MyTherapistNewYork

People don’t generally expect therapy when making out their budgets.  They really don’t expect it when they have insurance coverage that covers medically necessary treatments.  For these treatments to be covered, the clinician must give you a medical diagnosis, which becomes part of an elaborate trail of paperwork (sometimes electronic) that includes any number of people involved in getting your insurance claim from the clinician to the insurance panel, and getting payment from the insurance panel back to the clinician.   While the system has its flaws that are too many to discuss here, it does generally work if you are lucky enough to have great medical coverage, and have something like strep throat.  It does not, however, have your best interest in mind when working with mental health clinicians like marriage and family therapists and mental health counselors.

I am an outspoken critic of the book that we in the mental health profession are expected to use in our work with clients called the DSM (The Diagnostic and Statistical Manual of Mental Disorders) put out every ten or fifteen years by the American Psychiatric Association.  (Interestingly, there are no statistics included in this book, despite its name.)  In it, are lists of what psychiatrists have voted to define (based on research?) as mental illness.  Nevermind that psychiatrists are medical doctors trained in biological brain diseases, not usually  psychotherapy, sexuality, couples therapy, substance abuse, eating disorders, autism, or any other topic included in the wide field of psychology.  Yet the entire field of psychology is forced to use codes from this book, to diagnose you with a mental illness, if you want to have insurance pay for part of your therapy, even if your therapy does not include treatment by a psychiatrist/physician.

Let me make it a little more clear to you by giving some real life examples.  You know all those gay kids killing themselves because they are getting bullied?  Well, if they come to therapy, I have to give them a diagnosis, probably related to depression or something called “adjustment disorder”.  So it’s not the little shits DOING the bullying that get the diagnosis, but the victim. Interested in couples therapy because your partner cheats on you?  Are you the one that calls the office to set up the sessions?  Then you are called “the identified patient” (or IP), and the “medical chart” at your therapist’s office will be opened in your name.  If you are the one with the insurance, then you are the one who will receive the mental illness diagnosis.

If you are hearing voices, or know someone who is severely depressed and fear for your safety or theirs, by all means, call 911 or check our your nearest psychiatric emergency room.  But by and large, these aren’t the folks who are going to therapy, many of whom just have problems coping with all the obstacles that come with being alive, and it is unfair for everyone involved to make them fit into a psychiatric/medical model.

Instead of using insurance for therapy, my solution has been to offer psychotherapy/counseling/coaching (whatever you want to call it) on a sliding scale.  This means that I accept a range up to what I consider to be ethically acceptable as the maximum fee (in NYC, my fee is $150, and if you do a bit of searching, you’ll find that some other professionals charge rates that are much higher).   Your rate is calculated based on the number of people in your household and your annual income, and starts at $40.

This is my calling, and my passion, and if I could do it for free, I would.  But I went to school for a long time to be able to practice my profession, and have to pay my bills, too. ( I do not want to be part of a system that emphasizes illness and not wellness, and truth be told, the amount that I would get paid from any given insurance company is not worth the hassle, anyway.) So to make my living (and pay back those student loans), I offer realistic therapy with results.  You track your progress.  You see if you are getting better at dealing with what you came in to deal with.  If you’re not getting better, why would you stay with the same therapist for years on end?  If your therapist can’t tell you exactly their plan for helping you, what are you paying them for?  If you ARE getting better, then why do you need to stay in therapy forever?  I believe so much in what I do, I have developed my practice as a training practice to offer therapists-in-training experience in offering effective, ethical, solution-focused and evidence -based counseling.  (And since 2005 have supervised no less than 30 new therapists, many of whom are now my competition.)

Chances are if you are reading this, you are not mentally ill.  Maybe no one has ever told you that before, even.  I do hope this series sheds some light on the subject of using insurance coverage for therapy, and I hope that you will want to read more about my practice and how we can help you be who you are.

