Baby, sweet baby, you're my drug
Come on and let me taste your stuff
Baby, sweet baby, bring me your gift
What surprise you gonna hit me with
I am waiting here for more
I am waiting by your door
I am waiting on your back steps
I am waiting in my car
I am waiting at this bar
I am waiting for your essence
Baby, sweet baby, whisper my name
Shoot your love into my vein
What Is Sex Addiction?
In my practice I often get phone calls asking if I treat sex addiction. It is my experience the term means different things to different people. The majority of calls come from men. Often it involves an individual who has had extra martial affairs, is obsessed with internet pornography, put himself in a sexually compromising and/or illegal position, cannot stop sexual urges or fantasies, or suffers from excessive masturbation. All of these behaviors interfere with daily responsibilities and put strain on relationships, resulting in psychological distress to themselves and their families. In some instances, it is the spouse that demands their partner seek profession help or face consequences such as separation or divorce.
The History Of Sex Addiction
Different names have been used to characterize individuals who engage in excessive and at times deviant sexual activities. Labels such as Don Juanism, nymphomania, satyriasis, erotomania, hypersexuality, impulsive disorder, overactive sex drive has been around for along time. The term “sex addiction,“ however, did not arise on the scene until the 1970s. It was originally coined by members of Alcoholics Anonymous who set out to apply their 12 step principles toward sexual recovery. In a similar vein as alcoholics, they identified those who suffered from excessive and disruptive sexual activities as being physiologically dependent. Based upon the AA paradigm, they believed that sex addicts cannot be cured; but rather their disease can only be controlled by complete abstinence. To suppress their sexual dependence, members must acknowledge the disease is greater than themselves, surrender to a higher power, participate in group meetings in order to muster up the collective power to battle the disease one day at a time. With the popularity of the 12 step movement, numerous organizations formed that follow the AA doctrine - - Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addicts Anonymous, Sexual Compulsive Anonymous and Sexual Recovery to name a few.
Is Sex Addiction A True Addiction?
As these organizations expanded and continued to help many people, its fundamental premise has been called into question by many in the mental health communities. Neither the American Psychiatric Association, the American Psychological Association nor the American Medical Association recognize “sex addiction” as a valid diagnosis. According to the American Medical Association, there is no clear evidence that “sex addiction” is a biological disease that leads to physiological dependence and withdrawal. While past editions of the American Diagnostic And Statistical Manual of Mental Disorders had a category called Sexual Disorders Not Otherwise Classified, the latest version does not. After reviewing the empirical evidence, it decided not to include the diagnosis of “hypersexual Disorder” in it’s current manual. Despite its absence, mental health professionals have found the following disregarded criteria for Hypersexual Disorder to be of diagnostic value:
For a period of at least six months:
Compulsion Or Impulse Control?
The World Health Organization’s (WHO) manual does includes the diagnosis “excessive sexual drive.” In their manual, this diagnosis is classified as a compulsive behavior and/or impulse control disorder and not an addiction. There is extensive research that suggests hypersexual disorders are of a psycho-social nature. For example, people who identify themselves as “sex addicts” often come from dysfunctional families and have a history of being abused. One study found that 82 percent of sex addicts reported being sexually abused as children. Sex addicts often describe their parents as rigid, distant, uncaring and critical. Many parents of sex addicts have similar tendencies and were also abused as children. Many of these families, including the addicts themselves, are more likely to be substance abusers.
There continues to be great disparity as to the etiological and diagnostic criteria for hypersexual disorders. Is “sex addiction” a true addiction? Is it an obsessive compulsive disorder, impulse disorder, or perhaps not even a disorder at all? Where the responsibility falls - - the addiction, the learned character traits, or the individual’s bad choices - - has significant repercussions in terms of diagnosis, treatment and how society views and treats these individuals.
The answer to these questions are not so clear cut. Perhaps individuals struggle with sexual dysfunctions for different reasons or a complex array of multiple reasons. Even if the evidence suggests sex addiction is not an addiction, this does not rule out the possibility that physiological factors can still play an important role in its constitution. The existence of a strong correlation between hypersexuality and anxiety and mood disorders has been well documented in the literature. In fact, it has been shown that the same neurological transmitters that are involved in anxiety and depression appear to play a role in obsessive and compulsive behaviors.
