How Phone Counseling May Help Save Lives During the Covid-19 Lockdown

With the covid-19 pandemic now affecting virtually every country on earth, it is understandable that much of the world’s focus has been on protecting people’s physical health. Hand washing and social distancing is important in the fight against the coronavirus. However, it is important to remember that mental health issues may lead to loss of life as well. And as people’s anxiety, grief, frustration, and anger continue to rise as the pandemic continues, mental health services such as phone counseling may become very important in helping individuals who may be contemplating self harm or suicide.

The Dangers of Suicide

Suicide is a major global health concern. According to the World Health Organization, 800,000 people die from suicide each year. In 2017, approximately 47,000 American citizens committed suicide. That figure is twice the number of people who were victims of homicide (19,500) in the same year. 

If you think that you or someone you know may be at risk for suicide, phone counseling can help. Please call the National Suicide Prevention Lifeline at 1-800-273-8255 immediately.

Evaluating the Risk

Suicidal ideation (thinking about or planning suicide) has been linked with a number of mental health issues such as depression, anxiety, and hopelessness. It is also associated with declining physical health as well as sexual, physical, and emotional abuse. While it is true that not everyone experiencing these conditions thinks about suicide, all suicidal thoughts and behaviors should be taken seriously. 

How can you tell if someone you know is at risk for suicide? He or she may:

• Threaten to hurt or kill himself or herself
• Write or talk about his or her own death
• Feel trapped in an unpleasant situation with no way out
• Avoid family members and friends
• Feel like there is no hope
• Take unnecessary risks
• Have access to weapons, medications, or toxic chemical substances

Does Phone Counseling Really Work?

One of the challenges affecting people with mental health issues today is their inability to meet with their therapist face-to-face. The highly contagious nature of covid-19 has led to businesses, communities and even entire countries being placed on lockdown. Despite these restrictions, a large percentage of individuals are able to access mental health care over the phone. Therapy provided in this way may help save the lives of thousands of people who may be experiencing extreme emotional distress and considering suicide.

Some people may be unsure if over the phone therapy is effective. However, a 2016 literature review of fourteen studies published in the Journal of Telemedicine and Telecare showed that phone counseling shows “promise in reducing symptoms of depression and anxiety.” In fact, respondents in a 2002 study claimed the mental health benefits of phone counseling were similar to those experienced in face-to-face therapy.

It is estimated that for each person who dies from suicide, another 20 adults attempt to take their own life. It is essential that at-risk individuals are able to access professional mental health care over the phone. Therapy can help people with suicidal ideation to explore ways to resist the urge to self-harm and develop healthy coping strategies to manage feelings of distress or hopelessness. Once phone counseling has helped suicidal individuals passed the point of crisis, hospitalization or intense in-patient care may be necessary, 

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Intimacy vs Isolation: Why Do Some People Struggle to Form Intimate Relationships?

Loneliness is a surprisingly common phenomenon in the 21st century. In 2018, a survey conducted by The Economist and the Kaiser Family Foundation revealed that 22% of adults in the United States and 23% of adults in the United Kingdom often or always feel lonely or left out. Interestingly, many people who describe themselves as lonely are unable to explain the reason for their loneliness. They only know that other people seem to be making friends and falling in love, while they keep marching forward alone.

But why does loneliness develop in the first place? Erik Erikson’s theory of psychosocial development may provide some insight. 

Erikson believed that human personality develops in eight predetermined stages throughout a person’s life. Each stage presents the individual with a psychosocial crisis which may positively or negatively impact personality development. If the individual is able to resolve the crisis successfully, healthy personality growth occurs and the individual acquires a basic virtue. Erickson suggested that failure to complete a stage successfully hinders a person’s ability to resolve subsequent stages. 

