Annals of Psychotherapy & Integrative Health - Summer 2013 (Sample)

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SUMMER 2013 Volume 16, Number 2

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Professional burnout: recognition, PREVENTION, & REMEDIATION

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SUCCESS FILES:

PROBLEM SOLVING FOR SMALL BUSINESSES

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gloria’s funeral: a practitioner’s reflection

Differential diagnosis of

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Annals of Psychotherapy & Integrative Health®

SUMMER 2013

3

Contents

SUMMER 2013 Volume 16, Number 2

40

Features

Departments

40 Differential Diagnosis of anxiety disorders

08 EDITOR’S LETTER 26 mind news

By Salome Dubenetzky, BA, MA

70 The use of drumming in the Development of Self-Trust and Healing in the Therapeutic process

by Stephen Sideroff, PhD and Steven Angel

32 book reviews 94 new members

IN THIS ISSUE 28 psychometrics of ACCREDITATION

Interview with nate thompson,

BY MEGAN TURNER

82 practitioner’s Reflection

by daphne stephensonValcourt, PhD, LMFT, LMHC, BCPC

4 SUMMER 2013

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BUSINESS MATTERS 09 10 Chair’s Corner:

Integrative Health 47 10

Managing both your practice & your life

by Daniel J. Reidenberg, PsyD, FAPA, CRS, BCPC, MTAPA

14 Success Files:

Problem Solving for small businessES by wendy briggs

17 Practice Management:

The evolution of the business side of health care

By Ronald Hixson, PhD, DAPA, BCPC

20 the challenge of burnout: an ethical perspective

by Michael W. Hayes, EdD, LPC, NCC, BCPC

52

48 Natural Remedies Dandelion

49 healthy recipes

pamela’s Vanilla Coconut Protein Pancakes

by Pamela Hernandez, ACSM

50 Member Profile

INTERVIEW WITH Dr. Alan Pressman, DC, CDN, DACBN

by Cheryl Barnett

52 Understanding Wheat & gluten: issuES in Today’s clients

by Tammera J. Karr, BCHN, BCIH, Certifed Gluten Practitioner

58 Morgellons disease

By Debra E. Dallas, PhD

64 guided meditation

columns 34 Spectrum Suite:

Navigating the female aspergerian mind

By Marcelle Ciampi, MEd

90 short story:

overnight conflicts By james mcadams, MA

91 culture notes: Zombies ‘R’ Us!

Meditation for Every Occasion

By Eve Eliot

66 NUTRITION

QUESTIONS AND ANSWERS

by PHYLIS B. CANION, ND, DCCN, FAAIM

64

By Irene Rosenberg-Javors, LMHC, MEd, DAPA

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Annals of Psychotherapy & Integrative Health®

SUMMER 2013

5

CONTACT

Become a member of the American Psychotherapy Association®. We provide mental health professionals with the tools necessary to be successful and build stronger practices. For more information, or to become a member, call us toll-free at (800) 592-1125 or visit www.americanpsychotherapy.com.

MEMBER SERVICES: Karen Hope (karen@americanpsychotherapy.com) PHONE: (800) 592-1125 WEB: www.americanpsychotherapy.com FOUNDER & PUBLISHER: Robert L. O’Block, MDiv, PhD, PsyD, DMin rloblock (rloblock@americanpsychotherapy.com) ANNALS EDITOR: Cheryl Barnett (cheryl.barnett@americanpsychotherapy.com)

2013 EDITORIAL ADVISORY BOARD Debra L. Ainbinder, PhD, NCC, LPC, BCPC Kelley A. Armbruster, MSW, FAPA Diana L. Barnes, PsyD, LMFT Cherie J. Bauer, MPS Sabrina Caballero, LCSW, DAPA Stacy L. Carter, PhD, BCPC Susanne Caviness, PhD, LMFT, LPC Linda J. Cook, LCSW, CRS, DAPA, BCETS John Cooke, PhD, LCDC, FAPA Caryn Coons, MA, LPC Clifton D. Croan, MA, LPC, DAPA Catherine J. Crumpler, MA, LPC, BCPC Charette Dersch, PhD, LMFT David R. Diaz, MD Carolyn L. Durr, MA, LPC Adnan M. Farah, PhD, BCC, LPC Patricia Frank, PsyD, FAPA Natalie H. Frazier, PhD, LPC Sabrina Friedman, EdD, CNS-BC, FNP-C Robert R. Gerl, PhD Sam Goldstein, PhD, DAPA Jacqueline R. Grendel, MA, LPC, BCPC, CRS Richard A. Griffin, EdD, PhD, ThD, DAPA Yuh-Jen Guo, PhD, LPC, NCC Lanelle Hanagriff, MA, LPC, FAPA Douglas Henning, PhD Mark E. Hillman, PhD, DAPA Elizabeth E. Hinkle, LPC, LMFT, NBCC Ronald Hixson, MBA, BCPC, MT, DAPA Judith Hochman, PhD Antoinette C. Hollis, PhD Irene F. Rosenberg Javors, MEd, DAPA Gregory J. Johanson, PhD Laura W. Kelley, PhD Gary Kesling, PhD, FAAMA, FAAETS

