “A child can be sitting at a table full of kids because they don’t want to sit alone, but no one is interacting with them. No one is talking to them. They’re purposely being excluded,” she says.
Singh and Chatters-Smith also urge counselors to watch for signs of depression or anxiety, client withdrawal, client complaints that are not tied to anything specific, chronic tardiness, or changes in client behavior such as nervousness, avoiding school or sessions, or missing certain classes.
Counselors should exercise the same level of vigilance with young adult and adult clients. Chatters-Smith finds that counselors often fail to factor in the isolation, feeling of being ostracized and lack of belonging that some minority college students experience at
predominantly white institutions. Counselors “know all of [these factors] impact mental health from [the] K-12 research of bullying but seem to forget about it when people graduate from high school,” she argues.
In addition, counselors often “do not factor in the cultural pieces of experiencing bias-based bullying at work. It manifests itself differently,” Chatters-Smith says. For example, individuals may go on short-term or long-term disability, or bullying may result in harassment claims or absenteeism from work. In certain instances, clients may not be able to put a finger on the core issue causing them not to enjoy the workplace, or they find that for some unknown reason, they can’t please a co-worker or employer, she says.
Sometimes, clients don’t even recognize that bias-based bullying could be an issue until the counselor brings it up, Chatters-Smith adds. Thus, she advises counselors to ask questions such as “Have you experienced any prejudice or discrimination at work?” or “Do you have increased anxiety around yearly evaluations for work?”
“In any organization that has built-in hierarchies, bullying [is likely] to occur,” Chatters-Smith says. For example, in the military, transgender individuals still face discrimination, and often discrimination is based on race or socioeconomic status, such as enlisted individuals versus officers who require a college education and receive more money and leadership positions, she explains.
Avoiding assumptions
When people are introduced to the concept of bias-based bullying, they often assume that it involves someone from a dominant group bullying someone from an oppressed group. “When you think about bias-based bullying, typically people are going to gravitate toward majority [versus] minority … but at the same time, it can happen within group,” points out Cassandra Storlie, an assistant professor of counselor education and supervision at Kent State University. She cautions counselors not to overlook the possibility of intracultural bullying because it does happen. For example, a Latino child may bully another Latino child because that child doesn’t speak Spanish, or an individual may bully someone else of the same ethnicity because that person’s skin color is judged to be “too dark” or “too light.”
Just because someone is oppressed does not mean that they can’t be oppressing others, Chatters-Smith emphasizes. “For centuries … African Americans have bullied each other based on darker complexion versus lighter complexion, and the same thing happens in Latino and Hispanic groups as well,” she says. “What makes it identity based and bias based is because there are biases that come along with the perspectives of individuals who are of darker skin. Even though it’s within a specific racial category, the bias is still there, and then the individual still has the psychological impact because they’re being bullied just for who they are.”
In addition, although people of color have a higher likelihood of being bullied in predominantly white settings, bias-based bullying can still occur when they are in settings with higher diversity, Chatters-Smith notes. The bias may just take another form and be based on characteristics other than race, such as sexual orientation, she explains.
Within transgender communities, someone who is more binary identified and operates with certain gender stereotypes may discriminate against another transgender person for not looking enough like a woman or a man, says Singh, a past president of both the Southern Association for Counselor Education and Supervision and the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling. Within-group bullying is particularly painful to the individuals who experience it because the group is supposed to be their source of support and belonging, she says.
Singh also points out that bias-based bullying can be targeted at anyone based on how he or she is perceived. “If they’re perceived to step out of a gender or sexual orientation box, even if they don’t have that identity, they may experience [bias-based bullying].” In fact, Singh says, a substantial amount of anti-queer and anti-trans bullying is actually experienced by cisgender and straight people.
Creating a positive, safe environment
“Ethnic identities are strong protective factors,” says Storlie, president-elect of the North Central Association for Counselor Education and Supervision. She encourages counselors to find ways to celebrate cultures and differences. If counselors are practicing in a school district or community that isn’t taking preventative measures against bias-based bullying and being inclusive and advocating for all students, then they need to take initiative and educate those communities, Storlie says.
One approach that Storlie, an ACA member and a licensed professional counselor with supervisory designation in Ohio, suggests is to mention how diverse populations are increasing. In fact, according to the National Center for Education Statistics, the percentage of white students enrolled in public elementary and secondary schools decreased to less than 50 percent in 2014, while minority students (black, Hispanic, Asian, Pacific Islander, American Indian/Alaska Native and those of two or more races) made up at least 75 percent of the total enrollment in approximately 30 percent of these schools.
Storlie works with a school district that has Ohio’s second-highest number of students who speak English as a second language. Roughly 50 percent of the student body is Latino — up from approximately 2 percent only two decades ago.
When Storlie first walked into the school district, she couldn’t find any Spanish on the walls of the schools or in school materials, but since she started working with the educators and teachers, all of the school district’s documents are translated. “If you’re handing this information out to students … you’ve got to make sure it’s in the right language,” she argues.
Schools are in transition now because of increased diversity, Storlie notes. “It’s happening across the country where teachers don’t look like the kids that they’re teaching anymore, and they have stereotypes that can be pervasive,” she observes. Thus, counselors need to work with educators and communities to ensure that they are being inclusive.
Storlie advises counselors to facilitate events such as English classes for parents whose first language is not English to improve communication between teachers and parents, and workshops to educate parents, school personnel and the community on bias-based bullying. Counselors might also provide workshops for school personnel on multicultural competency, she says.
The Human Rights Campaign Foundation’s Welcoming Schools program is one helpful resource, Chatters-Smith says. The program provides training and resources such as recommended books, lesson plans and videos to school educators to help them create inclusive, supportive school environments and aid them in preventing bias-based bullying.
Building strong relationships
Storlie has found that teachers and school personnel who instill hope in their students — regardless of any identifying characteristic — have the best outcomes. These students often have higher levels of school engagement, demonstrate greater resilience and enjoy more academic success.
The therapeutic relationship can play a central role in instilling hope and achieving these positive outcomes, Storlie argues. For that reason, she adds, counselors shouldn’t become so focused on theories and techniques that they forget what it means to foster a good relationship with their clients. Among individuals who have been oppressed or marginalized, there is often an “us versus them” attitude, so the challenge for counselors is finding a way to reconnect and develop the relationship, Storlie says.
Trust is one key component of building a strong relationship with clients. However, Chatters-Smith has found that adults don’t always trust children’s reports of bias and discrimination. In her private practice, Chatters-Smith often works with children of color who report that no one believes them when they complain about bias-based bullying. Over time, this disbelief can result in their silence. Thus, she emphasizes, it is crucial that counselors believe children when they report having experienced bias-based bullying and discrimination.
In addition, Storlie stresses the importance of taking a team approach to bias-based bullying. “You can’t do it solo. … You really have to have the team approach because that’s how change happens,” she says. This is especially true for school counselors confronted with high student-to-counselor ratios, she adds.
When school counselors notice bias-based bullying in their schools, they should connect with other leaders in the school district and position themselves as a part of the leadership team, Storlie advises. Then, in this leadership position, counselors can educate school personnel on warning signs and interventions for bias-based bullying, thereby creating a team approach to intervening, she explains.
School counselors should also strive to work with families to address bias-based bullying. Because family members’ work schedules may not coincide with school system hours, counselors might have to get creative to find ways to reach families, Storlie continues. “School counselors who stay in their offices are not going to be able to reach families the same way that … [counselors] doing outreach with families would,” she adds.
In Storlie’s work with undocumented Latino youth, she found that the school counselors who were present, who made a point of getting out of their offices and who were visible to parents — for example, showing up at basketball games after school hours — enjoyed the most effective relationships with families and students. Their students were also more receptive to looking ahead and thinking about their future careers, she adds.
Bystander intervention
“What hurts [children] typically is not specifically the bullying itself. What hurts them is the other children around who stand and watch it happen,” Chatters-Smith asserts. The inaction and silence of bystanders causes people who are bullied to feel depressed and isolated, and it feeds into dysfunctional thinking that they are not good enough and no one cares about them, she adds.
In workshops, Chatters-Smith uses an active witnessing program to train people how to respond to discrimination and bias. Because bias-based bullying is often verbal, onlookers can state that they disagree with what is being said and question the validity of the biased comment, she elaborates. Bystanders can also support the person being bullied by telling them they are not alone or calling for help, she says.
Bystanders can also help people who commit the offense to self-reflect by asking them to repeat what they said and letting them know that it was hurtful, Chatters-Smith continues. If a bystander doesn’t feel safe to intervene at the time of the incident, they can later call a manager (if the bullying incident happened in an establishment or organization) or notify someone about what they witnessed, she advises.
