How To Have Boundaries Through The Holidays

There are some people that look forward to the holidays and find it to be the most wonderful time of the year but there are many others that dread the holidays. If you are one of those who do not think the holidays are the most wonderful time of the year, you are not alone. Although, it can feel that way with all the commercials and pressure to make everything perfect. You may have past trauma related to the holidays and this time of the year is triggering, you might have lost someone close to you so the holidays trigger grief, you may not have the same beliefs, or there is just too much pressure to do everything and make everything special. Whatever the reason, you are not alone in feeling this way and your feelings are valid. 

So the question is, what do you do about this?

One big thing is boundaries. Boundaries are the lines and limits you create between yourself and others. 

The basic steps for setting boundaries are: Define where you want the boundary to be. Communicate the boundary. Follow through with the boundary. Sounds easy, but it’s not because you are dealing with your emotions, other people’s emotions, and breaking old habits and patterns.

Define where you want the boundary to be. Where your boundaries should be is a very personal decision. Because every person and situation is different, everyone’s boundaries are different. Some examples you could have as boundaries is picking and choosing the social gatherings you attend instead of just automatically saying ‘yes’ to every single one. You don’t owe anyone an immediate answer or the answer ‘yes’. Take your time to decide if this is really an event you want to attend and then if you do, fully commit without resentment. Another example is going but leaving early or when you are ready instead of staying until the end or if someone crosses a different boundary. Say, you are an introvert and instead of feeling like you have to stay until the end, leave when you are done socializing or if you are around people drinking and that makes you uncomfortable, leave before anyone gets drunk. Or if you know a specific topic such as politics will cause conflict, decide to leave if that topic gets brought up. These are just a few common examples and are far from all of the boundaries you could possibly have during the holidays. But having a plan beforehand can be really helpful for your ability to follow through with the boundary. 

Communicate the boundary. For a majority of situations, communicate your boundaries. If you don’t communicate your boundaries, how are the other people involved supposed to know what your boundaries are. There are situations where no explanation is needed. It is also up to you how much information you give. If you decline an invitation, you don’t have to give a reason. But if you are leaving a function because someone brought up politics, it could be helpful to communicate. Also, if you don’t communicate your boundaries, your reaction to your boundaries being crossed could be seen as an overreaction to others and as if it came out of nowhere.

Follow through with the boundary. This is likely the most difficult step. Our emotions get involved and we might not want to hurt someone else’s feelings. It is the most active stage in the process and therefore, the hardest. Just because you have established the boundary and communicated it, doesn’t automatically mean people will respect it. You cannot control people, therefore, it is up to you to enforce it by following through on what you said that you were or weren’t going to do. If you said that you were going to leave if politics was brought up and it gets brought up, leave. If you declined an invitation and someone tries to guilt trip you into going, hold firm on your original answer. It is hard to change our patterns and habits, so be kind to yourself if you struggle with this step.

Boundaries are hard, especially if you are new to setting them. It is always helpful to have someone such as a therapist guide you. There’s a saying “people go to therapy to deal with the people around them who won’t.” I think this is especially true around the holidays. Don’t hesitate to reach out for extra support during what might be a difficult time of the year.

What You Need to Know About Superbills

What is a superbill?

A superbill is a detailed, itemized receipt from a healthcare provider that patients can submit to their insurance company for reimbursement. It is generally used with regards to out of network benefits. It works when you as the client or patient pays your healthcare provider directly for services and then submit your bill directly to the insurance company for reimbursement. Some information that is important for a superbill to include is patient and provider information, dates of services, diagnosis, procedure codes (CPT), and charges. 

What are some benefits of superbills?

It provides you, the client, access to more access to out of network providers. It gives you the freedom from choosing from more therapists, including specialists. It provides you cost transparency as you know the cost of therapy upfront and do not have to guess if or how much insurance will cover. And because you receive a breakdown of the costs, you can have a clearer understanding of the financial side of your therapy costs. You will meet your deductibles quicker by utilizing your out of network benefits. Submitting every superbill will help you meet your deductible quicker. You will have clear documentation of your medical expenses and evidence for insurance claims. 

Are there any downfalls to superbills?

With anything there are downfalls and the main one with superbills includes that you have to front the money initially. It does place a financial burden on you initially and you don’t know if or when you’ll be reimbursed by the insurance company. There is also the administrative complexities of having to deal with the insurance company directly.

How do I get started with superbills?

The first step would be to understand your out of network benefits. To do this, you should reach out to your insurance company and get clarification of benefits and the superbill submission process. Then you would ask your provider for a superbill and they would provide you with one, usually monthly. You would then submit the superbill to your insurance company for reimbursement. The insurance company could request additional information. 