C.G. Kledaras, PhD, ACSW, LCSW Michael W. Krumper, LCSW, DAPA Ryan LaMothe, PhD P. K. Frederick Low, MAppPsy, MSc, BSocSc, DAPA Edward Mackey, PhD, CRNA, MS, CBT Frank Malone, PsyD, LMHC, LPC, FAPA Beth McEvoy-Rumbo, PhD Thomas C. Merriman, EdD, SBEC (Virginia) Ginger Arvan Metcalf, MS, RN William Mosier, EdD, PA-C Natalie H. Newton, PhD, DAPA Kim Nimon, PhD Donald P. Owens, Jr., PhD Thomas J. Pallardy, PsyD, BCPC, LCPC, CADC Larry H. Pastor, MD, FAPA Joel G. Prather, PhD, MS, BCPC, Helen D. Pratt, PhD Ahmed Rady, MD, BCPC, FAPA, DABMPP Daniel J. Reidenberg, PsyD, FAPA, CRS Arnold Robbins, MD, FAPA Arlin Roy, MSW, LCSW Maria Saxionis, LICSW, LADC-I, CCBT, CRFT Alan D. Schmetzer, MD, FAPA, MTAPA Paul Schweinler, MDiv, MA, LMHC, DAPA Bridget H. Staten, PhD, CRC, MS, MA Suzann Steadman, PsyD Ralph Steele, BCPC Moonhawk R. Stone, MS, LMHC Mary E.Taggart, LPC Patrick O.Thornton, PhD Mary A.Travis, PhD, EdS, MA, BS Charles Ukaoma, PsyD, PhD, BCPC, DAPA Lawrence M.Ventline, DMin Cecilia Zuniga, PhD, BCPC

Annals of Psychotherapy & Integrative Health® (ISSN 2167-2113 / print • 2167-213X / online) is published quarterly by the American Psychotherapy Association. Annual membership for a year in the American Psychotherapy Association is $165. The views expressed in Annals of Psychotherapy & Integrative Health® are those of the authors and may not reflect the official policies of the American Psychotherapy Association. Abstracts of articles published in Annals of Psychotherapy & Integrative Health® appear in e-psyche, Cambridge Scientific Database, PsycINFO, InfoTrac, Primary Source Microfilm, Gale Group Publishing’s InfoTrac Database, Galenet, and other research products published by the Gale Group.

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6 SUMMER 2013

EDITOR: Julie Brooks (julie.brooks@americanpsychotherapy.com) ACCREDITATION EDITOR: Megan Turner (megan.turner@americanpsychotherapy.com) SENIOR GRAPHIC DESIGNER: Brandon Alms (brandon@americanpsychotherapy.com) GRAPHIC DESIGNER: Stephanie Lindberg (stephanie@americanpsychotherapy.com) ASSISTANT GRAPHIC DESIGNER: Cheryl Barnett (cheryl.barnett@americanpsychotherapy.com) ADVERTISING: Cheryl Barnett (cheryl.barnett@americanpsychotherapy.com) (800) 205-9165 ext. 116

EXECUTIVE ADVISORY BOARD CHAIR: Daniel J. Reidenberg, PsyD, FAPA, MTAPA, CRS MEMBERS: Frances A. Clark-Patterson, PhD Clifton D. Croan, MA, LPC, FAPA Gerald L. Dahl, MSW, PhD Natalie H. Frazier, PhD, LPC Donald E. Goff, PhD, MTAPA, DAPA Ron Hixson, MBA, BCPC, MT, DAPA Robert E. McCarthy, PhD, LPC, MTAPA Kenneth Miller, PhD, BCPC Chrysanthe L. Parker, JD Stan Sharma, PhD, JD Wayne E.Tasker, PsyD, DAPA, BCPC

CONTINUING EDUCATION The American Psychotherapy Association’s sister organization, American College of Forensic Examiners Institute (ACFEI), provides continuing education credits for accountants, nurses, physicians, dentists, psychologists, psychiatrists, counselors, social workers, and marriage and family therapists.

ACFEI is an approved provider of continuing education by the following: Accreditation Council for Continuing Medical Education National Association of State Boards of Accountancy National Board for Certified Counselors California Board of Registered Nursing American Psychological Association California Board of Behavioral Sciences Association of Social Work Boards American Dental Association (ADA CERP) Diplomate status with the American Psychotherapy Association® is recognized by the National Certification Commission.

For more information on recognitions and approvals, please visit www.americanpsychotherapy.com

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For more information and to become a member, call us toll-free at (877) 718-3053 or visit www.aaimedicine.com.

2013 EDITORIAL ADVISORY BOARD Martin Alpert, MS, DC Eleanor Barrager, DCCN, FAAIM Maggie Bloom, PhD Brenda Brown, PhD, ND Phillip Carlyle, DC, CCWP Zhaoming Chen, MD, PhD, MS, FAAIM Debra Dallas, PhD, MIFHI, DCNT Lynn Demartini, DSH-P, RN, LMT Kenneth Dennis, PhD David Getoff, CCN, CTN, FAAIM Cindy Griffin, DSH-P, DIHom, FBIH, BCIH, DCNT, FAAIM Christine Gustafson, MD W. Jeffrey Hurst, PhD Steva Komeh-Nkrumah, DrPH, RD, CNS, BCIM Cuneyt Konuralp, MD, LAc Tim Leasenby, DC

CONTACT MEMBER SERVICES: Judilyn Simpson (judy@aaimedicine.com) PHONE: (877) 718-3053 WEB: www.aaimedicine.com

EXECUTIVE ADVISORY BOARD CHAIR: Zhaoming Chen, MD, PhD, MS, CFP, FAAIM

Don Londorf, MD, CM, LAc, FRCPC Cheyenne Luzader, MS, ADS Robert McCarthy, PhD, LPC, BCPC Bill McClure, DC, JD Pamela McKimie, CHom, LAc Celestine McMahan-Woneis, PhD Mark Morningstar, DC Barbara Phibbs, OMD Donna Scattergood, PhD Cheryl Schuh, CBT, CBS Marilia Silva-Brand, FAAIM, DCNT, DCCN Martha Stark, MD Gayle Stockwell, DC Rodger Uchizono, DDS Paul Yanick, PhD, ND