Like many obsessions and compulsions - - be it video games, the internet, gambling, sports, the stock market or even watching TV - - sexual compulsions can only provide temporary relief from unwanted emotions. The moment the compulsive activity stops the unwanted thoughts and feelings do return with vengeance. Individuals who identify themselves as “sex addicts” tend to act out to mask or avoid unwanted emotions such as sadness, shame, loneliness, guilt, anger and fear. Many “sex addicts” also suffer from low self-esteem, impaired occupational, educational, social, family or relationship issues.
Empathy, Acceptance And Self-Responsibility
It is important to have empathy for individuals who suffers from hypersexual disorders. One must have an appreciation of the depth of their suffering, conflicts and daily struggles, be it of a physiological, psychological or self-inflicted nature. You must be aware of their personal histories, family dynamics, current stressors, sense of self, and underlying psychiatric issues such as mood, anxiety or character weaknesses.
To overcome hypersexual tendencies, one must accept and take self-responsibility for their own limitations, dysfunctional tendencies and past discretions in order to harness their inner strength and move forward in a productive manner. In addition to the support of family, friends and
organizational groups, having a seasoned clinical psychologist as your guide on this difficult journey is important to the healing process.
Dr. Klein is a clinical psychologist who practices in Westport CT. He specializes in the treatment of sex and porn addictions as well as substance addictions.
The most important men in town would come to fawn on me.
They would ask me to advise them, like Solomon the Wise.
Posing problems that would cross a rabbi's eye!
And it won't make one bit of difference if I answer right or wrong.
When you're rich, they think you really know!
Tevye -- Fiddler on the Roof
Money plays a significant role in how we live our lifes. While money is usually considered an asset, how we relate to money has significant psychological consequences.
The utilization of money as a means to trade goods has been around for thousands of years, be it a shell, a coin, a piece of paper or electronic payment. Money is valuable because we know everyone else will accept it as a form of currency. The coin or piece of paper independent of what it represents, however, is worthless. Money only has value as a symbol of what it signifies -- I.e, an elaborate barter system where you exchange services and goods.
Sometimes symbols can become over ridden with personal meanings. Like many symbols, money can detach from its originally intention and take on a totally different meaning with a life on its own. For example, money can be associated with freedom, power, personal identity, self-worth, or even immortality to name a few.
Money with all its symbolism and psycho-social significance can play a major role in people's life. Money can affect one's mental health, marriage, families, friendships, job, and even political viewpoints. It is no wonder that money is one of the top concerns people have when seeking out psychological services.
I see many individuals in my practice where money has become a symbol attached to one's sense of identity and self-worth. I saw one gentleman who was obsessed with how much he lost in the stock market 17 years ago. It still keeps him up at night. While he does well financially and lives a very comfortable life, he still looks back and beats himself up with "should have could haves" about his past investment strategies. No matter how good a person he is, his identity and self worth is dependent upon what he did with his money many years ago. He still owned this one stock that he lost a lot of money in. Each day he watches the stock market to see if this stock went up or down. If it goes up he feels good about himself, if it goes down, he has a bad week. He has a true case, of what I call "Dow Affective Disorder" -- an emotional roller coaster associated with perceived self worth based upon the paper value of an investment. You often hear that you should not be emotionally attached to investments, but to many, investments are the pillar upon which to value one's sense of worth. Is having a lot of money true wealth if you are still unhappy? Perhaps Benjamin Franklin had they right interpretation for this gentleman: "Wealth is not his that has it, but his that enjoys it."
I once saw a young man in his early thirties who was so successful in his career that he could retire. He did not seem to have much interest in the possessions that money could buy. However, he had no other interests than working and when he was not working he would become overwhelmed with anxiety. It was this anxiety that brought him to see me. Why did he continue to work so hard at making money and why did he get so anxious when he tried to relax? What was he getting out of the work that was so compelling? What he did for a living was about out-smarting others. Making the good deal and beating out his opponent is what made him feel good about himself -- gave him a sense of self worth. As I got to know him better, the connection to his childhood experience with his younger brother became apparent. He and his brother were always in competition, yet no matter how much he achieved, his parents always viewed his brother as being smarter and more successful. When he was winning the deal he felt good, but the moment he was not engaged in the game, he was once again overwhelmed with fears of being a failure.
I often hear stories of aunts or uncles who were thought to be poor, but died with millions of dollars in the bank. Why would a person live like a pauper, live so frugally to the degree of deprivation, yet die with so much money in the bank? What purpose did the money serve? Did it actually give them a sense of security or safety net from the unknown? Did they believe they could take it with them? Ironically, the distant relative that inherits the money often has a different sense of meaning attached to the money. Rather than deprivation for security, they see the money as something for nothing and freedom to spend. To quote Dire Straits: "Oh that ain't workin' that's the way you do it. Get your money for nothin' get your chicks for free."