Chatters-Smith has also used ABC’s What Would You Do? — a hidden-camera TV program that acts out scenes of conflict to see if bystanders intervene — in her workshops. She plays the scenarios from the show but not the bystanders’ reactions. Instead, she has workshop participants use the skills they have learned in the workshop to see how they would respond.
The more aware counselors become of bias, prejudice and discrimination in their day-to-day lives, the more it will affect them in their work with clients, Chatters-Smith says. “Practice is what helps us move forward as individuals,” she explains. “When you are at the store, when you are eating in a restaurant, when you are in the mall, when you see these things happening, if you feel [like you] know what to do, you’ll become more aware of what it is and you’ll feel more confident at not only being able to intervene and be empowered in your everyday life but also being able to talk to your clients about their experiences.”
Storlie and Singh both tout training student leaders as an effective approach to preventing bias-based bullying. Often, students — not counselors — are the ones who hear about or witness these instances of bullying. So, counselors can work with these student leader groups to teach them how to intervene, Storlie says.
Another way to create a team approach to bias-based bullying intervention is through the use of popular opinion leaders, Singh says. With this approach, school counselors and teachers nominate student leaders who represent different groups in the school (à la The Breakfast Club). With the counselor’s guidance, these students discuss bias-based bullying, what they’ve noticed and how they might be able to change it. Then, after learning bias-based bullying interventions, the popular opinion leaders try them out and report on which ones worked and which ones didn’t, Singh explains.
An ongoing issue
Singh warns of the danger of minimalizing bias-based bullying — such as saying that people “don’t mean it” — because it sends a message that it is OK to have bias. Comments that dismiss bias-based bullying “can really add up over time in the form of microaggressions for transgender people,” she argues. “But, more importantly, [these comments create] a hostile environment in society, and that hostile environment in society can set transgender people up for experiencing violence.”
“When children grow up in an environment where they are taught implicit and explicit messages about whose identities matter and whose don’t, and then there’s power attached to that, then you’re going to see those negative health outcomes,” Singh argues. “And they’re not just negative health outcomes and disparities. They’re verbal, physical and sexual harassment that play out across people’s bodies and communities. Those microaggressions add up to macroaggressions on a larger scale.”
Apologizing isn’t the answer either. Often, people who bully, commit a microaggression or say something prejudiced will apologize by saying that they didn’t intend it that way, Chatters-Smith says. “It’s not intent that matters. It’s impact. … Whether or not you intended it, it doesn’t matter. It hurt the person.”
One possible solution is to start bias education at a young age so that over the life span, people are more aware of bias-based bullying and discrimination, Singh says. Counselors can challenge the internalized stereotypes that people learn in society about themselves and others and counter those biased messages with real-life experiences and compassion, she adds.
Education and awareness are key because bias-based bullying is an ongoing issue. “[Bias] is not going to go away. … People are going to find a way to treat each other differently. I think that what will change is more and more people not accepting it,” Chatters-Smith says.
This past spring, social media revealed another case of discrimination when two black men who were waiting for a friend were arrested at a Starbucks in Philadelphia on suspicion of trespassing. The incident might have received little notice except that a white woman posted a video of the arrest on Twitter and challenged the injustice, which prompted protests. Starbucks responded by apologizing and announcing that it would close thousands of stores for an afternoon to conduct racial bias training in May.
Even though this injustice never should have occurred, the public outcry sent a message that these two men were not alone and that bias is not acceptable, Chatters-Smith says. “The intervention is what’s going to change [things],” she says. “If we have more eyes on it, hopefully we can reduce the impact and reduce the duration and the longevity of the impact of these instances.”
Chatters-Smith, Singh and Storlie all agree that counselors have an important role to play in educating people about bias and building strong partnerships between educators, parents, students and communities. “[Counselors] are in the business of helping people challenge inaccurate, internalized thoughts,” Singh points out. “Counselors have to challenge those thoughts and help rebuild beliefs systems that include the value of a wide variety of social identities.”
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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at consulting@lindseynphillips.com or through her website at lindseynphillips.com.
Letters to the editor:ct@counseling.org
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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
Category: Moving Forward
Friday Quote
Have a great weekend. M
Triple Shot Thursday *What do you think?*
Here are newer releases from people or bands I like. Not sure about the effects used but with a few more views I might change my mind. Leave me a comment on your thoughts. I love to spin for you, request line open 24/7. Have a great day. M
Interview with David Kanigan
I had the pleasure of interviewing David Kanigan at Live & Learn http://www.davidkanigan.com. He is well-loved as reflected by the large number of glowing comments left by followers. He is funny, gracious and well read. David thank you for taking time to talk, play phone tag, it was a pleasure.
As a child did you color inside the lines? Always between the lines. ALWAYS!
Best vacation parents ever took you on? We used to go to Radium Hot Springs in the summer. They had large swimming pools. Here’s the link: https://www.radiumhotsprings.com
As a teenager what was dream job? Did you find your dream? I was born and raised in a small town in British Columbia. My dream job was to work in NY. I work in NY!
The first and last song on your playlist? I rotate my playlists so there is no constant first and last. And have an eclectic music taste. Love Dave Matthews Band. Many groups from 70’s (eg, Doobie Brothers, Fleetwood Mac, etc)
Walking along the surf or jump in for swim? Walking along the surf, for sure.
Two examples of a perfect day. Reading a great book. Saturday morning in solitude after a long work week.
Hiking or Parasailing? Neither. Suffer from acrophobia even though I fly a good deal for work.
Before Blogging did you write journals, professionally? Never wrote a stitch before blogging.
Melinda
Story of my Life: Guest Margie Lakefield
Guest Margie Lakefield shares the trauma of Postpartum Psychosis in a multi series post.
I read Margie’s post in tears, feeling empathy, above all I knew she was a strong woman. A woman who made tough decisions for the better of her children’s future. Her story touched me deeply, I had to meet her. We worked together on the series. Unfortunately Margie had a family emergency and can’t be with us.
She is dedicated to sharing her story at the cost of lingering pain. Margie takes us thru the arrival at hospital until the moment she reached out for help.
The Series will post starting next Monday and consecutive Mondays. Margie’s participation in the app is dear to her heart. She encourages everyone to download the app, get familiar with the resources available and the DNA initiative.
Hope for the Helpless suffering from Post Postpartum Depression.
The pactforthecure app is a new initiative. Available at App Store. Giving Hope for the Helpless Suffering PPD •
March 28, 2016 •
Thank you to the University of North Carolina, Chapel Hill , for this initiative. I will forever be indebted to your servitude.
This past week I noticed a story on CNN of an upcoming app that was to be released. I am submitting this after receiving an email today giving me permission to submit my article to the organization responsible for this International Study of Women Suffering/or have suffered from Postpartum Depression, and/or, Psychosis. It is my sincere hope that you will spread this information in an effort to draw attention to this program. They are looking to collect thousands of participants for this study. You can find the app, for free. Look for PPD ACT app. I found it through the Apple Store.
I literally had tears running down my face when I read that this initiative was taking place. In 1984, at the time of my episode, there was not much information readily available to women suffering from PPD. This study will no doubt change that, and with it, the lives of thousands upon thousands of women. It is my understanding that one in five women will experience some sort of the so-called, ‘baby blues’ and some will not be as fortunate as those of us who have survived the mayhem of insanity that swallowed our souls. Thankfully, we have returned to tell a story, using genetic markers they may one day find the answer to helping others from being driven into the abyss.
Bring hope to those who have lost theirs by sharing this initiative. Again,
I thank you.
Looking For The Light Blog Celebrates Nine Years
WordPress sent a nice badge informing me Looking for the Light Blog was celebrating its ninth anniversary. I can’t find the badge and will improvise.
Looking for the Light became an outlet to share past trauma. The shame, guilt, self-hatred, my father’s suicide, each beating and bruise remembered. During this time I met many people going thru trauma and pain. I also met many supporters. Being able to unleash the secret box inside was life changing. Survivors Blog Here, http://www.survivorsbloghere@wordpress.com was born during this time. I’m so proud of the contributors and the knowledge gained from followers. Thank you!
Looking for the Light Blog was a “Where is Waldo” moment when WordPress Support Engineers took a two-week holiday leaving me with a big problem I could not fix. Like life, things worked themselves out. Looking for the Light Blog was born.
I thank you, celebrate our conversations, your prayers, support and understanding. Looking for the Light Blog would not be the same without you. More importantly neither would I.
You may notice Blog was dropped from the name on this theme.
