You know the adage "Variety is the spice of life."?  Within the field of psychology, there is no shortage on variety, especially in New York!  For a successful outcome in therapy, the most important thing is meeting the therapist and experiencing first-hand his or her style, something that may not translate through a google ad or a website.  Some styles of therapy are more passive.  Do you want feedback?  Do you REALLY want feedback or do you want Dear Abby style advice? Do you want to talka bout your childhood and your dreams or about doing something active to break self-defeating patterns?  Here's a few key terms to look out for when starting your research or when scheduling your first session for therapy.

Cognitive Behavioral Therapy, or CBT: Tends to be directive and non-judgemental.  Teaches you how to identify how your thinking leads to unhealthy emotions and behaviors and how to modify that thinking to achieve healthy results.  Tends to be relatively short-term therapy. Oriented mostly towards the present and the future, although the techniques can be applied to past situations which may be unresolved.

Psychodynamic Therapy, or psychoanalysis: Tends to be passive.  This style of therapy attempts to answer WHY things are the way the are, with the hope that this insight will change the situation.  This style of therapy tends to be focused on unresolved past conflicts that may be influencing the person on a sub-conscious level.  This style of therapy is long-term therapy, and it is not unusual for the psychoanalyst to recommend that you come in more than once a week for several years.

Solutions Focused Brief Therapy, or SFBT: Tends to be directive.  This style, often used in couples counseling and family therapy focuses on what you want for yourself and how you are already making some of that happen, and how you can continue to get to your desired goal.  This style of therapy is relatively short-term be definition.  This style of therapy does not focus on the past.

There are hundreds of different styles of therapy and a lot of psychobabble and jargon used to describe and define those styles. There is no shortage of therapists in New York! Simply put, find a therapist you like and can be honest with about what you want.  Therapists aren't robots.  We also aren't irreplaceable.  Somone recently asked me how to find a therapist after their last one died.  My response- The same way you found that one.  You try a few on, and when it feels right, stick it out for as long as it is effective.

Affordable psychotherapy?! In New York?!  Yes!  Mental Health Counseling and Marriage and Family Therapy of New York offers modern psychotherapy at a rate that works for each client.  Our regular rate is below average for New York, and our sliding scale is based on federal poverty guidelines.  By offering an affordable rate, this gives clients the control over the process of therapy, something they may not have when using insurance benefits.  By paying for their therapy themselves, the client avoids the possibility of their insurance company denying payment as well as considering their diagnosis as a pre-existing condition down the road. 

Modern psychotherapy isn't lying on a couch for four times a week for ten years and blaming your situation on your mother!  Cognitive behavioral therapy is relatively short-term therapy that produces tangible results.  Consider an investment in your mental health!  Are you ready for insight and change?

It's been a mild winter so far in New York, which means milder cases of seasonal affective disorder (SAD).  But like clockwork, the holidays are here, which means the inevitable stress of compulsory shopping, parties, cards, decorating, baking, and putting off rent so you can get that new whatever for whomever.

Though we let these traditions stress us out year after year, it is important to remind ourselves: this too shall pass.  Here are some common cognitive distortions (aka irrational beliefs, negative self-talk, stinkin' thinkin', etc) to watch out for to make it through the 12 days of whatever so we can ring in 2010 and get ourselves ready to do it all over again next year.

1. All Or Nothing Thinking: Often called perfectionism, this type of thinking is something along the lines of "I over salted the stuffing- dinner is ruined!". 
2. Overgeneralization: Look out for the alwayses and neverses "You always do this at my family's dinner.  You never treat anyone any good."
3. Focusing on the negative: The opposite of rose colored glasses.  You hear 57 comments about your chocolate babka, and one negative comment, and your life is over.
4. Discounting the positive: Similar to Number 3 in our list, discounting the positive is telling yourself (or others) that the positive comments don't count, and that anyone could have done just as well if not better.
5. Jumping to conclusions: Always a favorite.  "So your mother didn't like my green bean casserole.  I'll probably never get invited to bring a dish again!"
6. Magnification: "Well, I know I got this new promotion and won most likeable at the office, finished my dissertation, adopted three dogs and a cat, but I'm still a total loser for paying my credit card bill late this month."
7. Emotional Reasoning: Your feelings rule and define what's real and true for the entire universe.  Right?  "Ugh, tourists really piss me off for holding up the line at Macy's.  People from (choose your state) must really be total idiots.
8. Should Statements: We call this one "shoulding all over yourself".  "If you don't know how to run your metro card through the slot, you shouldn't be allowed to get on the subway during this time of year."
9. Self-rating: Labeling the whole of who you are with something you did, thought, felt, etc.  "I didn't impress your parents.  I am a failure."
10. Personalization and blame: Taking responsibility for things that aren't entirely within your control.  I think the same example applies " I didn't impress your parents.  I am a failure."

