Insights from The Gottman Institute: The Four Horsemen of the Apocalypse

Dr. John Gottman, a renowned psychologist and researcher, has dedicated his career observing relationships on a quest to discover what makes them work and what causes them to unravel. One of his most influential concepts is known as "The Four Horsemen of the Apocalypse," which identifies four communication patterns that can lead to the downfall of a romantic relationship if left unchecked. The four horsemen are:

Criticism

Contempt

Defensiveness

Stonewalling

Criticism

The first horseman, criticism, is attacking a partner's character rather than addressing a specific behavior or issue. It involves making sweeping negative statements about the other person, often using terms like "always" or "never." It sounds something like this:

“You always forget to do the dishes. I can never rely on you.”

Criticism can be destructive as it erodes the other person's self-esteem and creates a hostile atmosphere. Gottman's research shows that persistent criticism can be particularly harmful because it tends to escalate conflicts, making them more difficult to resolve. 

The better approach, or “antidote,” to criticism is the gentle start-up. Rather than blaming or finding fault with a partner’s behavior, it is more helpful to focus on using "I" statements, such as "I feel frustrated when the dishes aren’t done."

Contempt

Contempt is perhaps the most corrosive of the four horsemen. It involves expressing disdain, disrespect, or superiority towards one's partner. This can manifest as sarcasm, mockery, name-calling, or eye-rolling. Contempt often stems from a deep sense of resentment and can lead to long-lasting emotional wounds. It sounds like this:

“You still haven’t finished the taxes? (Eye roll.) Why am I the only competent person around here?”

Gottman's research indicates that contempt is a strong predictor of relationship dissatisfaction and divorce. 

The antidote to contempt is building a culture of respect and appreciation towards one’s partner. It’s challenging to break the cycle of contempt, but with time and better habits of expressing gratitude and appreciation, couples can begin to feel the love and respect needed to buffer against times of conflict.

Defensiveness

The third horseman, defensiveness, is a natural response to feeling attacked or criticized. Defensiveness shows up as making excuses, denying wrongdoing, or playing the victim. Unfortunately, it is also counterproductive when it involves shifting blame and failing to take responsibility for one's actions. It goes like this:

“It’s not my fault. You’re the one who overreacted.”

The antidote to defensiveness is taking ownership of one's mistakes and listening to their partner's perspective without immediately becoming defensive. A better response sounds like, "I understand why you're upset, and I'm sorry for my part in this."

Stonewalling

The fourth horseman is stonewalling which involves withdrawing from an interaction or conversation, often in response to feeling overwhelmed by conflict or criticism. Stonewalling occurs when one partner disengages, emotionally shuts down, or refuses to communicate, which leaves the other partner feeling unheard and rejected. It looks like this:

Crossing arms . . . looking away . . . staying silent . . . exiting the room.

The antidote to stonewalling is physiological self-soothing by taking a break. Couples should establish strategies for cooling off but commit to returning to the conversation later to resolve the issue constructively.

The Four Horsemen of the Apocalypse provide valuable insights into the dynamics of relationships and how negative communication patterns can lead to their downfall. By recognizing and addressing these behaviors – criticism, contempt, defensiveness, and stonewalling – couples can work towards healthier, more satisfying relationships. 

Author: Lana Phillips

Book Appointment: https://southtampacounselor.com/bookappointment

Transform Anger Into Connection

Transforming anger into an opportunity for connection and growth in intimate relationships is possible through the practice of Nonviolent Communication (NVC).

When anger arises in a relationship, couples often fall into destructive communication patterns, exacerbating the initial pain and creating a cycle of suffering. However, NVC offers a way to break this cycle and foster understanding and connection.

Marshall Rosenberg's insight into anger helps shed light on its underlying dynamics. When someone is angry, it indicates a strong need that they urgently want to be met. However, in an attempt to ensure their needs are met, they may employ moralistic rules, which often lead to unpleasant treatment of others. Recognizing these underlying needs and shifting the focus from moralistic rules to unmet needs is crucial for transforming anger into understanding and connection.

To identify the unmet needs behind anger, it is important to look beyond the rules and reactions of the person expressing anger. One approach is to set aside one's own reactions and inquire about the person's upset. Asking questions like, "When I hear that you are upset about this, it tells me there was a way you wanted to be treated that didn't happen. Am I right?" opens up the conversation and invites the person to share their perspective.

Continuing the exploration of unmet needs, asking questions about the ideal way they would have liked to be treated can help uncover their desires and dreams for the relationship. This can include questions such as, "If you could have been treated in a way that was perfect for you, what would that look like? What would have happened?" This process encourages them to think about the positive outcomes they envision and articulate their needs more explicitly.

The answers provided serve as clues to identify their unmet needs. By presenting different possibilities and allowing them to decide what resonates, it becomes easier to narrow down and understand their specific needs. This process is akin to trying on different clothes until the right fit is found. It requires empathy, active listening, and an open mind to accurately grasp the underlying needs being expressed.

By delving deeper into their needs and offering empathy and understanding, the initial anger can be transformed into a sense of relief, relaxation, and genuine connection. This process of uncovering and addressing needs is a form of deep empathy that brings joy and closeness to the relationship.

While learning this approach may take time and practice, it cultivates a sense of eagerness to explore the needs underlying anger and fosters a stronger bond between partners. Through NVC, anger can be seen as an opportunity for growth, understanding, and strengthening the connection in intimate relationships.

How I Integrate Gottman Method Couples Therapy and Emotionally Focused Therapy

Integrating the Gottman Method Couples Therapy and Emotionally Focused Therapy allows for a flexible approach that can shift between relationship-building and attachment-oriented therapy based on the client's needs. In the late 1970s and early 1980s, Dr. John Gottman and Dr. Susan Johnson conducted pioneering research on creating happy and lasting relationships. Initially known primarily in academic circles, their work provided an empirical foundation to the often chaotic and unpredictable field of couples therapy.

Both Gottman and Johnson developed unique models of successful adult relationships, based on different perspectives and data sets. Gottman's research focused on longitudinal and observational studies of couples, examining both distressed relationships and satisfying ones. Johnson, on the other hand, drew from the theoretical framework of John Bowlby and her extensive experience in decoding and tracking couples therapy sessions, resulting in an empirical model of couples therapy.

The Gottmans emphasized relationship skill-building and an existential lens, while Johnson's approach was firmly grounded in Attachment Theory. There were also differences in their views on couples therapy and the role of the therapist. The Gottmans cautioned against therapists becoming indispensable to the couple and encouraged coaching couples to manage their own conflicts and intimacy. Johnson, however, saw the therapist as a "secure base" and aimed to create a secure container where anxiously or avoidantly attached partners could express vulnerable feelings and needs.

Despite their differences, the exciting development lies in the convergence of their approaches and the ability to seamlessly integrate both in couples therapy. This integration allows therapists to adapt their approach based on the couple's emotional system.

When working with couples, I begin with the Gottman Method, using the Sound Relationship House model. It provides a practical and understandable framework that couples can readily adopt. The structured assessment process of the Gottman Method is reassuring and transparent, allowing couples to share their story, be heard individually and together, and identify their relationship strengths and areas for growth. The process instills hope as strengths are highlighted, growth areas are connected with specific skills to be learned, and couples leave with a roadmap for their therapeutic journey.

