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 co-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: —> ❤️

The Grief of an Affair (Your partner cheated. Now what? Part 2)

The revelation of a partner’s affair (sexual or emotional) comes as a shock to the hurt partner, even when doubts exist. The loss of trust in a relationship is no different from a physical loss. The closeness of the relationship and the hurt partner’s perception of preventability were identified as predictors of the grieving process’s intensity and duration in a study on human grief by Bugen. The predictors wouldn’t be different in the case of trust loss as well.

The process of grief includes five emotional stages to recovery from loss, as per the Kubler-Ross model. This process is not linear, and the hurt partner can find themselves at any stage throughout varying timelines. The stages of trust loss, applying the grief model to the aftermath of an affair, would be as follows:

DENIAL

The hurt partner struggles to comprehend what happened and is often unaware of the Gottman-Rusbult-Glass betrayal cascade that the betraying partner experienced or is experiencing . The hurt partner tends to minimize the pain of the affair initially and goes through the phase of “something is amiss, and it will be set right.” There is a strong need to confirm with the partner by asking questions in several different ways as they feel that this cannot be happening.

ANGER

The hurt partner starts to piece together the incidents from the past, and the reality gradually emerges. There is apparent anger about the betrayal, hurt for being let down, and sadness about losing the relationship. The anger can be toward oneself for letting this happen, the partner who did this to them, and the liaison who shouldn’t have crossed the boundaries. But then, there is also the fear that the anger may push away the very person they still love. The fear of losing the partner results in suppressing anger, which may erupt abruptly at different points as the entirety of the situation sinks in. There may also be self-doubt about their role in the case, which is overwhelming, given the immense emotional stress already persisting.

BARGAINING

The feelings of confusion, pain, anger, and other emotions seem unbearable and threaten the loss of control. It is a helpless state intensified by powerful emotions and therefore comes a need to regain control. The hurt partner tries to reset the past by exploring different paths, such as “if only I had stopped her that day when I saw her messaging,” “what if the other person had misused the situation and my partner is not at fault,” etc. There is a struggle to heal the pain faster by providing logical explanations and intellectualizing feelings. The hurt partner may try premature closure to postpone experiencing painful emotions.

DEPRESSION 

Here one feels the full impact of losing a trusted relationship. The affair erases everything the hurt partner believed. While the first three stages are more cognitive and solution-oriented, this stage is emotional and experience-oriented. It might involve heaviness and isolation. The hurt partner experiences intense emotions of anger, sadness, and doubts that can feel like there is no more running away. Questions may arise like, “does my partner love me at all?” “I should have given more time and attention before,” “What do I do now?” etc. These questions address the concerns at a deeper level, releasing intense emotions. It is a difficult phase that can feel foggy. Though depression may feel like a comfort zone as the inner conflict lessens, dwelling here indefinitely is unhealthy and would need counseling assistance to move on.

ACCEPTANCE

Acceptance comes concerning what happened and what it means in the future. It is not a perfect resolution and permanent closure (with emotions and interpersonal realities) but a transformative stage following a significant change. The hurt partner may start to have thoughts like, “I am aware of what went wrong and can understand the reasons,” “I will be able to forgive and move on,” etc. At this point, the perspective is more on the present moment and future rather than the past. Hope is renewed about the restoration of the relationship. This stage feels different as the outlook towards several aspects of life changes.

POST-TRAUMATIC STRESS DISORDER (PTSD)

Shirley Glass noted that the hurt partner often suffers from a PTSD reaction following an affair’s discovery. According to Drs. John and Julie Gottman, if the below symptoms persist, then the chances are that the hurt partner is experiencing PTSD. 

1. Recurrent recollections and intrusive visualizations: “Deja vu” events, days, locations, etc., tend to trigger flashbacks of affair specifics. For example, recurring dates of when the hurt partner had found out about the affair trigger memories and related emotions that can induce flooding (stress) and panic attacks.

2. Oscillating moods, confusion, irritability, and outbursts: As the hurt partner struggles between feelings of betrayal and acceptance, there are periods of emotional numbing followed by explosions.