Money is one of the top issues that comes up in marital therapy as a presenting stressor. What happens when two individuals, raised with very different financial values, become a family? What if he is a believer in saving and she believes in spending? What if one person comes to the marriage with much more money than the other person or has a significantly higher income? While the concept of two individuals become one under the eyes of God makes sense from a spiritual and emotional perspective, the merging of two bank accounts is far more complex and not so easy to work out. When you get married, should you keep separate accounts, have a joint account or have a little of both? How a couples handles their money can say a lot about a relationship. I often see couples in my practice, where one of the partners insists on having a separate account in his or own name. While under the law all wealth is communal, this separate stash gave this person a symbolic sense of control -- "without a separate bank account, I feel like I am vunerable and lose my sense of independence."
In premartial counseling the question of a prenup often comes up. The idea of a prenup by its very nature calls into the question the sancity of marriage. How can two people make a vow to be together forever if they they have a written contract prepared just in case it does not workout? I often hear, "I just don't find the idea of a prenup to be very romantic." Money can become a symbolic wall that protects individual interests yet keeps a wedge between couples.
Money clearly plays a significant role in how we relate to ourselves and others. At times, our real underlying concerns with money has to do with deeper issues such as identity, self-sufficiency, self-esteem, self-worth, freedom, stability, fear of loss, the battle for control and power and how one relates to mortality.
Perhaps there is more to wealth than money and more to money than wealth. Maybe Henry David Thoreau was right when he said: "Wealth is the ability to fully experience life."
Copyright Nov. 2016, Martin Klein, Ph.D.
To many parents a liberal arts education is no longer considered a realistic option for their children. Successful parents want successful children and as such expect them to go to highly competitive schools and study subjects deemed necessary to accelerate economic advancement.
The external pressures to get into a competitive school, however, can be overwhelming to a child. Admission into a “good school” has become harder and more complicated. The world of higher education has changed dramatically over the past decade. Being a good student is no longer enough. In addition to good grades and high test scores, you now need to demonstrate that you participate in sports, extra curricula activities, do volunteer work and have completed several advanced placement courses. Even the college essay has become a monumental task, requiring professional assistance.
In the “old” days students would apply to a handful of schools but now with the advent of the common application, a high school student can now send applications to 900 different colleges with a single click of a mouse. The common application has increased the pool of applicants at each college significantly, resulting is much greater competition.
The college application process has become so complicated that it requires sophisticated strategies and the aid of a dedicated college coach with a specialized software program to develop a personalized strategic plan. Do you apply early decision, early admission, regular admission, how may schools should you apply to, how many safety schools, how many should be reach schools? You can now sit in front of a computer program and see how your child statistically stacks up to past applicants who applied to each respective school based upon grades, test scores etc.
The severity of competition is even more intense for those kids who live in highly educated and affluent areas. It is difficult for a child to stand out from their peers when they live in a town where their cohorts all have grades and test scores two standard deviations above the norm. Being from a northeast suburb can also be a disadvantage when applying to colleges that desire student bodies that are geographically, ethnically and economically diverse.
While many students are academically strong, some lack the emotional aptitude required to handle the intensity of the application process. The pressure from parents, peers and one’s self can be overwhelming to the child. Many kids I see in my practice suffer from low self-esteem. They fear that if they don’t get into a good school they will let down their parent or perhaps be ostracized by their peers. Going to classes each day, while your classmates flaunt their early admission acceptances on Facebook or by wearing collegial emblems on their clothing can bring up feelings of inadequacy.
Overwhelmed by all this pressure, it is understandable why a senior in high school might become overridden with anxiety and exhibit symptoms such as an inability to relax, always feeling on edge, irrational fears of impending doom, restlessness, feeling tense and having difficulty concentrating. Sometimes general anxiety can manifest somatically as stomach pain, panic attacks, muscular tension, headaches or insomnia.
Some kids try to overcome their fears by irrational thoughts or ritualistic behaviors. They become obsessed with the college application process and cannot think of anything else. They cannot control these intrusive thoughts and they find it difficult to relax or even perform chores. In many instances, the child’s academic performance begins to deteriorate due to an inability to focus. Some kids develop compulsive behaviors as a means of avoiding these negative thoughts. They watch television excessively, play endless video games, constantly surfing the internet, spend significant amounts of time on social media, or even watch hours of pornography. Many even turn to alcohol and drugs for temporary relief.