There is no one size fits all when it comes to deciding if to utilize your out of network benefits. It is a wholly individual decision, but hopefully this short summary gives you clarity on the complexity of superbills to help you make the decision for yourself. Please reach out with additional questions!

Trauma Therapy

What is trauma?

A common definition of trauma is “when we experience very stressful, frightening or distressing events that are difficult to cope with or out of our control. It could be one incident, or an ongoing event that happens over a long period of time.” There is what is called big “T” and little “t” trauma. Big “T” trauma includes what is stereotypically considered trauma, such as major life threatening events, physical, emotional, or sexual abuse, experiencing a natural disaster, war, or experiencing or witnessing a violent crime. Little “t” trauma are not the things that are typically thought of when we think of trauma, but still have a negative impact such as chronic stress, bullying, emotional neglect, or witnessing a car accident. Both little and big trauma have a negative impact on one’s wellbeing. But some key differences include severity and impact. Big “T” are often life threatening and more severe. The impact is also more immediate and more symptoms.

How does someone respond to trauma?

There are many responses to trauma. Some emotional reactions include, anxiety including panic attacks, fear, numbness, dissociation, detachment, anger, irritation, rage, guilt, shame, self-blame, sadness, grief, and/or depression. Some physical reactions include hypervigilance or heightened sensitivity to stimuli, difficulty sleeping or nightmares, changes in appetite or weight, physical pain or aches, and/or fatigue or exhaustion. Some cognitive or mental reactions include confusion or difficulty concentrating, memory problems or flashbacks, difficulty making decisions or taking action, avoidance of thoughts or feelings related to the trauma, and/or intrusive thoughts or images. Some behavioral reactions include withdrawal from social activities or relationships, substance use or other unhealthy coping mechanisms, changes in sleeping or eating patterns, difficulty trusting others or forming new relationships, and/or increased aggression or impulsivity. These responses vary on the person and situation. Depending on the responses and mental health disorder could develop including but not limited to depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). Just because one experiences some of these responses after a traumatic event, it doesn’t mean it will develop into a mental health disorder.

What is trauma therapy?

Trauma-informed therapy is a type of psychotherapy that recognizes and responds to the impact of trauma on an individual's life. It is based on the understanding that traumatic experiences can have profound and lasting effects on a person's mental, emotional, and physical well-being. So what does that mean? Short answer…it means therapy that takes into account the trauma someone has experienced. Long answer…it includes a deep understanding of trauma on the individual, family, couple, and societal level. It creates a safe and supportive environment for healing to take place while empowering the client. It focuses on strengths and resilience of the client while avoiding re-traumatization. 

Types of Trauma Therapy

There are many times of trauma therapy. Some include:

Cognitive Behavioral Therapy (CBT): Focuses on identifying and changing negative thoughts and behaviors associated with trauma.

Eye Movement Desensitization and Reprocessing (EMDR): Uses eye movements or other bilateral stimulation to help process and desensitize traumatic memories.

Prolonged Exposure Therapy (PET): Involves gradually exposing individuals to trauma-related stimuli in a safe and controlled environment.

Dialectical Behavior Therapy (DBT): Teaches skills for managing emotions, improving interpersonal relationships, and developing distress tolerance.

Somatic Therapy: Focuses on the body's experience of trauma and uses techniques such as mindfulness and movement to facilitate healing.

Internal Family Systems (IFS): Views the individual as a system of different parts, and helps them integrate the traumatized parts into a more cohesive self.

Narrative Therapy: Helps individuals make sense of their trauma by constructing a narrative that gives meaning to their experiences.

Psychodynamic Therapy: Explores the unconscious motivations and conflicts underlying trauma and helps individuals resolve them.

Brainspotting: It is based on the premise that the brain stores traumatic memories in specific eye positions

Other Therapies: Hypnotherapy, acupuncture, yoga, and other complementary therapies may be used in conjunction with traditional trauma therapies.

*This is not an exhaustive list, but gives a general overview.

My Approach to Trauma Therapy

I take things slow when it comes to trauma therapy. First, focusing on building the therapeutic relationship, because if you can’t trust me there’s no way you’ll feel comfortable processing through your trauma with me. I meet you where you are. I also will not make you tell me your trauma as I believe that we can work on trauma without you telling your story and re-living the traumatic experience over again. 

I conceptualize cases through a CBT lens so there’s lots of CBT interventions but will borrow interventions from different theories and modalities as needed to meet my clients’ needs. For example, I might utilize mindfulness or narrative therapies if I think it would be beneficial for the client. I am a Certified Clinical Trauma Professional (CCTP) so I have the training to treat trauma clients. 

Please reach out with additional questions regarding my therapeutic style and approach to trauma therapy. Take advantage of the free 15 minute consultation!