AAIM ACCREDITATION COMMISSION BOARD CHAIR: Robert E. McCarthy, PhD, LPC, FAAIM, BCIM, MTAPA, FACFEI Kenneth L. Miller, PhD, PCC-S, NCC, ACS, BCPC, ABMPP Stuart Mitchell, DO, ND, PhD, MPH, FAAIM, BCIM, BCAAFP, DABFE, MEMBERS: Viviane A. Ngwa, MSW, FAPA, CRS Zhaoming Chen, MD, PhD, MS, DABMS, CFP, FAAIM Nora Osborne, BSN, RN, CNOR, BCIM Joseph Di Turo, MD Chrysanthe L. Parker, JD, ACPE, AAPC-PCS, CFT, C-BF, FAPA Michael W. Hayes, EdD, LPC, NCC, BCPC William M. Sloane, JD, LLM, PhD, APP, CAd, DABFC, Guy C. Jeanty, PhD, LMHC, LMFT FAAIM, FACC, FAPA, MTAPA Tammera J. Karr, DAAIM, BCIH, BCHN, CNC, CNW, CHN PUBLIC MEMBER: Gary Kesling, PhD, BCPC, DAPA Richard Woodruff

MEMBERS: Joseph Di Turo, MD, DAAIM, DEM, BCIM Brian L. Karasic, DMD, MBA, CMI-V, FAAIM, BCIM Gregory W. Nevens, EdD, FAAIM, FACFEI, DAAPM, DABDA Richard C. Niemtzow, MD, PhD, MPH, CHS-V, FAAIM Col. Richard Petri, Jr., MC, BCIM, DAAIM Robert E. McCarthy, PhD, LPC, FAAIM, BCIM, MTAPA, FACFEI Mark H. Scheutzow, MD, PhD, DHom, FAAIM, DABHM, DAAPM William M. Sloane, JD, LLM, PhD, FACFEI, FAAIM, DABFC George D. Zgourides, MD, PsyD, DCM

American Board of Integrative Health MEMBERS: David I. Rosenberg, PhD, LCP, BCIM Jayson B. Calton, PhD, FAAIM, CISSN Mira Calton, CN, FAAIM Nora Osborne, RN, BSN, CNOR, BCIM, DAAIM Phylis Canion, CNC, DCCN

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EDITOR’S LETTER

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8 SUMMER 2013

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BUSINESS MATTERS “Research tells us that to avoid burnout we must stay healthy, so what does it take to manage all of this and stay healthy? I believe what it takes is practice.” ~ Daniel J. Reidenberg, PsyD, FAPA, CRS, BCPC, MTAPA

10 CHAIR’S CORNER: MANAGING BOTH YOUR PRACTICE AND YOUR LIFE 14 success files: PROBLEM SOLVING FOR SMALL BUSINESSes 17 practice management: THE EVOLUTION OF THE BUSINESS SIDE OF HEALTH CARE 20 FEATURE ARTICLE: THE CHALLENGE OF BURNOUT (800) 592-1125 | (877) 718-3053

Annals of Psychotherapy & Integrative Health®

SUMMER 2013

9

Chair’s Corner

Managing Both Your Practice AND Your Life These are NOT independent variables

By Daniel J. Reidenberg, PsyD, FAPA, CRS, BCPC, MTAPA

10 SUMMER 2013

live in Minnesota and it has been a long winter, even by meteorological standards. It has been cold with more snow than I care to think about.

As the end of April nears, we’ve just been through two weeks of snow storms with more than 6 inches every three days. I’m tired of it. Shoveling, wearing heavy coats and sweaters, more shoveling, wondering where April showers are and if we are ever going to see May flowers again.

Among all the snow that we’ve had is this underlying concern of flooding (again from our meteorological friends who are the only profession to be paid a lot of money and are seen as local celebrities, yet they never have to be right on their predictions). News reports and predictions are for heavy flooding throughout my state, and in many other parts of the country, from the winter’s snow. Well, it really isn’t all because of the snow per se, it has to do with moisture, saturation, water tables, run-off, temperature variation, etc., but in any case, there seems to be a reason for the fears of floods. www.americanpsychotherapy.com | www.AAIMedicine.com

BUSINESS MATTERS

“Research tells us that to avoid burnout we must stay healthy, so what does it take to manage all of this and stay healthy?”

I happen to be one of those people afraid of a flood. Not because I live on a river, stream, or lake. And not because I have a pond in my yard or anything like that, but I am still afraid. You see in the few days the last couple of months when the snow has “melted,” the water just seemed to sit in my backyard. It is what they call “standing water” and it is making me very nervous because if they are right, the ground is not able to take any more snow melt and that would mean water would have to go somewhere and I surely don’t want it coming anywhere closer to the foundation, let alone inside of my house. And currently, it is less than a foot away from the back door, and we still have almost five inches of snow left to melt.

So I wait. But, is there anything else I could be doing? I’m sure there is, e.g. sandbagging, digging a ditch, praying for a drought, but I haven’t done those things. I’ve merely waited and let the anxiety mount with a belief that “this will all just be a bad dream” when summer officially begins.