In his theory, Erikson described the sixth stage of psychosocial development as intimacy versus isolation. All eight psychosocial stages, approximate age of onset, and basic virtues are listed below:

1. Trust vs Mistrust / Age 0-1.5 years / Hope
2. Autonomy vs Shame / Age 1.5-3 years / Will
3. Initiative vs Guilt / Age 3-5 years / Purpose
4. Industry vs Inferiority / Age 5-12 years / Competency
5. Identity vs Role Confusion / Age 12-18 years / Fidelity
6. Intimacy vs Isolation / Age 18-40 years / Love
7. Generativity vs Stagnation / Age 40-65 years / Care
8. Ego Integrity vs Despair / Age 65+ years / Wisdom

Intimacy vs Isolation 

According to Erikson, the sixth stage of psychosocial development (intimacy vs isolation) occurs when a person is 18 to 40 years old. In this stage, the major psychosocial conflict is centered on forming close, honest, and intimate relationships with people who are not family members. Erikson believed that the successful completion of this stage leads to lasting friendships, security, intimate relationships, and love. Individuals who avoid intimacy or fear commitment are more likely to experience isolation and loneliness later in life

Important Things to Do During the Intimacy versus Isolation Stage

Advocates of Erikson’s psychosocial theory believe that people need to learn how to be more emotionally open during the intimacy vs isolation stage. In other words, they need to figure out how to share some of themselves with other people. A few key tasks in this phase of development are listed below:

• Share more of yourself with others while still preserving a strong sense of identity.
• Become more intimate. This involves forming close emotional bonds and does not necessarily mean engaging in sexual activity.
• Make commitments to other people. This shows you can be relied on for the long-term.
• Show sincere concern for the needs of others and act on these concerns.

What to Do Next if you Have Relationship Issues Right Now

If you are an adult and currently experiencing relationship challenges, it may suggest that the psychosocial conflict during your intimacy vs isolation phase of development has not yet been successfully completed. To help remedy the situation, you can make an earnest effort to work on becoming more emotionally connected to the people around you. You may also need to embrace the responsibility associated with making more commitments in your work and social life. When you are willing to lower your defences, make long-term commitments and show love to people, they are more likely to show love to you.

Another thing to keep in mind is that Erikson believed that failure in earlier stages of development may lead to problems in later stages. This means problems in the intimacy vs isolation stage may indicate an issue in an earlier stage of development. For example, the fifth stage of psychosocial development is identity vs role confusion. During this phase you become more independent, figure out the type of person you really are, and determine your role as an adult in society. If you were unable to complete the fifth stage successfully, it may have a negative impact on your ability to form meaningful intimate relationships as an adult. 

Studies indicate that young people tend to be lonelier than older adults. While it is true that loneliness is not a mental health disorder, it is closely linked with a number of serious mental health issues such as chronic depression and anxiety. Working with a licensed therapist can help you to identify possible reasons for your loneliness and develop an action plan to address them in a healthy way. Therapy may help you improve your social life now and foster good mental health for years to come.

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Does Insurance Cover Therapy Costs in the United States?

Although mental health is just as important as physical health in promoting overall well-being, many insurance companies in the past did not agree with that viewpoint. This is shown by the fact that, for many years,  a large percentage of insurers provided better insurance coverage for physical issues than mental health issues.

However, in 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (also called the federal parity law or the mental health parity law) was passed. This law stipulated that coverage for substance addiction, behavioral health and mental health conditions should be comparable to the coverage provided for physical illnesses.

Although the law has been in effect for more than a decade, many people are unaware that it exists and how they may be impacted by it. A survey conducted by the American Psychological Association (APA) in 2014 showed that more than 90 percent of American citizens did not know the basic details of the mental health parity law. This general lack of knowledge has led many people to ask key questions such as:

• Is therapy covered by insurance in my state?
• How do I know if my insurance plan provides mental health coverage?
• Does insurance cover therapy for specific mental health issues that affect me?

But before those questions are addressed, it may help to review the mental health parity law.

What Does the Mental Health Parity Law Do?

