Managed Care: Path to Professional Disillusionment Dr. Barbara Becker Holstein

Posted on January 12, 2010
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Those of us who became clinicians 15, 20, 25 and 30 years ago did so because we had a mission. Each in his or her own fashion had a reason for becoming a clinician that tapped into a need to be of service to humanity, dedicated to utilizing skills that stressed talking and listening as an art/science. We served internships, wrote dissertations and gladly entered what we saw as a “healing” profession. In fact, we achieved what I refer to as The Enchanted Self (i.e. achieving positive states of being that are a reflection of each person’s uniqueness).

Each was able to utilize the uniqueness of one’s personal history, and talents, serving the public in a meaningful and skilled manner. As private as the treatment room had been, most can look back on those early years as years of collegial support and understanding. Whether one became an ego-psychologist, a behaviorist, or a family therapist, etc., each of us knew the mentoring, and the success that went with each discipline. We were able to achieve some form of enchantment within the treatment room, offering our clients the best of ourselves, psychologically supported by our colleagues and society at large. We were confident to encourage our clients to stay for the appropriate length of treatment, comfortable making clinical judgments, and enthused about learning new techniques and clinical skills. We offset our sleepless nights, our anxieties around difficult clients, with elation and moments of pure joy, as we saw clients grow and heal.

Those days seem long gone. Now we are in an era of disenchantment. By that I mean, we suffer the emotional and financial devastation of Managed Care. Whether a clinician chooses to practice within Managed Care or not, he or she is not protected from disenchantment. Disenchantment is all around. The public does not respect or understand the art/science of psychotherapy as they used to. Nor are the younger clinicians trained and mentored professionally to the standards that we took for granted. Clients come into psychotherapy, often with lowered expectations as to what therapy is, motivated primarily by their pocketbook or their Managed Care’s pocketbook. They expect cures within 4, 6 or 8 sessions. After all, that is what their plan offers. They are led to believe that a few sessions are an adequate number of contact hours with a therapist. They expect miracles while no longer having a cursory understanding of what talking therapy is all about. They, like most of America, want a quick fix, and they want it now!

As we find ourselves as “mental health providers” in a state of disenchantment, how can we utilize what we know about human potential to offset our own emotional and spiritual malaise? We know from the study of human potential that optimism and hope are extremely important factors in staying well both physically and emotionally.

How can we hold on to these capacities within ourselves? How can we at the same time fight Managed Care? In my book, The Enchanted Self, A Positive Therapy, I discuss how important our own histories are. Each of us has accumulated many memories. Our memory banks are unique to ourselves and hold within them, the potential for hope and optimism. Let me explain.

Only you can review your life’s history. Rather than looking for dysfunctional aspects of your past, search out and discover moments when you displayed talents, strengths and/or wonderful coping skills. Only you can review your life, discovering and recognizing the moments when you were filled with the potential for growth and success even if you were stymied. Now is a golden opportunity to look through your past and recognize these wondrous moments. Perhaps as a child you excelled at chess or playing tennis. Perhaps you were the child that brought home and nurtured abandoned birds and animals. Perhaps you longed to study the piano but there was no money and you could not take lessons. Yet even now you may remember the longing you had to play, or, perhaps to fend off feelings of anxiety in a quarreling family, you developed marvelous organizational skills. Were you the adolescent that displayed leadership skills, becoming president of the junior high school student council? Or were you the child that loved to dance or write poetry or just sit and daydream? You, who have guided so many others in finding their paths, can take the time to review your own history to find what is most positive about yourself.

Once you have begun to review and itemize your talents, strengths, coping skills, and potential, you are well on your way to bringing enchantment back into your life. Even during these dark days of Managed Care you can utilize your own enchantment in several fashions. You may discover in reviewing your past that you have much more potential to help in the fight for Managed Care then you thought was possible. Directing yourself to be a clearer and stronger warrior in the battle will in and of itself decrease anxiety and lessen the likelihood of depression. We all know that from what we advise our clients.

