Strive for What You Want

Striving for what you want has significant benefits over avoiding what you dread.

To make choices based on fear creates a state of motivation that inhibits growth. It is tantamount to living your life looking over your shoulder, running away from something unpleasant or even terrifying. Your motivation is to stay one step ahead, to do just enough to avoid what you fear. Anxiety would tend to be your dominant feeling as you worry about what you dread might happen. If you successfully manage to elude the undesired outcome, the best you can hope to feel is relief. If you are unsuccessful, your fears will only be reinforced and you will find it difficult to pick yourself back up. This way of thinking and behaving is uninspiring and it robs you of joy. It could also limit you in some very tangible ways.

Why apply for a job if you might not get it? May as well stay at the job you have, even though you hate it. Why try something new if you might not be good at it? There will always be others who can do it better so just leave it to them. Why get to know someone if they might not like you? Better to reject them first.

If your primary motivation is to avoid threat, you are unlikely to take the risks that are necessary to grow. You are unlikely to recognize opportunities, much less to take them.

To make choices based on striving creates a state of motivation that promotes growth. Instead of running away, you are running toward. Instead of looking backward, you are looking forward. You will feel excited during the process, which makes putting in the work more enjoyable. It’s easier to delay instant gratification because you are fueled by the possibility of attaining a longer-term goal. If you reach your desired outcome, you will feel triumphant instead of merely relieved. And here’s the genius of this approach – regardless of whether or not you get exactly what you want, you will make some sort of progress. Even in failure, there is something to be learned if only you look for it.

Failure is the key to success; each mistake teaches us something. – Morihei Ueshiba

Striving for what you want creates positive motivation, passion and resilience, as well as a willingness to take necessary risks. Next time you find yourself faced with a decision, challenge yourself to move toward, instead of away, and see how it feels. Allow yourself to want something while being willing to risk not getting it. Free yourself from the confines of fear and avoidance and open yourself to growth and possibility.

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Take Control of Your HealthCare: Buying Your Own Insurance

The Affordable Care Act (ACA), also known as “ObamaCare,” put into place many provisions to help protect consumers and make health insurance more accessible. However, purchasing your own insurance from the national marketplace or your state marketplace can be intimidating and overwhelming, not to mention frustrating. While your feelings may be justified, you don’t want to let this be a barrier to you and your loved ones finding the insurance plan that best meets your needs and financial means. Here are some guidelines and links that I hope you will find helpful.

See if you qualify for savings based on income.
The reason to buy your plan from a marketplace rather than direct from insurance companies is to have access to premium tax credits and cost-sharing reduction subsidies, which lower your out of pocket costs for health insurance and health care. You qualify for these savings based on projected income for the upcoming year for which you are applying, NOT on your income for the current year. So people who are currently applying for 2016 coverage must estimate their 2016 income, which you can do here.

To qualify for savings through the marketplace, your projected income must fall within a designated range which varies by state. If your income is below the minimum cutoff, you will likely be provided with free or low cost health insurance through Medicaid and will not be allowed to purchase subsidized private insurance through the marketplace. You can still purchase private insurance on your own directly from the health insurance company, but you will pay full price and will not receive any government subsidized savings. If your income is higher than the maximum cutoff, you can purchase insurance through the marketplace but you will not qualify for savings. Thus, you may also want to explore plans offered directly by insurance companies because you will likely have access to a greater range of plan choices that are not offered on the marketplace.

Choose Silver if you qualify for cost-sharing.
If you qualify for cost-sharing reduction subsidies, you must choose a Silver level plan if you want to receive them. They are the only plan that allows you to have both premium tax credits and cost reduction subsidies if you qualify for both (range of 100% to 250% of the Federal Poverty Level). However, all Silver level plans are not created equally. Read this in depth article to find out how to maximize your cost sharing by purchasing a Silver level plan.

SparklerSome plans waive the deductible for certain services!?!
You read that right. Yet there are many people who are not aware that they can receive coverage for certain health care services without having to pay their deductible. The Affordable Care Act mandates that compliant plans waive the deductible for preventative services so chances are your plan is one of them. However, there are a number of plans that also waive the deductible for other services, especially at the silver level and above. Unfortunately, it can be very difficult to figure this out. You will have to carefully read the plan benefits summary and even then it can be confusing. I suggest familiarizing yourself with the format of benefits summaries, which are now standardized because of the Affordable Care Act. Here are three ways to figure out if and when you need to pay your deductible by viewing your benefits summary.

  1. See Page 1, Important Questions, “What is the overall deductible?” The answer will tell you what your individual and family deductibles are and will hopefully state what they do not apply to if the company is being transparent. For plans that require you to pay the deductible for all services (except preventative), they will usually state it here. Sometimes they will refer you to Page 2 to see what services the deductible does and does not apply to which is a clue that your plan does in fact waive the deductible for some services.
  2. Page 2 is where the benefits summary begins to list specific services and your cost for participating and non-participating providers. Typically, you will see copay amounts (flat charge that you are responsible to pay) and coinsurance amounts (percentage of the overall fee that you are responsible to pay). If your plan waives the deductible for some services, you will notice that it is specified for each service whether or not you have to pay the deductible. When you do have to pay it, you will see something like “Deductible then 20% coinsurance” listed. When you don’t have to pay the deductible, there may simply be a copay or coinsurance listed with no mention of the deductible. Sometimes you will notice an asterisk next to some services with a footnote at the bottom of the page that states “deductible does not apply.” This means that you do not have to pay the deductible for those services with an asterisk.
  3. See Limitations & Exceptions, beginning on Page 2, for another place where you might find out if your deductible is waived. There may be a note that indicates that there is no deductible for that service, or that there is no deductible for participating providers for that service.