Keep reading at:

http://www.mytherapistnewyork.info

http://www.mytherapist.info

http://www.twitter.com/drdemarco

http://www.youtube.com/mytherapistnewyork

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We could learn our lesson from the world-renowned runners of the ancient Mexican people, the Tarahumara, and abandon our running shoes. According to 2010, the word’s leading athletic supplier, Nike, Inc., which is the name of the Greek goddess of victory, brought in a total net capital of $20.86 billion. This makes Nike, Inc., the largest international seller of athletic gear. Unlike the Tarahumara people who ran barefoot, modernized societies spend millions of dollars on marketing and professional athlete sponsorships to advertise how some new feature of extra air or cushion is actually better for our bodies as it provides more sustainability, comfort, and capability of achieving a faster pace. After you first strike up conversation with a professional runner, it is no surprise you may hear about some injury that inhibited them from participating in a national team qualification or event. Nevertheless, whether it is a long-distance or sprint professional runner, one may notice they rarely wear chunky running shoes. The enjoyable, simple act of running has been tainted because modern cultures are now conditioned to have extra support presented by luxury athletic goods that companies like Nike, Adidas, and New Balance sell, even putting aside the fact that these companies have supposedly also been associated with producing their merchandise in sweatshops.

Like happiness, I feel like running is a state of mind that you can control - you can turn it on and off.  Before February 2010, the longest run I completed was easily under 5 miles, however, now I consider myself an avid runner. Also like happiness, I believe the desire to run, or work out in general, and achieving that euphoric state, is something very unique that many of us take for granted until we can’t do it/don’t have it anymore. It took some work, but now I run as much as I can, and I learned that I will only achieve long-term success with running by ditching my running shoes and going barefoot.

You can do the same with happiness.  If you were once happy, and now you’re not, it may feel like you’ll never get there again.  So we try years of luxury psychotherapy or chemicals (prescribed or not).  Our style of therapy is meant to show you how to ditch the modern trappings and help you get back to the emotional basics.  Want to know more?  Check us out! http://www.mytherapistnewyork.info and http://www.mytherapist.info or http://www.youtbe.com/mytherapistnewyork for some video entries about cognitive behavioral therapy and rational emotive behavior therapy.

For more about running barefoot (and for original photos) check out: http://well.blogs.nytimes.com/2009/10/05/the-roving-runner-goes-barefoot/  and http://well.blogs.nytimes.com/2009/10/21/phys-ed-is-running-barefoot-better-for-you/

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You don’t have to be married. That’s right folks, a licensed marriage and family therapist doesn’t think you have to be married. Truth is, I tend to use my other titles more than my marriage and family therapist titles, because of what that license implies. I am not pro-marriage. I am not pro-family. Now that doesn’t mean I am anti-marriage and family, so don’t misconstrue. But I do think that we get too hung up on these two particular relationship structures sometimes, especially when they imply that heterosexual, western, judeo-christian, monogamous relationships are the only relationships that exist on the planet. What perpetuates this? We the people.

I’m not particularly political. I do, however, find it so interesting on a sociological level, this whole recent exposé from a Republican candidate’s ex-wife in the media right now that includes headlines like “Open marriages and dirty tricks emerge in Republican race” and “Gingrich angrily denies he sought open marriage”. Wow. Maybe I’m way too idealistic, but really? Open marriage accusations from an angry ex threaten to ruin someone’s political career? And the indignation that follows? It boggles the mind!

Life is full of contradictions in the US today. We have (supposedly) a free market. We don’t like monopolies where we don’t have a choice- but you’d better buy American. We have (supposedly) free elections so we can decide who we want to have in our government, and they don’t get to stay there forever, only for a certain amount of time- but you get Democrat or Republican. We have (supposedly) freedom of religion, although as someone who is non-religious, I feel the pressure daily to have some sort of religion, and in this country, it had better be a form of Judaism or Christianity, but nothing too out there like Mormonism, because that’s just culty. (How many times have we heard about Mitt Romney defending his religious beliefs, when the only difference between religion and cult is who has better PR!?) So we live in a place where we feel like we can pick and choose most things, except when it comes to relationships. The choice there seems to be you can have one sexually faithful, government-sponsored, pre-defined relationship template, or not.