High school students can also be plagued by depression. In children, depression can manifest in many different ways. For example, some kids with depression might feel sad, hopeless, have difficulty concentrating, sleep poorly, have little appetite or an inability to experience pleasure. Others can experience depression in how they interact with others. They can be socially withdrawn, avoid responsibilities, procrastinate, or become emotionally sensitive.
Some kids manifest their depression by exhibiting oppositional behaviors. They can become agitated, aggressive or even antisocial. Kids who have been well behaved can suddenly become deviant. It is common for students to feel embarrassed, ashamed, or over ridden with guilt about failing to live up to expectations. Many kids, as well as their parents, have separation anxiety and get nervous even with the idea of the child going off to college is mentioned.
Many high school students feel alone and isolated in their suffering. They feel like they have no one to turn to who can understand their pain and give unbiased advice. They fear rejection by their parents, teachers and friends.
Kids are often relieved to finally have someone who they can talk to confidentially, in an open manner, without the fear of criticism or judgement. Many can finally admit that the issues that are bothering them have been around for a long time. They can explore their family dynamics in a safe environment and begin work through the age-specific developmental issues of separation and self-identity, which can be overwhelming and confusing to a child at this age.
Who are they? What do they they want to be when they grow up? How do they get their needs met? How do they become that person they want to be? What is the path they should pursue that will make them happy? And most importantly, what college do they want to go to and what subjects should they study?
Surprisingly some kids feel a sense of relief when they discover they will be going to one of their safety schools. Safety, especially to a child, is not always a bad thing, and often times a welcomed surprise.
Dr. Martin Klein Is a clinical psychologist who practices in Westport CT. He specializes in working with high school students who struggle with issues of anxiety, stress, depression, low self-esteem and addictions. He works closely with students and their families who are going through the college application process.
Major Depressive Disorder (MDD)
Major depression is a disabling condition that can last for long periods of time. Without treatment, a major depressive episode can last months, years and even a lifetime. While the condition can worsen during the holiday season or winter months, it is most often triggered by a personal loss or negative situational event. MDD can run in families. In many cases, the mood disorder can be biologically or socially based or a combination of both. How one was raised as a child is an important contributing factor in MDD. Individuals who suffer from dysthymia, a low-grade continuous depression, are most vulnerable to bouts of major depressive episodes.
People who have never experienced major depression might not understand the depth or severity of the syndrome. There can be nothing more frustrating to a depressed person than someone telling them they should just “snap out of it,” “you have no reason to be unhappy,” or “you just need to pull yourself up with your own boot straps.” Major depression is not something that tends to go away on its own without professional intervention.
When you are clinically depressed you can feel totally helpless and have little hope that you will ever feel better. You tend to forget what it feels like not to be depressed. If someone tries to remind you of past times when you were happy, you quickly view their opinions as ill informed and agitating. You feel depressed and exhausted all the time. Your mind is occupied with negative obsessions, self-deprecating thoughts, and low self-esteem.
There is a melancholia to your mood. You might feel sad, overwhelmed and psychologically paralyzed. You might feel that your life has no purpose or meaning. You have a hard time falling asleep and if you do fall asleep you tend to wake in the middle of the night worried and frightened . You cannot shut off your mind. You thoughts are racing with irrational fears and anxiety provoking self doubts. When you are depressed you can become easily agitated and angry. Even the smallest gesture by another person can be misinterpreted and set off a tirade. Some people become so frustrated that their anger rises to the level of rage, whereby they become capable when provoked of doing bodily harm to themselves or others.
Depression can cause difficulties in focusing and concentration as well as deficits in abstract reasoning and memory. Being productive at school, work or at home can be difficult, if not impossible. In severe cases, a person might not have enough energy to get out of bed, care about their appearance or perform basic activities of daily living. Suicidal thoughts or actual attempts are not out of the question.
If you or someone you know suffers from clinical depression, it is important that seek professional help as soon as possible. Clinical psychologist are trained in the diagnosis and treatment of mood disorders. Depression is treatable. Utilizing a combination of cognitive behavioral therapy (CBT), insight oriented psychotherapy and sometimes medication, the clinical psychologist can come up with an action plan to alleviate your symptoms and make changes to how you think, behave, relate to others, and experience yourself and the world around you.
Dr. Martin Klein is a clinical psychologist who specializes in the treatment of depression. He has offices in Westport and Branford CT.
A man says to his wife:
"Listen honey, whoever dies first,
I want to make sure it is okay that I remarry."