Below is a sample benefits summary for you to view. Don’t be intimidated – knowledge is power!

PacificSource OR Standard Gold Plan

Consider a HDHP + HSA.
A High Deductible Health Plan (HDHP) is a plan with a minimum deductible of $1300 for individuals and $2600 for families. If your HDHP qualifies, you have the option of opening a Health Savings Account (HSA) with the insurance company or a bank of your choosing. Funds from your HSA may only be used to pay for qualifying health care expenses. Two benefits of having a HSA are that the money you contribute is tax-free and the money you contribute stays with you rather than going to an insurance company. A HSA may be particularly attractive for someone who is healthy and does not use their health insurance benefits often. Your HSA will accumulate over time and be there when you need it. Not surprisingly, health insurance companies are making it increasingly hard for you to find a HDHP that qualifies for a HSA. The two best resources I’ve found that explain the rules are here and here. I suggest finding a credit union that offers HSAs and asking a representative to help you choose a HSA-eligible HDHP. Note that credit unions are more likely to have low fee or no fee HSA accounts as opposed to banks and private companies.

Important detail about HDHPs and family deductibles.
Most employee sponsored plans and lower deductible plans for families allow the deductible to be met for an individual within the family when he or she has met the individual deductible amount. In other words, if the plan has a deductible of “$1500 individual/$3000 family,” an individual in the family can meet the $1500 individual deductible and receive coverage before the $3000 family deductible has been met. However, in a HDHP the entire family deductible must be met before any individual can receive coverage. Read this article to learn more. **For this reason, if you are purchasing a HDHP for a family of two you may be better off buying two separate individual plans rather than a family plan. For families of three or more who are purchasing a HDHP, it makes more sense to go with a family plan.

I hope this information will help you begin the process of learning how to navigate the health insurance system. I encourage you to call an insurance company representative to ask questions because of the variability that still exists despite the ACA. In addition, many communities offer resources for free assistance with health insurance. Follow this link to find local help with insurance.

[DISCLAIMER: I strongly encourage you to verify your benefits with your insurance company before seeking health care or making important decisions about your plan. I am not a health insurance benefits specialist, nor a representative of your insurance company.]

ObamaCare Facts – Very comprehensive site!
How the Family Deductible Works in HDHPs
HSAs: Readers offer questions and tips for using health savings accounts
HSAs: The ABCs of health savings accounts
HSAs: For your financial health, examine your health savings account
HSAs: The pros and cons of health savings accounts
IRS Rules for HSAs
Take Charge of Your HealthCare: The Language

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Do You Have a Mental Health Problem?

This post is for all of you who don’t think you have a mental health problem. Probably. Most likely. I mean, you’re basically fine. You get by. It’s really no big deal. There are a lot of people who are much worse than you are. Am I speaking your language?

Woman in WoodsSo how do you know if you have a mental health problem and what makes something a problem anyway? I’m guessing you’re not ready for a full psychological evaluation so I’m going to make this as simple as I can. There are three questions that I invite you to ask yourself to see if you might have a problem. Think of it as a screening test.

1. Does it cause you distress?
When I refer to distress, I am including various states of mild, moderate or severe discomfort affecting you on an emotional, mental, physical and/or spiritual level. You may feel pain and anguish, or numbness and emptiness. Perhaps it’s not THAT bad, but there’s a sense of something unpleasant that nags at you, that you can’t quite ignore or be rid of. People have differing levels of tolerance for pain and discomfort, but what you are feeling is something you would rather feel less of or not feel at all. While unpleasant feelings and sensations are a part of the human experience and do not automatically signify a mental health problem, you may have a sense that what you’re experiencing is in excess. You feel it quite often or all the time. It is triggered by specific situations that you subsequently find yourself wanting to avoid. It seems out of proportion to what you would expect yourself to feel. You suspect that your experience is different from the norm. The distress you are feeling may indicate that you have a mental health problem, particularly if it negatively impacts the quality of your life.

2. Does it impair your functioning?
Functioning can be applied to anything that you need to do, choose to do, or want to do with yourself and your life. It starts with the provision of your basic needs (i.e., food, shelter, clothing) and self care (i.e., hygiene, dietary habits, sleep, exercise, health). Some of you are also responsible for providing for the basic needs and care of others. Responsibilities are a large part of functioning with obvious examples being work, school, family and financial. Another part of functioning that some of us neglect – because we believe we don’t have to do it – is enjoyment and fun. If something is hindering your ability to meet your basic needs, to care for yourself and/or others, to fulfill your responsibilities or to feel a sense of enjoyment and fun, you may have a mental health problem.

3. Does it interfere with your relationships?
There’s a reason why “relationships make the world go ‘round” is a saying. Most people have the desire to form relationships with others in some capacity. Most people must relate with others in order to function adequately in their personal lives and as members of society (see #2). The most important relationships tend to be family, friends and coworkers or classmates. If something is interfering with the important relationships in your life or you do not have important relationships at all, you may have a mental health problem. This interference may be coming from you, from those with whom you relate or from outside forces and circumstances. While relationships can be tremendously enhancing when they are healthy and fulfilling, they can be highly stressful when there is a conflict or barrier and highly destructive when there is dysfunction or abuse. When we lack satisfying relationships or relationships altogether, we can feel deeply lonely and isolated. Has someone close to you expressed concern about you? Has someone told you that you have a problem? Has someone asked you to change or suggested that you seek help? While you may not be sure if their feedback is accurate, I encourage you to consider it. Sometimes others see things about us that we aren’t yet ready to see about ourselves.