The mental health parity law requires insurance companies to treat the financial requirements of mental health, behavioral health, and substance-use coverage equal to (or better than) medical or surgical coverage. That means your insurer cannot charge you a $100 copay for visits to your psychologist if it charges only $25 for the majority of medical or surgical office visits.

The law also prevents insurance companies from putting a fixed limit on the number of mental health visits you are allowed each year. However, your insurer may implement limits based on your medical needs.

Is Therapy Covered by Insurance in My State?

The mental health parity law is effective nationwide. It applies to the following types of health insurance:

• Children’s Health Insurance Program
• Health coverage purchased by your company (if it has 50 or more employees)
• Coverage obtained under the Affordable Care Act 
• Most Medicaid programs

Please note that Medicare is exempt from the mental health parity law. The same is true for some other government programs and plans. Some state government employee plans, such as those that provide coverage for teachers and employees of state universities, may opt out of the parity requirements.

How Do I Know if My Insurance Plan Provides Mental Health Coverage?

If you are not sure if your insurance covers mental health issues, it is best to check the benefits of your plan. In addition to checking your plan yourself, you may also speak with the Human Resources department at your company or contact your insurance provider directly. If you have Medicaid, you can contact your state Medicaid director to find out if the mental health parity law applies to your Medicaid plan.

Does Insurance Cover Therapy for Specific Mental Health Issues that Affect Me?

It is important to understand that not all insurance plans offer mental health benefits. The mental health parity law ensures that insurance companies provide comparable benefits if both mental health and physical health coverage are offered.

The mental health parity law applies to all mental health, behavioral health and substance use issues covered by your health plan. However, your insurer is allowed to exclude specific diagnoses from coverage. These exclusions should be made clear to you in the benefits of your plan. Speak to your insurance company if you are not sure if your plan excludes any diagnoses.

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Examining the Pros and Cons of Phone Therapy

Telephone therapy has taken on greater significance in the mental health industry in wake of the covid-19 pandemic. While some individuals may have avoided telephone therapy in the past, the temporary closure of mental health offices and the necessity of social distancing have resulted in an increasing number of people asking for more information on this form of treatment. 

But is telephone therapy effective? A 2002 study published in the Journal of Counseling Psychology states that telephone therapy “was helpful for both global and speck improvement.” The respondents in the study also indicated that the counseling relationship in telephone therapy is similar to face-to-face counseling. 

In this article, we will consider some of the benefits of phone therapy as well as some of the drawbacks you need to keep in mind if you are currently considering telephone therapy for yourself or a loved one. 

Advantages of Telephone Therapy

• You choose your counselor. No need to see a therapist simply because he or she is the closest mental health provider to your home.
• You do not have to set appointments. Accessing mental health care is easy and does not require you to fill out tons of paperwork. However you can set appointments if you wish to see the same therapist on a specific day at a specific time.
• Phone therapy is available 24/7. No need to change your schedule or rush to see your therapist before his or her office closes.
• You can save money. Phone therapy is often more affordable than traditional face-to-face therapy
• You are in the comfort of your own home. This may help you to relax and open up about the issues you are experiencing.
• You can protect your privacy. You can disable your camera and communicate with your therapist by audio only. Also, your neighbors and friends will never see you enter a therapist’s office.
• You are physically separated from your therapist. This is essential for minimizing the spread of Covid-19 and helpful for clients who are anxious about counseling.
• No need to travel. Effective care is available, even if (1) your community is under lockdown due to the covid-19 pandemic, (2) you live in a remote area, or (3) you have chronic health issues.

Despite the many benefits of telephone therapy, there are some potential challenges you should think about. A few of these are listed below.