Jerry Seinfield on Choosing a Psychotherapist
Bob Newhart on Brief Focused Cognitive Behavioral Therapy
Woody Allen on Long Term Psychoanalysis
Kelsey Grammer (Frasier) on Hypnosis
Ray Ramano on Martial and Family Issues
Robin Williams on Alcohol Dependence
Jackie Mason on Self-Identity and Psychiatry
Stephen Wright on Early Childhood Memories
Jim Parsons (Sheldon) on Facing Your Fears
Bill Murray on Hypochondriasis
Richard Lewis on Psychotherapy and Termination
A psychiatric diagnosis is a cluster of psychological and behavioral conditions as defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Over the years, there has been numerous revisions of this manual. With each revision, there tends to be significant changes to the different menus of diagnoses and how each diagnosis is defined. For example, in the most current manual the diagnosis of "Asperger's disorder" has been removed and is now considered as a part of the class of "Autistic Spectrum disorders." In one of the earliest manuals there was diagnoses termed "Neurotic disorder." The term " neurosis" is no longer considered a proper diagnostic disorder and it has been eliminated from the manual.
So what happens to an individual who has a diagnosis that the American Psychiatric Association decides no longer should exist? What happens to the child I work with who has been labelled "Aspergers" for the past several years and now has a new diagnosis? What about poor Woody Allen? If he can no longer be considered a "Neurotic" can he still make movies?
As several of the great existential thinkers have pointed out, psychiatric diagnoses are not objective disorders, but rather are social constructs that change over time (i.e., Szasz, Lang, Foucault).
When I worked in a psychiatric hospital 25 years ago, the most popular diagnosis was "Schizoaffective Disorder." What did that diagnosis mean? Basically the person was having problems with his or her thought process (schizo) and well as his or her mood (affective). I remember doing an inpatient group with 10 individuals, all diagnosed with "Schizoffective Disorder". All of the people in group did have something in common -- they were not thinking clearly and had mood issues. However, the similarities stopped there. Each person was unique. Each had a different reason for being in the hospital as well as different backgrounds and issues. In fact, at the time, I remember thinking to myself, I would not be thinking clearly or be in a very good mood if I was hospitalized in a psychiatric hospital against my will either.
Today the new popular diagnosis is "Bipolar." Almost everyone coming out of a psychiatric hospital comes out with a diagnosis of "Bipolar." If you are not thinking clearly or having mood issue you are now identified with this now popular disorder. The other widely popular modern day diagnosis is "Attention Deficit Disorder (ADHD)". So many kids these days are being put on speed to improve their attention. Does speed improve one's attention, most definitely. Should all children who have focusing issue be diagnosed with "ADHD" and put on speed? I personally feel it is a significant social problem.
Psychiatric diagnoses are clusters of symptoms. They change over time dependent upon what is popular in the current culture; and more specifically the psychiatric community. Diagnoses are tools people in the field of mental health use to describe a cluster of symptoms and behaviors. There are many theories as to what causes a person to be and act a certain way, but these theories also change over time and are historically dependent on the culture and trends in the psychiatric field.
So what is my point? You should not define yourself by your psychiatric diagnosis. Diagnoses are helpful in understanding psychological symptoms and patterns of behavior. They can be a great tool for the clinician or the psychiatrist in determining the best treatment or medication. A person diagnosed as "Bipolar" is an individual who is possibly struggling with his or thought process or mood. Therapy and medication can help. However, having these cluster of symptoms, thought or behavioral patterns, do not define who you are as an individual with unique personal issues and struggles.
Dr. Klein is a clinical psychologist who practices in Westport CT. He specializes in psychiatric assessment and psychological treatment from a humanistic existential orientation.
Copyright April 2016, Martin Klein, Ph.D.
I often see patients who want to know why they do certain activities that on the surface do not seem to make sense. From a practical perspective, these odd behaviors seem out of character or of a compulsive nature. "I cannot stop doing the action, even though it seems irrational and a waste of time."
In the therapeutic process, the reasons whey we do certain things or act out in a particular fashion is not always transparent and may take awhile to figure out. It is a wonderful part of the psychology process -- an "aha moment" -- when the person and his or her psychologist discovers the meaning of an action.
Many people want a quick fix -- they want the negative behavior or the painful symptom to go away quickly and effortlessly. In some cases this makes sense. But sometimes, it does not. To use an analogy, does it make sense to turn off the fire alarm while there still is a fire burning or a lack of understanding as to the cause of the fire?