If you answered no the the above three questions, congratulations you are problem-free (or in deep denial, but I’ll have to cover that in another post). If you answered yes to any of the above three questions, further exploration is warranted. The purpose of a screening test is to identify the need for more rigorous examination – to confirm the true positives and to rule out the false positives, if I’m going to be technical. How do you accomplish that? By gaining knowledge from reputable sources, consulting with people whom you trust and by seeking the help of a professional when the first two options do not suffice. To get you started, here is a list of resources.

If you are ready to say that you have a mental health problem, or to at least consider it, let me be the first to welcome you to Contemplation. What is Contemplation, you ask? It is a state of being that is integral to the process of change. Stay tuned because it is one of my favorite things to talk about.

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Take Control of Your HealthCare: Mental Health Parity

Why do you need to know about mental health parity? Because it is a law that was fully implemented in 2014 that directly affects just about everyone who has health insurance, but only 4% of Americans surveyed were aware of it. Read more to learn about how mental health parity pertains to you and the people you care about.

A Little Background
In 2008, Congress passed an act to ensure equal health insurance coverage of treatment for mental illness and addiction with other types of health conditions. The official name of the act is the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). It is usually referred to simply as the Mental Health Parity Act. While the law was passed in 2008, health insurance companies were given time to implement the changes that the law required. Before the law, mental health treatment was usually covered at lower levels than physical health treatment. Number of visits per calendar year could be limited and preauthorization was often required before you could receive mental health care. Consumers may have had to pay more money out of pocket. Insurance companies had greater leeway to deny claims for mental health treatment without providing you with an explanation. In 2014, health insurance companies were required to give full parity for mental health and substance abuse treatment for the majority of plans. (Read this article to learn about plans that do not have to follow federal parity).

What is Parity?
stones-800791_1920A health insurance plan is said to have parity when its members are given the same access to mental health care as they are given for physical health care. So if you get unlimited physician office visits, you will also get unlimited office visits for outpatient mental health. If you pay a $20 copay to visit most physicians, you will pay the same amount to visit your psychologist. If your deductible is waived when you see your primary care physician, it is also waived when you see your substance abuse counselor. If you can get an appointment with a local physician within two weeks, you are supposed to be able to get an appointment with a local psychiatrist within two weeks.

Advocating for Yourself
Mental health parity is great news! We have the right to receive the same coverage for treatment of mental health and substance abuse problems as we do for physical problems. Yay! End of story, right? — Unfortunately no. Health insurance is big business for some companies that are run for profit, which means that they may be more focused on their bottom line than they are on your health care. To for-profit companies, mental health parity is bad news because it means that they stand to lose money . . . unless they find ways to minimize the damage such as passing the extra costs on to their consumers (you), reducing reimbursement rates for providers and/or limiting use of mental health benefits by deeming them not “medically necessary.” So where does that leave you?

Understand Your Benefits. Be sure that you thoroughly read and understand your plan benefits summary which will tell you exactly what your coverage is for all aspects of your heath care. You may have received this summary in the mail, by email or you can access it online through your insurance company website. I know it’s difficult to understand health-insurance-speak, which is why I wrote a post that explains the common health care terminology. Before seeking treatment, you will want to know what your deductible is (if you have one), whether or not it applies to the type of treatment you are seeking, and the amount you will have to pay to the provider at the time of services (your copay or coinsurance). You will also want to know if you have the option of seeing an out of network provider and what your coverage is for out of network services. If you didn’t understand the last two sentences, I encourage you to read this post!

Watch for Red Flags. According to the National Alliance of Mental Illness (NAMI), here are some signs that your insurance company may be violating mental health parity [my comments in italics]:

  • Higher costs or fewer visits for mental health services than for other kinds of health care. [While your insurance company may be required to provide unlimited visits for mental health treatment to achieve parity, they may try to limit your treatment by claiming that it is not “medically necessary.” They may also attempt to steer you toward lower cost alternatives by favoring treatment with medications rather than psychotherapy, by asking you to see a primary care physician rather than a psychiatrist, or by limiting access to providers who receive greater reimbursements due to higher levels of education and training.]
  • Having to call and receive permission to get mental health care covered [referred to as pre-authorization], but not being required to do this for other types of health care.
  • Getting denied mental health services because they were not considered “medically necessary,” but the plan does not answer a request for the medical necessity criteria they use. [Mental health parity requires health insurance companies to provide an explanation when they deny coverage.]
  • Inability to find any in-network mental health providers who are taking new patients, but you can for other health care. [This may indicate that your insurance company is not contracting with a sufficient number of providers to meet the demand of its members, and/or that providers are unwilling to contract with the company due to low reimbursement rates and poor provider relations.]
  • The plan will not cover residential mental health or substance use treatment, or intensive outpatient care, but they do for other health conditions. [Also beware of efforts by your insurance company to shorten the duration of your treatment in residential, partial hospitalization or intensive outpatient programs by claiming lack of medical necessity.]

Contact a Representative. If you suspect that your insurance company is not providing mental health parity, you can contact a customer relations representative to ask for an explanation or to file a complaint. There is a general phone number on the back of your insurance card that you can call and contact information for specific departments is also available on the company website. If you receive your health insurance through your employer, you can contact human resources and ask for the designated benefits representative. In addition, your state may have resources for advocacy or filing complaints against health insurance companies who are not in compliance with mental health parity. Here is the link to information from the Oregon Insurance Division.