Melinda
Double Shot Thursday *America by The Boss & Ray Charles*
I had not planed to spin for you today but it didn’t feel right. Hoping everyone had a safe fireworks show, don’t forget the burn bans. Have a great Thursday. Don’t forget I love your comments and request. M
The Nightmare Videos of Children’s YouTube-What’s Wrong With The Internet Today
Friday Quote
“WE DO NOT HAVE TO BECOME HEROS OVERNIGHT”
Eleanor Roosevelt-You Learn By Living
Triple Shot Thursday *Schools Out For Summer*
This post is dedicated to the nervous parents whose kids are learning to drive. Hope you enjoy the tunes. Have a great day. M
Ten Important Fibromyalgia Facts
National Fibromyalgia Association
1. ALWAYS believe in yourself emotionally and physically. No one can tell you what you are experiencing is not real! FM is a chronic medical disorder just like diabetes, hypertension, & asthma. While there are still gaps in our complete understanding of FM, the symptoms are real, & patients’ concerns are legitimate.
2. NEVER feel guilt for your illness. FM isn’t something you wished for & it isn’t something you can wish away. FM is not a character flaw, it’s a neurological disorder.
3. FIBROMYALGIA can wax and wane, so on the days that are extra-challenging, remember it will get better. FM is much more than just pain. In fact, surveys of patients have consistently suggested that fatigue may be just as problematic. Other symptoms associated with the disorder include: sleep disturbances, stiffness, & problems with concentration referred to as “Fibro Fog”. Patient self-management techniques can help keep flares under control.
4. FIBROMYALGIA “affects” many more people than it “afflicts”. Everyone who knows someone with FM is affected. It is now estimated that more than 10 million Americans have FM, and it is considered a global health issue. Studies have shown that FM is a disorder of the central nervous system.
5. FIBROMYALGIA can sometimes make you feel very alone. Keep in mind that over 10 million Americans have FM and most feel like you do! Although there are standard criteria that have been established to help a health care provider to diagnosis FM, it is important to recognize that people with FM can experience variations in their symptoms. Since systems which send pain signals and interpret pain signals in the brain involve many different processes, it is possible that different types of problems can arise, in different people.
6. FIND ways to improve your quality of life. It is important to find health care providers who want to partner with you along your journey. Ideally, the relationship between
a healthcare provider and a patient should be comfortable and based on mutual respect.
7. EDUCATION is empowerment! Learn as much as you can about FM and then put what you’ve learned into practice. Often simple remedies can have a big impact on your health – and the more you know, the more options you will have. The U.S. Food and Drug Administration has granted approval of drugs specifically to treat fibromyalgia. Some patients have experienced significant benefit in terms of reduced pain from these medications.
8. DON’T MAKE DECISIONS while in terrible pain. Never make rash decisions, especially when you are hurting! Finding a treatment strategy that works best for you may take time. Be open-minded and know that improvement will occur over time.
9. REMEMBER to be good to yourself. Every day should include activities that make you happy. Don’t forget to stop and smell the roses! Management techniques are key. Control your sleep hygiene, find motivational techniques that will keep you active, & eliminate stress through life-style management.
10. EVERY DAY advances are being made in awareness, research, and the treatment of FM. There are all kinds of organizations and companies that are working to secure a better future for people with FM.
Why We All Need To Practice Emotional First Aid
TED Talk: Why We Do What We Do
The Path Not Seen — Return of Dragons
“The clearest way into the Universe is through a forest wilderness.” ― John Muir After two soul-crushing treks into the wilderness; one where I came within millimeters of plummeting off a cliff before arresting my fall and the next where another fall and injury sapped my strength and caused me to doubt my ability to make it […]
Psychiatric Hospital Stay 2001 Part One
My Journal
What a day! Checked in at 1:00 and processed at 3:00. Next step is the questions, why so many questions. Telling your traumatic experiences to a stone-faced woman waiting for her shift to end. Now a strip search and off to search my bag.
No CD player or wire bound journal someone may hurt themselves. Losing it, I’m screaming fuck you over and over till my lungs hurt.
No room was available, I had to stay in the criminal ward. It was late when taken over to building, nothing looked different. The next morning was a surprise, one shower for the entire group with no shower curtain, and bathroom stalls with no locks. Talk about privacy.
Under suicide watch the first week, someone had to bring my meals. The same meal the entire week. I’m not allowed to close my door, it’s a prison, not a Mental Hospital to help people move forward or past an episode.
I checked in for ECT, not meetings, making friends, or being fucked with. The stories of ECT treatments going bad….everyone had something to add. One woman had 40 treatments, she was lying or very sick.
Planning to stay three weeks I brought 10 books to pass the time. I stayed in my room for three days waiting for an EKG. This is how extra money is made, it was a week before my first ECT treatment. A week wasted.
Melinda
to be continued……..
Triple Shot Thursday Celebrate Men of Motown
I love hearing the tunes of my youth, dancing around to Love Train. Get on your feet and let loose. I love to spin for you. Request line open 24/7. Have a great day. Melinda
How Would Jesus View Prosperity Gospel Preachers?
Jesse Duplantis recently asked his followers for money to purchase a new $54 million private jet, explaining that God wanted him to have it. He later backtracked on those comments, saying that he just wants his followers to “believe” for the jet, not necessarily pay for it. However, given that he’s still accepting money from followers (and since free jets don’t tend to appear out of thin air), we’re not so sure “believe” isn’t a codeword for “donate.”
Jesse Duplantis Ministries already owns three private jets. This would be the fourth. Why does he need another one? To better spread the gospel, of course. Oh, and in his words, regular commercial planes are known for carrying “demons.” Yikes.
But Duplantis is far from the only prosperity gospel preacher. He’s not even the first to wish for an airplane from his followers!
Traveling in Luxury
Back in 2015, the televangelist Creflo Dollar requested $60 million from his followers to buy a fancy jet. And Kenneth Copeland, another televangelist, just recently acquired his own plane – a Gulfstream V – paid for by donations from his flock. When pressed on the issue, these superstar pastors justify their lavish mode of travel by insisting they need private jets to effectively spread the word of God.
According to Copeland, the famous televangelist Oral Roberts suffered greatly on commercial flights: his spirit was “agitated” by other people on the plane who requested prayers. Apparently, such minor requests are too much for mega-pastors to handle. Better to get away from the needy masses – that’s what Jesus did, right?
Jesus Leading by Example
Er, not exactly. Consider what the Bible says about how Jesus treated people. In the book of Mark, right before Jesus feeds 5,000 with 5 loaves of bread and 2 fish, it says:
“When Jesus landed and saw a large crowd, he had compassion on them, because they were like sheep without a shepherd. So he began teaching them many things.”
By examining another comparison, one gets the idea that Jesus would not approve of preachers traveling on private luxury jets. When Jesus entered Jerusalem on what we now call Palm Sunday, he chose not to ride on a horse or a camel – symbols of wealth and status – but instead rode a lowly donkey, the animal of the masses.
Christian Compassion
There are many other instances in which Jesus talks about helping those who are less fortunate – the Parable of the Good Samaritan being perhaps the most well-known. In the discourse with a ruler recorded in Luke 18, Jesus tells him to “sell everything you have and give to the poor” to have eternal life.
Jesus did acknowledge that money was needed to support the Lord’s work, and also seemed to believe that it was right to pay taxes. In one parable, a man is praised for investing his resources to gain money. But in other scripture, believers are told to depend on God to meet essential family needs. We shouldn’t hoard our resources but invest in the lives of others.
Jesus may not ride a donkey today, but it’s debatable whether he would expect first-class travel accommodations to carry out his mission. The picture painted of Jesus in the Bible does not give the impression that he would expect to be lifted up and put ahead of others.
Prosperity for Whom?
So where does that leave so-called “prosperity gospel” preachers like Jesse Duplantis and Ken Copeland? Are they truly doing the Lord’s work by crowdfunding private jets and living in luxury? Or are they just putting on a “holy act” to squeeze money out of naïve followers?
If the prophecy of the Second Coming is fulfilled, one wonders what might happen to these prosperity preachers. When it’s their turn to be judged by God, will they ascend to heaven? Or will they be left behind with the other “heathens”?
At least they could still travel in style.
Read more at https://www.themonastery.org/blog/2018/06/how-would-jesus-view-prosperity-gospel-preachers/#7OJw8De7e9GbxBIh.99
Through the child welfare kaleidoscope: A Therapist view
By Sheri Pickover and Heather Brown June 27, 2017
The amazing feature about kaleidoscopes is the endless, ever-changing scenes and complex patterns they reveal to anyone who takes the time to look. The gentlest of rotations invites a new and oftentimes completely different perspective on the same set of colorful shapes.
Working with children, adults and families involved in the child welfare system is not so different. A vast array of interplaying events, reactions, concerns and characteristics make up a mosaic of factors that drive a counselor’s assessments and interventions. Any counselor who has worked with one or 100 cases involved in foster care understands how complex and overwhelming it can be to help this population. However, in using the metaphor of looking through a kaleidoscope, we are reminded of how one gentle turn of our focus can change our perspective of the case at hand in a way that will continuously drive more attuned, meaningful interventions. Knowing that the myriad shapes exist before, during and after our treatment with these clients, we can more easily remain open both to seeing and making sense of our clients, the child welfare system and its players, as well as our own experiences of these cases.