However, the real work starts when addressing the emotional focus and the influence of attachment histories, styles, and internal working models in intimate relationships, as recognized by both Gottman and Johnson. While helping couples replace destructive patterns with healthier alternatives, I am attuned to their negative emotional cycles and unresolved hurts. With Gottman's language and relationship science in one hand and Johnson's emotion-focused and interpersonal tools in the other, I weave both approaches into the therapeutic process.

For example, when addressing criticism and contempt, I provide practical information to one spouse while simultaneously validating and exploring the attachment needs and emotions of the other partner. I employ Gottman's structured exercises, such as the Aftermath of a Regrettable Incident form, to help couples process arguments and improve their dialogue. Simultaneously, I examine the underlying dynamics of the conflict, considering attachment histories and their impact on individuals' ability to let go of anger or offer tenderness.

The integration of Gottman and Johnson becomes evident in working with bids, turning towards, and processing failed bids. I understand that not all hurts are equal and that certain emotional injuries can be traumatic, triggering deeply held beliefs about oneself, the partner, and relationships. Gottman's Sound Relationship House theory helps couples understand the connection between emotional bank accounts and the overall health of the relationship. Johnson's tools, on the other hand, aid in repairing depleted emotional accounts, acknowledging and healing attachment injuries, and restoring the bond between partners.

While I confess my initial affinity for the Gottman Method, finding comfort in its alignment with my therapeutic style, Johnson's approach challenges me to navigate the depths of primary emotions.

References:

Gottman, J.M. (2007). Marital Therapy: A research-based approach. Training manual for the Level I professional workshop for clinicians. Seattle, WA: The Gottman Institute.

Johnson, S. (2008). Hold Me Tight: Seven conversations for a lifetime of love. New York: Little Brown and Company.

Meunier, V. and Baker, W. (2012). Positive Couple Relationships: The evidence for long lasting relationship satisfaction and happiness. In Roffey, S. (Ed.) Positive Relationships: Evidence-based practice across the world. Sydney, Australia: Springer Publications.

Young, M.A. (2005). Creating a Confluence: An Interview With Susan Johnson and John Gottman. The Family Journal, 13(2), 219-225.

Elizabeth Mahaney, LMHC, MFT, Ph.D

Book an appointment with Dr. Liz: https://SouthTampaTherapyBOOKAPPT.as.me/initialintake

Are You Arguing with Your Spouse?

Many couples believe that arguing with their spouse is a sign of a troubled relationship. However, the truth is that disagreements are a natural part of any healthy relationship. In fact, it's normal and even healthy for couples to have arguments from time to time. Here are some reasons why it's okay to argue with your spouse.

1. It allows for honest communication: Arguing with your spouse can provide an opportunity for honest communication. When couples argue, they are expressing their true feelings, thoughts, and concerns. This kind of communication is essential to building a strong and healthy relationship.

2. It helps to resolve conflicts: Disagreements can provide an opportunity to resolve conflicts. When couples argue, they are addressing issues that need to be resolved. By working through these conflicts together, couples can strengthen their relationship and create a deeper understanding of each other.

3. It shows that you care: Arguing with your spouse can also be a sign that you care about each other. When couples argue, they are expressing their passion, which is a sign of emotional investment in the relationship. It shows that you are willing to stand up for your beliefs and values, which can create a more meaningful relationship.

4. It leads to growth and learning: Arguing with your spouse can also lead to personal growth and learning. When couples argue, they are challenging each other's perspectives, which can lead to new insights and understanding. By working through conflicts and disagreements, couples can learn from each other and grow together.

5. It can bring you closer together: Finally, arguing with your spouse can actually bring you closer together. When couples argue, they are working through difficult issues together, which can create a stronger bond. By being willing to engage in difficult conversations, couples can create a deeper connection and a more intimate relationship.

Arguing with your spouse is a natural and healthy part of any relationship. It allows for honest communication, helps to resolve conflicts, shows that you care, leads to growth and learning, and can bring you closer together. The key is to approach arguments with respect, empathy, and a willingness to listen to each other's perspectives. By doing so, you can turn disagreements into opportunities for growth and strengthen your relationship in the process.

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Author: Crystin Nichols
Book Appointment: https://SouthTampaTherapyBOOKAPPT.as.me/CrystinNicholsMFTI

Can Gottman Couples Therapy Help Your Relationship Improve?

If you are facing relationship struggles, Gottman Couples Therapy can provide you and your partner with the support you need to work through your problems. This approach to couple’s therapy is based on over 40 years of research conducted by Dr. John Gottman and his wife Dr. Julie Gottman.

The main goal of Gottman Couples Therapy is to help couples strengthen their relationships by improving communication, enhancing love, and building trust. The therapy process focuses on evidence-based interventions that have been shown to be effective in strengthening relationships.

One of the key elements of this therapy is the concept of “The Four Horsemen of the Apocalypse” which refers to four negative communication patterns: criticism, contempt, defensiveness, and stonewalling. These patterns can be some of the most significant predictors of relationship breakdown. During the therapy sessions, the couples learn to recognize and avoid these patterns, which helps them to communicate more effectively.

Another essential component of Gottman Couples Therapy is the “Love Maps” exercise. This exercise involves creating a detailed understanding of each other’s inner worlds, including dreams, hopes, and fears. By building these Love Maps, couples can stay connected and understand each other better.

In addition, Gottman Couples Therapy helps couples to develop conflict management skills. During the therapy sessions, couples learn how to navigate argument and disagreements by expressing their own needs while also listening to their partner's feelings and concerns.

Gottman Couples Therapy also emphasizes the importance of reinforcing positive behavior. Couples are encouraged to express appreciation, admiration, and affection towards one another regularly. This allows the couple to build and maintain a strong foundation of love and positivity.

Overall, Gottman Couples Therapy is an evidence-based approach to counseling that can help couples work through various relationship challenges. By focusing on improved communication, increased trust, and building stronger emotional connections, couples can learn ways to enhance their relationship and increase their overall happiness.

How Psychotherapy Retrains the Brain to Expect (and Feel) Better!

People enter psychotherapy with the desire to feel better, but they are often unsure how therapy will help them accomplish this goal. A common refrain from people hesitant to enter therapy is, “How is talking going to help?” People are used to talking to other people to get practical solutions to problems, and while problem-solving does have a place in therapy, change also occurs on a much deeper and unconscious level. This process has to do with the way the human brain is programmed and cannot easily be mimicked outside of a relationship with a psychotherapist.

Our brains are always evolving unconsciously through our relationships. People who experienced painful relationships growing up have been trained to expect hurtful experiences with others. It takes a new type of relationship—in particular, a therapeutic relationship—to retrain the brain to expect more positive experiences, which is a big part of ultimately feeling better. 

WHY CAN’T A THERAPIST JUST TELL ME WHAT TO DO?