3. Intense emotions of anger, hurt, shame, grief, and frustration: There are ambivalent fears of anger, guilt, self-doubts, etc., that can overwhelm the hurt partner. Empathetic listening goes a long way in healing.

4. Hyper-vigilance and startling: Hurt partners can become startled and vigilant about mundane things like message notifications, phone rings, delay in replies, etc., and may seem to make impossible demands. Compassion and assurance will help.

5. Avoidance, detachment, and seclusion: The overwhelming feelings appear challenging, and isolation may seem like the only option. The betraying partner often misunderstands it as distancing and tends to stay away. It may enhance the feelings of rejection in the hurt partner when what is needed is emotional support.

6. Loss of focus and interest: The depression symptoms of demotivation, loss of interest, lack of energy, irregular sleep, no appetite, low feelings, etc., can persist.

7. Hopelessness about the future: As the world, they know, collapses, there may be hopelessness and helplessness about the relationship.

Although not all partners hurt by an affair will develop PTSD reactions, many will experience grief and depression. Hurt partners may become obsessed with the affair’s details, feel powerless with their emotions, and need therapeutic assistance at such times. It is important to note that these reactions are normal responses and can benefit from couple therapy.

FINAL THOUGHT

An affair shakes everything that the hurt partner believes in their understanding of themselves and the world. Gottman Method Couples Therapy can help a couple learn to atone, attune, and attach as they restore new purpose and meaning together.

Jinashree Rajendrakumar

References:

Bugen, L. A. (1977). Human grief: A model for prediction and intervention. American Journal of Orthopsychiatry, 47(2), 196–206. https://doi.org/10.1111/j.1939-0025.1977.tb00975.x

Glass, S. (2007). NOT “Just Friends”: Rebuilding Trust and Recovering Your Sanity After Infidelity. Simon & Schuster.

Gottman, J. (1995). Why Marriages Succeed or Fail: And How You Can Make Yours Last. Simon & Schuster.

Gottman, J. M. (2011). The science of trust: Emotional attunement for couples.

Gottman, J., & Gottman, J. (2017a). The Natural Principles of Love. Journal of Family Theory and Review, 9(1), 7–26. doi: 10.1111/JFTR.12182

Gottman, J., & Gottman, J. (2017b). Treating Affairs and Trauma. Unpublished manuscript,  Gottman Institute, Seattle, USA.

Gottman, J. M., & Levenson, R. W. (1986). Assessing the role of emotion in marriage. Behavioral Assessment.

Gottman, J. M., & Levenson, R. W. (1992). Marital processes predictive of later dissolution: behavior, physiology, and health. Journal of Personality and Social Psychology, 63(2), 221–233. doi: 10.1037/0022-3514.63.2.221

Gottman, J. M., & Levenson, R. W. (2002). A Two‐Factor Model for Predicting When a Couple Will Divorce: Exploratory Analyses Using 14‐Year Longitudinal Data*. Family Process, 41(1), 83–96. doi: 10.1111/J.1545-5300.2002.40102000083.X

Hall, C. (2011). Beyond Kubler-Ross: recent developments in our understanding of grief and bereavement. InPsych: The Bulletin of the Australian Psychological Society Ltd, 33(6), 8.

Holland, K. (2018, September 25). What You Should Know About the Stages of Grief. Retrieved from https://www.healthline.com/health/stages-of-grief

How Do Affairs Happen? (See the cascade of events that can lead to infidelity) PART 1

WHAT WENT WRONG?

It is hurtful and devastating when an affair shatters a relationship’s trusted stability. It leaves both partners to pick up the pieces before starting all over again, which is painful. One of the questions that plague partners recovering from an affair is “What went wrong?” Even when individuals and relationships are unique, is there a commonality across affairs?

Dr. John Gottman with Dr. Caryl Rusbult and Dr. Shirley Glass explained an affair as a cascade of steps that culminate in a transgression. It all starts with the bid for attention. If it sounds like a simplified excuse for an affair, it is not. When one can’t count on their partner to be available in their time of need, it leads to unfavorable comparisons, emotional distance, and eventual betrayal, if not the demise of love. Based on research, the steps that lead to betrayal (the Gottman-Rusbult-Glass Cascade) are as follows.