You may be wondering why I shared the story above (all of which is true, by the way), but what does this have to do with psychotherapy or practice, clients, or anything important to you as a reader. Let’s start by me asking you to think back to what you’ve just read and try to recall how many different emotions, cognitions, and behaviors I mentioned. Over a dozen by my count and this is just one area of my life right now. We all have lives like this, and many of us also have practices like this. We might have one client who is really on the brink of a meltdown and possible hospitalization. Another client might be on the brink of a tremendous breakthrough that leads him or her to a whole new outlook on life. A couple we’re seeing might be on the verge of a breakup or divorce, while another is just finishing premarital counseling and are ready to start a new chapter in their lives. How many of you have a practice that is boring, mundane, or running smoothly? I know there are some of you out there, but I also know that I talk to many practicing clinicians who say there is rarely a day that goes by without at least one ‘something pretty big happening.’

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With that being said, our practices have a lot going on for us, and not just because our clients’ lives have so much going on. We have insurance companies to fight with and make claims to, we have competition so we have to market ourselves to keep clients coming in the door, we have colleagues who want to share cases with us for consultation purposes, and we also have bills to pay, forms to be copied, and the unending stream of paperwork, charting, and other documentation that is required of us. Don’t forget we have to keep current on the state of knowledge in the field, transitioning over to electronic medical records, television and movies portraying therapy unfairly, and clients who want a quick fix. Yes, welcome to the world of being a healer!

At the very same time, let’s not forget that we have lives outside of our offices. You may not have a flood to worry about like I do, but you might be flooded with other things that need your attention, like your spouse, children, friends, family, and volunteer activities. You have bills to pay, events to attend, projects that you’re working on, and each one of these things might have ups, downs, challenges, and even a crisis or two that you have to deal with. Each having an emotion, a thought, and/or a behavior that will undoubtedly have to change as you confront them.

Research tells us that to avoid burnout we must stay healthy, so what does it take to manage all of this and stay healthy? I believe what it takes is practice. If you can practice some different things, you can better manage your clinical work and your personal life, and these are definitely connected.

Some tips for practice management: Practice fun It is really important that you have fun at home and at work. Our lives are filled with many stresses, but fun can help us better manage through those tough times. So practice finding ways to have fun. At home do at least one fun thing every day. Whether that is watching a movie you like, listening to a favorite song, playing a game or sport, drawing or painting, cooking or building something, make it a point to do something that at the end of it you can say “that was really fun.” And home shouldn’t be the only place you have fun. At work organize a pot-luck or surprise everyone with breakfast or lunch, send out a funny message to co-workers that alleviates some of the stress in the office, take a few minutes and listen to some music and talk about it in the office and relive old times, have a “dessert and charting” break over cupcakes. Whatever you can do to have fun will certainly make you smile, and when you smile and laugh, you release chemicals throughout your brain that are feel-good chemicals and that is a healthy thing.

Annals of Psychotherapy & Integrative Health®

SUMMER 2013

11

Chair’s Corner

Schedule vacation days One thing I find interesting is that many therapists I know seem to be afraid to schedule a vacation. Whether it is for one day or for a week, they worry about their clients (a good and noble thing) and how they will be if they can’t have their regularly scheduled appointments. TAKE YOUR VACATION DAYS! Not only is taking a day off (or more) good for you and your personal life (on many levels), it is good for your clients. Think back to my story about the weather that keeps changing and just when I think it’s over, it’s not. Think back to my waiting and not doing anything.

Your clients have these same circumstances in their lives, and they will be fine if they don’t see you for a week. As a matter of fact, I believe it is really good modeling for clients to see that: A. you have a life even though you don’t go into what you’ll be doing on your day off with them, and B. they can live through changes in plans and routines.

I’ve often told other therapists to give their clients an extended assignment to work on during the time between sessions, maybe one that has two or three phases to keep them actively engaged in the therapeutic process outside of your office. You can also have them journal different thoughts, feelings, or behaviors over the time between sessions and rate them to see if/how they change. In the end, the idea is that you get some time to do your things and they learn that life requires flexibility and fun.

Look for perspective I’ve written about this many times before, but perspective means a lot. When you are in the thick of things with your clients telling you that they are distraught over a partner moving out of their home, you can feel that pain and empathize with them. But thankfully because you’re not in that, you can also help them through it and you know there will be another side to their current state that they can’t see right now. However, if someone were flying in a plane over your office, they couldn’t see both of you there dealing with this pain, fear, anger, sadness, etc., so their perspective on your client’s situation is that it doesn’t even exist.

The key here is to always be able to give your clients perspective as they navigate through tough times. And in your personal life, always remember that how it feels to you right this minute is not how it will feel to you in an hour, much less tomorrow.

return is not going to be successful on the court. It takes diversity in your skill set to make you invaluable. Thus for your clients, it’s good for you to know about anxiety just as much as about depression. Add in there knowing about alcohol use, since we know it is a depressant and if you don’t think to inquire about it, you might miss something really important. Also, practice diversity in your skills. This might mean learning a new skill, such as DBT, or simply trying a new approach with clients than the one you always rely on. This keeps you fresh and engaged so things do not become routine. At home it is great to have traditions, such as Sunday family dinners, but you can even mix that up and do a Sunday brunch instead. Start a new project, learn a new skill or hobby, plan a trip, just do something different than simply coming home and putting out one fire after the next.

Practice humility The truth is, we are all really important in this world to someone.

