If I feel it, it must be true!

Pop psychology and psycho-babble has done us a real disservice. In the 1970s and 80s, the height of the "Me Generation" (although the 2000s make those decades pale in comparison) people began to get enough psychological information to be dangerous, but not enough to be helpful. The proliferation of "reality" TV shows emphasizes this ad nauseum. Everyone is an amateur shrink, has supposedly incredible insights, and if only everyone believed what she said, then they'd "grow" so much.

There's this disorder that I've discovered called, If I Feel It, It Must Be True. Recently, I conducted a cognitive assessment on a 12-year-old girl who did NOT want to go through with it. Usually, I can reason well enough to get kids to cooperate, but she was having none of it. She has an extensive abuse background and has tremendous trouble controlling her emotions. In fact, she's learned to use her emotions to get out of things she doesn't like to do. This was her plan that day. She worked herself up, yelling that she didn't want to be here and she just wanted to go home. She ended up at the point where she concluded that He's EVIL!

Conclusions are not feelings.

"He's evil" is not a feeling. It's a conclusion. It's a value-judgment (not a very nice one). When you catch yourself confusing a conclusion for a feeling, ask yourself whether you're using feeling words. Yes, I know it sounds corny, but there's a lot of wisdom there. Feeling words are words like hurt, sad, pain, confused, angry, mad, frustrated, and many others. Conclusions are thoughts, not feelings. Feelings are not "I feel that you're an idiot." The word "that" leads to a conclusion, not a feeling. I see this all the time with the couples I work with.

"He's home late again. He must either not like me or think I'm important," concludes the wife. "Man, she's got a sour look on her face. Here I am exhausted after a long day and she can barely say hi to me," he thinks to himself. She's probably feeling lonely and put-off and she reaches conclusions that are very negative about her husband. He does the same thing.

Feelings are extremely important clues. They can tell us when something is wrong, when something needs to change. Feelings are probably universal. When I tell you that I'm sad, you know what it's like to feel sad. Feelings can help us feel connected. I believe that connectedness is one of the basic human emotional needs. They help us understand each other.

When we communicate feelings to each other, although it can be vulnerable, it is extremely powerful. Sharing with each other our sadness, our tears, our fears, our joys, makes us so human, and I'd argue is also a spiritual exercise. Doing so helps us connect at a heart level.

On the other hand, when we only communicate thoughts, conclusions or judgments, we can get quite defensive. One of my absolute favorite authors, psychologists, and researchers, is John Gottman, Ph.D. He writes and speaks extensively about the effects of defensiveness. It keeps us disconnected, contributes to anger and resentment, and when it gets really bad, leads to contempt. Dr. Gottman explains it well when talking about how contempt affects us. Contempt is when you truly think that the other person is a bad person. If you're married or in a close relationship with this person you deem worthy of all this contempt, first of all it prevents you from seeing him or her in their full human-ness. Secondly, if this person is really such the loser that you may believe she or he is, then what does that say about you? What kind of person are you that you're with such a worthless specimen of the human species? Dr. Gottman calls contempt the worst of the Four Horsemen of the Apocalypse. See his book, The Seven Principles for Making Marriage Work for not only an excellent explanation, but some very helpful ways to deal with defensiveness.

This will sound weird coming from a psychologist, but feelings are not the end-all and be-all of the human existence. Yes, they're extremely important information. Understanding what you feel and, at times, where those feelings come from, can give you tremendous power in determining how you want to behave and move through the world. But feelings do not determine reality, and often don't even reflect reality very well.

Emotional Intelligence, sometimes referred to as EQ, is quite helpful in determining success in life. Daniel Goleman, made the term popular in Emotional Intelligence, his book published in 1995. High emotional intelligence is probably a better predictor of success in the real world than cognitive intelligence (IQ). Emotional Intelligence is basically the ability to recognize and manage your own emotions and those of others. Knowledge and the ability to think well are definitely good qualities to have. So are the ability to throw a 100 mph fastball or slam dunk a basketball. Being able to sing (or lip-sync), dance, and shake everything that God and/or the plastic surgeon gave you can also be quite lucrative qualities. But for the vast majority of us, having a decent EQ has a major impact on one's personal, relational, and professional success.

High EQ allows the human organism to recognize and deal with his own emotions as well as those around him. Instead of "I feel it so it must be true," the person with good EQ knows how to take her emotions as important information. She can determine where the emotions are coming from, what they mean (and don't mean), and how to manage them.