If a review of your past makes clear that you are not cleared to be a warrior in this battle, you can still access long forgotten talents and pleasures which can make your life more fulfilling. Perhaps it is time to take up tennis again. After all, you may have a few more open hours. Perhaps it is time to join a writer’s group or offer volunteer services on the local first aid squad. Perhaps it is time to finally make those plans for a walking or biking tour next summer and use extra hours to strengthen those old leg muscles. In reviewing your talents you may discover new avenues to provide mental health services to your local community.

Remember, whatever way you go you will find yourself most successful if you are utilizing your own specific talents, and coping skills. You will soon find that you are able to expand your horizons and have a more positive sense of yourself. You will be back on the road to enchantment.

Dr. Barbara Becker Holstein, Positive Psychologist Presents her paper, WRITING FOR PSYCHOLOGY, CASE BOOK, FICTION, WHAT’S NEXT? at Norwalk Community College.

Posted on July 29, 2009
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I uploaded a very short video in which I discuss some of the core concepts of The Enchanted Self. The video excerpt is part of a lecture that took place at Norwalk Community College, November 2008 at the annual Writer’s Conference. The full title of my presentation was: Writing for Psychology, Case Book, Fiction, What’s Next? To read a summary of my talk, which appeared as an article in the APA journal for Division 42, Independent Practice. To watch the video go to: The Enchanted Self

Dr. Barbara Becker Holstein, Positive Psychologist, Begins Her Adventure of Enchanted Self Clothing for Women and Girls.

Posted on July 17, 2009
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We need to live our lives, not just pass through. Yesterday I went to NYC with two girlfriends. We went to a fabric store with fabrics from around the world. I just soaked in the colors and textures and I was like a kid at her first circus. My mind was full of sunlight and energy from the colors and the feel of the materials. Do you know that I’m starting an Enchanted Self clothing line? I’m not sure how it will actualize. Right now I am just on the adventure and enjoying every moment. I want women and girls to have the courage to wear more fun and colorful garments! There just isn’t enough fun stuff in the stores. From what I see, the Tweens have the most choice of color and cute styles. As you get to the bigger sizes designed for us ‘Women’ the styles become bland and the colors less beautiful. What do you think?

Of course, I bought a piece of material yesterday. It is a light turquoise and it is wonderful. It will make a perfect summer shift for us ‘women’. I’ll be working on the design! Yes, let’s have fun and be delicious not matter what our size and/or age. Let’s not just wait until we are 80 and dare to wear purple!


Posted on June 3, 2009
Filed Under A Positive Therapy, Happiness, The Enchanted Self | 1 Comment

We may be in a wonderful mood only to enter the workplace or home and be met by a scowl, a frown, or negative remark from a coworker or family member. How quickly one’s positive state of well being can dissipate. For example, if I walk into the house in a good mood and my mother, or my wife, or my husband, immediately barrages me with a list of things that I didn’t take care of, or criticizes me for chores I didn’t accomplish to their satisfaction, I will find the experience a clear interruption of my positive state of being. However, if someone were to gently say, “Can you give me a few minutes? I want to go over some of the chores we had agreed to split,” or “I want to check with you as to what has been done or what has not been done,” then I may be able to maintain not only my state of well being, but be in a good enough mood to help improve the other person.

A speaker once compared giving constructive criticism to that of a sandwich. The first slice of bread is telling the person something honest and positive about that person. The filling consists of gently leading into a suggestion or sharing ones’ feelings about how something is being done. The second slice of bread again finishes with positive reaction or remark to that person. How desperately most of us need to practice the art of positive criticism.

The Wise Older Woman

Posted on April 29, 2009
Filed Under Happiness, Positive psychology for women, The Enchanted Self | 1 Comment

Recently, I attended a beautiful wedding. A young Jewish couple came together in joy and the room was filled with happiness. Outside of the banquet room I noticed a group of older women sitting near the door collecting charity. They all looked very pure and plain at the same time, young seniors and older seniors, nothing fancy about them. Their hips were full. They were wearing comfortable walking shoes and somewhat frumpy looking clothing. There wore either wigs or kerchiefs. They had a sweetness that if I were a child again, I would have felt delighted to have come home to milk and cookies with any of them. I ended up giving a dollar to just about each woman, in fact two dollars to the woman who actually changed a twenty for me so I could give out my money.