For those of us who are healers and who have families, we are pretty important to a lot of people. I think, however, at times we often forget that our importance to someone else is contingent on us being truly humble about it. If we talk to our children like we know everything, there is no way we can expect them to believe us much less respect us, and the truth is we don’t and they know that. If we think our spouses are better off because of us, I promise you that is a sign of problems to come. We are often the ones better off because of someone in our lives, and the only way to truly know that is by giving more, taking less, and by accepting that we are a mere one part of others’ lives and that means we must be careful to not overly value ourselves when there is always someone or something else that might be what is called for, and that is okay. Getting to the place where you can accept that someone else might have a better answer/response/option for someone is a good place to be, because we just can’t be everything to everyone all of the time. So practice being okay with a colleague who sees more clients than you. Practice being okay with needing to learn a new skill from someone who might be able to teach it to you. Practice being able to say to your client: “I’m sorry, I just don’t know how to answer that for you.” At home practice asking for help, practice asking for forgiveness, and practice managing your time to be part of a faith community where you can see that there is something out there greater than just what we can see with our eyes.

Practice diversity

About the Author

When we do one thing over and over again, we get really good at it.

Watch any professional athlete and you will see them practice doing the same thing over and over and over again: putting, dunking, catching, etc. Given how much athletes make these days, there must be something to practicing their trade that we would all do well to copy. But where does diversity come into this? It is fantastic to be great at something, but if that is the only thing that you can do, your value is very little to most situations. For example, take a pro golfer. If they are terrific at putting but they can’t drive to get to the green, their skills are meaningless. The tennis player who can serve better than anyone else but can’t hit a back-handed

Daniel J. Reidenberg, PsyD, FAPA, CRS, BCPC, MTAPA, is the chair of the American Psychotherapy Association’s Executive Advisory Board and has been a member since 1997. He is a Fellow and Master Therapist of the American Psychotherapy Association and executive director of Suicide Awareness Voices of Education (SAVE) in Minneapolis, Minnesota.

Contact him with your thoughts at dreidenberg@save.org.

12 SUMMER 2013

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SUCCESS FILES

By Wendy Briggs

Step

01

DEFINE THE PROBLEM

Problem Solving

for

small BUSINESSES

Problem solving skills are essential to everyday life. Every person on the planet has to make decisions on a daily basis. Being able to solve problems effectively and make decisions is one of the keys to being successful. This could not be more true for small business owners. According to the Small Business Administration’s Office of Advocacy, three out of ten new businesses with employees fail within the first two years. Five out of ten small businesses are closed within five years. And the numbers only get worse for sole proprietor businesses.

There are a lot of different causes for small business failure, but poor problem solving doesn’t have to be one of them.

Being able to solve problems effectively can literally make or break your business success. By learning some tried-and-true steps for solving problems in the workplace, you can keep your small business or practice up and running for decades.

While different business resources give a variety of problem solving advice, most include some version of the following five steps.

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To truly solve a problem, you have to know what that problem is. This requires talking to the people who are affected by the problem and gathering information.

Sometimes the problem may seem too vague or overwhelming to tackle. It may affect several areas of your business or it may exhibit many different symptoms.

Don’t get overwhelmed or distracted by these aspects. Instead focus on the crux of the issue. It’s not enough to treat the symptoms of the problem; you must identify the root cause. Observe the situation and identify the essence of the problem.

When defining the problem, it helps to describe it in several different ways. Nadia Goodman, a blogger for Entreprenuer.com, says that simply describing the problem in a new way cues the brain to think of the problem as a different situation, giving fresh perspective. She suggests looking at the problem in an abstract way. You can do so by asking, “What is the essence of the problem?” It helps to develop this into a problem statement— a simple sentence that clearly says what needs to change.

According to Richard Chang and P. Keith Kelly, in their book Step-By-Step Problem Solving: A Practical Guide to Ensure Problems Get (and Stay) Solved, a problem statement should be a simple declaration of fact that is defined in a way that makes it manageable for a team or individual to realistically solve. It should also be written in a clear and easy-to-understand way. This may mean breaking a larger problem down into smaller groups or chunks. Then you can tackle the smaller problems one at a time, choosing the most urgent or most important areas first.

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BUSINESS MATTERS

Step

Step

BRAINSTORM SOLUTIONS

CHOOSE A SOLUTION

02 01

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Once the list of ideas is compiled, it’s time to choose a solution you can work with. Frank Tillman and Deandra Casson, authors of A Professional’s Guide to Decision Science and Problem Solving, suggest evaluating the possible solutions by rating each against different criterion for success. Then you can choose the best one in the group. They spell this out in a simple process. (See Table 1.1 for a sample of what this might look like.)

(A) Decide what is important for the success of the plan. These are the “rules or criteria” for making the decision. For example, to improve or lower the amount of wait-time for patients in your practice you might want to consider the cost, personnel needed, feasibility, and convenience of the proposed plan or solution.

(B) Write these criteria in a column down the left side of a sheet of paper and determine the weight or importance of each criteria by assigning each a percentage (e.g., cost 50%, manpower 15%, feasibility 25%, convenience 10% = 100% total).

Write these percentages next to or below each criteria.

(C) Write each idea from the brainstorming session at the top of the paper, creating a column for each idea. This will form a grid on the paper. Rate the criteria for each idea on a scale of 1 to 10—one being the lowest preference and ten being

Table 1.1 Sample Criteria/Weight Analysis

After you’ve broken down the problem into a manageable task, it’s time to establish what The Big Book of HR calls a SMART goal.

SMART goals are specific, measurable, attainable, relevant, and trackable.

This provides a target you can focus your efforts toward. Next, take the problem statement (with the gathered information about the problem) and your target goal and brainstorm solutions. This is the point in the process where there are “no bad ideas.”