Do we need to talk about how many of our political representatives/morally superior folks have made headlines because of alleged sex scandals? Oh, let’s do it in alphabetical order- Barr, Cain, Chenoweth, Cleaveland, Clinton, Condit, Craig, Duvall, Edwards, Eisenhower, Benjamin Franklin, Ganley, Gibbons (not the primate, as they are usually monogamous), Gingrich (aside from open marriage, he also allegedly had an affair), Giuliani, Haley, Hart, Thomas Jefferson, Andrew Jackson, Johnson, Kennedy, Kilpatrick, Lee, Livingston, Massa (gay tickler), McCain, McGreevey (gay American), Newsom, Roosevelt, Spitzer, Schwarzenegger, Viers, Villaraigosa, Vitter, Weiner - okay, I’m bored of making this list already- check this Wiki link and the sources.

Maybe Newt was angry because he tried for an open marriage and didn’t get one. But to be angry of being “accused” of wanting an open marriage, as if it were something so morally reprehensible? Yet another example of how difficult it is for us to Be who we Are. And since we walk around feeling bad about who we are, we elect people who we think will make us better. The problem is that these people aren’t better. These people make laws that seem to come from some moral high ground, but then are unable to abide by the laws that they create. Marriage good- oops, my intern gave me a beej. Gay bad- oops, I hired a male prostitute. The thing is, the laws and politics that they initially created are still there. We’re still debating gay rights because of homophobic folks who later are involved in gay sex scandals. We still think marriage is between one man and one woman, when the people telling us this can’t make that work in their own lives, and are involved in extra-marital affairs. So we forget about the scandals, and keep trying to make something work when the something is just a meme, an idea based on nothing. One of the hot topics this season? Gay marriage! Great! another step towards equality and freedom, yes, and a whole other segment of the population that will feel pressure to conform, and a whole other group of people to feel bad about themselves when they realize they can’t/don’t want to.

If you’re not inclined to be monogamous, don’t be. Make your own way. It might not be helpful for you to choose a political party to represent you that doesn’t accept your relationship choices, but ultimately, having freely chosen your relationship style, one of many relationship styles on the planet (read the book “Sex At Dawn by Ryan and Jetha), you’ll fare much better psychologically and emotionally in the long run. A relationship built on honesty, working through difficult conversations, mutual trust, respect, empathy, and unconditional acceptance sounds much more appealing and healthy than accepting the seemingly unnatural (if you read any research on sexual fidelity whatsoever) hetero-normative, government-sponsored (reread above about government sex scandals) marriages.

Regardless of my license title, my whole style of therapy is summed up in the statement “Be who you are”. There is a lot of pressure to be what other people want you to be - “straight-acting”, sexually faithful to one person, married, in a monogamous relationship, rich, famous, educated, a homeowner, materialistic, religious, a parent, etc. The secret here is this is also the list of things people are struggling against when they come to therapy. When you realize that these states of being are not necessarily innate, that they are socially constructed and forced upon you, that is where you start to have some choice. Do you really want these things, or are you telling yourself that you absolutely have to have/be these things? This is where you start to have some freedom. That is where much of the depression, anxiety, paranoia, anger, (all normal feelings for humans) start to subside, and you’re on the right track to Be Who You Are.

Dr. Michael DeMarco is a therapist (licensed mental health counselor, licensed marriage and family therapist, and board certified clinical sexologist) and clinical supervisor in private practice in the hotbed of sex scandals, New York City. For more information, and other articles by Dr. DeMarco, visit http://www.mytherapistnewyork.info and/or http://www.mytherapist.info or follow him on http://youtube.com/mytherapistnewyork and http://www.twitter.com/drdemarco

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As I was saying in Part 1, cross-cultural couples have to negotiate an additional level of complexity when in a relationship. More of an awareness of each other’s cultural interpretations of actions can give cross-cultural couples the tools they need to deepen their relationship and understanding of each other. For this piece, lets look at the concept of “space.”