Choose Non-Profit. If you are purchasing your own health insurance or otherwise have the freedom to choose which company to work with, you may want to consider a non-profit. Regardless of your personal opinions on this hot-button topic, it is logical that a health insurance company that is not driven by profits will be more likely to prioritize the care of its members. In addition, the non-profit companies tend to have better relationships with providers because they generally reimburse at higher rates and do not tend to limit how patients are treated to cut costs. If more providers are willing to contract with your insurance company, you will have greater access to the best care for yourself and your loved ones.

The time of year is nearing when you may be eligible to choose your employer sponsored benefits or to purchase health insurance through the federal or state exchanges. Don’t let another year go by where you make an uninformed decision and end up with a plan that doesn’t meet your needs. Become an informed consumer by educating yourself and accessing your resources. Make informed choices about your health care. Know when and how to advocate for yourself to ensure that you receive the mental health parity that is afforded to you by the law.

[DISCLAIMER: I strongly encourage you to verify your benefits with your insurance company before seeking health care or making important decisions about your plan. I am not a health insurance benefits specialist, nor a representative of your insurance company.]

Does Your Insurance Cover Mental Health Services? – APA
Understanding Psychotherapy and How it Works – APA
What is Mental Health Parity? – NAMI

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How to Set Effective Goals

Reaching a meaningful goal is one of the best feelings in life. However, many people struggle to work toward and achieve their goals, leaving them feeling disappointed and defeated. In my last post, I listed Five Common Goal Setting Mistakes to help you identify how your goals may be undermining your progress. Now I present some ways to set more effective goals – because effective goals generate motivation and motivation moves you forward.

Set a long term goal that inspires you.
The purpose of your long term goal is to provide you with inspiration. It is the vision that you daydream about; the picture in your mind that sparks excitement and perhaps some nervousness. When you talk about it, your eyes light up . . . Am I sounding a bit idealistic? YES. This is where we can learn a lesson from children. Have you ever seen a child talk about what she wants to be when she grows up? About the places he wants to visit? About how she wants to buy a horse or a helicopter? That is the stuff of dreams, and many adults need more of that spark and passion in their lives. DSC01363While we eventually learn not to set unrealistic goals that we don’t truly believe we can achieve, many of us have allowed the pendulum to swing too far to the other side. We set goals that lack luster, and therefore find ourselves lacking in motivation. Set a long term goal that is meaningful to you, that inspires you to reach for it, that compels you to put one foot in front of the other. I often use the summit of a mountain as a metaphor – so clear before you that you can almost touch it as you imagine what it will be like to reach the top.

Set goals that move you toward what you want.
Word your goals in a positive direction. While this may seem like a minor detail, the research on motivation says otherwise. Moving toward what you want creates a state of motivation that is based on your anticipation of achieving a desired outcome. This type of motivation is more optimal than the motivational state that is created when you are seeking to avoid an outcome that you dread. The former elicits excitement, while the latter elicits anxiety and fear. When you successfully achieve a goal that you were looking forward to, you are likely to feel a sense of accomplishment and triumph. When you manage to avoid a dreaded outcome, you are likely to feel relief at best. It’s the difference between running a race with your eyes on the finish line versus looking over your shoulder fearing your opponents. It’s the difference between “I won!” versus “I’m so relieved I didn’t lose.” You will be more optimally motivated to move toward what you want than to avoid what you dread.

Find the right balance of challenge and attainability for you.
The old guideline says to set goals that are challenging, yet attainable. I will add that this balance is not only going to be different for different people, but that it will also differ for you at different times in your life. One consideration is your current level of functioning. There are many reasons why you may not be functioning at your best, whether you are recovering from an injury, working through depression, or you recently experienced a major life transition. When you are not operating on all cylinders, it is appropriate for you to modify your goals accordingly. Set goals that are less challenging, shorter term, and more manageable. It is important when you are in a vulnerable state that you do not set yourself up to be overwhelmed, discouraged, and unmotivated. Remember that the purpose of goals is to generate motivation and to move you forward. Another consideration when determining the right balance of challenge and attainability is the amount of time and energy you currently have to devote to your goal. Take into account your other life obligations and activities and your current level of stress. Perhaps there are some sacrifices you are willing to make while in pursuit of your goal, such as giving up some social time or taking a break from one of your hobbies. However, there will be some things in your life that you are unwilling or unable to put aside such as family and your health. Set goals that fit in with the rest of your life and that are attainable given the resources you currently have available.

Set goals that are specific, measurable, and time bound.
Vagueness implies lack of commitment and gives you too many ways to avoid being accountable. Make your goal a definitive statement that leaves no question in your mind of what you want to achieve. Once you have specified your goal, you will want to consider whether it is measurable. If you don’t know how to measure your goal, how will you know when you’ve achieved it? Some goals are inherently measurable, such as taking that trip to Italy that you’ve always dreamed of or achieving a new personal best in a 5K race. Other goals will require you to define how they are measured, such as improving your self esteem for example. Write down your definition of self esteem and the ways that you can measure your progress. Determine what will designate that you have achieved the level of improvement you desire. And since self esteem can fluctuate and is constantly evolving, identify how you will maintain the progress you’ve achieved. The last component to your goal is time. I don’t know about you, but if I don’t have a timeline or deadline I will tend to procrastinate. Attaching an expectation of time to your goal creates more of an incentive to take action and helps keep you accountable. To further ensure accountability, I suggest writing down your goal, displaying it somewhere where you will see it (e.g., taped to your wall, in your journal, on your screensaver, etc.) and talking about your goal with people who will support you in your efforts.