Later on in the evening, I went back out where they were, when nothing much was happening in the social hall. I was looking to have a bit of conversation with one of the ladies. I think I felt a need to be connected to their warmth. I certainly couldn’t ask for milk and cookies, but I could talk!

The woman I started to talk to was well up in years. She had beautiful, lively eyes-eyes that could have gone with a twenty year old or even an infant, they were so bright and full of life. Her skin was beautiful. Her body and her face showed age, but no where near the age that she apparently is. She told me that she came to this country 65 years ago with three children and then went on to have seven more. That means that she is about 90. She didn’t look a day past 75!

She told me that she comes out to all the weddings to collect charity. She’s very proud of the fact that last year she collected $30,000 for poor, sick people in Israel and brides who needed money for their wedding expenses. She told me that she doesn’t keep a dime for herself and that her daughter who lives in Israel helps to disburse the money.

By her intensity, I could see that she took her job extremely seriously and with utter devotion. She told me a few other things about herself. Her husband is no longer alive. She receives Social Security. Of her ten children, nine are living; one daughter was lost at 41-I don’t know to what illness. She is very proud that a number of her children are Rabbis, teachers and school principals in the Jewish educational world. That’s about the extent of the details.

She opened a window to me. I never really knew nor had I ever really talked to any of these women that are always at weddings of this type, asking for money. I guess, like we often do with people we don’t know, I basically dismissed them almost as non-entities even though I always gave at least a few dollars.

Talking to this woman of course made her so alive and real to me as she obviously was for 90 years before I knew her! I was impressed with her generosity of spirit, her sincerity and her utter devotion to her cause. She was passionately committed to her cause. She refreshed me with her energy and focus.

She is a woman, of course, who has known so many people and seen so many things! Having nine living children, she probably has 80 grandchildren. Her world is rich with people, children and grandchildren and probably great grandchildren to love. A private life, her name even if I shared it with you, would not ring a bell. Her charitable work is not a registered charity. She doesn’t go on TV with commercial pitches. She just comes to one wedding after another, sits out in the hallways, puts a little sign asking for money for the poor, ill and brides, in a dish and collects. Then she ships the money to Israel and starts all over again. There’s no middle management. There are no commissions to pay. There are no cuts. It’s just dollar bills transforming lives.

It’s simple. It’s without layers. It certainly is the antithesis, the absolute opposite of the concept of managed care where one hand doesn’t wash the other-where one hand watches the other and takes a cut until there is less and less left.

Yes, as a positive psychologist and a woman, talking to her was for me, really the best part of my week! She uplifted me and reminded me small is not less!

I hope you enjoyed my little story. Remember, the Seventh Gateway to ENCHANTMENT is Positive Action-Good Deeds! I hope this wonderful wise woman helps all of us have the courage for lots of good deeds this holiday season!

Spring Into Enchantment

Posted on April 21, 2009
Filed Under Positive psychology for women, The Enchanted Self | 1 Comment

Who can control a smile sneaking across your face as you go outside on a beautiful spring day, suddenly finding your nostrils filled with a sweet aroma of fresh blooms, while feeling warm breezes against your skin, whispering, “No coat today.”? Nature provides enchantment all around us in the spring. The birds sing, the flowers bloom, animals have their babies, new birds learn to fly. If you look high up in a tree you might see an exquisite bird singing loudly, full of life. It is as if nature gives humans an opportunity for enchantment all around. Yet, we often are indifferent, not responding spontaneously to the rebirth of spring. We seem to be, at times, equipped to live lives of misery brought on by ourselves. Many of us are able to generate a bad mood, put ourselves down, see our future as dark or today as gloomy. We have lost or never had the easy comfort and capacity to relax and enjoy life that a cat has on a sunny porch just snoozing and rolling over. We humans have to work at enchantment. Let s take a moment and look at what the major components of this work called “enchantment” are.

To experience what we call THE ENCHANTED SELF, that is positive states of mind and body again and again, a person must be able to develop three capacities. The first is the ability to successfully meet one s needs. This can be challenging when we find ourselves committed or obligated to be elsewhere or doing other things. There is a saying, “If you can t go to the mountain than bring the mountain to you.” You may yearn to be outdoors playing sports or gardening but find yourself stuck indoors at home or at work. Opening the windows to let fresh air in, displaying a vase of colorful flowers on a table are some of the ways that can enable you to experience a spring day.