As someone who spent the first 16 years of my life in India before moving to this country, I am intimately familiar with the experience of ‘culture-jumping.’  As a senior in high school, I remember thinking it was odd that when a girl in school got upset about something, all her friends would leave her alone so that they could “give her some space.”  I was perplexed by this concept, which I soon realized meant creating physical distance from the person who “needed space.”  I wondered how in the world having all this “space” around them, especially at a time when they were feeling sad, was going to help?  Where I grew up, the opposite was true.  The more “upset” the person was, the less “space” you gave them because you wanted to communicate that you really cared about them and what they were going through.  In that cultural context reducing the space was a demonstration of love, support and concern for the other, especially in time of crisis. It was obvious to me that in my new cultural context, giving someone “space” (especially at certain emotionally charged times), was about showing respect and caring.  In spite of my ever-increasing cross-cultural fluency, I continue to be intrigued by the concept of “giving someone space” and how the meaning of this act is culturally defined.

Cross-cultural couples need to understand each other’s beliefs about “giving space” and “needing space.”  They need to become conscious about when it is appropriate to give someone space and how one does this.

If one person in the couple comes from a culture that interprets “giving space” as a sign of respect, then they may need to think about how their partner might be interpreting this need.  They may also need to consciously give their partner “less space” at times simply because to their partner, “less space” may be a sign of caring.  They may also need to be more careful before characterizing their partner’s space reducing behavior as a sign that they are “clingy” or “needy.” Basically they need to interact with the behavior within the relevant cultural context.

If one person in the couple comes from a culture that associates “more space” with a “lack of caring,” they may need to be careful not to interpret their partner’s need for space as a personal attack.  They may need to give their partners “more space” than they believe is appropriate, based on their partner’s culturally different interpretation of the very same act.  They may also need to think about how their need for “closeness” in times of crisis is being interpreted by their partner.  Again, cross-cultural couples need to develop a keener understanding of their partner’s “cultural settings” in order to avoid misunderstandings and unnecessary conflict and to deepen their relationship.

As a therapist in New York working with cross-cultural relationships, I try to help clients to understand such cultural perceptual differences, which can profoundly shape interactions between partners.

(Note: Pt 3 will deal with the concept of Food)

- Aditi Vidyasagar, M.Sc., E.d.M, M.A.

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Over the Holiday break while visiting family, some of the cognitive distortions that run amok in my family became very clear to me. Don’t get me wrong I love my family and I wouldn’t be the (most-of-the-time-hopefully-good) person I am today if it hadn’t been for their parts in my life. However, as I watch many of my younger cousins getting older and coming of age, it becomes clear to me how many the parents’(my aunts and uncles) cognitive distortions are being passed down to the children. Since I’m away most of the time, I can maintain a third-person perspective and can see the distortions for what they are with less bias.

The main cognitive distortions I saw was Albert Ellis’ aptly phrased “musterbation” and Clayton Barbeau’s ‘shoulding all over yourself’. Many of my family members, along with many people that we all encounter in our every day lives, waste the day musterbating and shoulding about how they should live their life, and it causes them a great deal of unnecessary stress, anxiety, and guilt. It manifests with members of my family wasting a great deal of time by trying to figure out what other people are thinking about them, which gets them so stressed out that they limit themselves in their daily lives. This practice of ‘mind reading’ typically yields us less than stellar results in regards to our emotional well-being. Once a person starts mind reading, we can get caught up in what we think others are thinking, and with this train of thought it’s very easy to get carried away and begin losing touch with reality.