To understand why the therapeutic relationship can be so valuable and cannot be mimicked by, for example, advice in a self-help book, it is instructive to look at how the human brain has evolved. Broadly, there are three parts of the human brain that represent different phases of evolution: There is the reptilian brain, which evolved first and is responsible for the automatic control of vital bodily functions such as breathing; the limbic brain, which evolved second and is responsible for the regulation of emotion and behavior; and the neocortex, which evolved last and is responsible for higher-order functions such as symbolic thought, language, and reasoning.

When a person asks their therapist or a friend what they should do about something, they are essentially asking for a neocorticol solution—something that is rational and can be consciously implemented. Often, however, their problems are a result of hurtful experiences in their earlier relationships that have caused changes in their limbic brain, and only a new type of relationship can alter their limbic brain to produce fewer negative emotions and more positive ones.

BRAIN WIRING IN OUR YOUTH: HOW EMOTIONAL ISSUES BEGIN

Our emotions are meant to help us survive in a world in which we need the help of others. Over time, our limbic brains evolved to automatically create emotions, such as anger and sadness, that are meant to help us navigate the social world. When someone mistreats us, evolution has programmed us to become angry to try and change their behavior. When someone rejects us, we feel sad so we can mourn the loss of what we wanted with them and move forward with our lives.

However, when we are young and particularly dependent on others for survival, whether our emotions actually help us navigate the world has a lot to do with how other people—our parents in particular—respond to them. A child who responds to unfair or disappointing experiences with anger and is further punished for doing so may, over time, come to unconsciously pair the expression of anger with pain. As this occurs, rather than directly experiencing anger at times of unfair treatment or disappointment, they may instead experience anxiety about having anger because their brain has been trained by their social environment to expect that anger will hurt rather than help. Their limbic system is in effect attempting to prevent further emotional pain in the form of being punished, but the cost is another type of emotional pain in the form of persistent anxiety. This can be particularly problematic when people enter into new relationships (friendships, romantic relationships) where there would not be the same costs associated with the open expression of an emotion like anger, but earlier experiences still create anxiety and inhibit its expression.

RETRAINING THE BRAIN WITH PSYCHOTHERAPY

A psychotherapy relationship allows a person to essentially retrain their limbic system to no longer expect negative reactions to the expression of certain emotional experiences, and in doing so can alleviate the anxiety and unconscious emotional suppression their earlier experiences programmed into them. The therapeutic relationship does this in part because the parameters of psychotherapy recreate the type of relationship in which a person was first forced to suppress their emotions: one where they are dependent on another person to meet their needs.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships.

Just as a parent has a daunting task in meeting all of a child’s needs, so too does a psychotherapist, especially since many people arrive to therapy wanting a conscious, rational solution to their problems when such a solution often does not exist. Therapy presents a unique opportunity to heal and feel better by the way the therapist solicits and responds to feelings such as disappointment, anger, and sadness that emerge over the course of treatment. Rather than punishing a person for having these emotional experiences in the same way that may have occurred when they were younger, a therapist can actively solicit, explore, and normalize their feelings. This helps to retrain a person’s limbic system to no longer pair the expression of those emotions with punishment. As this de-coupling unconsciously occurs, the person becomes more easily able to tolerate the experience and expression of emotions.

THRIVING IN ADULTHOOD

This shift in tolerance for emotions naturally causes a person’s anxiety level to diminish because their mind is no longer fighting to ward off their innate emotional impulses. In addition to symptom relief, the beautiful part of this process is it restores a person’s ability to constructively access their emotions for their original purpose—as a way of helping to navigate the social world. It is hard to thrive in relationships when we have been programmed to believe we must accept the mistreatment of others or that we cannot show others when we are hurting and in need of care. As adults, this is often no longer the case, but our early experiences may make such underlying beliefs unconsciously feel true.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships. The result can be genuinely transformative, and studies suggest people who have been through therapy show less activity in the areas of the brain responsible for creating negative emotions. Talking, it turns out, can help quite a bit when the person you are talking to is a skilled and compassionate therapist.

If you’re struggling, reach out to a therapist in your area for help.

References:

1. Bowlby, J. (2005). A secure base: Clinical applications of attachment theory (Vol. 393). UK: Taylor & Francis.

2. Cozolino, L. (2010). The neuroscience of psychotherapy: Healing the social brain. New York, NY: W.W. Norton & Company.

3. Damasio, A. R. (2006). Descartes’ error. New York, NY: Random House.

4. Grecucci, A., Theuninck, A., Frederickson, J., & Job, R. (2015). Mechanisms of social emotion regulation: From neuroscience to psychotherapy. In Emotion regulation: Processes, cognitive effects and social consequences, pp.57-84.

5. Karlsson, H. (2011). How psychotherapy changes the brain: Understanding the mechanisms. Psychiatric Times, 21.

6. Lewis, T., Amini, F., & Lannon, R. (2007). A general theory of love. New York, NY: Vintage.

7. MacLean, P. D. (1990). The triune brain in evolution: Role in paleocerebral functions. Berlin: Springer Science & Business Media.

Suicide Awareness and Assessing Signs of Risk in Loved Ones:

 According to the CDC, suicide is the 10th leading cause of death in the United States. Nearly 46,000 people died by suicide in 2020, which would equate to an average of 1 death every 11 minutes. But suicide can be preventable, and there are resources available to help.

On July 16th of this year, 988 became the nationwide suicide hotline number. All texts or calls made to 988 are directly rooted to the National Suicide Prevention Lifeline where you will be supported and helped by trained mental health professionals.

YOU can also help!

Noticing signs of suicide:

If you hear or notice any of the following thoughts or behaviors in someone you know, they may be at risk for suicide.

• Talking about wanting to die

  • “I just can’t take it anymore”

  • “I wish everything could end”

  • “I feel too much guilt or shame to continue on”

  • “I feel like a burden and people would be better off without me”

• Expressing feelings surrounding:

  • Loneliness, feeling isolated and that there is no one to live for

  • Hopelessness, feeling like there is no “light at the end of the tunnel”

  • Trapped, feeling stuck in a difficult situation with no foreseeable way out

  • Sad, depressed, anxious feelings

  • Strong emotional or physical pain

  • Low self-esteem, feeling unworthy of love and connection

• Behaviors:

  • Researching ways to die

  • Making a suicide plan

  • Purchasing lethal weapons (guns, knives, pills, rope)

  • Withdrawing from social circles and saying goodbye to loved ones

  • Giving away important keepsakes

  • Writing a will

  • Dangerous risk-taking behaviors, such as driving reckless

  • Exhibiting extreme mood swings

  • Eating and/or sleeping less

  • Increased substance use (drugs and/or alcohol)

  • Poor self-hygiene

The first step in being a helpful resource to someone who is struggling with suicidal thoughts is knowing and understanding the signs above. If you notice someone who is exhibiting any of these signs, it’s important to talk directly with them about it. It’s also important not to pass judgment or shame on the individual for having these thoughts.