Disadvantages of Telephone Therapy

• You need to figure out what plan works best for you. Telephone therapy services may be offered in a variety of ways. Some services request that you purchase “bundles of minutes,” some work by subscriptions, and others use a system that is unique to their platform. You need to evaluate your options and pick the one that suits your personal circumstances.
• Your session may be interrupted. As your sessions will likely be conducted in your home, they have a greater chance of being interrupted by family members or unexpected visitors.
• Your therapeutic progress may slow down. While some individuals are more likely to open up on the phone, others prefer to discuss their issues face-to-face with their counselor. If you fall into the latter category, your telephone therapy sessions may be less productive than those at your therapist’s office.

As shown, telephone therapy is not for everyone. Nevertheless, it has proven to be extremely convenient for people who are comfortable speaking with their therapist on the phone. If you need mental health services but are unable to see your therapist in person, consider telephone therapy. You may be surprised at how fast, easy, and effective this form of mental health care can be.

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Day #255: The impossibility of complete knowledge

Have you ever tried to learn something and you just can't seem to get it to stick in your brain? That would be my life, well most of my adult life since I left the Marines. There is just so much knowledge in the world and wrapping my brain around even a fraction of a fraction of a fraction of that knowledge seems to be an impossible task. So what is one to do?

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Helping Your Child or Teen Stay Socially Connected During COVID-19

Parents’ first concern when schools announce they are closing for the remainder of the semester is likely, “How am I going to maintain my child’s learning?” However, your child’s social and emotional development is also impacted by the loss of structured school time. While the schools are working hard to provide academic work to your child, you may find your efforts best suited to help your child with another consequence of school closing… their social life and developing social skills.

School time allows your child, whether they are a young child or a teenager, a structured reliable time each day when they can see their friends, practice social skills, and build relationships. Even if they talk to friends on social media or texting, there are invaluable skills your child builds by communicating face to face with their friends. 

When your student has a disagreement with a classmate, they must go back to school and face the person the next day. This helps them try out the necessary skills of repairing relationships and getting along with people who may not necessarily be their favorite. When students have a disagreement with a teacher, they must face that teacher again within a couple of days, and work on ways to rebuild that relationship. 

Many children and teens struggle with social anxiety, and going to school each day provides them with an environment that challenges their social interaction skills. They must walk into a crowded cafeteria and find their friends. They are called on by the teacher to answer a question in class or make a presentation at the front of the class. 

In our own experiences working with children and teenagers, when they find out school is closing for the year, their first concern is about the loss of social opportunities and how to remain connected to their friends. Teenagers and older children, largely starting around middle school, highly value their social groups. Their friendships and social connectedness are seen as highly important parts of their life and identity.

Here are some concrete ways you can support your child’s social and emotional functioning during the chaos of COVID-19:

1. For an elementary age child, help the child establish a routine of talking with their friends. They may choose an app such as Google Hangouts to meet with their friend group, or platforms such as FaceTime or Skype to meet with one friend at a time. 
2. If you were thinking of taking your child or teen’s phone away, you may want to reconsider. Phones are likely your child’s only way to stay connected with their friends. Taking your child’s phone away for a certain part of the day may be the better option. Many parents have found it helpful to have the child’s phone in another room while they are working on their online schoolwork, and it is advisable to charge a child’s or a teen’s phone in the parent’s bedroom overnight in order to avoid staying up late on their phones. 
3. Encourage your child or teen to come out of their room and spend time with family members. They can use this time to strengthen sibling relationships and continue to play cooperatively with others. Too many hours isolating in their room is not helpful for maintaining your child or teen’s mental health during this stressful time. It may be helpful to have certain times a day when a child or teen can be in their room, and other times when they are expected to be interacting with family.
4. A fun activity that can help your child stay connected to friends can include writing a letter or drawing a picture to send to a friend in the old-fashioned regular mail. It’s always exciting to get mail, and this can give your child another activity to keep busy!
5. Allow your child limited time on computer or video games where they are connected to their friends from school. In order to avoid your child spending too much time on games, it may be helpful to speak with their friend’s parents and agree on a time when they can all get onto a certain game. 
6. At school, your child and their peers had the opportunity to speak with school counselors and teachers when they were upset and needed support. With COVID-19 school closures, your child or teen likely lost this trusted adult they had a relationship with. It may be helpful to remind your child that you are available to support them through this difficult time. You can also remind them of other trusted adults, such as extended family members they can maintain relationships with. If you suspect a significant issue, reach out to a mental health provider, many of whom are offering telehealth. 