Come up with as many ideas as possible.

According to Scott Halford, a writer for Entrepreneur.com, “The best brainstorming happens when you have the opportunity to bounce ideas off others. Get the right people in the room and think of as many solutions as you can.” Invite the people who are affected by the problem to join in the brainstorming. They may have ideas and insight that can help tackle the problem in a new and more productive way. It also creates an atmosphere of respect, pride, and camaraderie in your practice or business, making it more productive.

In their book, The Great Workplace, Michael Burchell and Jennifer Robin used decades of research to uncover the importance of creating a great workplace. They say that “ideas are indeed everywhere, the managers at best companies continually seek out suggestions for business problems.

They seek to understand the likely impact of business decisions on the employee experience. They employ two basic but important skills: they ask questions, and they listen.”

If this is what works best for large Fortune 500 companies, such as General Mills and SC Johnson, how much more effective will it be for a small counseling practice or local acupuncturist’s office.

03 01

Criteria Cost

Weight 50%

Manpower

15%

Feasibility

25%

Convenience

10%

Total

100%

the highest. Write these numbers in the column and the row of the corresponding idea and criteria. Then multiply the rating by the weight of that criteria to produce a weighted score (e.g., If the cost of the first idea was rated a 4 on the scale, it would receive a weighted score of 2 as shown here: 4 x 50% = 2). Write that score below the scale number you already assigned to that particular idea/criteria.

(D) Add the weighted scores for each idea and write the total at the bottom of the idea’s column. Choose the one that scores the highest (e.g., If the weighted score of Plan A totals 4, Plan B totals 3.55, and Plan C totals 3.4, the Plan A idea would be the best choice).

The Eight-Step Problem Solving Model (developed by the Toyota company), instructs problem solvers to create an action plan for implementing the best choice and lay out a time line for the different steps. Include who is involved, what responsibilities they will have, and any deadlines for results.

Decide how you will track the progress of the plan. You may eliminate ideas based on the inability to create a sufficient plan or tracking process. It’s a good idea to include the stakeholders in the decision-making process. Their input can be quite valuable. However, when all is said and done, it’s the boss who must make the final choice.

Plan A 4 (2) 1 (.15) 5 (1.25) 6 (.6) 4

Annals of Psychotherapy & Integrative Health®

Plan B 5 (2.5) 3 (.45) 2 (.5) 1 (.1) 3.55

Plan C 2 (1) 6 (.9) 4 (1) 5 (.5) 3.4

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Step

04 01

Step

IMPLEMENT THE SOLUTION

REVIEW EFFECTIVENESS

This is the step in which you and all other stakeholders put the chosen plan into motion. Be sure to explain why that particular plan was chosen to help everyone involved feel informed and part of the process. The success of the plan is contingent on how well those who actually work the plan understand and implement it. It’s hard to act on a plan you don’t believe in. So, try to get all stakeholders on board if you want your “solution” to work.

Break down the solution into manageable steps, creating an action plan. Don’t be vague in describing the steps. Use action words that specifically describe what needs to be done. In her book, Organize Your Office…in No Time, Monica Ricci is adamant about using specific action words such as “call, read, sign, mail, log” to describe what needs to be done. “These are examples of specific actions that leave no question as to their meaning.” This helps to dummy-proof your plan and improve your chances of success.

As the solution is being implemented, develop a clear process for reporting progress. This can be as easy as checking in with people at the end of the day or asking people to write a report or fill out a questionnaire periodically. It is important to check progress at regular intervals. Set a date to review the plan’s success. This can be a few weeks or a few months depending on your situation.

After the predetermined time, revisit your plan. Evaluate the overall results of the solution you chose to implement. Consult the notes and reporting documents used during the implementation. Discuss the success or failure of the plan with the stakeholders. You may need to tweak the process or toss it out and start over. Ask questions about the effectiveness of the plan, what worked, what didn’t, and why? If it didn’t work at all, go back to step two and choose another idea to try.

Once you’ve tweaked (or completely revamped) your plan, standardize the implementation by making it a company policy.

This may mean including it in an employee handbook or simply making it a part of your everyday routine. The size of your business or practice and the number of employees/ clients will dictate how you do this.

Problem solving is often a trial and error venture. The important thing is to have a plan and use it. You need to understand why the plan succeeded or failed. Even failures can be considered valuable when they reveal weaknesses or when they suggest alternative methods of solving the problem.

Keep an open-mind and stay determined and you’ll be able solve the problems you face in your business and increase the success of your business.

05 01

“Problem solving is often a trial and error venture. The important thing is to have a plan and use it.”

References Chang, R., & Kelly, P. K. (1993). Step-by-step problem solving: A practical guide to ensure problems get (and stay) solved (pp. 19, 184). Mission Viejo, CA: Practical Learning Press.

Goodman, N. (2012, May 23). A secret to creative problem solving [Web log post for Entrepreneur. com]. Retrieved from http://www.entrepreneur. com/blog/223588.

Halford, S. (2010, November 12). How to become a master problem solver. Retrieved from Entrepreneur.com: http://www.entrepreneur.com/ article/217516 Mitchell, B., & Gamlem, C. (2012). The big book of hr (p. 188). Pompton Plains, NJ: Career Press.

Ricci, M. (2006). Organize your office…in no time (p. 27). Indianapolis, IN: Que Publishing.

Small Business Administration. (2011, January).

Frequently Asked Questions (Research Fact Sheet). Retrieved from the SBA Office of Advocacy Web site: http://www.sba.gov/sites/default/ files/sbfaq.pdf.