When I work with clients who are struggling with suicidal ideation, I start by normalizing those thoughts and taking some of the weight and judgement away. I explain that it’s natural for our minds to search for escape routes from life’s struggles. For some people, that escape route looks like “I just want to drop everything and move to a remote island where I know no one and have no responsibilities.” For others, it may look like suicidal thoughts. The theme of escaping life’s responsibilities is the same — and we can share empathy about how hard it can be to face overwhelming difficulty, especially when we don’t have enough support. 

Suicidal thoughts can be very isolating for an individual. Letting someone know that you are aware of their struggles and here as a helpful support for them can make all the difference. Know that it can help to talk with the individual openly about their suicidal thoughts, make it known that it’s okay that they are dealing with this, and always share that there are resources to help.

The National Suicide Prevention Lifeline at 988 is available 24/7, 365 days a year.

https://988lifeline.org/

Also, helping that individual find a supportive therapist can help with long-term improvement and maintaining safety plans. Book an appointment for you or a loved one today.

Author: Jamie Rudden, MFTI https://SouthTampaTherapyBOOKAPPT.as.me/JamieRuddenMFTI

For more facts on suicide visit:

https://www.cdc.gov/suicide/facts/index.html#:~:text=Suicide%20rates%20increased%2030%25%20between,one%20death%20every%2011%20minutes.&text=The%20number%20of%20people%20who,attempt%20suicide%20is%20even%20higher.

A special thank you to Jamie Rudden for all of the supportive work that you have done with us and prior to your hard work at South Tampa Therapy! It takes a special compassionate and supportive person to BE THERE and STAY ATTUNED.

I appreciate you.

Liz

Practice Empathy in Three Ways: Cognitively, Emotionally, and Somatically

You must first take off your own shoes to put yourself in someone else's shoes.

We stretch our hearts and minds beyond our own experiences, viewpoints, and feelings in order to imagine what it's like to be inside someone else's head. We employ imagination, creativity, and instinct to envision what life is like for them.

Listening with empathy is a fundamental component of coming from curiosity and care, as well as the foundation of discussion. Here are three strategies to start practicing incorporating more empathy into your daily life that integrate living purposefully and empathetically.

PRACTICE: Empathy

It's important to remember that practicing this doesn't have to be limited to situations in which you are the center of attention. Its easier to feel for others when you aren't being attacked. Remember that empathy isn't something you put into words; it's a quality of presence in your heart. Aim to comprehend the other person's situation and let the conversation unfold organically.

SILENT EMPATHIC PRESENCE: Practice listening completely, with the heartfelt intention to understand and "feel into" what the other person is saying. How is this issue for them?

PARAPHRASE: After listening, summarize the gist of what you've heard. What are the key features of what they've said? It's also possible that repeating just a few words will be enough.

EMPATHIC REFLECTION: After listening, check that you understand by reflecting what you hear is most important to them. This may include how they feel and/or what they need. What's at the heart of this individual's narrative? What can you do to assist them to feel understood? Remember to phrase your reflections as questions and double-check that you're correct.

There are other methods for conveying compassion. We may convey empathy by giving a kind word, with a loving touch, or by describing how we're feeling in response to what we've heard. By expressing interest with open-ended questions like "Tell me more," "What else?"

As an example, my daughter's friend a freshman who is usually cheerful and bubbly, began showing up early to practice. I struck up a conversation and realized how much she was struggling. This friend was saying, "I don't want to go to this school anymore," and was thinking about dropping out. I noticed the impulse to go into problem-solving mode, an old habit of mine. Having just finished another book on empathy, I paused and decided to try listening instead. "Tell me more. What's going on?"

She began to open up. She was being bullied. She felt sad, alone, and depressed. Every time I noticed the urge to fix or solve, I attended to feeling the weight of my body and my feet on the floor, and resisted the temptation to offer solutions. I focused my attention on what she was feeling and reflected what I was hearing. She began to cry, oscillating between speaking, sobbing, and awkwardly making eye contact as if to check whether all of this was okay. There were a lot of tears, tissues, and long moments in which I simply held her gaze.

She spoke more about her feelings of sadness, loneliness, and not feeling valued. "I've felt like this since first grade," she mentioned. "Was that the first time you felt so sad and alone?" I inquired. No, it started when she was three, when her dad left. They looked at each other, realizing they'd hit the root of her pain. Eventually they explored what she might need at school. They came up with some strategies to address the bullying. She decided to stay in school and to make a public art piece for the classroom about depression.

This is the power of which empathy may help us. With a listening spirit, we can absorb each statement made, each emotion felt. Healing and change are possible if we come from a place of curiosity and care rather than our usual mode of behavior.

PRINCIPLES

People are more likely to be willing to listen when they feel heard. To build understanding, reflect before you respond.

KEY POINTS

The desire to comprehend is frequently expressed through listening, which entails putting away our own ideas, emotions, opinions, and views temporarily.

We can listen in many ways:

• With complete, wholehearted presence

• To the content of what someone says

• To the feelings and needs beneath the content

Staying connected in conversation helps us build understanding and

collaborate:

DON'T LET THE CALL DROP: Seek to establish and maintain connection in conversation.

REFLECT BEFORE YOU RESPOND: Confirm that you're hearing each other accurately before moving on. This "completes a cycle' of communication.

At the heart of listening is empathy, which includes:

• Cognitive empathy: seeing things from another's perspective

• Affective empathy: feeling another's emotions

• Somatic empathy: sensing another's embodied experience

Q & A

Q: What if someone wants advice? Is that ever okay?

Of course. When someone asks for advice, you might try offering empathy

first. I'll often say, I'm happy to share some of my ideas, but first I just want

to take in what you've said. I'll follow that with an empathic reflection of

what I'm hearing and check if I've understood. This can help the other

person process their experience and clarify what matters. I then circle back

to inquire if they still want advice; sometimes it's no longer relevant.

If the tables are turned and you want to give someone advice, check

first. Let them know: "I have an idea that I think might be helpful. Are you

open to some advice?" This honors their autonomy, minimizes the chances

that your input will be disempowering, and guards against giving advice

as a way of soothing your own anxiety.

Q: I've been exploring these empathy tools with close friends and family

and my new approach creates a lot of awkwardness. What do you do

when others expect you to communicate in a certain way?

It can be confusing when our attempts to create more connection backfire.

Part of what you are experiencing is the relational dimension of communication habits. They occur in a dynamic, so when we shift it affects others.

It also may simply be the learning curve; it takes time to find an authentic

voice with these tools.

Let go of the form and focus on your genuine intention to connect.

What would help this person to feel heard? If someone is used to us

showing care by asking questions or agreeing and we respond by reflecting

their needs, that may throw them off. Try to tune in to what they want.

When all else fails, let people know that you're trying something new that

you hope will bring you closer. Ask them to humor you while you learn.

Empowering Couples to Communicate Compassionately~ Using Non-Violent Communication (NVC)

The process of non-violent communication (NVC) was developed by Marshall B. Rosenberg and encourages us to connect with others in a more heartfelt and empathetic manner. NVC emphasizes the significance of language in our day-to-day encounters, calling for conscious responses, instead of reactions, based on perceptions, feelings, needs, and visions for what we DO want to see happen.