Attach a plan to each long term goal that includes short term goals.
“A goal without a plan is simply a wish.” I don’t know who first said that, but I have found the phrase to be a useful reminder to myself and my clients that declaring a goal is only the first step. The next step is to work on outlining a plan to achieve your longer term goal that includes incremental short term goals along the way. The purpose of your short term goals is to provide positive reinforcement, to move you forward, and to maintain motivation. Therefore, you want to set short term goals that are manageable and have a high probability of success. In order for short term goals to be effective, you must be able to achieve them. It is important for you to see yourself making progress and to allow yourself to acknowledge the small accomplishments that short term goals provide. Much of what you do on a daily basis to move toward a long term goal is made up of small tasks that may not seem meaningful. If you tie those tasks to short term goals, which are in turn tied to your long term goal, you are more likely to get them done. An example of this is being able to relate a mundane homework assignment in a class that doesn’t interest you to your long term goal of graduating from college. Connecting that small bit of homework to your long term goal allows you to create meaning in a seemingly meaningless task. Putting forth effort to complete that assignment signifies your commitment to your long term goal, and is a small victory in and of itself.

If you find yourself struggling to work toward and achieve your goals, view your difficulty as a signal to reevaluate. See Five Common Goal Setting Mistakes for ideas about what may be getting in your way. Remember that goals can and should be modified if they’re not effectively moving you forward.

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Five Common Goal Setting Mistakes

The purpose of setting goals is to create success, whether small or large. When done effectively, goal setting is a beneficial tool that increases your motivation, gives you direction, moves you forward, and provides positive reinforcement. When goals are set ineffectively, they can decrease your motivation, create anxiety, lower your self-esteem and result in failure. If the latter has been your experience, you may be making these common goal setting mistakes.

1. Your goal is not meaningful enough to you.
Forcing yourself to pursue a goal that is not meaningful enough to you is an exercise that requires a tremendous amount of willpower. Luckily willpower is a resource that most of us have, but to varying degrees. Even if you pride yourself on the strength of your will, you may be surprised to learn that researchers in psychology have found willpower to be a limited resource. Numerous studies have supported the existence of willpower depletion, with evidence that repeatedly exerting your self-control is a significant factor in reducing your capacity for willpower. So if you expend a lot of your self-control and willpower in pursuing tasks and goals that are not meaningful, you are bound to reach a point of exhaustion and motivation deflation.

2. You have set a “should goal.”
Many people fall into the trap of setting what I refer to as “should goals.” You set goals that you believe you should achieve. “I should eat healthy food.” “I should quit smoking.” “I should save more money.” “I should fix up the house.” When you apply the word “should” to any goal or task, you instantly create a state of internal resistance. It’s the same phenomenon you experienced as a child when you were told by a parent that you should do your homework, or you should clean your room. It works in reverse too. “I shouldn’t spend so much time on the computer.” “I shouldn’t eat so much junk food.” “I shouldn’t work so much.” Psychologists consider “should” a dirty word because of the power it has to undermine you. Also beware of should’s in disguise – sometimes they hide behind have-to’s, need-to’s, and supposed-to’s. They can come from what others want us to do, or perhaps more often they come from what we perceive that others want us to do.

3. You do not believe in your ability to achieve your goal.
Whether you are lacking in self-confidence or you have set a goal that is likely unrealistic for you, the effect is the same. You will find yourself faltering, lacking in motivation, perhaps even sabotaging your efforts. In order to find that amazing state of being where you are internally motivated and taking steps to move toward your goal, you must believe that you can achieve it. You must have the expectation that the work you are putting in has a reasonable likelihood of leading you to your goal. While we certainly don’t have control over all factors that contribute to goal attainment, there needs to be a sense of belief in your ability to meet the demands of pursuing your goal.

4. You have set an outcome goal that is largely out of your control.
Outcome goals refer to results that are reliant upon external, culturally derived measures of performance that often involve competition and comparisons with other people – money, winning, being selected, being recognized. While outcome goals in and of themselves are not bad, and they certainly have their place, the obvious drawback is that most of what determines outcome goals is out of your control. In other words, outcome goals are risky. They tend to have higher probabilities of failure. The amount of effort that you put in may not be proportional to the likelihood of achieving your goal. The other drawback is that if you perceive that you have little or no control over the outcome, you may experience reduced motivation and/or anxiety, which will only make your path more difficult.

5. You are not yet ready to take action toward your goal.
You set your goal with good intentions. You want to improve, achieve, move forward, progress . . . but the fact is that you may not be ready to take action toward that particular goal. There are a multitude of ways that people can move forward, and a great many of those ways do NOT involve observable actions. Whether or not you are aware of it, there is often a lot of internal work to be done to prepare yourself to take action. Sometimes there is work to be done in seemingly unrelated areas. For example, if your goal is to go back to school and earn a college degree, you may first need to improve your self-esteem so you believe that you deserve to earn a college degree. If you jump ahead and expect yourself to start applying to schools, you may be setting yourself up to fail – not because you cannot achieve your goal, but because you are forcing yourself to take an action before you are ready.

Failure is information. If you have set a goal for yourself that you’ve failed to achieve, it’s time to learn from the information that is being offered. Goals are meant to be modified when they are not effectively moving you forward. See my post on how to set effective goals.