Given that each turn of the kaleidoscope brings a new feature into view, we have some idea of the shapes that are there: neglect or abuse, histories of mental illness and substance abuse, court involvement, grief and loss, trauma and attachment. One element might stand out from the others at different times during treatment, but all are present in the kaleidoscope, and we should always acknowledge them throughout the course of treatment even when they don’t dominate our view.
In this article, which is based on our book Therapeutic Interventions for Families and Children in the Child Welfare System, we will provide an overview of six perspectives, or “turns of the kaleidoscope,” to take with these cases. These perspectives focus on specific considerations and guided structure to drive effective intervention and counter burnout when working with this population.
First turn of the kaleidoscope: Client worldview
When a client is involved in the child welfare system, instead of beginning treatment with assessment, start with a curiosity about the client’s worldview (whether that client is a child or an adult) and a desire to understand that worldview better. This process builds empathy for the client and reminds counselors to evaluate possible motivations for the presenting behavior concerns. What is it like to be a child in foster care? What is it like to have your child removed from your care? What it is like to care for a child you don’t know in your home?
Many factors influence the worldviews of children in foster care:
- Exposure to traumatic events such as being removed from their homes and the abuse or neglect that prompted removal
- Shame and guilt related to blaming themselves for the removal
- Their attachment style with their family members
- Grief from multiple losses (home, school, friends, neighborhood)
- A sense of constant chaos and a fear of what will happen next that is beyond their control
Children in foster care wonder if they will ever be safe, and if a child has experienced frequent foster home place disruptions, this fear only intensifies.
Birthparents’ worldviews begin with the helplessness and hopelessness that humans feel at losing their children. Grief and loss are compounded by judgment from family, friends, court personnel, therapists and case managers. The reason for removal, such as ongoing substance abuse, their own history of trauma or attachment issues, possible mental illness, poverty or a lack of educational opportunities, is further complicated when their family enters the child welfare system. Often viewed as resistant or unwilling to accept responsibility for their actions, these birthparents often feel alone and angry and use their energy to defend themselves against the onslaught of judgment.
Ironically, foster parents’ worldviews may also begin with helplessness. Although they receive training and support, sometimes it is not enough to counteract the effects of caring for a child in their home who is angry, traumatized, grieving and filled with anxiety. In fact, the experience of foster parents can be similar to that of the child’s birthparents in that they are quickly judged and required to abdicate control in their home to the child welfare rules and a series of child welfare workers. Foster parents are also asked to love a child and then let that child go, so they struggle with attachment, grief and loss issues on a constant basis.
Second turn: Counselor worldview
As counselors, what we see in others is often influenced by our own family histories, personal values and clinical experiences. These issues rise up early in the child welfare system, where counselors are often novice professionals just starting out, and they are given clients with chronic treatment issues who have often seen myriad other professionals.
Meanwhile, the pressure from the systems and individuals involved is often overwhelming. Counselors often feel responsible to “fix the kid” or “fix the family,” and this pressure can lead to countertransference, ethical violations and burnout. These children and families often exist in chaos, and counselors can easily be pulled into that chaos by a system that expects miracles but provides minimal support. The child welfare kaleidoscope can become a series of fast-approaching shapes, constantly spinning with what appears to be little direction, or it can become stuck, making it difficult to move or view another shape.
Counselors must always be on guard against the creeping sense of helplessness and the compassion fatigue that can occur when working with this population. Counselors must also combat the countertransference that can force the kaleidoscope to become stuck on one shape or color. Seeking qualified supervision with professionals who are experienced with this population can make a world of difference. Making self-care practices a necessity rather than a commodity will help protect counselors against compassion fatigue.
When working with this population, counselors can be pulled toward feeling pity or overwhelming sympathy for these clients. On the other side of the coin, they can find themselves judging or feeling angry with these clients, either for how the adults behave toward their children or how the children seem ungrateful toward the adults. These are all ineffective responses, both for the counselors and for their clients.
Using the metaphor of a bridge, remember that to stand in empathy is to stand on the rickety, scary bridge over raging waters to allow ourselves to feel what our clients feel. Either side of the bridge — pity or judgment — feels “safer,” but they both lead to ineffective therapy and further harm to the client. Closely evaluating your own personal values before beginning this work and knowing the child welfare laws in your state will provide necessary support to curate an empathic, realistic perspective on your cases.
Working with children in foster care also can be a minefield of ethical issues. Confidentiality can be complicated depending on the referral source and the child’s legal status. For example, the birthparent of a temporary ward of the court still possesses legal rights and must be consulted over treatment issues. At the same time, the child is placed in foster care, and foster parents need to be made aware of important issues that might impact the child in their home. The court might subpoena therapy files, and caseworkers also require treatment updates and recommendations. Each of these possible breaches is relevant to informed consent with this population.
The issue of mandated reporting can also become a prominent part of treatment. Children may disclose abuse in the birth home, foster home or both. Managing the ongoing relationships with birthparents and foster parents when required to report suspected abuse or neglect requires counselors to be honest, forthright and empathetic at all times.
Finally, facing clients with complicated trauma, grief and attachment histories can become demoralizing for counselors because they rarely see the type of progress that allows for professional satisfaction. The potential for experiencing vicarious or secondary trauma responses is also high. Counselors working with this population should engage emotional support from peers, supervisors and even their own counseling. These actions can help heal emotional wounds, keep the work in perspective and prevent the type of burnout that ends up hurting rather than helping clients and counselors alike.
Third turn: Assessment
Assessments with clients involved in child welfare must be understood as living documents of sorts. After all, anything captured at one particular time can be expected to shift because of the unstable nature of so much that influences the client’s life in profound ways. Counselors should obtain ongoing strategic updates on the child’s behavior, emotional status and the status of the relationship with the birthparent, then adjust goals accordingly. For example, try to find out when a placement transition or court-ordered change in permanency status takes place, when the client experiences an additional loss or traumatic exposure, or when the client newly acknowledges a past traumatic exposure.
Counter to the tendency of many counselors to see the concerns of each case first, this population greatly benefits from intentionally identifying their strengths during the assessment process. Children and adults who are involved in the child welfare system often possess amazing resilience, creative coping skills, abundant humor, deep love and extraordinary courage.
Beyond just accounting for strengths, effective assessment looks around the kaleidoscope, gaining information on all aspects of clients’ lives, not just the current presenting problem. Clients in the child welfare system often get viewed through one shape in the kaleidoscope — their behavior. As a result, trauma, grief and attachment concerns often get lost in the desire to stop the current behavior and the pressure felt to “fix the child” or “fix the parent.”
Assessment of the child begins by listening and watching: listening to a child’s stories, listening to the reports of both the foster parents and the birthparents, and watching how the child plays and interacts with you, other siblings and adults. Attachment style will be evident by whether the child seems angry or withdrawn from adults, or whether the child clings and appears fearful. The child’s response to trauma will be evident through sleeping patterns, the way the child eats and the level of fearfulness the child exhibits at home and at school. Educational information and potential medical concerns also may be highly relevant to interventions.
In addition, the amount and type of losses the child has endured and the child’s grieving process matter greatly. Taking session time to normalize the child’s reaction to removal from the home and any subsequent placements can have a significant impact on the child’s adjustment efforts. Finally, after examining and prioritizing behavior problems and building an understanding of what is driving them, work with the families to create a realistic and achievable plan that focuses on one or two concerns at a time. Using this approach, the counselor can keep the many parts of the client’s kaleidoscope in mind while knowing that trying to work on everything at once would be ineffective.
One common challenge in working with this population is the tendency to turn therapy into nonstop crisis intervention sessions, responding to the complaints of foster parents or case managers rather than holding steady to the set treatment plan. Although crisis management is necessary at times, learn to determine what is truly a crisis (e.g., suicidal ideations, homicidal ideations, an immediate risk of removal) and what qualifies as an ongoing complaint (e.g., trouble in school, acting out in the foster home). Holding focus on just two or three shapes at a time prevents therapy from turning into a nonstop process of confronting the child.
Fourth turn: Treatment
Beginning treatment for any primary concerns with this population must focus on giving the child and family space to feel safe and comfortable. For example, get on the child’s eye level, allow the child to move freely throughout the room, and be clear and open about what therapy is and is not. Because treatment is often specific to the needs of the child, be sure to research and seek training in specific interventions related to trauma, attachment, grief and loss, or behavior issues. The following brief case studies illustrate an intervention for each treatment issue listed above.
Trauma: A 15-year-old girl came into care for the second time in her life because of allegations of sexual abuse by multiple family members. She barely was eating or sleeping and kept her body and hair covered with multiple layers of clothing at all times. The counselor took time to connect with her in simple ways that she could handle — drawing, listening to a song she liked, smelling a favorite hand lotion, updating her on the status of her many siblings and naming how much had changed since she had come into care and how normal it would be to feel overwhelmed. Creating this routine of predictable, soothing interactions built a sense of psychological safety in the therapy space. From there, the counselor helped her learn how to lower her arousal enough to open up about her inner world. This allowed her to begin the long and life-changing intensive trauma treatment process that had previously been inaccessible to her.