The uncertainty and stress of COVID-19 affects us all, yet making a conscious effort to support continued social development and connectedness can ease the anxiety of your child or teen and likely yourself, too! 

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The Elusive Person: When You Love Someone With an Avoidant Attachment Style

I have come to realize this is a thing. It recently occurred to me that there are some people we encounter and may even have long term relationships with, that...

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How Self-Compassion Can Relieve Stress And Tension

How to deal with current setbacks and frustrations.

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• Accept Yourself: How to feel a profound sense of warmth and self-compassion
• The Anxiety Plan: 42 Strategies For Worry, Phobias, OCD and Panic
• Spark: 17 Steps That Will Boost Your Motivation For Anything
• Activate: How To Find Joy Again By Changing What You Do

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Telephone or Video Therapy — Valuable During the Crisis?

In today’s shelter-in-place world, it’s not just people with compromised immune systems who are at risk. The anxiety about contracting the coronavirus, paired with the inability to relieve stress by going to most places and events that are now unavailable, is increasing the severity of psychological or emotional conditions, such as depression, anxiety, relationship issues, and other personal challenges for many. 

Consequently, even in this short time, there’s more risk of substance abuse, suicide, domestic violence, and moving toward divorce. Others, who’ve felt fine before the coronavirus hijacked their ability to interact with others in ordinary ways, feel frightened or lonely. 

These situations point to a crying need for therapy, yet the shelter-in-place order means that treatment can’t happen in-person right now. But help is still possible; it’s merely occurring in different forms. Many clients are transitioning smoothly from in-person meetings to phone, or video sessions via Skype, Zoom, or a different option. Others are less comfortable about either making the switch or becoming a new therapy client. 

Telephone and Online Sessions Aren’t New Methods

Many therapists, including myself, have been providing phone and online therapy for some time, usually for special situations. A few examples: Someone moves too far away to continue office visits but wants to continue their treatment via Skype. A parent and adult child want to heal an estranged relationship, but one of them lives too far away for office visits. A couple wants to see a marriage therapist, but they live hundreds of miles away. Instead of in-person therapy, it happens on Skype.

As a former crisis line volunteer, I’m comfortable with telephone therapy; I’m sensitive to nuances of people’s voice tone, inflections, and frame of mind. Usually, adding the visual part via Skype, Zoom, or another online method is better, because body language and facial expressions convey so much more of our communication, and they’re missing in telephone therapy. Some clients prefer phone therapy, which works fine in many situations.

In video sessions, I can see smiles, misty eyes, and raised eyebrows. But some things are still missing. For example, a wife asked her husband during a recent Skype session with me why he was wringing his hands, which didn’t show on the screen. If she hadn’t mentioned this, I wouldn’t have known to ask him what was on his mind, because his face showed no angst.

While physical distancing is needed to help prevent the spread of the coronavirus, we do the best with what we have. Remote therapy is an effective way to gain help in living and loving more fully. Although the energy, chemistry, general aura present in office visits is lacking, there’s no reason to wait for therapy until it can happen in-person again.  

Meanwhile, some adjusting is occurring for all involved. Clients who tend to view their therapists as all-knowing may be surprised to find that their technology skills surpass those of the professional’s. That’s not necessarily a bad thing. Realizing that their therapist, like them, is an imperfect human, can strengthen their bond, the “therapeutic alliance” which supports growth and change. 