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Take Control of Your HealthCare: The Language

I have a confession. I never fully understood how health insurance works until I became a health care provider. As a consumer I often relied on my providers to tell me what was my responsibility to pay, or I just waited to receive my bill and be surprised (usually not in a good way). I now realize how important it is for consumers to learn about their insurance benefits so they can make more informed decisions about their healthcare. This post will be the first of several to help you more effectively use your benefits and advocate for yourself with your insurance company, and with your healthcare providers.

In order for you to understand your benefits, you need to understand the language that insurance companies use. I will share what I consider to be the most important terms for you to know, and provide you with information about an often underutilized tool to help you pay your out-of-pocket health care costs.

[DISCLAIMER: I strongly encourage you to verify your benefits with your insurance company before seeking health care or making important decisions about your plan. I am not a health insurance benefits specialist, nor a representative of your insurance company.]

Premium. This is a flat amount that you must pay each month for the duration of your coverage period, which is usually one year. If you do not pay this amount each month, your insurance company will end your coverage. If you receive health insurance through your employer, this cost is shared between the two of you. Generally, the lower your monthly premium, the more you’ll pay in out-of-pocket costs such as deductibles, copayments, and coinsurance – however, choosing in-network providers can significantly reduce your out-of-pocket costs (see below).

Deductible. This number is arguably the most important to determining whether you can afford a given health care service. It is the amount that you must pay out-of-pocket before your insurance company will provide coverage for the services that you receive. Your plan will have a deductible amount if you are an individual. If your spouse and/or family are also covered under your plan, there will be additional deductibles for them or one higher family deductible amount. If this number is greater than you can afford to pay out-of-pocket, then it can be a significant deterrent to you seeking healthcare (read about possible solutions to this below). When it comes to your deductible, you want to read the fine print and the footnotes. On the negative side, your prescription drug coverage may also be subject to your deductible, and some expenses that you pay may not count toward paying your deductible. On the positive, there may be services for which the deductible is waived such as preventative services and in-network physician and mental health office visits. If you have immediate coverage for some services, you may as well use them because you are paying that monthly premium amount no matter what.

Out-of-Pocket Maximum/Limit. This is the amount that is designated as the most you will be required to pay out-of-pocket during your coverage period (usually one year). After you have paid this amount, your insurance company will cover 100% of your healthcare costs. This provision is put in place (theoretically) to protect you from financial ruin if something catastrophic happens, such as an accident or serious illness, if you require an expensive surgery, or if you develop a chronic health problem. Needless to say, this number can be quite high for many plans. Note that not all of your expenses will count toward the out-of-pocket maximum; your premiums do not count. Important: Pay attention to the difference between your deductible amount and your out-of-pocket maximum amount. I have noticed that these two amounts on some low-premium plans are very close and very high. If your deductible is almost as high as your out-of-pocket maximum, you are essentially paying for the majority of your health care expenses out-of-pocket barring a catastrophic occurrence.

Copayment. Copay for short. This is a set amount that you will automatically pay when you receive certain health care services, such as office visits, emergency services, or admission to a hospital. You will be asked to pay this amount at the time of services. Be aware that if you have not paid the full amount of your deductible, you may also have to pay for additional charges beyond your copay. Your insurance company does not pay for most services until you’ve met your deductible (see above).

Coinsurance. This refers to the shared costs of services between you and your insurance company, expressed as a percentage or a ratio. For instance, if you see “35% coinsurance” on your benefits summary, it means that you are responsible for paying 35% of what a provider charges and your insurance company pays 65%. If you see “50/50,” it means that the fees are split equally between you and your insurance company. Sometimes coinsurance and copay are combined, such that you pay your set copay amount ($35 for instance) and then you pay your coinsurance percentage of the additional fees. Again, be aware that your insurance company will not pay their portion of coinsurance until after you’ve met your deductible for most services (see above).

In-Network. This refers to providers and facilities who have contracted with your insurance company, often at a rate lower than what they usually charge, in exchange for increased access to you and other members. It is a way for insurance companies to control costs. Your insurance company creates incentives for you receive care from in-network providers by offering lower deductibles and better coverage than they do for out-of-network providers. Some plans waive the deductible entirely for certain in-network services, such as physician and mental health office visits. Beware that some plans do not offer out-of-network benefits at all, so if you are in a position to choose between insurance companies you will want to select one that has enough available in-network providers in your area.

Out-of-Network. These are providers and facilities who have not signed a contract with your insurance company. If you have out-of-network benefits, your insurance company may cover your services with these providers.  Your out-of-pocket expenses will likely be greater, however, you may be willing to pay more if working with a particular out-of-network provider is in your best interests. If you’d like to work with a provider who is out-of-network, I encourage you to inquire with them directly about your options. They may be willing to work with you by reducing fees or creating a payment plan.

Covered vs. Non-Covered. Insurance companies designate whether or not they cover certain conditions and whether or not they cover certain types of services. There are several factors that determine this. First, there may be services that your specific plan does not cover. For instance, some plans do not cover alternative health care, such as chiropractic and acupuncture. Similarly, there are some conditions or diagnoses that an insurance company may not cover, such as conditions that they consider to be cosmetic. Often they base their decisions on whether or not they deem that there is medical necessity (see below). Fortunately there are federal and state laws that dictate that certain conditions and services must be covered. However, if your situation falls outside of those parameters, your coverage or lack thereof is dependent upon your insurance company’s policies and your specific plan. You are responsible for paying for non-covered services, and for services received for non-covered conditions and diagnoses. When in doubt, contact a member representative to verify whether a service is covered or you may be responsible to pay for it out-of-pocket.