I once had a patient with a unique presenting problem. For dinner he would eat the same thing every night -- steak, string beans and creamy mashed potatoes. He would eat the steak first, then the string beans and then finally the creamy mashed potatoes. He would always save the creamy mashed potatoes for last, it was his favorite. However, each night, by the time he finished the steak and string beans, the creamy mashed potatoes were cold. That is right, his presenting problem was cold creamy mashed potatoes. Now if I was a "practical type of psychotherapist", the fix would be easy -- after you finish the steak and string beans, stick the creamy mash potatoes in the microwave and warm them up. But to follow-up with my fire analogy, it is my view that such an action would be like shutting off the fire alarm and not dealing with the real burning issue. For this gentleman, this compulsive pattern was symbolic of a greater issue that in fact affected the very core of how he lived his life. I would call it the "you cannot win syndrome." In his life, he felt like he works very hard, but the reward that he expects for his hard work never comes or when it does finally come, it is cold lumpy and does not taste good. The creamy mash potatoes was symbolic of personal freedom -- the "easy life" -- the effortless melting in your mouth -- an experience this person never seemed to get to.
As many of the great existential thinkers have taught us, human beings are symbolic creatures and think, act and behave with in the realm of the symbolic (Freud, Jung, Eliade, Ricouer). Many of our activities have deep symbolic significance. While these symbolic actions resonates with our sense of well being, their meanings tend to stay hidden.
The most obviously place where the symbolic realm can be most seen is in the world of games. What is the attraction of tennis? Is tennis a working through of some deeper issue? I often talk about tennis when I am doing marital therapy. Isn't tennis a game about relationships -- who is left with the ball in their court --who is at fault? -- are we equally at fault? -- ah then we have "love."
Why do we love to watch football so much -- the great American obsession? What is the symbolic meaning of the game? What is the goal of football, if not to get the ball, which is shaped like a egg -- the symbol of perfection -- to the goal post without it falling and cracking. Why do they pile on the player who is already down with the ball? Why is it so important to make sure the other team does not get back up?
Why are our kids so addicted to video games? Are the themes of these games resonating with our children's needs or desires on a symbolic level? In 1980s, when I was working as a school psychologist, I was fascinated with adolescents' obsession with "Pac-Man." This was before computers, and kids would spend endless hours after school at the arcades. In 1984, I published an article entitled "The Bite of Pac-man" where I explored the symbolic allure of the game. Why did the theme of the "Pac-Man"game resonate so much with adolescents? As I discussed in the article " The themes and strategies of the game perfectly accommodate the adolescent's relation to the world. The Pac-man creature, which the player controls and symbolically becomes, is all mouth and is referred to as "Jaws." "Jaws" spends his time and energy running from the engulfing monsters. There are four different types of monsters, each with its own personality: "Shadow" always follows you; "Bashful" will run away when you turn around; "Ambition" is always willing to attack you; and "Speedy" is fast and will run over you.... If the player engulfs enough monsters before they engulf him, he becomes a winner." While the game of "Pac-Man" might be a safe place to work out issues of separation and individuation, it is still a game -- a feel good fantasy -- not an achievement of personal maturity and a true reflection of one's ability to survive in the world.
What are some of the symbolic things you do or participate in as you live your life? Do you have activities or compulsions that you are addicted to and are not sure why?
Symbolism and everyday actions, it is something to think about.
Dr. Klein is a clinical psychologist who practices in Westport CT. He specializes in life transitions, relationship issues, identity, personal growth and self understanding. He is trained in both clinical psychology and existential philosophy.
The Affordable Care Act, more commonly known as Obamacare, is a perverse twist on the Robin Hood tale. Rather than steal from the rich, Obamacare has taken from the middle class.
Prior to ACA, the self-employed middle class had many options for comprehensive insurance. They were largely able to afford their premiums and deductibles, and out of pocket costs were manageable. Most importantly, they were free to choose their own doctors and hospitals from a nationwide provider network.
To use my family as an example, four years ago I had a PPO plan that cost around $16,000 a year and had a maximum out of pocket expense of $2,500. The plan offered a national network and I was able to go to any doctor or hospital. Today you cannot buy such a plan at any price. The option that comes closest to the plan we had is a “Gold” HMO policy, with a premium of around $44,000 with a $9,600 out-of-pocket maximum. For the middle class, such a policy is financially prohibitive.