What s important is that you recognize what you need and then act upon it. This may mean verbalizing what you want to others or just giving yourself permission to take the time to do something that adds enjoyment to your life.

The second capacity we need to develop is having a positive appreciation of yourself, so that you see yourself as worthy of experiencing enchanted times. This means recognizing your personal value. Your children and/or husband, wife, boss, significant others are all important and should be treated with care and respect, but they are not more important than you. You are unique, with talents, coping skills and potential. You have the right to balance your life so that your needs can be taken into consideration. This self value is another building block of enchantment.

The last component is recognizing what really does give you pleasure. You may love walking on the beach, your bare feet touching the sand, still cool in the spring. You may enjoy going to a local county park when temperatures start rising. Someone else may prefer to engage in a more active social life in the spring and perhaps does not care about being outdoors. The spring may stimulate a yearning to have friends visit, or go to the local fine restaurants and experience different types of foods Enchantment requires a self knowledge that only each person must know for himself or herself.

And don t forget your memory banks, your wonderful treasure chests. As you begin to spring into enchantment,

it is in these memory chests that you will recognize your special interests and preferences. Your positive memories can help you frame out what you would like to do this season.

Here is an exercise to get you started:

Close your eyes and let your mind wander back to something that you loved to do as a child in the spring. Did you like to climb trees? Did you like to ride a bike? Go fishing? Run? Catch lightning bugs at night? Think about the way your body felt as you did this activity. Did you feel excited? Did you feel particularly alive and alert? Did you feel relaxed? Think about how you felt when the activity was over. Were you exhausted? Were you revitalized? Were you hungry? Now list some of the skills that were necessary to perform that activity. For example, if you used to love to climb trees, some of the skills might have been agility or arm strength to lift yourself onto branches. Another skill was probably good balance. Do you still have these skills? If so, what would you like to try at this stage of your life that might let you get back in touch with the physical pleasures that you were so naturally in touch with as a child? Perhaps dancing or lifting weights or rock climbing? Whatever your physical pleasure may have been, lift it out, dust it off, and use it. And most important, enjoy!

If you do not have these skills, what are some alternatives? Perhaps rather than tree climbing you could stretch in all directions, lying on a mat or on a soft carpet. This will require much less in the way of balance or risk-taking. Perhaps you would enjoy a risk-taking adventure via a book, movie or a computer game. Reinvention of yourself in order to experience pleasure is a never ending pursuit.

How do we finally begin to generate a world of enchantment? It is very simple. If you are leading an enchanted life you will quickly see that you send out positive energies and positive messages. Before you know it, there is a mutuality of shared enchantment going on. Laughter is infectious, good moods are catching, and like the birds singing, all of these happy reflections of harmony are resonated again and again as they move out in ever expanding circles. We hope you will take some time to spring into enchantment and to let yourself move from feeling enchanted to being truly enchanting.

We all need to take Vacations, at least vacations of the Mind!

Posted on January 11, 2009
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Recently, in a women’s therapy group that I run, the desire for fun and a change of pace over took me. I suggested that we deviate from some of our typical work and instead go around the room imagining a vacation treat designed to suit each woman’s desires.

It was fascinating to see how many marvelous vacation ideas quickly emerged. One woman wished to go to Mexico and South America to view the ruins and lie on the sun in beautiful beaches. Another woman wished to go to Greece and see the ancient ruins there and then slowly make her way through Europe. This could take a leisurely period of time, perhaps even a year. Another also wanted to go to Europe but to do other things, such as take gourmet cooking classes in the South of France and become somewhat fluent in several languages. Another woman opted for spas and other experiences to bring vitality to her body and ultimately her spirit. One person was in reality making plans to go to several meditative retreats over the next few months.

I was fascinated as each woman spoke and realized two things. First, I would have been a happy companion on any of the presented vacations. Each one sounded fulfilling, energizing and provided a change that would be good for me, as well as the person who thought of it.

Secondly, I realized how much each woman, no matter what her background or problems, yearned for change, adventure, getting to know strangers and other places, no matter how burdened by daily problems of relationships, children, money, employment.