I love the word "manage" when it comes to emotions. We certainly can't control what we feel. Feelings just are. They just happen. We can't control where they come from, but we can control what we do with them. We manage them. They give us important information. If I hurt, there's a reason for it. If I know or can learn what that reason is (or reasons are), it gives me power I can use to move through life.

If I feel hurt, there can be a multitude of reasons. It may be that the person who hurt me is just being mean, being intentionally hurtful. It could mean that I have some experiences that have left open wounds. Certain words or experiences poke those wounds, making me hurt. I may need to do some work to heal those wounds or protect them. Knowing these things gives me power and gives me strength. My feelings become sources of important information rather than something I have to be enslaved to. I can choose to act or not act on my feelings, rather than just react in a knee-jerk sense. In my opinion, we should act based on what we know and what we value, not just on what we feel.

Remember, feelings do not dictate reality or truth. And we can all be quite thankful for that.

It’s All in Your Head

    Much psychological theory has been developed based on the idea that many of the problems we have live in our minds. People develop amazing sets of beliefs about themselves as they grow up. Unfortunately, many of the people I work with believe some pretty negative and sometimes nasty things about themselves. These beliefs often keep people pretty stuck.

    My favorite example is of this red-headed freckle-faced kid I knew when I was growing up. He, like all good kids, played Little League baseball. He started off in right field, aka the Place of Banishment, but with a couple years experience and some practice, moved his way into the infield playing first and second base. This lad, let's call him Sparky, could put the ball all over the field when he was taking batting practice. His very first at-bat of his career, he faced the fastest pitcher in the league. Not only that, this guy threw side-armed, creating a natural curve ball. Sparky, not knowing any better, swung at the second pitch and lo and behold, out into the gap in right-center it went for a bases-clearing double. The crowd went wild! Sparky never got another hit in the next 3 years that he played.

    Sparky developed some mistaken beliefs. First of all, he was deathly afraid of striking out. This, in his mind, was the worst form of failure. Pitching in Little League isn't that good, so to get 3 strikes before you get 4 balls is somewhat rare. Secondly, he just wanted to get on base. What's the best way to get on base? Right! Get a walk. Which he did, quite often. The coach and the crowd would yell "Good eye! Good eye!" It wasn't a good eye. He was scared. Scared of "failing" by striking out.

    Babe Ruth hit 714 home runs. This is his claim to fame. He also struck out 1330 times. This was fueled on beer and hot dogs, not steroids. My interpretation is that the Babe swung for the fences. He wasn't afraid of "failing" in the same way our little Sparky was.

    Here's what Sparky needed. He needed a coach to sit him down, look him straight in the eye and say, with a little spittle on the corner of his lip, "Son, I'm tired of you walking all the damn time. [Before the age of political correctness, coaches could cuss.] I want you to go up there and swing the bat. I don't care if you strike out. The important thing is to swing. If you don't swing at a good pitch, you're running laps." You may think this is a bit harsh, but remember, Sparky knocked the ball all over the place in practice. The problem was definitely in his head.

    The solution, however, was in his body. He wasn't going to think or analyze this problem until it was solved. The only way was to take a swing. His fear kept him from having fun. It also kept the faulty beliefs intact. "I can't hit the ball in a real game."

    In my office, we explore problems from lots of different angles. There are a number of different types of questions that help in this exploration. "When did you first start believing that or behaving that way? What was the purpose? What do you think caused this belief?"

    Although the answers can be illuminating, they often do not lead to changes. Why? Pop psychology has tricked us into believing that if we can just come up with answers to some of these questions or get the right insight, the problems are solved. Now before you turn me into the Psychology Police, I am not minimizing the usefulness of insight. Without it, it can be hard to change. However, insight only gets you so far. If you want to get moving, the rubber has to meet the road, and begin rolling.

    Most of us learn much more by doing than by thinking. Now don't get me wrong, I'm a big fan of thinking. What I'm talking about is getting stuck in your head. While the human mind is an amazing thing, it can be a scary place. Stuff can bounce around inside of there and take on a life of its own. It can get warped the more it bounces. Instead, we need real experiences to develop our skills, beliefs, values, and abilities. While it's helpful for me to imagine myself being a great free-throw shooter, until I get into the driveway and shoot a bunch of them, I won't get much better.

    I believe that our minds work in similar ways. It is good to think about things and to plan, but until the plans and thoughts become action, we are limiting ourselves in what we can learn. So, while the problem may be in your head, the solution is in action. To quote a person I worked with who definitely got this concept, you have to "Do the Doing."