The Four Components of NVC

There are four basic components to NVC that include observations, feelings, needs, and requests. What actions are we seeing around us that have an impact on our well-being? How do we feel based on what we've seen or heard? What need, desire, or value sparked those feelings? All negative feelings are unmet needs. Finally, how may we make positive requests of others that will improve our lives? These elements all work together to create NVC's foundation.

Our Language Shapes Our Thinking

Sometimes our thoughts sabotage our needs. It is helpful to gather more data and not just react from our triggers or automatic thoughts. Our thoughts produce the way we feel. Negative thoughts point to an unmet need. If I don't know what I need and react from the story that I tell myself, a lot of bad habits can form from this bad habit. Instead, I can gather more data, not just from thoughts but I want to drop down and gather more data from my feelings, where my feelings live somatically in my body, and what needs I have. When I discover my needs, I am in a powerful position to get my needs met. If I do not know what I need in real time, I may react and sabotage my needs which disconnects us from ourselves and other people in our lives.

All attacks are unskilled ways of trying to get a need met. Attacks create disconnect and defensiveness. Using NVC helps us accept influence and stay connected even through some of the most difficult conversations.

NVC not only challenges us to change the way we talk to one another, it also challenges us to change the way we think and perceive the world around us. In other words, NVC is not just a process of communication where words are simply exchanged. We must reframe our thinking so that we are able to genuinely express ourselves and be empathetic to what others are observing, feeling, needing, and requesting. NVC is truly an amazing process that empowers us to connect with one another in a compassionate way.

How to Calm The Jackal and Put on Your Giraffe Ears

Marshall Rosenberg conceptualized our tendency toward aggression and dominance as a jackal, while our more compassionate side he imagined as a giraffe (since giraffes have the largest hearts of all land mammals). When we listen with Jackal ears, we hear complaints as criticisms and requests as demands. When faced with a demand, collaboration isn’t possible. You either submit or you rebel which disconnects us and neither feels good, nor works well in a long-term relationship.

Conversely, when we put on our Giraffe ears, we listen with more empathy and compassion. We are more likely to hear the feelings and the needs behind what someone is saying. We’re more likely to see those needs as being understandable and reasonable, and not in competition with our own needs. When we understand and empathize, compromise and collaboration become feasible.

Nonviolent Communication in Couples Therapy

With couples, NVC bridges the gap in understanding between each partner and helps counter the judgmental negative stories that may build up about the other person:

“They’re lazy.”

“They’re not putting in as much work as I am.”

“They don’t love and care about my feelings.”

These interpretations or evaluations discourage us from being vulnerable and trusting the other person, and they prevent us from making needed changes. When we choose to replace those judgmental stories with greater understanding, more connection is possible.

NVC may challenge our preconceived notions about others and the world, which can help us to appreciate one another and live more freely. When the guy who is cutting me off in traffic stops being a jerk and becomes a person going through something terrible in their own life, I am able to let go of my anger. When I recognize that my difficulties in keeping my home clean aren't "laziness" but rather a battle for motivation or a desire for "rest and recuperation," the self-compassion I gain not only lessens my suffering, but it also increases the likelihood that I will be able to satisfy that need AND keep my house clean.

Whether you’re looking for Couples Therapy or Individual Counseling, Nonviolent Communication (NVC) can help you create the life you want to live together as a team.

The 4 Trauma Responses: Fight, Flight, Freeze, Fawn: Examining The Four Trauma Reactions

According to a research on the neurobiological consequences of psychological trauma, our bodies are designed to respond to perceived threats with a set of near-instantaneous, reflexive survival behaviors. Chemicals are introduced into our circulation via a short-term technique in order to rouse the body's defensive measures through the sympathetic nervous system. However, when our stress responses are continually activated, there isn't enough time to break down the chemicals, and our nervous system becomes overloaded and dysregulated—placing us firmly in the survival mode. The short-term protections become permanent as our body undergoes sympathetic nervous system dominance.

These post-trauma responses, on the other hand, aren't limited to those who've experienced significant "Trauma" events (such as war, death, or disaster) frequently associated with profound trauma. The fact is that trauma exists along a continuum of stress. Because trauma is subjective and personal, minor "T" incidents may be just as traumatic as big "T" events. Trauma, for example, might include a terrible breakup, a betrayal of trust, a work environment that is chronically abusive, or anything else that is mildly frightening over time. They may not seem serious at the time, but the long-term effects of trauma can still have a significant influence on you physically, spiritually, and mentally when they are not emotionally processed and integrated—somatically, intellectually. If a problem is left unresolved, past trauma may turn into trapped, frozen energy that your body will respond to physiologically in the form of a trauma response.

Fight, flight, freeze, fawn: the four types of trauma response.

Healthy stress responses aren't inherently negative; they can help you stand up for yourself in the short term. However, while trauma is a major cause of internal upheaval, it may be taken to an unhealthy and wearing extent. 

The fight response

When functioning properly, the fight response enables for assertion and solid boundaries. It's an active self-preservation function when it's used as a trauma response, in which you move reactively toward conflict with anger and aggression. It's a fear state in which you confront the danger of being assaulted or otherwise harmed so that you can defend yourself. A fight trauma response is when we believe that if we are able to maintain power over the threat, we will gain control. This can look like physical fights, yelling, physical aggression, throwing things, and property damage. It's possible to experience a tightening in the throat, along with other symptoms such as balling your hands into fists, stomach knots, tears, contentiousness, or a firm jaw.

Take a few moments to take a look at yourself and determine how you're currently positioned. It may feel wonderful to use your body to get mobility in the situation while having your insides mirror your outsides, but it comes at the cost of connection and others feeling safe around you.

You may use deep breathing, warm baths, routines, mindfulness, and self-love to help you let go of this. The fight response prepares you to be physical, so you can also utilize exercise to help the body return to normal. It activates your parasympathetic system by practicing mindfulness and a burst of constructive activity like yoga or stretching. It relieves anxiety and allows you to reconnect more deeply by releasing tension.

The flight response

The flight response is triggered when a person feels threatened or exposed. Avoidant behavior occurs as a result of the flight response. You can be discriminating in high-stress situations and disengage within limits if you're healthy. However, as a trauma reaction, you go one step farther by shutting yourself off entirely.

When we feel that if we can get away from the danger and avoid conflict, we will be okay, this is known as the flight response. This might look like fleeing and avoiding social interactions. To escape unpleasant emotions, you may stay occupied or flee for the door whenever things become difficult.

Do things that produce an immediate, physical response from your body to drop back into yourself. Pay attention to any tense muscles and relax them to relax the mind. Use bodywork and purposeful movements to stop the stress response so you can reflect on how you want to react rather than reacting spontaneously. 

Coping techniques that are tactile (such as drinking a warm beverage or eating crunchy food) and grounded, such as snuggling with a pet or doing some yoga, can all help. It's critical to make connections with those around you in order to release feel-good, happier chemicals like endorphins and serotonin.

The freeze response.

When healthy, the freeze response may assist you in slowing down and evaluating the situation carefully in order to figure out what to do next. When this protection is activated, it frequently leads to "freezing"—feeling frozen and unable to move or getting trapped in a fog or oblivious to reality. You don't feel like you're really there, and you're mentally checked out as you leave out what's going on around you and what you're feeling in an attempt to obtain emotional security.