State of Washington. (2012) The eight steps for successful problem solving: Based on the Toyota business process. Retrieved from the State of Washington Web site: http://www.accountability.wa.gov/ leadership/lean/documents/The_Eight_Steps_ for_Successful_Problem_Solving.pdf.

Tillman, F., & Cassone, D. T. (2012). Professional’s guide to decision science and problem solving.

Upper Saddle River, NJ: Pearson Education, FT Press.

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BUSINESS MATTERS

Practice management

CPC

PA, B son, PhD, DA

ix

By Ronald H

uring the early years of psychotherapy, people shared office space and worked out of primary care offices or in government positions, such as the military or the Veterans’ Administration, or even taught in universities.

The fees for private practice were approximately $20 to $30 for a 45-minute session and were paid in cash. Eventually Medicare began reimbursing individual, group, and family practices. Due to this, the rates went up, as did the requirements to be enrolled in panels. States set up requirements for licenses and, as a result, exams were created which required hours of supervision to ensure quality of knowledge of the providers who wanted to be licensed. Health care insurers made licensing a requirement for panels and they set the standards and billing codes for reimbursement.

Since the 1970s and ‘80s there has been an increased effort by insurers to find a way to control costs. Health maintenance organizations (HMOs) were created and took a lot of negative hits in the media including a movie by Michael Mohr which depicted HMOs as the monster who refused health care which led to long term health problems, or even death. Mohr’s movie compared the health care programs in Canada and Cuba with those in America. Gradually the HMOs were replaced by managed care organizations (MCOs), which created a more palpable mark on the gatekeeping process with less negativity than was created by HMOs. In the 1990s the Clinton health care reform failed for many reasons, but mainly because of the fear created when rumors began to replace any meaningful discussion of health care reform.

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I began writing about the business of therapy ten years ago. Many therapists were aware of the growing influence of the business community on the practice of medicine and psychotherapy, while others tried to ignore the whole issue and remained focused on patient care.

These articles were written to increase awareness of the increasing influence of business and regulatory organizations on private practice in mental and medical health care practices, and also to alert the traditional schools of psychology and mental health to these issues in an effort to encourage them to change their curriculum to include business courses. Neither goal was satisfied. Today very few graduate programs in psychology have changed due to the fact that no one on their staff has the degrees necessary to put business courses in their curriculum. The articles discussed the emergence of managed care, fluctuations in the economy, varying political priorities, an expanding national health care debate, new laws affecting state licensing requirements, state and federal alterations in laws affecting the delivery and administration of health care, new laws affecting the workplace and minimum wage requirements, and new laws used in the prosecution of insurance fraud (Hixson, 2004). Since those early articles there have been many others discussing the risky business of healthcare, how the economy affects decisions within the health care field, the growing number of outside influences on providers, and the need for providers to be more effective managers of their practices. Along with these issues was a growing concern about the toll on the health of health care providers who were feeling the growing tension and were beginning to feel discouraged (Hixson, 2011).

Not only are large corporations dictating to providers how to run their practices, but politicians have also gotten into the mix. Three years after the Affordable Health Care Act of 2010 was legislated we Annals of Psychotherapy & Integrative Health®

SUMMER 2013

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Practice management are finding ourselves in a much deeper hole then we ever imagined.

According to the Department of Health and Human Services, the number of primary care practices have been shrinking and now 90% of the counties in Texas are now considered to be qualified for the government’s ranking of Medically Underserved Area Populations for mental health providers.

Health Professional Shortage Areas (HPSAs) are designated by HRSA as having shortages in primary medical care, dental care, and mental health providers. This may be geographic (a county or service area), demographic (low income population), or institutional (comprehensive health center, federally qualified health center, or other public facility). Medically Underserved Areas/Populations are areas or populations designated by HRSA as having too few primary care providers, high infant mortality, high poverty, and/or high elderly population (Department of Health and Human Services, 2013).

To survive health care reform, there are a number of pathways that may help.

According to Frelick, a Deloitte Center for Health Solutions survey states that 60% of physicians are expressing concern about the future of medicine as they watch their autonomy in their practice shrink along with their income (Frelick, 2013). Nearly all physicians are pessimistic about getting malpractice tort reform passed during the next three to five years. Over half of the physicians surveyed acknowledged that they expect their income to fall during the next three to five years.

To survive health care reform, there are a number of pathways that may help: • Become more knowledgeable about the business side of your practice.

• Find someone who can serve as your mentor; choose someone who is successful financially, ethically, and legally.

• Market to your strengths rather than operating as a general practitioner; your advertisements need to focus on what you do best.

• Consider late night info programming to discuss some of your programs and how they might help those watching.

• Join or form an independent network of providers (IPA).

This type of network focuses on building a program of collaboration with both primary care physicians and physician groups. States are authorized by DHHS and CMS to set up guidelines for ACOs that are similar to IPAs or professional provider associations (PPAs). Seek counsel from an attorney that has experience in creating these types of organizations and who has a success record in getting them approved through the state agency that oversees IPAs, PPAs, and ACOs. Without that approval, HMOs and MCOs, including Medicaid and Medicare, will not have to panel a provider.

One example of this is how the American Mental Health Alliance created what they call the “Collaborating Care” program which includes an IPA. Michaele Dunlap, of the Mentor Research Institute in Portland, Oregon, has offered a definition of Connecting Care.

These organizations have been very active in helping their members to prepare for the health care reform movements in member states.