Over the past four years, medical costs for the self-employed have gone up over 300 percent and the coverage of the plans has deteriorated. For a middle class family of four, making around $98,000 there are no subsidies. You have two options — buy what amounts to an expensive catastrophic policy with constricted benefits, or pay the tax penalty, be uninsured, and hope for the best. And while many middle class families — whether they qualify for subsidies or not — may be able to afford their premiums, they may not be able to afford their deductibles. How many of us can afford to pay a $13,500 bill that comes in the mail? In effect, they will be able to afford their policies but be unable to utilize them.
On the individual market, there are only two insurance companies to choose from — Anthem or Connecticare. Connecticare’s rates are slightly less expensive. But for the most part, the plans are similar.
There are only two places where you can buy insurance — on the exchange or off the exchange. The exchange plans tend to be significantly cheaper than the off-exchange plans. For example, a Connecticare plan is about 35 to 40 percent cheaper on the exchange than on off the exchange.
From a cost perspective, the exchange plans make the most sense. However, from a network perspective, the plans on the exchanges are extremely limited in terms of the size and scope of their networks.
On the exchange, the provider network is restricted to the state of Connecticut, and even then many of the best doctors and hospital programs in the state are not on the panels.
While many of the exchange plans offer out-of-network coverage, this benefit has even higher deductibles, and poor reimbursement rates – often less than half of the customary rate. So if you choose to go to an out-of-network provider, your out-of-pocket costs can be through the roof.
In terms of coverage, the off-exchange plans are better, but not much better. Off the exchange, your network will be larger and you will have a better chance of finding a provider you like or one that is taking new patients. Some plans even let you see providers in some of the surrounding areas beyond the borders of Connecticut. However, even if you go with an off-exchange plan, the networks are still limited and are not national in scope. They do not compare to an employer-sponsored policy.
Once you’ve decided whether you want to buy a plan on or off the exchange, the next decision, is the type of plan — a high deductible or low deductible plan.
There are three sets of numbers you have to look at to compare plans: premiums; deductibles; and maximum out-of-pocket costs. For the most part, it all boils down to a simple equation: the higher the premium, the less the out-of-pocket expense; the lower the premium, the more the out-of-pocket cost.
From a financial perspective, I believe it makes sense to go with the lowest premiums and the highest out-of-pocket cost. If you have few health care needs during the contract year, you will have to spend little out of pocket towards your deductible. So whether you pay the actual amount of your deductible is not necessarily a given.
If you are fortunate and do not meet your $13,500 deductible, you end up saving money with the lower premium plans (lower premiums in my family’s case is $28,500 a year, with a $13,200 out of pocket maximum). I think you have nothing to lose by taking the lower premium plan, and much to save. But some people, from a psychological perspective, prefer to pay higher premiums and then not have to worry about having to pay for services rendered.
But whichever route you go, maximum out-of-pocket costs, (premiums, deductible, out-of-pocket max) for all the plans ends up being about the same.
In summary, if you are OK with only going to a Connecticut hospital, and most of your doctors are on the exchange network, the exchange plan makes sense. If you might want to go to a New York City hospital, there is a strong possibility that there can be a significant out-of-pocket expense. If you want to go to a provider or facility in Ohio or California, this is no longer possible, no matter which plan you choose, except in the case of emergencies.
For the behavioral healthcare provider, the ACA has been problematic as well. While they have raised premiums, they have not raised what they pay providers in over a decade. In some cases, they have actually decreased their allowable rates by over 50 percent. Member cost have gone up over 300 percent, provider reimbursements have stagnated or have gone down – yet the stocks of these managed care companies have gone up over 400 percent in the past four years. No surprise there.
At risk of being labeled the “L” word, I believe that everyone — middle class included — should be entitled to good health coverage.
Martin H. Klein, Ph.D. is a licensed clinical psychologist practicing in Westport and Fairfield CT.
This article was originally published in the CTMirror. Click below to see link to original article
Seasonal Affective Disorder (SAD) is a type of depression that is related to the changes in the season. Symptoms typically start out mild in the fall and gradually become more severe as the winter approaches. This syndrome is often referred to as the "winter blues” because it is triggered by the lack of day light and the cold weather. Like other forms of depression, people who have SAD can be overwhelmed with feelings of guilt, anxiety and despair. They can feel like the energy in their body has been zapped resulting in sluggishness, poor concentration and little motivation to do activities that they once found to be pleasurable. Due to intrusive negative thoughts, they can easily become agitated. This high degree of irritability can make it hard to fall asleep and stay asleep, resulting in exhaustion and mood swings. One's appetite is often affected and accompanied by either weight gain or loss. Many people who have SAD suffer from low self-esteem.