Sometimes this type of thinking happens. Keep it in check and challenge it if you notice yourself doing it, and you'll make it through.  At least until Valentine's Day.

Psychological therapy may be much more effective at making people happy than getting a raise or winning a lottery prize, suggests an English study.

Researchers analyzed data on thousands of people who provided information about their mental well-being and found that the increase in happiness from a $1,329 course of therapy was so significant that it would take a pay raise of more than $41,542 to achieve an equal boost in well-being. {Click for complete article}

Dr. Michael DeMarco was recently nominated to serve as Member At Large for the New York Association of Marriage and Family Therapy.  Marriage and family therapists in New York have been licensed since 2006, along with mental health counselors, yet continue to work for professional recognition as master's level psychotherapists.  Dr. DeMarco currently serves as president of the New York Mental Health Counselors Association Metro NYC Chapter.

I am writing to ask for your help in changing the face of the mental health field in New York.  As president of the NY Metro Chapter of NYMHCA, my email box is flooded with graduate students and recent graduates who want to work in their field, but are coming up against impasse after impasse.  More on that later.  Let me first tell you about mental health counselors and the training and work we do.

Mental Health Counseling is a distinct profession with national standards for education, training and clinical practice.  The American Mental Health Counselors Association is one of the national organizations that represents our profession, along with the American Counseling Association and the National Board of Certified Counselors.  The core areas of training required by the Council for Accreditation of Counseling and related Educational Programs (CACREP) include: diagnosis and psychopathology, psychotherapy, testing and assessment, group counseling, human growth and development, counseling theory and supervised practicum and internships.  Before a mental health counselor can sit for the licensure exam, they must earn 3000 hours of post-masters supervised experience.  These are national standards for the profession. 

Mental Health Counselors (MHC’s) are licensed in all 50 states, the District of Columbia, Puerto Rico and Guam.  MHC’s practice in a variety of settings, including private practice, community agencies, managed care organizations, integrated delivery systems, hospitals, employee assistance programs (EAP’s), schools, substance abuse treatment centers, university counseling centers and more.  More than 90% of the nations managed care organizations either employ or contract with licensed mental health counselors who are reimbursed the same as other masters level behavioral health clinicians.  MHC’s provide a full range of services including: assessment and diagnosis, psychotherapy/counseling with individuals, couples, families and groups, treatment planning and utilization review, brief and solution-focused therapy, alcoholism and substance abuse treatment, psycho-educational and prevention programs and crisis management. 

LMHC's have been recognized by the New York State Education Department as one of four licensed mental health practitioners since 2006, and number over 110,000 clinicians across the country, nearly taking over social workers as the masters-level field with the most licensed individuals.  The Bureau of Labor Statistics predicts 30% growth in the number of mental health counselors between 2006 and 2016.   Federally, counselors are accepted as clinicians in the National Health Service Corps, SAMSHA, and earlier this year, the Department of Veterans Affairs (VA)  approved the establishment of a new occupational category, or categories, for licensed mental health counselors and marriage and family therapists working within the Veterans’ Health Administration (VHA).