Attachment: The counselor used a metal Slinky as a transitional object with a 7-year-old boy who refused to enter the counseling room. The counselor brought out the Slinky, and the boy played with it as he ran around the waiting room, not responding to verbal prompts or directions. When he stopped, he and the counselor would go and walk the Slinky up and down the stairs. After three sessions, the counselor stated that to play with the Slinky, the boy had to enter the counseling room. He was able to enter for a short time in the first week and stayed for the entire session from that point forward.
Grief and loss: An 11-year-old girl had witnessed her mother die of breast cancer in her home. The child had limited verbal skills and would draw pictures of herself jumping rope with her mother in the sky. Using her art, the counselor encouraged her to draw herself as she currently felt. She drew herself crying with her mother in the sky. As treatment progressed, she could draw herself smiling as she jumped rope, and this action was identified as showing her mother that she was coping. The counselor arranged to have the pictures sent to her mother in a balloon so that her mother could see she was starting to cope.
Behavior modification: A 10-year-old boy acted out constantly and did not respond to normal punishment. The counselor created a “caught being good” plan. The child received a star for every positive behavior and a check for every unwanted behavior. To earn his reinforcing reward — an allowance — he had to be good only one more time than he was bad. The counselor encouraged the foster parent to set the child up to win the reward, so he gained stars for stopping in the middle of acting out or for flushing the toilet. He received lots of verbal praise for the stars and no verbal response for the checks.
Fifth turn: Engaging adults
Perhaps the greatest challenge for counselors working with children in foster care is finding a way to also work with the myriad adults involved in the system. These adults include birthparents and any involved relatives, foster parents, caseworkers, casework supervisors, attorneys, educators and medical professionals, to name a few.
It’s easy to become stuck in silo thinking, focusing only on the therapeutic process in your sessions and becoming frustrated when others do not support or engage in the treatment. During this turn of the kaleidoscope, counselors can remember to picture the colors and shapes of all the other involved adults, including these adults’ own histories of trauma and their own feelings of helplessness and frustration. This will help counselors keep empathy at the forefront of all interactions, thereby avoiding blame and patterns of disempowering, ineffective interactions.
Reframe engagement as something the counselor is responsible for rather than it being the responsibility of the other adults in the child’s life. In other words, counselors need to take on the mindset that it’s our job to work with them, not their job to work with us. That way, if they don’t engage or respond to our efforts, it becomes our responsibility to try different engagement interventions. Trying different approaches might engage an adult who otherwise would not work with the counselor.
For example, focus on asking birthparents and foster parents for help with treatment. Identify the birthparent as the expert on her or his child. Even if you do not use the advice or data the parent gives you, the act of asking is often enough to engage the parent.
Another engagement technique involves remembering to praise something about the child and attribute the behavior to the parent. For example, “Your child has such good manners. It’s clear you spent time teaching him.”
Finally, remember to validate foster parents and birthparents whenever possible: “I wonder if you feel judged and belittled by having all these other adults tell you how to raise your child” or “People expect you to just deal with serious problems and don’t listen to your expertise.”
If collaboration with other professionals proves difficult, remember to empathize with their frustration over the many cases they have and the stress of their workload. Attempt to find compromises, such as shifting your schedule or using encrypted email to keep information flowing. Collaboration helps children in foster care in many ways. For example, it keeps these children from having to repeat stories over and over again. It also guards against having their needs fall through the cracks because everyone assumes that someone else is getting a task accomplished. Collaboration also sends a message to these children that they matter and that the adults in charge of their lives are making decisions together.
Final turn: Self-care
We already touched on this topic under the “counselor’s worldview,” but it bears repeating. Self-care cannot be viewed as a luxury when working with this population. It is a necessary set of supports and adaptive coping skills. Self-care is subjective, not prescriptive, so it should involve whatever works for the counselor.
At bare minimum, counselors should seek peer and professional supervision with others who have experience working within child welfare so that counselors can both vent and get validated. Remember that by nature, these cases are heavy with deep psychological wounding that will bring out countertransference one way or another. Building awareness and tending to your own reactions rather than trying to fight or minimize them will only make you a better counselor and person.
Professional development support, training and consultation around specific troubling cases or treatment concerns, such as sexual abuse reenactment, severe posttraumatic stress disorder or deep attachment insecurities, can make a significant difference in supporting feelings of competency and utilizing best practices for the challenges these cases will present. Give yourself permission to notice any signs of depression, anxiety, grief and secondary or vicarious trauma in yourself, and then seek professional support.
It’s also important and helpful to remember that working with clients with complicated trauma and attachment histories can become disheartening because the counselor rarely sees the type of progress that allows for professional satisfaction. Find ways to keep the work in perspective and balance work-life demands. Take time to seek joy and pleasure in life to prevent the type of burnout that ends up hurting rather than helping clients.
Sheri Pickover, a licensed professional counselor, is an associate professor and director of the counseling clinic in the University of Detroit Mercy’s counseling program. She has been a counselor educator for 13 years and worked in the child welfare system for 20 years as a therapist, case manager, foster home licenser and clinical supervisor. She currently teaches courses in trauma, human development, assessment and practicum. Contact her at pickovsa@udmercy.edu or childwelfaretherapy.net.
Heather Brown is a licensed professional counselor and art therapist in private practice in Detroit. She has more than 15 years of experience working with youth (both in and adopted out of the child welfare system), parents and professionals as a program developer, therapist, trainer and supervisor. Contact her at BrownCounselingLLC@gmail.com or BrownCounseling.com.
Letters to the editor: ct@counseling.org
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
The River In My Soul — Return of Dragons
The River in My Soul is a freeform poem that explores love lost and a hope for reunion in the next life.
Friday Quote
I’ve learned that if you want to have loving feelings, do loving things.
Anne Lamont
About Me
I am a Survivor
After years of therapy and my grandparents love, I was pulled from the abyss. I have a clear heart, no anger or self loathing. Not forgiving….forgetting, allowing me to move forward. Over the years, people brought sunshine into my life. I can’t thank them enough. You were like Angels dropping in when I needed a push or pat on back.
My mother and stepfather physically and emotionally abused me until 12 years old. My stepfather beat my mother almost daily starting with hitting her head side to side down the hallway, the hallway ended at my room. Everyone in the house lived in hell, I got an extra dose
As a small girl, I dreamed my father would save me. The dream was over when he started sexually abusing me as a child. It was innocent at first or so it seemed. At 12 years old I moved to my father’s. It’s impossible to wrap your head around sexual abuse at any age.
In 1992 my father committed suicide. Estranged since my teens, we talked several times before his death. He called delusional and paranoid. Saying someone was tapping his phone. He told me about suicide, I told no one. My Granny was devastated, her only child was dead. We had a closed casket service. It’s hard to reconcile death when you can’t see them.
I battle with Treatment Resistant Bipolar Disorder. Diagnosed at 19 years old, I struggled for years without medication or over medicated. Thru the years I ‘ve taken over 40 or prescriptions cocktails. Some medications worked for a while, then I had to try another mix. Bipolar Disorder is a Mental Illness without a cure. I manage my illness everyday and each day is different. Through advances in medicine, future generations may not struggle with Mental Illness. We can pay it forward by participating in questionnaires, clinical trials and talking about our illness. Educating others is the road to Breaking The Stigma.
I am alive with the help of God, Husband, Grandparents, Therapist and Psychiatrist. I’m blessed with a husband who won’t give up no matter how hard it gets.
My background and Mental Illness is NOT a complete picture of who I am. Photography, Art and Music are my passions. I love vintage cars, riding motorcycles and the great outdoors. As a teenager I set a goal to see the world. My Bucket List continues to grow.
I’m an animal lover. I’m sickened by animals being abused and killed testing dog food or facial cream. I’m concerned about extinction, global poverty and the planet. Above all Education, children are our future.
Thank you for pulling up a chair to read about me. I hope to see you again soon.
Xx Melinda
I enjoy hearing from you, comments are always welcome!
Triple Shot Thursday *More Favs*
I hope you enjoy a few more of my 80″s favorites. Have a great day. I would love to hear your comments! M
Youth Suicide-Related Hospitaliztions Has Nearly Doubled
By Bethany Bray May 31, 2018
Recent research has revealed an alarming development: The number of youth admitted to the hospital for a suicide attempt or suicidal ideation nearly doubled between 2008 and 2015.
The findings, published in the May 2018 issue of the journal Pediatrics, analyzed seven years of billing data for emergency room and inpatient visits at children’s hospitals in the United States.