When parts of your sympathetic nervous system have reached a state of overload, they may shut down your brain. I compared this reaction to that of our animal friends playing dead in the presence of a predator. When we freeze, it's as though we're at a loss for words; we withdraw into our minds; it's difficult for us to break out and be present; we sleep; we dissociate/spacing out; and we become emotionally or physically numb.

It's the same as temporary paralysis and disconnecting from your body to avoid additional stress.

To counteract that loss of connection with yourself, do grounding exercises if you catch yourself starting to dissociate. My personal therapist taught me this one. I call it "See Red." Look around your immediate surroundings for a red thing. For me right now, my husband's red sweatshirt flashes by. Then I'll look at it and take a deep, slow breath before scanning the area for another red item. I do this five times in a row. This may help us return to our current reality rather than the one we create when we're under stress due on traumatic reaction that takes us out of the present moment.

The fawn response. 

At its most fundamental, fawning is all about pleasing others and engaging in pacifying behaviors. It's characterized by putting people first above all else by doing whatever they want to avoid conflict and gain their approval. It appears to be beneficial to be well liked and defer to others in order to secure safety, but not when it comes at the price of losing yourself. It may eventually lead you to abandon yourself and your needs by merging so completely with others. Most likely, you don't feel understood by others or feel overshadowed by the individuals in your life.

Fawn response is people-pleasing to the point of forgetting oneself entirely; thoughts, feelings, bodily sensations. When someone tells me what I want to hear and I inquire how they're doing, they respond, 'I'm OK,' or 'I'm all right; so-and-so did this to me and I felt terrible.' I'll get a quick answer about how they're doing followed by a longer one about how someone else in their life is doing.If you're noticing that you're fawning often, be extra compassionate with yourself as you begin to separate what feelings belong to you and what belongs to other people. Observe yourself when you're around others to add in buffering time to help prevent resorting to fawning. The first step is awareness and learning how to start putting up boundaries to take up space.

Through my own experience, I've learned that focusing on it when I'm doing it is difficult, and calling attention to it may be uncomfortable. Recognize that your body and mind did their utmost to keep you safe but that you have the ability and worthiness to return to a secure state of mind.

Is it possible to have more than one trauma response?

Because trauma responses don't always neatly fall into a category, you may not overuse the same methods when confronted with fear. It's more likely that you'll primarily identify with one or two of the 4 Fs, but you'll still change between them depending on the context-specific environment in which you find yourself. Responses combine to form hybrids such as fight/fawn and flight/freeze for individuals who have experienced severe trauma.

Another element that influences our responses is the reality or perceived consequences of our behaviors. One stimulus for trauma might cause you to flee, while another may encourage you to fight—an example of this is an age-old battle with a loved one where you both want to hang up the phone and scream. Or if you're fawning, you just want to tell them they're right so they'll stop nagging at you.

The conclusion.

Know you aren't alone if you identify with one of the four trauma responses. Social support and journaling as self-soothing methods to figure out how to handle difficult circumstances and recover.

It's good to notice and speak about your trauma reaction with someone who cares for you, and who won't judge or provide unsolicited advice. Identifying our present behaviors as well as knowing we can make adjustments as needed is the first step toward better health.

In tandem, embodied healing is crucial to processing and feeling safe in your body. Managing your mental and physical health can help you find a new direction in order to cultivate responsive behaviors that are good for your health. Yoga as a method of relaxing the survival brain and meeting with a trauma-informed therapist at South Tampa Therapy will help in your healing journey.

Keep in mind that you're only human. You've been doing all that is necessary to keep thriving. It will take some time to unlearn some of these habits, which is fine. It is all in time... compassion, acceptance and patience in this process takes practice one day at a time.

Couples Counseling South Tampa: Couples Reveal What They Have Learned In Therapy

As a marriage and family therapist in Tampa, Florida, I have received feedback from several different clients. I combine some of the most powerful approaches utilizing Internal Family Systems, Compassionate Communication and Non-Violent Communication, The Gottman Method, Emotion Focused Therapy, Holistic Psychology, CBT, and DBT.

Here are the 10 best lessons couples learned from therapy.

1. Go to therapy sooner rather than later.

   It is best to go to a counselor before sh*t hits the fan. This way, you can start to develop conflict resolution and communication skills before resentment builds. Establishing a therapeutic relationship with a counselor early on can be beneficial when and if you find yourselves in a rut. Having an unbiased and supportive counselor can help you and your partner maintain a healthy relationship when and if you need support along your relationship journey.

2. You are on the same team.

   There is no winning and you don’t need to fight against each other. Therapy is a great tool and safe space to really work through things together. Meeting both of our needs, growing, and thriving together is the goal. We often ask ourselves, are you trying to listen to understand or are you trying to be right?

3. Play and have fun together.

   Unstructured quality time to just be living purely in the moment increases connection, creativity, and releases negativity. A couple that plays together stays together!

4. Unfinished business of childhood can show up in adulthood.

   Continuing to work on intrinsic positive change is a lifelong learning process. Insight and empathy can help partners understand conflict in a whole new light. When we create an awareness of patterns and habits we are able to create awareness regarding intentional choices in real time. If we are not aware, we keep reacting. Responding intentionally knowing what is happening is being awake to our inner experiences. Self-witnessing is a tremendous tool that can be used in so many facets of our lives. Practicing compassion for our partner's story, and becoming more empathetic to each other, we could actually help our partner heal from their painful childhood experiences.

5. It is not about changing the issue, it is about understanding.

   We have learned so much about communication and the ways to really listen to understand one another. Most people listen to try to change the other person’s perspective. When we get into trying to change the other person, defensiveness comes into the game. When defensiveness shows up, it creates disconnect. Communication either connects us and helps us get needs met or it disconnects us and sabotages our needs. We feel all sorts of negative feelings when our needs are not being met. However, we are in homeostasis when our needs are met and feel positive emotions. Our feelings are always signals to pay attention to which provide data about whether our needs are being met or not. When we know what we need, we are in a powerful position to get the needs met intentionally. When we do not know what we need, we will probably be in autopilot, reactionary-mode. Tune into your inner worlds so that you can understand yourself. When we understand, we can communicate honestly about what is happening internally.

6. Our thoughts are the root cause of anger.

   Anger masks more vulnerable feelings like hurt, disappointment, and sadness. It's helpful when both partners understand that the words or behavior hurts their partner, even when their partner tends to react with anger or stonewalling. Therapy can help couples connect — which includes learning how to get calmer and go slower rather than to lay out their arguments about who's "right".

7. Hear your partner out before letting emotions get in the way.

   Getting guidance from a therapist around how to listen to each other without being emotionally charged about the topic can help couples stay engaged in the conversation, to accept influence from one another, and compromise based on needs. This is huge! We can stay curious about what is actually happening in the moment. When our partners feel heard and understood, they are in a better position to hear us too. Listen to each other without reacting! This sounds so simple but bad habits can be hard to break and its beneficial to have a therapist as a sounding board to make neutral observations.