TURNING AWAY

Partners can make an emotional bid that is met with turning away or against instead of turning toward. Turning away would include ignoring or being preoccupied with something else while turning against would be a retort or a lash back. When “Would you like to plan for the weekend?” is met with silence or “Can’t you see that I am busy?” the bidding partner feels rejected and hurt. Over time repeated failed bids lead to reiterating the belief that “you are not there for me,” and trust associated with the partner starts to erode gradually. An anticipatory rejection starts to flood (stress) the bidding partner, making them feel vulnerable, insignificant, or unwanted.

NEGATIVITY AND AVOIDANCE

The bidding partner soon enters the negative absorbing state, which is the negative affect from past failed bids building up with every new failed bid. It gets easier to get into the negative state but challenging to exit, resulting in a persistent negative state of mind. Soon unheeded requests turn out to be stressful and pointless arguments. Therefore bidding partner suppresses feelings and needs, leading to avoidance of conflict and self-disclosure.

INVESTING LESS AND COMPARING MORE

When partners favorably evaluate the relationship compared to other alternatives, they are more likely to stay committed to the relationship, as Thibaut and Kelley suggest. Therefore, the unfavorable comparisons propel a relationship towards a lack of commitment and betrayal. The bidding partner starts negatively comparing the partner with a real or imaginary partner who would make them feel cherished. As approaching the partner with an emotional bid is found futile, bidding and investing in the partner reduces, while substituting begins.

FEELING LESS DEPENDENT AND MAKING FEWER SACRIFICES

As Rusbult notes, commitment is a gradual process of making a good comparison level for the relationship within alternatives. Similarly, the opposite process of un-commitment is a gradual process of damaging comparison levels with other options. Commitment leads people to make sacrifices while building interdependency. It also leads to disparaging alternatives in comparison to their partner. As reliability or dependability on the partner lessens, trust reduces. The partner opens up to others and engages in talks (or self-talks) that magnify the relationship’s negative qualities.

TRASHING VS. CHERISHING

As one maximizes the partner’s negative qualities, one also minimizes positive characteristics. The Four Horsemen of the Apocalypse (defensiveness, criticism, contempt, and stonewalling) become rampant. Dr. Gottman suggests that people committed to their relationship cherish their partner by reminiscing about the positives with gratitude, even when not together. An essential part of a relationship, cherishing and expressing gratitude, is replaced with trash-talking the partner (directly and in front of others).

RESENTMENT AND LONELINESS IN RELATIONSHIP

Gratitude for the partner becomes replaced with bitterness. Resentment seeps in with silent arguments such as feeling the partner is selfish and uncaring. There is loneliness enhanced with unfavorable comparisons like “my ex would have understood me better” or “my colleague is more there for me than my partner.” With loneliness, vulnerability to other relationships increases. The built-up resentment results in low sexual desire and impersonal sex. The refusal to have sex may result in the partner’s blaming, leading to further feelings of rejection, and the affair cascade intensifies.

IDEALIZING ALTERNATIVE RELATIONSHIPS

There is less dependency on a partner, less reliance on the relationship for meeting essential needs, less investment in the relationship while idealizing alternative relationships, and thinking fewer positive pro-relationship thoughts. Instead, anti-relationship thoughts take over like “maybe we will be better off without each other,” “it may be a relief to let go of the relationship than hold on,” etc. The window between the partners is replaced with a wall, as the window opens up to outsiders. Other harmless liaisons provide the safe house.

SECRETS AND CROSSING BOUNDARIES

Secrets begin with omission. The other patterns such as inconsistencies, lies, confidence violations follow. While in cherishing relationships, interactions with others that hurt the partner are avoided, in denigrating relationships, ties with others are sought to fill the prevailing emotional gaps. As the hiding increases with the partner, there is an active turning toward others, and at a vulnerable moment, boundaries are crossed, and actual betrayal unfolds.

As one partner goes through the cascade of betrayal, the other partner experiences the ground sinking beneath their feet. Trust is broken and, over time, may develop into Post Traumatic Stress Disorder.

Jinashree Rajendrakumar

References:

Gottman, J. (1995). Why Marriages Succeed or Fail: And How You Can Make Yours Last. Simon & Schuster.