In New York, though things are progressing slowly, we are seeing progress!  Mental Health Counseling programs have been started at NYU, Columbia, Mercy College, Iona, several CUNY schools including College of Staten Island, Hunter, and Brooklyn College.  NYMHCA continues to lobby at the local, state and national level for increased recognition.  For decades, mental health clinicians went largely unregulated and unrecognized.  However with the ushering in of the mental health practitioner licenses agencies, government and managed care panels have begun to re-evaluate the scope of practice of some of the other licenses which allows for mental health counselors who are in graduate school to complete internships and once finished with their masters degree, to get jobs in approved settings with their limited permit to work towards their full license.  These approved settings, often in agencies working with the Office of Mental Health (OMH), Office of Mental Retardation and Developmental Disabilities (OMRDD), the Office of Alcoholism and Substance Abuse Services (OASAS) are beginning to understand the importance for these highly qualified professionals and how these categories mirror the ones for social workers, psychologists, psychiatry residents, etc. 

A graduate student in mental health counseling is charged by their school to find a clinical practicum/internship site from 1-3 semesters.  At these sites they are allowed to perform many of the duties of a mental health counselor including psychotherapy, assessments, intakes, managing their caseloads, etc, under the supervision of a licensed mental health practitioner (not including LMSW’s).  Upon graduation and finding a job, the mental health counselor may take the licensure exam and applies for a limited permit to count the 3000 clinical hours gained from this paid position towards their full license.  During this time, their credentials, often called

MHC-LP (Mental Health Counselor– Limited Permit), allow them to perform all of the duties of a mental health counselor under the supervision of a licensed mental health practitioner.  These limited permit clinicians, like LMSW’s, are not yet qualified for independent practice, and in order to become independently licensed, must but working in approved settings with an approved supervisor.  Once the MHC-LP has earned their 3000 hours, he/she then applies to become a licensed mental health counselor (LMHC) which allows for independent practice. 

NYMHCA continues to work with its lobbyists at the state level on issues such as OMH restructuring, parity with other licensed masters level mental health clinicians on issues such as billing Medicaid, and more. 

I hope that this helps to clarify some of the confusion that we face in considering job postings and job descriptions, and that the confusion over credentials sometimes keeps highly qualified people from earning a living.  Mental Health Counseling was rated 33rd on Money Magazine’s Top 50 Jobs in the country!  NYMHCA wants to do strive to reflect this in New York. 

If you are interested in knowing more about NYMHCA or if you are interested in hiring a mental health counselor, please do not hesitate to contact me.

Michael DeMarco, PhD, LMHC, LMFT– President

841 Broadway, Suite 302, New York, NY 10003

president@nymhcametro.org

www.nymhcametro.org

Where psychologically damaged troops in far-flung places cannot reach a therapist, the military now flies therapists to them in numbers not seen before. {Click for Complete Article}

Called the Counselor Accessibility Reform and Expansion for Soldiers Act, or CARES Act, the bill would allow anyone covered under Tricare to have the same access to mental health care professionals that many people covered under private insurance enjoy today. Rooney said this addresses another key issue in suicide preventiion — access to professional counselors.  {Click for complete article}

It continues to surprise me, all of the misconceptions that still exist about therapy, even in 2009.  (Even in New York.)  Sometimes people come to the office with something very specific, very situational problems, and report that they have been given anti-depressants.  It's also common for some of these folks to want to "figure out why things are the way they are". 

There are many styles of therapy, and someone once told me that therapists are like shoes, and that one should try a few to find a great fit.  Some therapists understand people by the past events the client has faced, increasing insight and self-awareness.  Other psychotherapists, myself included, are less focused on they "Why" you got to where you are, and more about "What are you going to do about it?".  This style of therapy is meant to focus on solutions, not on the problem. 

How do you know what style of therapy you are in for?  Ask.  Schedule an appointment with a psychoanalyst, a marriage and family therapist, or a mental health counselor and you will quickly understand the different styles of therapy and which one will work best for you.  It's important to note that a mental health counselor may be more past-focused, and that a psychoanalyst may be more modern in style than someone heavily influenced by Freud or Jung- there are always exceptions!

Regardless of the style of therapy, you have alternatives to pills.  Pills don't make you recover from loss.  Pills don't change the fact that you have no direction in your life.  Pills don't make you want to have sex with your partner when you still feel attracted to someone else.  Having someone to talk to that is as objective a party as possible is therapeutic in and of itself.  Your therapist is not your "yes man".  Your therapist is not there to give you advice.  Your therapist cannot hug you better.  You can learn the tools to take control of your feelings and behaviors, and by implementing those tools, you can put your life back on track.  This may not be easy to do, and doesn't happen overnight, but you can do it. 