Because my online video therapy practice had been on a very occasional basis until lately, I’ve had to do some mucking around to remember which links and buttons to click for Skype and Zoom, which is humbling and also okay. I know that I don’t know everything. I’m good at therapy and writing and am left in the dust about many other topics. So, we’re all adjusting, while appreciating that the work can continue with both ongoing and new clients. 

Both In-Person and Remote Therapy Have Advantages

Advantages exist for both in-person and remote therapy. Some people view office sessions as an excellent way to get some distance from their problems that concern them at home. They find that in their therapist’s office, it’s easier for them to see and deal with their challenges objectively. 

Also, remote sessions lack the energy or chemistry that in-person sessions have; the former kind can feel more like watching a show on television instead of in a theater.  

Yet, phone sessions can feel intimate while allowing a degree of privacy. For example, a mother and her adult child who want therapy to repair their estranged relationship may live too far away from each other for office sessions. The mother may choose phone therapy so she can hide her distressed facial expressions or body language when something her daughter says upsets her. She senses that it’s easier to control her voice tone and volume than her body’s movements. Also, she finds technology intimidating.

Both phone and video sessions save travel time and expenses for everyone. No one needs to leave home for therapy. 

Helping People Gain Comfort with Different Options

Many people who are not now in therapy but would benefit from it may think they need to wait until virus-related restrictions are lifted. Others who’ve been seeing a therapist in-person aren’t comfortable with changing to remote sessions. 

Some individuals who are already stressed may find it hard to commit to therapy that’s different from what they’ve come to expect, especially if they are at the stage of contemplating gaining professional help. Therapists can help them gain confidence in remote therapy by spending a few minutes trying out Zoom, Skype, or another service together a couple of days before a scheduled session. 

Others may be okay with the idea of remote therapy, but economic hardships resulting from closures of places where they worked, to prevent the spread of the virus, may keep them from seeking or continuing treatment. Therapists tend to be compassionate. Many will reduce the fee for financially-stressed clients, or offer them shorter sessions at half the cost, e.g., 25 minutes instead of 50. Some clients find that shorter sessions force them to plan, sharpen their focus, and be more concise.

Maximizing Benefits of Remote Therapy

By treating remote sessions like in-person ones, therapists and clients will ideally bring their most constructive selves to them. We do this by dressing and grooming ourselves similarly to how we do for office appointments. Doing so can make a huge difference, even if it doesn’t seem like it would. We’re more likely to bring alertness and clarity into sessions when dressed for business rather than for lounging at home in pajamas or workout clothes. 

What the future will bring in terms of where therapy will usually occur is uncertain. Remote treatment may become a standard way to be helped after the crisis has passed because people appreciate its advantages. Or in-person office visits will again be the primary way sessions are held. 

Flexibility, resourcefulness, and the ability to adapt to changing circumstances are signs of mental health. Anyone who needs assistance or support can receive it promptly. Remote therapy is available, effective, and convenient.  

 

Photo courtesy of Jessica Koblenz, PsyD.

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Why does awe have prosocial effects?

An interesting perspective from Perlin and Li:

Awe is an emotional response to stimuli that are perceived to be vast (e.g., tall trees, sunsets) and that defy accommodation by existing mental structures. Curiously, awe has prosocial effects despite often being elicited by nonsocial stimuli. The prevailing explanation for why awe has prosocial effects is that awe reduces attention to self-oriented concerns (i.e., awe makes the self small), thereby making more attention available for other-oriented concerns. However, several questions remain unaddressed by the current formulation of this small-self hypothesis. How are awe researchers defining the self, and what implications might their theory of selfhood have for understanding the “smallness” of the self? Building on theories regarding psychological selfhood, we propose that awe may interact with the self not just in terms of attentional focus but rather at multiple layers of selfhood. We further reinterpret the small self using the notion of the quiet ego from personality psychology. Linking awe to an enriched model of the self provided by personality psychology may be fruitful for explaining a range of phenomena and motivating future research.

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