In 2008, the number of hospital visits for suicidal thoughts or suicide attempts in children and adolescents younger than 18 was 0.66 percent of total hospital visits. In 2015, that percentage 
nearly doubled to 1.82 percent.
The co-authors of the journal article note that “significant increases” were seen across all age groups, but the highest rise was seen in adolescents, specifically the 15 to 17 and 12 to 14 years-old groupings. The data also pointed to a seasonal curve, with the fewest suicide-related visits in the summer and the most in the spring and fall.
“These findings are deeply troubling and also not surprising,” says Catherine Tucker, president of the Association for Child and Adolescent Counseling, a division of the American Counseling Association.
Tucker points to several factors that were in play during the time of the Pediatrics study (2008 to 2015), including an economic collapse that contributed to stress in families — even forcing some in younger generations to change career or college plans.
Also, “during this same time period, many states drastically cut funding to schools and youth-serving programs,” adds Tucker, a licensed mental health counselor and research director at The Theraplay Institute in Evanston, Illinois. “It is highly likely that the positive resources that were keeping some youth from hitting bottom were removed, making it harder for adults to intervene in a timely manner.”
Changing these statistics will take effort on the part of parents, schools, medical and mental health practitioners alike, says Tucker. Universal screening for anxiety, depression and trauma should be done in schools and doctor’s offices to identify youth who are struggling.
“In order to reverse this trend, schools need to bolster school counseling programs and free school counselors from spending the majority of their time on administrative tasks like testing and scheduling. School counselors see a majority of American children and are in a prime position to do preventive education and identify kids who are struggling before they become so distraught that hospitalization is required,” Tucker says.
“Additionally, parents and caregivers should be encouraged to monitor children’s and teens screen time and limit it to be sure that youth are getting adequate sleep, exercise and in-person interaction,” she continues. “Social media should be carefully monitored in younger children. Parents can reduce late-night use of phones by turning off WiFi after bedtime or not allowing phones or other screens in bedrooms. Counselors in agencies and private practice settings can help by encouraging parents to be alert to behavioral changes, monitoring screen time and helping kids manage their symptoms.”
Why do men have so many eating disorders?
MEN”S HEALTH
Chris Marvin had a secret morning ritual that he practiced in college. Sunlight creeping through drawn shades, he’d roll out of bed around 7 a.m. with a pounding head. After making sure his door was locked, he’d rummage through drawers and the depths of his mini fridge. Then, on a white marble desk that would have been pristine if not for the Thrasher and Mayhem stickers, he’d line up everything he needed to get through the day.
First, he’d pop a caffeine pill to feel alive; then he’d chase it with a couple of painkillers — a preemptive strike against the grind of training two hours a day, seven days a week. (“There is no rest muscle,” he’d tell himself.) A hit from his bong would help calm his racing heart. Instead of water, he’d pour a glass of whiskey to wash down his pre-workout supplements. Then he’d inject himself in either his glutes or deltoids with black market anabolic steroids. After putting his supplies back in their hiding places, he’d ride his bike a half mile from the off-campus house he shared with frat brothers to Sonoma State University in Northern California, where he studied exercise science.
“A kinesiology major doing all that shit? I was a walking oxymoron,” says Marvin, now 32. Nothing could keep him out of the gym, not even injuries that would eventually require surgery. “I’d have my training partner hold my shoulder in its socket so I could do heavy preacher curls. In my mind, I was indestructible.”
By the time he was 25 and working odd jobs back home in San Diego, Marvin weighed 210 pounds, and his back rippled like the Hulk’s. When he eventually cycled off the steroids and ramped up his use of synthetic marijuana, ecstasy, sleeping pills, and Valium — on top of the booze and painkillers — he dropped down to 141 and fell into a deep depression. After one wild bender, he spent more than a week locked down in a psych ward.
“I had done so many drugs that I didn’t sleep for eight days coming down off them,” he says. “From there, I went to a cognitive behavioral therapy program, and that’s where they pointed out that I had muscle dysmorphia. I’d never heard of it before. I was like, ‘What the fuck is that?'”
If you look closely, you might see a bit of yourself in Marvin. From a young age, men are taught to be bigger, stronger, and faster, and to fight through pain. Anger? Self-loathing? Anxiety? Who needs a therapist when you have the gym? And who among us hasn’t tried to fix our inward insecurities by addressing our outward appearance?
Unlike Marvin, you probably don’t have a mental disorder, much less a substance abuse problem that you developed to cope with it. Muscle dysmorphia, or MD, is a little-known psychological condition first described in scientific literature in the late 1990s. Because formal diagnostic criteria define MD as a subset of a broader group, body dysmorphic disorder, it’s impossible to know how many people are affected.
But the current diagnostic parameters, such as they are, can apply to millions of people who just aren’t satisfied with their physique. Those who suffer from so-called “bigorexia” obsess over their appearance, perceiving themselves to be insufficiently muscular even though they are indeed muscular, if not ripped. “People would give me compliments,” Marvin says, “but in my head I was like, ‘This part sucks.’ I was super insecure even though I looked better than most people. I would almost give myself dry heaves thinking about my body.”
The difference between someone with muscle dysmorphia and a regular fit guy is one of degree. Early research in the American Journal of Psychiatry reveals that a typical bodybuilder spends about 40 minutes a day thinking about improving his physique. Those with muscle dysmorphia spend about 325 minutes and check themselves out in a mirror an average of 9.2 times a day. The condition usually takes root in late adolescence or early adulthood, and most guys who exhibit hallmarks of MD have been bullied or shamed about their strength or appearance.
Marvin’s case was textbook. In high school, he was 5’11” and weighed around 150. Uncoordinated and nonathletic, he warmed the bench for the basketball team and became the butt of jokes in the weight room. “They laughed at me for being the weakest guy there,” he says. “I was a lot smaller than everybody. I was picked on a lot.”
Research shows that boys as young as 6 express a desire to be muscular, and that men are more likely to pursue such a physique if they were either teased or received encouragement to do so from parents or peers. And beyond their inner circle, men face constant pressure to look a certain way.
We see it in movies: Mark Wahlberg isn’t the world’s highest-paid actor because of his Boston accent. We see it on TV: Fat guys like Kevin James always play the fool. We see it in advertising: Quick, what’s an underwear model look like? We see it in magazines: Even at Men’s Health, we sell it on our covers. We see it in dating apps: How are you framing your Tinder profile? We see it in social media: The Rock has 100 million Instagram followers. We see it in video games: Research shows that men have lower self-esteem about their bodies after using very muscular avatars. We see it in toys: In the late 1990s, G.I. Joe Extreme action figures were pumped up to have the real-life equivalent of a 55-inch chest and 27-inch biceps.
“When we see images of muscular bodies, which we are bombarded with, we become less satisfied with our own,” says Stuart Murray, Ph.D., a clinical psychologist at UC San Francisco. “The established norm is unrealistic in a lot of ways. A lot of the idealized images we see are Photoshopped and by definition impossible to replicate. And models often do extreme dieting for a photo shoot.”
The ideal male body in pop culture has a V-shaped torso, big arms, broad shoulders, a flat stomach, and a small waist. In one study, nine out of 10 college-age men expressed a desire for greater muscularity. In yet another, more than 90 percent of adolescent males reported exercising to look more muscular; two-thirds altered their diet to increase their muscle size or tone; and nearly 6 percent admitted to using steroids, which are now also viewed as appearance enhancers instead of just performance enhancers.
A few months before Marvin started at Sonoma State in 2008, he had a vision not so much of who he wanted to be but of what he wanted to become. “I had these fantasies like all guys have. I wanted to be big, buff, ride a motorcycle, get chicks, be athletic,” he says. “I was none of those things.” So he started working out, but didn’t know what to do in the gym or how long getting buff was supposed to take. A few months in, he bought steroids from an acquaintance and learned how to inject them from a classmate’s mom, a nurse who gave him syringes that she took from her hospital.
“I was 21 and a half. My testosterone was as high as it was ever going to be. I decided it wasn’t good enough,” he says. “I wanted that quick fix. And, of course, I put on 30 pounds and was like, ‘Holy shit, this is awesome.’ The feelings of power and confidence were pretty incredible. The drugs allowed me to be what I wasn’t. I felt smarter, I felt more confident, I felt sexier. I felt at ease.”
But the steroids didn’t address the underlying pathology of muscle dysmorphia, which led Marvin to focus obsessively on his perceived flaws. “I wouldn’t take my damn shirt off because I was so embarrassed about my chest,” he says. “Instead of being like, ‘Dude, check it out, my arms are growing, my legs are growing, my back is growing,’ I would zero in on my chest and be like, ‘Oh my god, I’m pathetic.’ I only focused on my inadequacies.”