You Scratch My Back, I’ll Scratch Yours

 

Forrest Gump's mom, Sally Field (aka Frog Legs in Smokey and the Bandit and also Norma Jean) is credited with teaching Tom Hanks (formerly Kip Wilson in Bosom Buddies) that "Life is like a box of chocolates." The best one that I'm going to claim credit for making up goes like this:

 

A good relationship is like giving and receiving a good back scratch. Let's say that the husband is trying to give the wife a good back scratch. She just sits there wishing that "I wish he'd go a bit lower" or "scratch a bit harder," but she keeps her mouth shut, just being thankful that he's paying any attention to her at all. In order for her to enjoy it, she's got to give him directions. "A little lower. Down to the right. AH YESSSS!!!!"

 

On the other hand, he has to listen. He can't say, "Shut up, I've scratched a hundred backs before. I know what I'm doing."

 

Giving and receiving a good back scratch requires open ears, open hands, open communication and open hearts. Good fingernails or one of those plastic back-scratching hands you get at the county fair can help, too. You have to focus on the goal – to give the gift of complete, undivided attention, to help your cherished one feel good.

 

So many times, couples get into trouble when they stop giving their partner directions, and stop listening. If you really want to "hit the spot," ask questions. Receive directions. Adjust where you scratch, how hard, and when. Give your poor partner directions. Don't expect him to read your back (mind). Lack of the ability to read minds does not automatically equal insensitivity. Be brave – give directions. Let her know what feels good. Listen to what he's telling you.

Too often, when couples keep their mouths and ears shut, each person is doing a lot of scratching, but it isn't hitting the spot. This leads to resentment, feelings of futility, irritability, and sometimes anger.

Examples of this are endless. Take a couple married for 10 years with 2 pre-school children. She stays at home a couple days a week and works a couple days a week. He puts in the "normal" 50 hours and does what he can around the house. She takes care of all of the shopping, 90% of the cooking, and about 70% of the child-rearing, although he does a lot when he's home. He runs the family business, pays the bills, takes care of the vehicles, and does the yard. Neither of them do that much house-work, except for keeping stuff that causes diseases cleaned up.

He secretly wishes that she'd greet him at the door with a long, passionate kiss instead of the usual peck on the cheek and the retreat into her reading room now that she's not in charge of the kids anymore. She wishes he'd just clean up after himself. After all, she cleans up after 3 people all <insert expletive> day long, two of whom can turn a room upside down in less than 4.2 seconds.

Each morning, he's up first and the boy usually is up not long after he does. The boy wants attention, so Dad grabs him and they eat cereal together, even though the boy would much rather go up and see what Mommy is doing. Dad wants Mommy to have that extra 20 minutes of sleep he knows she deserves since she works so hard. He is scratching away.

She cooks this 3-course dinner and has it warm and ready when he walks in the back door. This beats the hell out of the microwaved frozen dinner that passes for culinary fare at least 3 nights each week. She's scratching.

Unfortunately, they miss each other, not from lack of effort, but lack of communicating. Each of them wants the other to know that they care how they feel and wants to help them feel better. Yet, making assumptions and not giving directions leaves them both feeling frustrated, angry, tired, hopeless, and too often – alone.

Although you're certainly not in charge of your partner's feelings, you can sure affect them. Unless you're a total Neanderthal (no offense intended to those of the Neanderthalic persuasion), you want to give each other good feelings. Talk and listen and you stand a much better chance of hitting the spot.

Ooooh, that feels really good.

Health Care does NOT equal Health Insurance

In the public discussion about the necessity of fixing the extremely broken health care system in the United States, the terms "health care" and "health insurance" or "health coverage" are essentially used interchangeably. If the discussion is to progress constructively, it is imperative that consumers, policy-makers, and health-care providers use these terms accurately. Health care is what is provided in the doctor's office. Health coverage
is all about who pays for it. I'll explain why this distinction is important.

First, insurance companies like this confusion because it makes them look viable. The following quote is from the Iowa Health Insurance Network website (www.iowahealthnetwork.com) : "Wellmark provides (emphasis mine) all health care services through their highly acclaimed PPO network known as Alliance Select and the managed indemnity plan through their Classic Blue network."Now while this is technically accurate, the wording is misleading. Wellmark does not directly provide any health care whatsoever. The doctors in its networks are contracted with, but not employed by Wellmark. If Wellmark actually provides health care services, it is practicing medicine without a license.