8. Conflict is normal, you will have different perspectives at times, and disagreements are inevitable in every relationship.

   There will be different stages throughout life and couples will never stop getting to know one another. The most important thing is that you listen, respect, and acknowledge each other's viewpoints. Many times, people listen to respond and not to understand — which is one of the biggest reasons why many relationships fail. Attending couples therapy, can help partners communicate feelings, emotions, and concerns more effectively. Counseling equips couples with valuable skills that will be instrumental throughout their lifetime and once they become parents.

9. Marriage therapy taught us how to communicate about our needs and desires without hurting the other person.

   When we are emotionally and intimately disconnected, it is challenging to help each other to feel heard and understood. The way we deal with conflict is directly correlated to intimacy. Change the way we fight, change the way we love. When we trust each other more and give each other the benefit of the doubt, we're less hurt when the other person isn't in the same place as us in the moment, We may still have issues and hurt feelings from time to time, but we're better equipped to handle those problems when they come up.

10. Psycho-education and therapy helped couples identify patterns.

    One partner was pretty direct and the other partner tended to be more thoughtful in the way he delivered information. One partner said the thing that stuck with her the most was that the therapist was able to reframe and articulate her partner's concerns in a way that he couldn't — which then helped her to understand him better. Therapy can help couples become aware of how reactions to difficult situations can be unhelpful. Attempting to respond in a way that is more productive for the relationship can feel very different. Psycho-education can be of tremendous value when co-morbidity plays a role in relationships. Trauma informed therapy can help partners empathize, respond to each others needs, and heal together. It is advantageous to the relationship when partners learn about mental health together.

To learn more about how therapy can help you, please text or call Dr. Mahaney directly 813-240-3237 or book an initial consultation: www.SouthTampaCounselor.com/BookAppointment

Why I Only Accept 50% of Insurance Clientele & 50% Self-Pay In My Private Practice (50/50/❤️ MODEL)

WHY I ONLY ACCEPT A FEW NEW INITIAL INTAKE INSURANCE APPOINTMENTS

USING MY MORAL COMPASS AND COMPASSION FOR HUMANITY, I’M CHOOSING TO CREATE A 50/50/❤️ MODEL:

50/50/ ❤️= 50% SELF PAY 50% INSURANCE ❤️SLIDING SCALE FEE

Sliding Scale Fees help advocate for affordable mental health care and create an opportunity for highly qualified INTERNS to counsel clients in need. I interview interns extensively, decide selectively, and supervise very closely and yet very trustingly. I will be an active participant in each session.

I initially started accepting insurance 15 years ago when I felt a strong need to support my community, who needed financial support, to get consistent help. Despite hearing horror stories from colleagues about insurance paperwork and clawbacks, I joined a few insurance panels. I loved every minute of being a therapist! I hated everything about the administrative process when it came to dealing with insurance companies. Don’t get me wrong, I love my insurance peeps! We have connected over the years and I will continue to support my clients who choose to use insurance as they should!

I too, have health insurance. I get it, we have health insurance for a reason, pay high monthly premiums, and should be able to use insurance when we need it!

Regardless, I will show-up powerfully for ALL of my clients.

I feel good about my choice to create a 50/50/ ❤️BALANCE in my Private Practice!

As a healthcare member and a private practice provider, I’ve had the unique experience of seeing both perspectives of the healthcare system in the US.

As my specialty has continuously evolved, I have realized that mainly accepting insurance no longer make sense for the advanced work that I do. Ultimately, my decision came down to acting with integrity and practicing what I preach to my clients.

Here are some key points to help you understand my decision to create this model for my Practice:

LACK OF PRIVACY & CONFIDENTIALITY

When insurance companies pay for your treatment, it also means that their employees (clinicians or not) will audit my treatment plans and read what we talked about in my session notes. These employees are paid to save the insurance company money by searching for fraud and determining whether you're overusing your insurance coverage. In turn, the insurance company may decline authorization of additional sessions because you're not progressing fast enough; our work in psychotherapy does not qualify as "a medical necessity": or because my treatment approach isn't recognized by the insurance company as an "evidence-based treatment" (that's code for short-term, as in 6-8 sessions).

Hell, some insurance providers don't reimburse for 60-minute sessions anymore!

This doesn’t seem right.

I recently got audited by an insurance company. This audit took me countless hours, staying up late at night, time away from my family, unnecessary stress and scrutiny to provide tedious paperwork and specific details to prove that my clients needed the services provided. This is just not okay in my book. I totally understand documentation for integrity but demanding extra proof during a pandemic when I am already submitting the necessary information and feel overwhelmed and overworked helped me create the awareness and opportunity for me to reflect on MY CHOICE to accept insurance.

At first, I reactively felt angry resulting in thoughts and hopes that the insurance company would fire me! However, when I pause and feel to respond intentionally, I honestly and truly feel honored to hold space and care for ALL of my clients and I would feel disappointed if I were unable to offer insurance as an option.

In conclusion, I believe that everyone has a right to confidentiality of your medical records. You also have the liberty to progress through treatment at a pace that's best for YOU - one that allows you sufficient time to process everything that you're experiencing. Things unfold differently for each person, especially when our world seems chaotic (Global Pandemic)! If the insurance company fires me, they rip the therapeutic relationship apart that my clients and I have securely built over the years. Emotional injuries and attachment issues can be easily re-traumatized within seconds.

DIAGNOSIS OF ILLNESS

Insurance companies operate on a medical model, which means they require a diagnosis to establish that you have "a medical necessity" to seek services in order to pay providers. To justify that you have a "medical necessity" I have to assign you a diagnosis to be reimbursed for our work together when there may not be one that really fits what you're going through. The vast majority of insurance companies don't consider relationship issues like couples or family therapy, developmental/attachment trauma, existential issues, life-transitions, personal development, or self-improvement as "medical necessities" because there are no diagnoses for these in the DSM-V.

And even if there are appropriate diagnoses, there are some diagnoses that insurance companies don't consider debilitating enough to pay for. So, if I know what diagnoses are and are not paid for, l'd have to label you with a more severe diagnosis they will pay for, but one that may not really reflect your situation. I am not ok with this either!

You're probably wondering, "What's the harm in that? A little truth-bending never hurt anyone." Well, that's just it - it can. It can come back to bite my clients in the ass... your medical record. While that might not be such a big deal right now, it may become one later on if you want to: get life insurance, work in the financial sector managing other's assets, regularly handle firearms, or seek employment in any sector in which your decision-making might be called into question due to your emotional state. Call me crazy, but I feel that people should get the help they need without fear, stigma, or reprisal for making their mental health and personal growth a priority.

FRAUD

If I engaged in the aforementioned truth- bending, I'd essentially be committing insurance fraud. There are providers out there that are willing to walk this fine line and take this risk. In my opinion, the penalties and professional consequences of insurance fraud are huge, and frankly, not worth it. I have a strong need for peace of mind that comes with integrity.

LOW RATES

In order to be "in- network" with an insurance company, I have to agree to accept a lower fee in exchange for the insurance company listing my practice in their directory of providers and sending me referrals. In the spirit of transparency, most of my clients find me through friends, family and through searching online. And each year, insurance companies continue to cut the rates they pay therapists for their work.