My style of therapy is called rational emotive behavior therapy, and is a style of cognitive behavioral therapy, pioneered by the late Dr. Albert Ellis of New York.  This style of therapy is very directive and interactive, and you begin learning tools to take control of your life almost immediately.  It is difficult, sometimes, to let go of the ineffective ways we've taught ourselves to cope, but I can tell you it is a joy when people come to session and have begun to shed that old self-defeating thought pattern.  It is more of a joy when people, once in crisis and feeling like they need to come once a week (sometmes more) start to do it on their own, coming in on an as needed basis. 

Therapists don't have your answers.  Some therapists may interpret your "issues", but many therapists are seeing your "issues" through the lenses of their own "issues", and that's okay.  Therapists are people, too, despite the notion that we're crazier than everyone else, or that we somehow have it all figured out.  Rational emotive behavior therapy (REBT for short) accepts this, and uses this so the session doesn't turn into a confessional, with therapist as judge.  You have nothing to confess to me!  I just want you to be able to ask yourself if what is going on in your head is leading you to feel and behave in a healthy way or in a depressed, anxious, angry, jealous, guilt-ridden, embarrassed, phobic way. 

So there you have it.  Lots to think about.  There are many ways of understanding what is going on with people.  The bad news is that no one has the answers for you.  The good news is you can learn how to find your answers.

 Are you ready for insight and change?

(New York therapist, Dr. Michael DeMarco is a licensed mental health counselor, licensed marriage and family therapist and board certified clinical sexologist in Manhattan. )

While books like the Harry Potter series create an imaginative fantasy world, the Wimpy Kid books give us a rare glimpse into a child’s ethical mind. {Click for complete Article}

Mental Health Counseling and Marriage and Family Therapy of New York, PLLC is offering free depression screenings all day on Ocrtober 8th in honor of National Depression Screening Day.  Psychotherapy, particularly cognitive behavioral therapy, is sometimes more effective than medication for treating depression, although many physicians are still reaching for their prescription pads instead of for their local mental health counselor's card.  Check out this April 2009 article on depression from US News & World Report.  To schedule your free depression screening at 841 Broadway or at 42 Broadway, call 212-343-7008 or email staff@mytherapist.info .

For starters, there is little proof that the antibacterial soap you buy at the drug store actually kills the most-dreaded microbes: S. aureus (staph) and E. coli. Plus, living in a disinfected bubble can actually be bad for your health and the environment. Many experts believe that too much sanitization weakens the immune system and may create lethal superbugs that are antibiotic resistant. If that's not enough, the bacteria-killing chemicals go down the drain and into our waterways, harming wildlife and potentially ending up back in our bodies where they can present health risks. {Click for full article}

Ask Senator Charles Schumer to vote YES on

Medicare coverage of Licensed Mental Health Counselors



This TUESDAY, September 22nd, the Senate Finance Committee will start voting on health insurance reform legislation, including major Medicare changes. Your Senator Charles Schumer is on the committee, and we need him to VOTE YES on the Lincoln Amendment to establish Medicare coverage of licensed mental health counselors (LMHCs) and marriage and family therapists (MFTs).



The health bill introduced by Senate Finance Chairman Max Baucus unfortunately does NOT include counselor coverage. Senator Blanche Lincoln (D-AR) is expected to offer an amendment to include counselor Medicare coverage in the bill, and we need Senator Schumer and as many other Senators as possible to vote for the Lincoln Amendment.



ACA and AMHCA have been working to gain Medicare coverage of counselors for a long, long time, and we need Senator Schumer to know that his constituents in New York—meaning you!—support including Medicare coverage of counselors in the legislation he will be voting on next week. LMHCs are well-trained, qualified, cost-effective mental health professionals, and should be covered under Medicare. The Senate has already approved counselor Medicare coverage legislation in both 2003 and 2005, and with the increasing size of the beneficiary population, counselor coverage is an even better idea now.