In my experience, health insurance companies provide very little service at all. They make money in 3 ways – by collecting premiums, denying payment, and investments. Premiums are skyrocketing. According to Linda A. Johnson (her article)with the Associated Press, "Health insurance premiums have skyrocketed, making it ever-tougher for workers and employers to afford them. From 1999 through 2008, annual health insurance premiums jumped 119 percent, according to Kaiser data. The average family premium paid by workers rose from $1,543 to $3,354 a year, and employer payments per worker jumped from $4,247 to $9,325." However, for them to be profitable (and their profits can be obscene), they must figure out ways to keep more and more of the premiums and pay out less and less to the doctors who actually treat patients. Indeed, as a new report by Health Care for America NOW points out, "profits at 10 of the country's largest publicly-traded health insurance companies in 2007, rose 428 percent from 2000 to 2007, from $2.4 billion to $12.9 billion." In 2007, the chief executive officers at these companies collected combined total compensation of $118.6 million — an average of $11.9 million each." The average salary for your family physician is about $173,000/year.

The 2^nd way they make money is by denying payment. In a study conducted in 1999 by Price Waterhouse Cooper that determined if health insurance companies denied only 1% of all claims, even if they later paid those claims within the maximum allowable time (usually about a year), the industry would make $280 million in interest during that period of time. By denying this payment, and even eventually making it, they generate interest income while the doctors whose payment is denied either lose interest, or worse yet, have to borrow money to cover the shortfalls created by this procedure. I can't tell you how many times we have submitted clean claim forms, have them denied, and then re-submit the exact same form and have it paid for.

Insurance companies do not value their doctors. I recently received a letter from the largest health insurance company in the US greeting me as "Dear Provider," with no recognition that I am a licensed doctoral-level psychologist. Other letters refer to me as Paul M. Conditt, LP, presumably standing for Licensed Psychologist – or perhaps Liquid Propane or a classic vinyl record. My correct title is Psy.D. (Doctor of Psychology). Reimbursement rates for doctoral level psychologists are only slightly higher than that for master's level therapists, even though we have usually 2-3 times as much training. In the medical field, increasingly more treatment is being provided by Physician's Assistants or Advanced Registered Nurse Practitioners to save costs, even though their training is a fraction of that obtained by an MD. A couple of weeks ago, I got a call from an insurance company asking if I needed help with a child diagnosed with Asperger's Disorder. I was highly offended. They offered to have me consult with a master's level therapist who may or may not have any training with the disorder (I have a lot), who has never seen the child, and did not take into account that I have successfully worked with this child off and on for over 4 years. I assured the representative that when I need consultation, I seek it from highly qualified professionals who have excelled in the area of treatment I could use some guidance in.

Insurance company policies greatly drive up my over-head costs. Billing can be a complete nightmare. We get multiple denials each month where there is absolutely nothing wrong with the claim form. We resubmit it and it gets paid. What a waste of time, paper, and postage. A couple of years ago, a big switch was made nationwide to make claim forms more universal. The company that covers about 70% of our clientele had some problems with its system in receiving the claims. We kept getting denial after denial. After many hours of intense discussion the phone with a myriad of different "representatives," I finally decided to lodge a complaint with the State Insurance Commission. They did nothing, explaining that "we assume that insurance companies are telling the truth unless there is evidence to the contrary." They didn't bother to try to gather any other evidence and ignored the evidence I sent them that outlined how the insurance company made multiple mistakes and lied to me about how to "fix" the claim forms. The company ended up owing us over $15,000, which we eventually collected, but this is a huge percentage of our gross annual revenue. Having to go without that cash flow for 3 months nearly put us out of business.

A huge talking point by the more conservative politicians is that a public insurance option will limit competition. What they don't recognize is that there is, in practice, almost no competition. In Iowa, Wellmark Blue Cross Blue Shield insures about 70% of the population. No doctor or clinic can afford not to be on their provider panels for two reasons. Business-wise, since so few people pay out of pocket for psychological care, we would be cutting 70% of our customer base. Secondly, because most doctors are in business to help people, we don't want to discriminate against people who have a certain insurance plan that they cannot afford not to utilize. The "competition" they speak of is not about competing over who will provide the highest-quality, best bargain health care, but who will pay for it.

Another option is to essentially expand Medicare and Medicaid to cover anyone who wants it. As a psychologist, my experience with these programs has largely been negative. First of all, our small business could not keep the doors open if the majority of our clients were covered under these plans at current reimbursement rates. We accept Medicaid in our practice because of our commitment to provide for the lower income population. However, this requires us to give a 40% discount below our standard fee. Secondly, the rules for participating in these programs can be prohibitive. Years ago, Medicare changed the rules about documentation, saying that start and stop times must be recorded for each session. Prior to that, the total length of the session was reported. They did not inform providers of this rule change. When large organizations were audited, any records that did not have start and stop times recorded were considered to be fraudulent charges. Therefore, the agency had to not only pay back what was paid for those sessions, but also a stiff penalty. Also, any clinic that accepts Medicare has to have all records comply with Medicare standards. When auditing, the Medicare officials are allowed to examine all charts, not just those covered by Medicare.