Medical Necessity. This concept is applied to whether or not an insurance company chooses to cover a particular condition or service. If they deem a condition or service not medically necessary, and there is no law requiring them to provide coverage, they may choose not to cover your costs. Important: Even if you have a covered condition or diagnosis, there may be services that you receive from a provider that are not covered and therefore will not be reimbursed by the insurance company. The insurance company also designates which services are medically necessary treatments for a given covered condition or diagnosis. When in doubt, contact a member representative to verify whether you will receive coverage or you may be responsible for paying out-of-pocket.

Prior Authorization. Your insurance company may require you to essentially get their permission ahead of time for certain services and procedures. This will be designated in your plan benefits summary, and usually applies to surgeries, hospital stays, and inpatient mental health and substance abuse treatment. If you fail to obtain prior authorization, your insurance company may refuse to cover your costs or may impose a penalty which will result in you having to pay more out-of-pocket. Often, your health care provider will be aware of prior authorization and will even call your insurance company on your behalf to obtain it. However, it is ultimately your responsibility to make sure that this is done. Fortunately, prior authorization does not apply to services and procedures that you may receive in emergencies. However, your insurance company’s opinion of an emergency may differ from yours. When in doubt, contact a member representative.

HSA’s, FSA’s, and HRA’s. I don’t like acronyms myself, but our health care system loves them. Health Savings Accounts, Flexible Spending Accounts, and Health Reimbursement Accounts are becoming a MUST HAVE in my opinion to offset the high deductibles that are becoming commonplace these days. FYI, a high deductible is considered to be $1,300 or more. You read that right. Who has a deductible below $1,300 anymore? Opening one or more of these accounts is a way for you and/or your employer to save money to help you pay your out-of-pocket health care costs before you have met your deductible. Money that is deposited into these accounts directly from your paycheck is not taxed. HSA’s seem to have some significant benefits over the other two – you can open them through your employer, your health insurance company, or even a bank; you own the account so you decide how you use the funds; unused funds roll over at the end of your coverage period into the next. Read more about all three types of accounts here and here.

If you’ve made it this far, I commend you on your fortitude. It is overwhelming and sometimes distressing to navigate our health care system. However, I hope that this information will help you feel more empowered to take control of what you can control. If you are a consumer of mental health services, you may be interested in reading my post about Mental Health Parity. It will help you determine if your plan is in compliance with state and federal laws that require insurance companies to provide equal coverage for mental health and substance abuse treatment with medical/surgical treatment.

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Do you control your destiny?

If you believe that you do, then you may have an Internal Locus of Control (LOC). High achieving athletes and professionals are likely to have a strong Internal LOC, and it has been associated with numerous psychological strengths.  The good news is that you can learn how to identify your own LOC associated strengths, and use this information to become a better version of yourself.

LOC refers to the extent to which you believe that your self and your life are controlled by you (Internal) or factors outside of you (External), such as chance, fate, circumstance, or a higher power. There is strong agreement that this distinction lies on a continuum so that the stronger your Internal LOC, the weaker your External LOC, and vice versa.

Internal LOC <—————————————> External LOC

Research suggests that people with a strong Internal LOC are more likely to take responsibility and initiative, to be goal directed, and to bounce back from setbacks and failures. They have also been found to have better mental health and more fulfilling relationships than people with a strong External LOC. However, there are also some potential drawbacks to having a strong Internal LOC, and potential benefits associated with an External LOC.

Learning about your own LOC beliefs and behaviors presents an opportunity for you to be more intentional about maximizing the benefits and minimizing the drawbacks. [I think I just outed my own Internal LOC.] To help you in your quest to be a better version of yourself, I have listed common benefits and drawbacks associated with both Internal and External LOC. Don’t get discouraged if you identify with some of the drawbacks — gaining information about yourself is necessary in order to grow. Oftentimes, small adjustments in the way that you think, perceive, and behave result in great changes. Make the most of the benefits that you already relate with, and remember that you have the ability to create the self who you want to be. Build on your strengths, because it is your strengths that will move you forward.

External LOC – Benefits
  • Willing to accept events as out of your control.
  • Protective factor in coping with loss.
  • Less likely to be self-critical.
  • Will seek help and support from others when needed.
  • May be easier to let go of failures when attributed to factors beyond control.
  • Motivated by a team environment.
External LOC – Drawbacks
  • May not take responsibility, may blame circumstances and others for mistakes.
  • Difficulty being self-motivated.
  • Dependent on others for direction and validation.
  • May develop learned helplessness.
  • Experience difficulty taking action after setbacks and failures.
  • Attribute successes to chance or circumstance (e.g., the test was easy).
Internal LOC – Benefits
  • Likely to take initiative to make things happen.
  • Self-motivated and goal-directed.
  • Believe that your hard work leads to positive outcomes.
  • Willing to accept responsibility for mistakes and take steps to improve.
  • Attribute successes to hard work and personal characteristics.
  • Recover quickly from setbacks due to belief in responsibility to pick yourself up.
Internal LOC – Drawbacks
  • Overdeveloped sense of responsibility.
  • May tend to be self-critical, particularly after perceived failures.
  • Experience discomfort when not in control.
  • May assert control over others and/or be perceived by others as controlling.
  • Difficulty asking for help, believe you are supposed to solve your own problems.
  • Tend to blame yourself, even for events outside of your control.