Another prominent example of shoulding is when you tell yourself something along the lines of ‘I should be this successful, should make beaucoup bucks, should have the hottest girlfriend/boyfriend, should should should…’ There’s nothing wrong with achieving these things, but the very nature of this language is placing outside standards on yourself that are not necessarily your own (or even real for that matter). It’s ‘outside driven’ motivation as opposed to ‘inner driven’ motivation. A problem with outside driven language and thought patterns: what happens when the outside motivation is not enough and we find that we have lost touch with ourselves? What happens when we realize that this life isn’t bringing us the happiness we thought it would? What happens when we find ourselves with $500,000 in debt that we can’t pay off because we ‘should’ have that expensive house, car, and boat? Of course, this is an extreme example, but unfortunately it’s becoming more common these days: http://www.nypost.com/p/news/local/deadbeat_reality_8f3qwDPV2oY8s9N51fL82I

Okay, so I know what to not do, so what do I do do (hehe) to stop musterbating and shoulding all over the place? This is where Albert Ellis’ Unconditional Acceptance of Self, Others, and Life comes into play. By developing unconditional acceptance for our self, we learn to accept ourselves based on the fact that we are alive and human, not based on how big of a house we own. By developing unconditional other-acceptance, we learn to remove conditions about how people “should” treat us and accept that we aren’t going to treated fairly all of the time. We also learn that, as much as we would like to, other people are going to think whatever they want to think, and, for the most part, out of our control. By developing unconditional acceptance of life, we learn that life doesn’t always work out the way we want it to, and life doesn’t have to conform to our personal preferences. Life is life.

As a closing note, the benefit of developing unconditional acceptance is that it helps us get rooted back to reality. Many anxieties arise because our thought patterns are based on myths and self-deception (believing that you can afford a $5 million home when in reality you earn $60,000/year), as opposed to reality (being able to afford a $150,000 home when you earn $60,000/year).  Fantasy and dreams are wonderful things, but it helps when they are tempered with a dash of reality here and there. Basing our thoughts and beliefs in reality will go a long way in helping you maintain a healthy emotional equilibrium.

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As practicing psychotherapist and clinical sexologist since 2002,  I have worked  with individuals,  couples, families, and groups dealing with a range of issues ranging from anxiety, depression, communication, to sexual and gender identity issues, to name a few.  I have supervised therapists-in-training since 2006 at the graduate and post-graduate level, and have served as adjunct professor in various counseling and psychology departments (including CUNY’s BMCC and Hunter College, Long Island University and Mercy College).

I am active in advocating for marriage and family therapists and have served on the state board of the new York Association of Marriage and Family Therapists (Member At Large) as well as for mental health counselors, serving as President of the New York Mental Health Counselors Association Metro Chapter.

I also work with the public and media, and have done segments for VH1, HBO and SpikeTV. I have been quoted in Details and Esquire magazines, wrote a regularly featured column called “Head Case” in the newspaper Camp, and frequently speak on issues related to psychology and human sexuality at local schools, churches, community groups, and organizations.

In 2010, I began working on a not-for-profit project called Our Collective Mental Health, currently based in Vermont.

In New York, I  currently supervise two post-graduate therapists as well as graduate students from Long Island University, Columbia University’s Teachers College and CUNY’s John Jay College, a requirement for eventual state licensure.

American Counseling Association (ACA)- Professional Member # 6276576

National Credentialing Academy (NCA)- Certified Family Therapist (CFT)

World Professional Association for Transgender Health (Formerly HBIGDA)- Clinical Member

Missouri State Licensed Professional Counselor (LPC) License # 2006022129 (Inactive)

New York State Licensed Marriage and Family Therapist (LMFT) License # 136 (Inactive)

New York State Licensed Mental Health Counselor (LMHC) License # 2337

Vermont State Licensed Clinical Mental Health Counselor (LCMHC) License # 068.0073060

Vermont State Licensed Marriage and Family Therapist (LMFT) License # 100.0073062

American Board of Sexology (ABS)  Board Certified Clinical Sexologist- # 2657

National Board of Certified Counselors (NBCC) - National Certified Counselor (NCC) # 211463

University of Missouri in Kansas City- BA French (2000)

Miami Institute of Psychology/Carlos Albizu University- MS Psychology (2002)

American Academy of Clinical Sexologists/Maimonides University- PhD Clinical Sexology (2007)

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