What Am I Like As A Therapist?

Some words that have been used to describe me as a therapist are authentic, collaborative, laid-back, honest, straightforward, understanding, empathetic, and humorous/sarcastic. If these are words that you would want to describe your therapist, keep reading.

The first session is a get to know you session. I’ll try my best to get to know you as a person and try to understand your situation. I also understand that some things take time to open up about and will not force you to talk about something that you are not comfortable talking about. I understand that this is the first session and trust takes time to build. I’ll also provide you the opportunity to ask any questions you have for me, regarding my therapeutic approach or treatment.

Therapy with me is collaborative, which means we will come up with the treatment plan goals together. I don’t want you to be wanting to work on one thing and I have a completely different idea in mind. Therapy would not be successful and you would not find it helpful if we do not work together. Because of the collaborative nature, if you are ever unhappy with your sessions or treatment, please bring it up to me and we can discuss what you dislike and are wanting from therapy.

I consider myself a laid-back therapist, meaning I let you lead the session. You can talk about whatever you want, whatever is on your mind. My reasoning behind this is if you have something on your mind and I come to session with a specific agenda that is different from what you want to talk about, you are not going to pay attention to me, you are going to be focusing on what you want to talk about. If you are struggling to come up with things to talk about, I have no problem asking questions to guide the conversation. There are no right or wrong topics or things to talk about. There’s not one size fits all to therapy. I also understand that you may need different things from your therapist from session to session and try to be flexible to accommodate. 

I believe that the therapeutic relationship is the most important thing in positive outcomes from therapy. Because of this, I make it a priority to continuously work on the relationship with all of my clients. I do this through displaying empathy, understanding, being my authentic self with humor, and providing honest, straightforward feedback. I understand that healing, growing, and wanting to become the best versions of ourselves are all extremely difficult things and being a part of someone’s healing and growing journey is not something I take lightly. I am honored to hold that safe space, be that listening ear, celebrate the wins, and everything in between for you. 

My goal for you is that I become someone you trust to confide in and you can appreciate the ways in which therapy can challenge you, heal you, and help you grow in ways you never thought possible. I want you to help you grow and realize the person you’ve always dreamed of becoming. It is possible and you can become that person!

Benefits of Private Pay Therapy

You are probably wondering, what are the benefits of private pay therapy as opposed to using insurance to pay for therapy? That’s a valid question. There are actually many benefits to private pay. Have you ever thought to yourself, wouldn’t it be great if insurance didn’t dictate my therapy treatment, if my diagnosis wasn’t on my permanent record, if I didn’t have to worry about what insurance was or wasn’t going to pay, or if I didn’t have to wait until insurance approves my treatment to start. If these are some of the thoughts you’ve had then private pay might just be for you. Below are some of the wonderful benefits for private pay therapy. Check them out!

One benefit is greater confidentiality and privacy. Because with private pay therapy, there is not a third party paying for your treatment, they are not allowed access to any of your records, which increases confidentiality. This can create a safer space to share vulnerable topics without fear that anyone else will ever read the notes.

Another benefit is greater autonomy over treatment. Without insurance involved, they cannot dictate treatment, including length or type. This grants you more control over the length, frequency, and type of therapy, including alternative or holistic approaches. It also gives you the freedom to choose the therapist you wish without the worry of being in network with your insurance company. It provides you more flexibility and control over treatment. It gives you the opportunity to take your time to work on your goals at your own pace. You can move slowly and you have the opportunity to get to the root of an issue. You are truly in control of your treatment.

You’ll have faster access to treatment with private pay as you don’t have to wait for insurance to pre-approve your therapy treatment. There are also often waitlists associated with insurances. This is something that you can bypass with private pay. Therapists who do not accept insurance can often dedicate more time and energy to each client because they are not burdened by excessive paperwork and low reimbursement rates from insurance companies. Therefore, they will be able to get you in sooner and be more present during sessions.

With private pay therapy, insurance doesn’t dictate it, therefore, a formal diagnosis is not required. You can focus treatment on whatever you desire including stress management or relationship issues without a formal diagnosis. With private pay, you can bypass a diagnosis being placed on your formal record. A mental health diagnosis on your permanent medical record can potentially impact future life insurance or health insurance application. With a diagnosis comes stigma which you may want to avoid. 

Another benefit with private pay therapy is no surprise bills, you’ll know what you are paying upfront. With insurance it can be a surprise if they will or won’t pay and you can be left with a huge unexpected bill. With private pay, you can plan for the payments without a surprise. In some cases, the out-of-pocket cost may be lower than using insurance, especially for individuals with high-deductible plans.

Overall, private pay therapy offers many benefits and can be worth the cost for many. Private pay therapy might just be the way to go for you!