Marvin checked off almost every box for symptoms and associated behaviors of muscle dysmorphia. Mood swings? “If you cut me off in traffic, I’d get angry because I assumed you did it on purpose.” Depression and anxiety? He lived in a state of “general discomfort just below panic,” especially around muscular guys. OCD tendencies? “I’d do a flex routine in the mirror every day and focus on my weaknesses.” Impaired social functioning? “I was incapable of being around people without at least being stoned on marijuana. I needed that buffer to feel okay about myself.” Some of his symptoms were associated complications of MD: Substance abuse? “At the inpatient program, they told me I was the most advanced drug user they’d ever met.” Suicidal thoughts? After a bad breakup, he says, “I contemplated driving my car off the road every day for about two years.”
When he stopped taking steroids in 2013, he faced a new problem: His body no longer produced testosterone naturally, a condition known as anabolic steroid-induced hypogonadism, or ASIH. He now uses a prescribed androgen cream every morning, rotating between sites on his forearms and upper torso. (His girlfriend can’t touch the active site for hours to protect her hormonal balance. Even a hug could do harm.) Because of the damage to ligaments and tendons from his insane workout regimen and steroid use, he wakes up to aches and pains in just about every joint.
“I fucked my body up for the rest of my life,” he laments. “Part of my therapy was realizing that my outsides do not define my insides. I would assign my morality based on how my body looked, how my workouts went, and what I ate that day.”
Eating disorders are another hallmark of muscle dysmorphia. Bulking up requires a high-calorie diet, but even with anabolic steroids, it’s extremely difficult for an experienced, genetically maxed-out lifter to do a “clean” bulk — a term for building muscle without also adding fat. The quest to get bigger while staying shredded leads to bizarre diet choices, with grossly inadequate levels of vitamins and minerals.
“Guys can look amazingly healthy, like Greek statues, and yet they’re very compromised medically,” says Murray, who is also codirector of the National Association for Males with Eating Disorders. “You can end up with a dangerously low heart rate and electrolyte imbalances.”
Clinicians identify three main types of disordered eating. Anorexia is calorie restriction; bulimia is purging calories by regurgitating food, using laxatives or diuretics, or exercising to cancel out intake (or a combo of these); and binge eating is losing control, eating when not hungry, or consuming excessive amounts at one time.
Though eating disorders and muscle dysmorphia are listed separately in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, current research views them as a constellation of related behaviors. Both are the direct result of over-evaluating an idealized body type, which fuels either a drive for leanness, a drive for muscle mass, or both. These body image disturbances can give rise to disordered eating behaviors — an issue rarely talked about in the lives of men.
“There’s a double stigma in males,” says psychiatrist Brad Smith, M.D., medical director of eating disorder services at Rogers Behavioral Health, a treatment facility with branches nationwide. “There’s the stigma of having a psychological or psychiatric issue. It’s hard to get men to seek treatment even for depression. On top of that, this is typically characterized as a women’s illness.”
“Society has trained us that we are strong, masculine figures who don’t really think about that kind of thing,” says Dan Stein, 35, a strong, masculine figure who nearly died from that kind of thing.
Two weeks before he left home for the University of Minnesota in 2001, Stein weighed 215 pounds, thanks to years of McDonald’s runs, sugary sodas, and junk food. “My parents called me husky,” he says. “Dad bod, that’s probably the most accurate description of where I was at.” Determined to get in shape, he began running 6 miles a day, five days a week, and occasionally lifted weights in the school’s gym. By the time he returned home for winter break, he was down to 185 and, he says, “everyone told me how great I looked. It was an ego boost.” By the end of his second semester he weighed 165. “I did the freshman minus-50. But I was skinny-fat. I didn’t have muscles or much definition.”
A turning point came early in his sophomore year. Shirtless, Stein was throwing a football around with some friends on a grassy field near his apartment. Members of the school’s football team, also shirtless, happened to pass through. “Some very attractive girls went over and started talking to them,” Stein says. “In my head I was like, ‘I’ve been working out like crazy. What can I possibly do to look like these guys and get that attention?'”
Stein thought the problem must be his diet. He wasn’t getting shredded, he figured, because he was eating too much. In truth, he was eating too little to gain muscle. Misguided about how the body works, Stein’s diet became so restrictive that breakfast was a handful of Special K Protein or Honey Bunches of Oats. For lunch, he’d eat a small can of tuna and half a cantaloupe. Dinner was a bag of microwave popcorn or a protein bar. All the while, he was running up to 50 miles a week and lifting weights three times a day for 90 minutes a session. He’d often wake up at 2 a.m., do 45 minutes on the stair climbing machine in his building, and then go back to sleep. He was consuming some 1,000 calories a day and burning around 4,000, and says he “started getting weaker in the gym.”
Stein skipped so many classes to hit the gym that he failed out of school. He moved back in with his parents in Wisconsin and began waiting tables at a local steakhouse. Each night, he brought home the same dinner — pasta with marinara — and locked himself in his room so no one could see him swallow the marinara sauce and spit the noodles into the trash. He allowed himself just one real meal a year, Thanksgiving dinner, but only after running a solo half marathon in the morning. His exercise was so compulsive that he once ran in minus-10-degree weather. He was so obsessed with his body shape that he’d spend up to 15 minutes agonizing over which bottle of diet soda to drink: one that had five calories, or another that had 10.
“I was one of those ignorant people who thought the only way you burn calories is by working out,” he recalls. “I didn’t know that eating food is burning calories. That breathing, every function of our body, burns calories.”
At his lightest, the 5’10” Stein weighed just 132 pounds. He had sunken eyes, emaciated cheeks, and cold fingers and toes. The summer before his senior year of college (he eventually got his grades up at a technical school and finished at the University of Wisconsin-Milwaukee), he visited his older brother in Georgia. Though it was 90 degrees out, Stein wore a t-shirt, sweatshirt, and two pairs of sweatpants. His fingernails were blue, his lips purple. On the way to lunch, he asked his brother’s fiancee to turn the heat up in the car. “She looked at me like I was insane,” stein says. “My hands were ice cold. I started to think I had something physically wrong with me. Did I have cancer?”
A doctor back in Wisconsin told him he had 20 signs of starvation. “That’s when I had the realization I was anorexic,” he says. “My family always knew I had an issue, but they skirted around it, and I just pushed it aside. My body was in decay, and it really hit home that if I didn’t change something soon, this could kill me.”
“We need to educate people on what to look for and how to speak to our children,” says psychotherapist Andrew Walen, L.C.S.W.-C, founder of the Body image Therapy Center in Maryland and president of the National Association for Males with Eating Disorders. “It’s not about beauty. It’s about what makes you special — your humanity, your empathy, your kindness. These are the messages we need to give our young men, rather than ‘Are you the best? Are you the strongest? Are you the fittest?’ We’ve got to tell them that their body is their home. It’s not their billboard.”
Multiple eating disorders can overlap in people, and men with muscle dysmorphia often cycle through behavioral symptoms of all three; even a cheat meal can be considered binge eating if it causes mental distress. Early warning signs that your body might be compromised include dehydration, a slower heart rate, low blood pressure, and reduced body temperature. Compounding the problem: Doctors don’t always know what to look for in men.
Case in point: Walen recalls being approached by the parents of a 14-year-old boy who had lost more than 20 percent of his body weight in three months. He had become fixated on running, biking, and lifting weights, and he’d also become emotionally disconnected. “This is a classic case of a young adolescent male with an eating disorder,” Walen told the parents. “Let’s get labs to make sure he’s not medically compromised.” But the teen’s primary-care doctor didn’t believe it. He patted his patient on the belly and said, “He looks fine. I wish I had abs like that.” When the blood work came back, it showed failing kidneys and compromised liver enzymes.
Walen, 45, might understand male eating disorders better than anyone. He was a patient before becoming a therapist. In 1997, an MRI revealed that compulsive running had reduced his left hip socket to bone-on-bone. Afraid he’d need a hip-replacement surgery before age 30, he began lifting weights. If he couldn’t be as thin as he wanted to be, he figured he’d make himself as muscular as possible. He lifted so obsessively that he tore his rotator cuffs and labra in both shoulders. “That is absolutely a male experience of eating disorders, muscle dysmorphia, and body-image disturbance,” he says.
Hoping to find support, Walen attended a conference on eating disorders, but he felt out of place when he realized the other men in the room were fathers of young girls with eating issues. The only book that connected with him, Making Weight, focused on anorexia — wrestlers, boxers, MMA fighters, distance runners, and gymnasts are especially at risk — and didn’t address the spectrum of his experiences, particularly binge eating and compulsive lifting. So, in 2014, he wrote and self-published Man Up to Eating Disorders, to “normalize the experience and create a tribe of recovery.”
It’s vital work. By the time a man admits he has a problem and gets past his reluctance to seek help, the damage is often perilously advanced. One study found that between 1999 and 2009, the number of men requiring hospitalization for an eating disorder increased 53 percent, more than double the increase in women. “There’s a mistaken belief that this is rare and that men who suffer from these are atypical, emasculated, or weird,” Murray says. “We have to shift that gym culture.”