Please take a moment to do one or more of the following:



1. Call Senator Schumer’s office in Washington DC—at 202-224-6542—and ask to talk to an aide who handles Medicare issues. Whether you talk to this person or are asked by the receptionist to leave a message, describe in your own words why Medicare should cover licensed mental health counselors, and ask the Senator to vote YES on Senator Lincoln’s amendment to establish Medicare coverage of counselors and marriage and family therapists. The amendment would improve Medicare beneficiaries’ access to outpatient mental health services. Be sure to leave your name and postal address so that the Senator can get back to you.



2. Send Senator Schumer an e-mail conveying the same message. You can do this by visiting the Senator’s webpage at http://schumer.senate.gov/new_website/contact.cfm.



3. Call one of Senator Schumer’s offices in the state near you, and talk to a staff member as in #1. His district office phone numbers are as follows:



New York 212-486-4430

Buffalo 716-846-4111

Rochester 585-263-5866

Albany 518-431-4070

Binghamton 607-772-6792

Syracuse 315-423-5471

Peekskill 914-734-1532

Mellville 631-753-0978



Thank you in advance for your time and assistance; it could make the difference between success or failure on this issue!



For more information contact either Scott Barstow with the American Counseling Association at sbarstow@counseling.org (800-347-6647 x234) or Julie Clements with the American Mental Health Counselors Association at jclements@amhca.org.



Scott Barstow

Director of Public Policy and Legislation

American Counseling Association

5999 Stevenson Avenue

Alexandria, VA 22304

703.823.9800 x234
703.405.9711 (cell)

703.823.0252 (fax)
800.347.6647 x234
703.823.6828 TDD
sbarstow@counseling.org
www.counseling.org

Note from Dr. DeMarco:  LMHC's and LMFT's are not able to currently bill Medicare in the US and in New York, these quaslified therapists are not able to bill Medicaid.  Currently, if someone comes to my office with one of these plans, we see at Mental Health Counseling and Marriage and Family Therapy of New York, PLLC are seeing them for free.  This doesn't change the fact that mental health coverage is unfairly biased towards certain license areas such a social work (LCSW/LMSW) which keeps many underserved population from being able to seek help, and keeps highly trained therapists from working.

"Relationships typically start out with a bang. But for some long-time couples, those days and nights of steamy, passionate sex are a distant memory." {Click for complete article}

Since starting my practice in 2002, I have specialized in working with people with gender dysphoria, the experience of one's psychological sex not matching one's anatomical sex.  This is a poorly served population that continues to be pathologized by the medical and mental health communities, much as homosexuality was in previous decades.

In my work with transgendered folks (FTM as well as MTF), I work on the adjustment issues that arise when coming out to yourself and those around you, and the issues that continue to arise when you go through something as challenging and life-changing as transition.  This time is not easy, and my goal in working with the trans community is to offer some stability in a time that can have many ups and downs. 

For the past year, I have worked at a transgender program in the Bronx that recently lost its funding and can no longer offer my services there.  I do, however continue to work with the community in my private practice, where I have additional therapists available.  We work on a sliding fee scale, and do not turn people away.  If you are interested in starting therapy with us, I encourage you to check out the various on-line and real-life support groups available around New York to ask about others' experience with me as well as the other therapists who work with the community. 

There's an adage that therapists are like shoes, and you have to try a few on before you find a fit.  It's tough in this underserved population where there may only be a handful of therapists who work with the community to be able to try on several different therapists.  That said, I urge you to weigh the information you collect from various resources with your personal needs and goals and go from there. 

My staff and I want to work with your primary care physician and other providers to ensure you as healthy a transition as possible.  We work from an informed consent model that is informed by the standards of care, but not dictated by the standards of care.  You will, no doubt, during transition, come across providers who follow the Standards of Care strictly, and you will need to have followed some of the steps in order in order to continue with transition under their care.  My staff and I try to balance your therapy with what you need and where you are with what might be asked of you or from us down the road for further treatments, procedures, etc. 

Feel free to call us or schedule through www.mytherapist.info and we would be glad to set up a treatment plan that works for you as well as refer you to a variety of resources who will have a variety of styles, attitudes, opinions, risks, benefits and information to offer.