The last time I was audited by the large HMO contracted by the state to run the state Medicaid contract, I was docked points for not having documented the allergies a client has in the chart. I argued with the auditor, saying that doing so essentially forces me to practice outside my area of competence. I am a clinical psychologist, not a medical doctor or an allergist. By me documenting this, I am implying that I know at least something about allergies. All I know is what happens in my own sinus system at certain times of the year. Many dentists will not accept the state Medicaid in Iowa at all because of low reimbursement rates and the fact that this clientele tends to have poorer outcomes and higher no-show rates.

Health insurance companies have no positive influence over the quality of health care, and if anything, are decreasing the quality. It is similar to teachers teaching to the test. Doctors are getting more pressure to treat based upon what will get reimbursed, having to balance that with what is in the best interests of the patient. Lesser-trained providers are cheaper, so insurance companies give preference to policies that utilize them over doctors.

In summary, health care does NOT equal health insurance. In the upcoming decision-making process, policies must be developed that help rein in costs. Insurance companies will try to focus the discussion on ways that doctors, hospitals in clinics "waste" money, implying that they (the insurance companies) are the models of efficiency. This is far from true, and if they want to be a player in the reform, they must reform themselves first. Doctors must learn to be more transparent about what the benefits and costs are of different treatment options, communicate them to their patients, and then be given the freedom to make decisions based on what is best for the patient, not for the insurance company.

Re-valuing value

Here in the culture of the pursuit of happiness, we have lost our ability to value. Not that we have necessarily lost our values, but we have lost the ability to assign value. We can put dollar amounts on some things, but even that does not impart value, in and of itself. In these dire economic times, we need to learn HOW to value.
Current examples of not knowing how to value things are abundantly obvious. Part of the problem with the “credit crunch” is that there is now all this property available that is not worth what is owed on it. How much is a house worth? The simple answer is – whatever someone is willing to pay for it. You may own a beautiful zillion dollar beach property, but if you need to sell it and no one is willing to buy it, it is worth zero dollars.
We have Wall Street executives receiving multi-million dollar “performance bonuses.” First of all, if these bonuses are truly tied to performance, and the performance is pitiful, why are they still getting bonuses?
While a common explanation (or more accurately, blame) is that greed is at fault, I believe that our inability to value goods and services is also a factor.
There’s a book I recommend, called Your Money or Your Life, by Vicki Robin. She and Joe Dominguez developed a program that has a very interesting formula to help determine value. In this formula, you take your wage and determine your “real” wage. Divide what you make by the hours that you work. Then subtract out commuting time and other variables that detract from your earnings. For example, if your commute is an hour each way, then your 8-hour day turns into a 10-hour day. You also subtract the gas money, wear and tear on your car, etc. Once you figure out how much you actually make, then you equate that to your life energy. To make the math easy, let’s say your real wage is $10/hour. For every $10 you make, you have traded an hour of your life energy for that $10. For every $10 you spend, you have traded an hour’s worth of life for whatever it is you purchased.
When explaining this to clients, I draw the difference between spending $5 at a fast food joint versus $10 at a nice sit-down restaurant. For me personally, the half hour I trade for a fast-food meal is not worth it. However, if I truly enjoy the meal and the restaurant, the hour I trade may be worth it. If your house (or rent) payment is $1000/month, then you trade 100 hours of life energy for your dwelling.
Contemplate this. What if we only spent our life-energy on things that give and support life? Spending $12 on a picnic lunch at the park with your kids may give a much greater return on your investment than $12 spent at the nearest fast-food joint. Renting movies that provide true entertainment rather than just an escape from the grind of life and give energy back. Reading books that engage your brain gives life.
Think about not only what you value, but how you value things and experiences. Invest in things that give you life.

Getting Started

Howdy Y'all,

This is my very first blog entry. To begin, please do not confuse me with Dr. Phil. We have the same first name (Dr.) but that's where the similarities end. In this blog, we'll be discussing all sorts of things psychological, emotional, cognitive, relational, spiritual, and even current events. Email me with questions you've always wanted to ask a psychologist, but were afraid to ask.