Gottman, J. M. (2011). The science of trust: Emotional attunement for couples.

Gottman, J., & Gottman, J. (2017). The Natural Principles of Love. Journal of Family Theory and Review, 9(1), 7–26. doi: 10.1111/JFTR.12182

Gottman, J., & Gottman, J. (2017). Treating Affairs and Trauma. Unpublished manuscript,  Gottman Institute, Seattle, USA.

Gottman, J. M., & Levenson, R. W. (1986). Assessing the role of emotion in marriage. Behavioral Assessment.

Gottman, J. M., & Levenson, R. W. (1992). Marital processes predictive of later dissolution: behavior, physiology, and health. Journal of Personality and Social Psychology, 63(2), 221–233. doi: 10.1037/0022-3514.63.2.221

Gottman, J. M., & Levenson, R. W. (2002). A Two‐Factor Model for Predicting When a Couple Will Divorce: Exploratory Analyses Using 14‐Year Longitudinal Data*. Family Process, 41(1), 83–96. doi: 10.1111/J.1545-5300.2002.40102000083.X

Haan-Rietdijk, S. D., Gottman, J. M., Bergeman, C. S., & Hamaker, E. L. (2016). Get Over It! A Multilevel Threshold Autoregressive Model for State-Dependent Affect Regulation. Psychometrika, 81(1), 217–241. doi: 10.1007/S11336-014-9417-X

Hawkins, M. W., Carrere, S., & Gottman, J. M. (2002). Marital Sentiment Override: Does It Influence Couples’ Perceptions? Journal of Marriage and Family, 64(1), 193–201. doi: 10.1111/j.1741-3737.2002.00193.x

Top Rated Marriage Counselor In Tampa

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Thank you so very much for this recognition. I love what I do!

Feeling Honored and Passionate About Helping Couples & Families! ~Liz

Internal Family Systems: 8 C's of Self Energy/Awareness List

8 C's of Self Energy/Awareness List

1. Calmness -

a physiological and mental serenity regardless of the circumstances 2. the ability to react to triggers in your environment in less automatic and extreme ways 3. to be less vulnerable to adopting the common fight-flight-freeze response when threatened

2. Curiosity -

a strong desire to know or learn something new about a topic, situation or person 2. to have a sense of wonder about the world and how things work 3. genuinely interested in non-judgmentally understanding something or someone

3. Clarity -

the ability to perceive situations accurately without distortion from extreme beliefs and emotions 2. the ability to maintain one’s objectivity about a situation in which one has a vested interest 3. the absence of preconception and objection 4. the ability to maintain a “beginner’s mind” in which many possibilities exist

4. Compassion -

to be open heartedly present and appreciative of others without feeling the urge to fix, change or distance from them 2. an intuitive understanding that the suffering of others affects you because of your connectedness to them 3. to simultaneously have empathy for others and a belief that the other has a Self that once released can relieve his or her own suffering

5. Confidence -

to maintain a strong belief in one’s ability to stay fully present in a situation and handle or repair anything that happens with the belief that “no matter what, it’s all okay and will all work out the way it can” 2. to have healed from previous traumas and learned from previous failures to such a degree that their effect does not spill into the present 3. to understand that mistakes are only lessons to be learned

6. Courage -

strength in the face of threat, challenge or danger 2. the willingness to be take action toward a goal that others would find overwhelming 3. the ability to recognize the damage we do to others then take action to make amends 4. the willingness to reflect and “go inside” toward our own pain and shame, carefully examine it and act on what we see

7. Creativity -

the use of the imagination to produce original ideas 2. the ability to enter the “flow state” in which expression spontaneously flows out of us and we are immersed in the pleasure of the activity 3. the ability to create generative learning and solutions to problems 

8. Connectedness -

the state of feeling a part of a larger entity such as a partnership, team, community, or organization 2. a connection to a meaningful purpose or a higher calling above the circumstances of daily life 3. to be in a relationship with someone who truly knows and accepts you for who you really are 4. to be able to relax your defenses with others as you know that you won’t be judged or controlled and are not afraid of getting hurt because you have confidence that you can repair any damage or misunderstandings that may occur