18 SUMMER 2013

They champion patient’s rights and confidentiality, as well as the professionalism of their members. Their members have a website that elucidates the principle issues of the organization and also presents pictures and information about each member’s practice. The organization is made up of independent mental health care providers primarily in Oregon. Connecting Care’s goals are: • To improve the health of the population • To enhance the patient experience, including quality, access, and reliability • To manage, or contain, the per capita cost of care This model has six primary functions: • A referral system that connects physicians and patients with qualified and appropriate counselors, social workers, and psychologists • Evidence-based measurement of referral effectiveness, including progress and outcomes • Practice management, including billing, electronic health records, and auditing data between physicians and mental health professionals • Clinic and community based screenings • Risk assessment screening that supports public safety • A health education resource that includes written content and videos (Hixson, 2013, pp. 24-25) Other options on revising your practice: • Add coaching to your repertoire of services, which does not require any licensing at this time. Certifications are available, and they often give instruction on how to market, or how to create a website with videos that offer online or telephonic coaching services. These are cash only services.

• Changing from a private practice to working within the VA, or other governmental agency, non-profit, or hospital group are alternatives that many are employing in order to continue using their skills.

• Changing careers is always an option. A popular field is the public health service profession that blends in well with medical or mental health degrees. This field relies on academic qualifications rather than licensing.

• Retirement provides opportunities for other options such as becoming a mentor within the local school district for school counselors, offering continuing training courses in behavioral health issues, or working for a senior group that offers mentoring services to small businesses. These options are often part-time positions so those wanting to spend more time in the garden can enjoy that part of life, too.

A growing field that bears watching is the promotoras program that is seeing success, especially in regions with a severe shortage of mental health providers. Promotoras de Salud is a way to hire non-licensed individuals who have been trained, some certified, as community health workers (CHW). Agencies and some states offer certification. People who serve may begin as volunteers; those with certifications are making $15-$18 an hour offering counseling and guidance to parents and children in their communities. This program started in Mexico, but many countries are showing an interest in trying to meet the need for people who are willing to spend time with individuals and families without the need of a medical physician. Those with more serious mental health issues are normally referred to a licensed professional which, as in Texas, can be over two hours away. According to their website, the Northwww.americanpsychotherapy.com | www.AAIMedicine.com

BUSINESS MATTERS west Georgia Healthcare Partnership, the Promotoras/CHW have some basic goals: • Create a bridge between the community and health system by providing assistance in accessing the health care system, assisting with completion of service applications, and facilitating patient-provider communication • Provide culturally appropriate health education and information by teaching concepts of health promotion, disease prevention, and self-management of chronic diseases • Assist patients in getting the services they need, such as care management, referrals, and follow-up appointments • Provide informal counseling and social support for individuals and also look into forming or leading support groups • Provide advocacy services for individuals to help meet their health care needs and to also advocate for individuals in order to meet their basic health care needs (Northwest Georgia Healthcare Partnership, 2013).

The Promotoras/CHW brings back memory of the Community Action Programs of the 1960s and 1970s.

In conclusion, the Phoenix may rise from the ashes again; however, sitting back and moaning has limited value. We as individuals and professionals, who have had the passion to serve as health providers in our communities for years, now have to find a way to reinvent our strategies, and re-energize into a new presentation of our skills, talents, and values. The future, as we’ve heard before, really is now. Sticking our heads in the ground has a negative effect on our careers as well as our finances. Now is the time to wipe our tears and to count our blessings.

References

April 24, 2013 from http://hpsafind.hrsa.gov/HPSASearch.aspx.

Frelick, M. (2013). Most physicians concerned about future profession. Retrieved on March 29, 2013 from www.medscape.com/viewarticle/781599.

Hixson, R. R. (2004). The business of therapy. The Annals of The American Psychotherapy Association, Summer, 7. Springfield, MO. Hixson, R. R. (2011). In the practice of health care, The search for satisfaction.

ACFEI Media, Springfield, MO. Hixson, R. R. (2013). Endangered private practice: How to survive health care reform. Jason Aronson Publishers, Northvale, New Jersey.

Northwest Georgia Healthcare Partnership (2013). Promotoras de Salud/Community Health Workers. Retrieved on April 24, 2013 from http://www.nghp. org/what-we-do/promotoras-de-salud/.

About the Author Ronald Hixson, PhD, DAPA, BCPC, is a licensed psychotherapist in private practice on the TexasMexico border. His background includes 10 years in the military mental health field (substance abuse, crisis center, community mental health, and teaching), and for the past 23 years, he has worked in an inpatient psychiatric hospital, a biofeedback outpatient clinic, an outpatient group practice, and then in private practice. His graduate degrees are in communication studies, psychology, business management, and health care administration. He has been a regular columnist for Annals, the quarterly journal for the American Psychotherapy Association, for the past seven years. He has served as chairman, Board of Professional Counselors, the Executive Advisory Board for the American Psychotherapy Association and is a board member of the American Mental Health Alliance. He is a trained hypnotherapist and a licensed sex offender treatment provider in Texas.

Department of Health and Human Services (2013). HPSA by State & County.

Health Resources and Services Administration. Washington, D.C. Retrieved

In the Practice of Health Care The Search for Satisfaction

by Ronald Hixson

ISBN-13: 9780983260110

(Paperback)

This book is offered as a work of encouragement as health care providers of all disciplines struggle with the current storms of political and economic unrest.

As psychotherapists, we frequently assist our patients with solving problems. Keeping things in perspective can be a helpful tool.

To order your copy or to find out more information visit:

Only

$14.95 +S&H

www.Amazon.com (800) 592-1125 | (877) 718-3053

800.423.9737 | media@acfei.com

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