Here's an example with real numbers and real circumstances of how this happens: My fee is $170 per session. But I joined XYZ Insurance Co.'s network because I had a client in need of services. I chose to help and chose to agree to the insurance reimbursement rate of $60 per session. My client would also be responsible for a co-pay of $0-$40 per session depending on his plan, bringing the total to $60-$100 per session. That means I'm waiving at LEAST $70-$110 for each session. As a healthcare professional, I want to help! I have made these types of choices for the 20 years that I have been in private practice. I will keep choosing to advocate for my clients who have insurance because I also have insurance for myself and my family.

Would you be willing to forgo ~65% of your salary?:-/

I will also continue to set boundaries with ALL of my clients and companies that I choose to work with. If you no-show as a self pay or insurance client, I will treat you the same and ban you from being able to book an appointment until we have a meeting. I get it. I want to understand one another and use empathy. Life happens. I want to turn toward these curveballs

Additionally, insurance companies have been increasing their members' premiums, deductibles, and co-pays in the last few years claiming rising costs of care. You'd think that that would translate to higher reimbursement rates to care providers, but it doesn't...at least not in the mental health fields. In fact, insurance reimbursement rates have actually decreased over the same period of time. You're probably wondering, "How do the therapists and psychologists that take insurance afford to?

For such insurance-based practices, taking on more clients than is clinically prudent is the only way to make up the difference and keep their doors open. This then leads to another problem...

BURNOUT & EXHAUSTION

Here's the reality, many providers that accept insurance overbook their schedules in order to turn a modest profit after rent, utilities, malpractice, and other expenses.

Additionally, these providers often only offer a 30-50-minute session to maximize the number of clients in a day (10 vs 8) and the chances of insurance reimbursement (remember, most insurance companies don't pay for 60-minute sessions anymore). Also, if you use the 60 min codes, you are flagged for audits which take hours and hours to complete.

DELAYED (OR NON) PAYMENTS

Despite the insurance companies agreeing to a set reimbursement rate, these companies require therapists to jump through a bunch of hoops to get paid. It is common practice for most insurance companies to reject submitted paperwork to delay payments. When they're not seeing clients, these therapists are drowning in insurance paperwork and resubmitting billing claims in order to get paid, or spending hours on the phone contesting unpaid claims.

On average, it takes an additional 1.5 hours of UNPAID work outside of the session to get paid for sessions. And remember, the therapist is already making less by agreeing to take insurance. (In my previous example, it would cost $255 of my time ($170x1.5) to get paid my $60 reimbursement rate from XYZ Insurance Co.)

The alternative is to pay a medical billing company 8-10% of the claims' costs to do the aforementioned, but that increases expenses and cuts into that modest profit I mentioned before. But let's say that I or my medical billing admin ARE able to see the claim through the labyrinthine insurance payment process, the payment will finally arrive in my bank account anywhere between 3-6 months after the session took place IF everything goes smoothly.

RETROACTIVE CLAIM DENIALS (AKA CLAW BACKS)

Now imagine that, after all that trouble, that insurance company asked you to give the money back, even years later. Yep, this really happens and, unfortunately, it's a common practice among insurance companies. They'll audit your claims and paperwork for several years back. If they find any mistakes or inconsistencies in the therapist's paperwork they missed when they originally approved the therapist's claim, the insurance company will request that the therapist return the fees she was paid.

Pretend that your employer sent you a bill requesting that you repay the income you'd earned 3 years ago. Would that seem fair to you? I didn't think so. Claw backs can amount to thousands of dollars that can bankrupt a small business like a private practice. Many insurance- based clinicians live in fear of such retroactive audits.

Before reflecting and reassessing the insurance-based private practice I founded, I recently heard from a friend and colleague that a major insurance company requested thousands of dollars be returned by the end of the month. Talk about stressful!

All together that's a recipe for a tired, overworked, and stressed out therapist.

This may have been the problem if you've ever been to therapy that you felt didn't "work" with a provider from your insurance company. I should know. I started to experience the symptoms of burnout after two years of insurance-based practice. And that's when I realized, "Crap! I'm doing the things I tell my clients not to do!" Talk about incongruence!

So I changed my business model for the sake of the well-being of myself and my team to preserve the quality of care we want to provide every client. It breaks my heart to REDUCE ACCESS to care for people in need, but I realized early on that we can't help anyone if we're stressed/burned out or have to close our doors. I am choosing the 50/50/❤️ MODEL to advocate for mental health and well-being for all!

This makes sense to me!

WHAT ARE THE BENEFITS OF PRIVATE SELF-PAY AND/OR A 50/50/❤️MODEL FOR MENTAL HEALTH CARE?

No Labeling - You don't have to carry an unnecessary diagnosis on your medical record. Although, if you’d like to create awareness and assess for diagnostic criteria, I would invite this curiosity and self exploration.

Confidentiality & Privacy - You and your psychotherapist are the only people that will know you're in therapy. You get to choose who you disclose this information to. Session notes are private records so there won't be intimate details to “prove medical necessity/ diagnosis info”.

I am highly confidential and keep minimal notes. I naturally remember our sessions together because I truly care and our therapeutic relationship is genuinely important to me.

Self-Determination - You get to work with a psychotherapist that is free to use the best therapeutic approach to help YOU meet YOUR goals. You and your psychotherapist are the only people involved in the decision about the length of your care. You won't have to seek additional authorization to continue your work or return to psychotherapy, if you have new goals you'd like to explore.

Quality Care & Attention - You'll get a psychotherapist that's alert and engaged during your session, remembering the details of previous conversations. You'll have the help of a professional that's invested in your process of growth because they've taken the time to do the same for themselves. She will be able to use the healing methods that are most appropriate for you.

You might be thinking that this is just one therapist's rant against insurance companies. Don't take my word for it. Feel free to do your own research!

If you tried psychotherapy and were disappointed with the results or the treatment didn't seem to "fit" after working with a provider from your insurance company, I hope you have a better understanding of what might have been happening behind the scenes. We urge you to reconsider getting some support now that you do. There are great providers in the healing professions on both sides of the insurance divide that can help you.

I HOPE YOU HAVE A BETTER UNDERSTANDING ABOUT WHY I HAVE DECIDED TO CHOOSE THE 50/50/❤️ MODEL!

50/50/ ❤️= 50% SELF PAY 50% INSURANCE ❤️SLIDING SCALE FEE

Call or TEXT with any questions:

📱#813-240-3237 or ***Book Now: —> ❤️

Stonewalling

Stonewalling is when a person is actually emotionally overwhelmed and instead of expressing the overwhelm actively with outward intensity, the person detaches and appears to be cold to their partner and uninterested in what they are saying. Stonewalling is actually for form of flooding and a signal that that person needs to take a time out of at least 20 minutes or more, until they feel safe and can actually engage with the other person.

Video excerpt of Making Marriage Work seminar with John Gottman explaining what Stonewalling is and what to do about it. This is a great resource for marriage therapy to help resolve relationship conflict and communicate effectively.