Dan Stein calls it a “fascinating miracle” that he didn’t die or suffer long-term complications from his battle with anorexia, which lasted nearly five years. His recovery included a few sessions with a therapist but was largely a self-guided education. “I learned as much as I could about the human body,” he says. “How it survives, how it works, fitness, nutrition, health — literally everything I could get my hands on.”
Stein now lives just outside Los Angeles and works for a social media company a few blocks from Muscle Beach. Five days a week, for no more than 75 minutes, he pumps iron at the original Gold’s Gym. “I’m surrounded by some of the most fit, attractive human beings on the planet,” he says. “There are moments where you think, ‘Good god, I wish I looked like that guy.’ But I push those thoughts out and they don’t derail me.”
He limits his cardio to 30 minutes a week, he says, “because I don’t want to lose weight anymore, and I associate cardio with losing weight.”
He maintains his 180 pounds and 9 percent body fat by eating six meals day, including lean protein (chicken, egg whites, fish), complex carbs (sweet potatoes, quinoa, whole wheat pasta), fruit (blueberries, apples), vegetables (asparagus, broccoli), and healthy fats (coco nut oil, almond butter, olive oil). He even has an occasional slice of cheesecake.
“I thought I was genetically dealt a bad hand,” he says of his old mindset. “When I started to understand that my body doesn’t act different from 99 percent of the public, I realized it wasn’t physical; it was mental. I know now that I bring so much more to the table than just how I look.”
Chris Marvin has experienced a similar transformation. The man who once popped 68 Percocets in less than 72 hours now attends 12-step fellowships at least three times a week. “My brain got me in the mess I was in, so I shouldn’t be trying to figure this stuff out alone,” he says. “I air stuff out.”
Marvin has been clean and sober since completing an intensive, three-month behavioral modification program five years ago. His new morning routine includes drinking a cup of coffee and saying a prayer that he wrote after finishing the program. It includes this line: “Relieve me of my fear and insecurity, and replace it with self-love and acceptance.”
Marvin named his personal-training business One Rep at a Time — a nod to overcoming addiction one day at time and to building genuine muscle over months and years. Some of his clients are also in recovery, and Marvin shares his struggles with them openly. “I feel like I’ve finally found my calling,” he says.
To put himself in the right mindset in the gym, Marvin listens to epic, intense battle music that “makes me feel like I’m saving the world.” He doesn’t swear at himself anymore, and he’ll frequently reset his body and mental focus with deep-breathing exercises. “I used to think that everybody who was a workout junkie would give themselves high blood pressure from being so angry,” he says. “My old workouts were a way to punish myself. I do this now as a way to improve myself.”
But Marvin knows what lurks in the background, waiting for a chance to consume his life once again. Every time he posts a shirtless photo on Instagram — a tried-and-true marketing strategy for personal trainers, but a risky one for someone recovering from muscle dysmorphia — he worries about triggering old insecurities or introducing new ones to his clients and followers. “My recovery is fluid,” he says. “It will always be a balancing act.”
Do you have an eating disorder?
Consider these statements from a 50-question eating disorder assessment designed specifically for men. Choose one of six responses — never, rarely, sometimes, often, usually, or always — as it applies to the following statements. Answering “always” to these and other statements suggests you may have a problem.
With additional reporting by Joshua St. Clair and Micaela Young. A version of this article was published in the May 2018 issue of Men’s Health Magazine.
If you suspect that you struggle with an eating disorder, please seek professional help immediately or call the National Eating Disorders Association support line at 1 (800) 931-2237.
Definition of a “REAL MAN” is changing for the better
Last week, Joyful Heart released our latest research report, “Defining Manhood for the Next Generation: Exploring Young Men’s Perceptions of Gender Roles and Violence.” Funded by the Verizon Foundation and conducted by GfK Custom Research, the research examines young men and boys’ perceptions of norms around masculinity, gender equality, and sexual violence and the male role models who influence those views. The report is now available on our website; I hope you will read it and share it. The good news is young men surveyed in the study unanimously agree that “real men” treat women with respect. However, many young men agree with outdated and dangerous societal norms—and far too many of them refuse to push back against these norms. Changing these views about gender, gender roles, sex, and sexual assault present our biggest challenge to catalyzing a cultural shift. Men and boys play a critical role in the movement to end sexual and domestic violence. While deep cultural change cannot happen overnight, it cannot happen at all until young men stand against outdated, sexist beliefs about gender and violence. Over the next few months, Joyful Heart will use these findings to create educational materials promoting aspirational, authentic, and intersectional views of healthy masculinity. |
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Cita de viernes
“La disposición a aparecer nos cambia. Nos hace un poco valientes cada vez”.
Brene Brown
Feel like your workplace is depressing?
Published: May 17, 2018 5:58 p.m. ET
Feel like your workplace is especially depressing? Scientists found out why.
A stressful job can lead to serious mental health consequences.
Some 14% of common mental illnesses could be prevented by reducing job strain, a study published Tuesday in the journal Lancet Psychiatry found. The study, conducted by Australian mental health nonprofit the Black Dog Institute, analyzed the ways work conditions may affect mental health among 6,870 employees. It found that people experiencing job strain at age 45 were at an increased risk of developing mental illnesses such as depression and anxiety by age 50.
“These findings serve as a wake-up call for the role workplace initiatives should play in our efforts to curb the rising costs of mental disorders,” University of New South Wales associate professor and lead author on the report, Samuel Harvey, said.
To determine “job strain,” researchers looked at employees’ decision authority (the ability to make decisions about work), skill discretion (the opportunity to use skills during work), and asked questions about job pace, intensity and conflicting demands. More strain meant higher rates of mental illness regardless of gender, occupation, or class.
“It’s important to remember that for most people, being in work is a good thing for their mental health,” Harvey said. “But this research provides strong evidence that organizations can improve employee well-being by modifying their workplaces to make them more mentally healthy.”
Depression costs the U.S. economy more than $51 billion a year in absenteeism from work and $26 billion in direct treatment costs. The number of missed work days varies depending on mental illness: People with depression lose the equivalent of 27 work days per year, according to Harvard University researchers — nine of them because of sick days or other time taken out of work, and another 18 reflecting lost productivity.
Employers are increasingly allowing employees to treat mental health days like normal sick days, and it pays off: For every $1 spent on mental health training, companies see a return of investment of almost $10, according to a previous study from the Black Dog Institute, which researches mental health in the workplace and provides training for employers.
Some companies even offer free meditation and yoga classes. Consumer goods company Unilever UL, +0.18% for example, provides training for senior employees to recognize potential mental health problems and offers employee workshops on sleep, mindfulness and exercise.
Friday Quote
“The willingness to show up changes us, it makes us a little braver each time”
Brene Brown
June is LGBTQ Pride Month
| June is LGBTQ Pride Month, when lesbian, gay, bisexual, transgender, and queer/questioning people and their allies celebrate diversity, progress, and pride. This month, Joyful Heart reaffirms our support for survivors of all sexual orientations and gender identities or expressions.
Sexual and domestic violence can happen in all different relationships and to anyone. Respecting survivors’ diverse identities and experiences is essential. Many survivors face obstacles when it comes to disclosing their experiences or seeking help. However, these hurdles can be amplified for LGBTQ survivors who fear being “outed” to their friends and families, or who fear being discriminated against in the legal, medical, or criminal justice systems. Throughout the month, we will share resources, including our blog post: 5 Facts About Sexual and Domestic Violence in LGBTQ Communities. It takes courage for a survivor of sexual or domestic violence to share their story with anyone. Never underestimate your power to affect the course of a survivor’s healing journey. |
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Your child is sick or hurt, where do you go?
A few weeks ago I fell and gashed my head, needing six staples. We talked about going to a Doc-in-a-Box but decided to go the hospital. We didn’t choose a Doc-in-a-Box since some charge outrageous fees. My General Practitioner didn’t have anyone available so the choices were narrowed down.
We didn’t have time to find out if the Doc-in-Box charged reasonable fees or Urgent Care fees. What is the difference between the two is worth finding out. Here are a few options.
Tele-doctor Can handle colds, flu, baby needs and other non urgent care from your computer. Our Insurance company is pushing this option, it’s very affordable.
General Practitioner I prefer my GP, fees like a visit.
Doc-in-the-Box Doctors? Skilled Nurses? Handles a broken bones, sprained ankle, cold, flu and baby needs.
Urgent Care. Doctors? Skilled nurses? Fees? This is a gray area to me.
Choosing the hospital over other options put a dent in our pocket-book. I was there three hours, IV and all the fan fare which came to $12,000. Insurance will negotiate the amount to a number we can live with, thank goodness.
Know your options to be prepared.
lookingforthelight.blog 