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About RunnerShrink

Welcome to RunnerShrink. The purpose of this blog is to share information from the applied science of psychology to a wider audience than I could possibly reach in my professional work. FYI, a discipline is referred to as an applied science when scientific principles and theories are applied to practical problems, often in a creative and artful manner. While this definition so aptly expresses what I love about psychology, it also conveys what I want RunnerShrink to be.

To say that the science and practice of psychology is enormous would be an understatement. Performing an internet search on any topic related with psychology or mental health returns an overwhelming number of results. It’s difficult to know which sources are trustworthy and confusing when you receive conflicting information. It is my hope that people will come to regard RunnerShrink as a reliable resource that they can trust because they know exactly who is providing them with the information. I place great importance upon being open, transparent, and approachable. I want you to know who I am, what I do and why you might be interested in what I have to say. I want you to be able to contact me if you have questions about the information I share. I also welcome your feedback and suggestions, especially if you’d like to give me an idea for a blog post that you would connect with.

I will be writing about areas of psychology where I have a breadth of training and professional experience. Sport & Performance Psychology is an obvious choice, since it is one of my specialties. It is a branch of psychology that focuses on enhancement of skills, maximizing one’s abilities and functioning at a higher level. Its principles are closely aligned with another branch called Positive Psychology, which strives to help people become a better version of themselves; to experience fulfillment and meaning in their lives. These approaches reflect both my professional values and my athlete mentality, and you will notice them in just about everything I write.

I hope you will find RunnerShrink to be informative, interesting and relevant to you. Please submit a message with your feedback, ideas, or questions and you may find that you’ve inspired a blog post. I look forward to hearing from you.

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A Runner and a Shrink

I am a Runner and a Shrink.

Running became a passion of mine sometime around the age of 13, when my middle school started a track & field program. I was immediately good at it, and it took on an importance in my life above most things. What made it so meaningful to me was that it was all mine. No one ever asked me to run, told me to run, or pushed me to run. Running was something that I intrinsically wanted to do because I loved doing it. By the time I finished high school, it had become a significant part of my identity. I was not just someone who ran, I was a Runner.

Psychology was an interest that I discovered in college when my roommate and very dear friend suggested that I take an intro class. The professor’s name was Dr. Larry Hamilton, and his enthusiasm for psychology was contagious. He talked about “symbolic survival,” and all of the things that people do to protect themselves from a “symbolic death.” I had never heard anything like it before and I was hooked. Larry became my faculty advisor and the first person who suggested that I go to graduate school. I won’t try to pretend that I knew exactly what I was doing when I came up with the idea of pursuing a career in sport psychology. I would call it a happy accident, but it seemed like a win-win situation to combine my passion with my interest.

I went to graduate school to be a psychologist who specializes in sport psychology. The transition was tough, and I largely gave up my running because I convinced myself that I didn’t have the time. After a year of high stress and low self-care, I decided that I missed running and I missed who I am when I am running. It brings out the best in me, and the worst in me if I am completely honest. Without it, I felt like I was a more subdued version of myself. I had a sense that I needed to be the person I am when I am running in order to succeed in graduate school. I needed to be passionate. I needed to be a fighter. I needed to believe in myself. So I ran again, and I became all of those things again. There’s something about the mindset of excellence . . . it cannot be compartmentalized to just one area of the self. It transcends and it inspires. My journey through graduate school was long and it was hard, but I made it happen – I became a Shrink.

I poured my heart and soul into running as fast as I could for as long as I could. Unlike practicing psychology, running fast has a short timeline and I vowed not to let it passWhile I made some money running, it wasn’t enough to live off of. So I also worked at a hospital as a therapist, where I developed my own intensive outpatient group treatment program. This was the first time that I practiced psychology without supervision, and the first time that I truly had the freedom to find myself as a professional. In a room filled with the ever-changing faces of my patients – looking to me for guidance, for perspective, for knowledge, for hope – I discovered my passion for the science and the art that is psychology. I discovered a sense of purpose that was about more than just myself.

A couple of years ago, running became hard. Of course running is always challenging, and running fast is sometimes blindingly painful. But this was different. What I was feeling was the drag of a body that could no longer handle the rigors of training, and the void left by a temporary break from my work in psychology. I had relocated to another state, and I allowed myself some time to focus solely on my running. I thought it would be an amazing experience to be a full time professional runner, if only for a little while. But I missed psychology and I missed who I am when I am practicing psychology. I realized that being a psychologist had become even more meaningful to me than being a runner. I never thought something like that would happen. I had often worried about how I would cope with retirement from competitive running, who I would be without it . . . well, I’m figuring it out. I have the support of my friends and family, I still run fast (sometimes), my career in psychology is entering a new chapter and I have the honor of working with clients who put a lot of trust in me. One might say I’m finding my way. I prefer to say I’m making my way.

[Before I go, I want to mention that I love to write. I actually majored in English as well as psychology. Anyone who has received an email from me knows I have a (long) way with words. While I have a lot to say, I generally avoid saying it in any sort of public forum. So why start a blog? Because I am at a place in my life where I want to share what I have to say with others. Truthfully though, I am a little afraid. What if I am terrible? What if people judge me? I used to have similar thoughts before I raced, until I made a conscious effort to change that about myself. Running has taught me many things that I have applied in other areas of my life . . . to move forward even with my fear . . . to accept uncertainty . . . to allow myself to try, to really try, without holding something back to protect myself . . . to risk failure when something means enough to me . . . and so I will write, and I will see what happens.]

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