Some of the factors that seem to play a role in the onset of SAD is a change in circadian rhythms. The research suggests the reduction in sunlight disrupts the body's internal clock and throws off one's sense of well-being. Not having enough sunlight can also cause of drop in serotonin, a neurotransmitter, that when lowered results in mood changes associated with depression and anxiety. The change in seasons can also disrupt the body's level of melatonin. Melatonin plays an important role in sleep patterns, affect and energy level.
There are several treatment options for individuals who suffer from Seasonal Affective Disorder. It is important to discuss your symptoms with your primary care physician (PCP) to rule out the possibility of other medical conditions that can cause mood changes. If your PCP does diagnose you with SAD, he will most likely refer you to a clinical psychologist for psychotherapy to learn strategies to identify and change negative thoughts and behaviors as well as learn relaxation techniques to reduce stress, bodily tension, and elevate one's mood.
Light Therapy, also called phototherapy is often utilized to treat SAD. Utilizing a special light box, a person sits in front of this special bright light for an hour each morning. The light therapy mimics the natural light that occurs in the spring and summer months and affects a change in the brain's chemicals linked to moods. Light therapy typically begins working within a few weeks and there are few negative side affects.
Some people benefit from medications. Wellbutrin is an anti-depressant that is often used to treat severe cases of SAD. The medication can be taken during the SAD season, from late fall until the end of winter each year. Exercise, meditation and stress management tools can also be helpful to reduce SAD symptoms.
Dr. Martin Klein is a clinical psychologist who specializes in Seasonal Affective Disorder. He has offices in Westport and Branford CT.
What is Hypnosis?
When you hear about hypnosis, often you might think of an ominous figure waving a pocket watch back and forth or a stage hypnotist making people do things against their free will. While these images may be popular on TV or in the movies, the type of hypnosis I am going to discuss is not used for dastardly deeds or entertainment purpose. I promise none of my patients are turned into zombies, bark like a dog or cluck like a chicken after I hypnotize them.
Hypnosis is a deep relaxed state where you become open to intense focus, heightened imagination and suggestion. This hyper-attentive state is called a “trance.”
Counter to what many people assume, you do not lose your free will or ability to be in control of you own wits when you are in a trance. In a trance you are fully conscious and alert. You are not asleep, but rather you are intensely focused on the subject at hand. When you are in a trance, you feel uninhibited, relaxed and tune out the worries, doubts and self–conscious thoughts that restrict your ability to be attentive and focused.
Most people have experienced a trance like state. Milton Erickson, a world renowned hypnotist of the 20 century, contended that most people walk around in a trance on a daily basis. Have you ever spaced out in your car and miss your exit, day dreamed during a lecture, became so absorbed in a book or video game that you do not hear someone calling your name? Perhaps we spend more time in a trance than we would like to admit.
When done properly, hypnosis can be a helpful intervention used as part of the psychotherapeutic process. Hypnosis can be combined with psychotherapy to treat an array of psychological issues related to trauma, anxiety, stress, addictions, pain and eating.
The History of Hypnosis
Hypnosis is not a new procedure in the world of mental health. The medical community began using hypnosis to treat psychological conditions over two hundred years ago. In the 18th century an Austrian physician, named Franz Mesmer, was the first person to utilize hypnosis to treat both medical and psychological aliments. His name is still synonymous with hypnosis. A person in a trance is sometimes referred to as being “mesmerized. ”
In the 19th century, hypnosis was being used by the psychiatric community to treat psychosomatic related illness. Sigmund Freud was one of the first physicians to use hypnosis to treat patients who suffered from psychological conditions due to repressed memories. By using hypnosis, Dr. Freud was able to reduce the patient’s high level of anxiety so she could unblock and work through the past trauma that was causing her symptoms.
How Does Hypnosis Affect You Physiologically?
Most scientists today believe that hypnosis subdues the conscious mind so that it takes a less active role in your thought process. By calming your conscious mind, the psychologist can have greater access to your subconscious thoughts and be attuned to your deeper thoughts and emotions that affect who you are and how you think and feel. It can bring up past memories and experiences that you have either repressed because they were too painful or anxiety provoking.
There is ample evidence in the literature that hypnosis does in fact make significant physiological changes to one’s body and state of mind. Like many forms of deep relaxation, research has shown that hypnosis lowers heart rate and slow down respiration.
Utilizing electroencephalographs (EEG), researchers have demonstrated when in a trance there is a boost in the lower waves associated with sleep and dreaming and a decrease in the higher frequency waves associated with full wakefulness.
In addition, neurologists studying the cerebral cortex have demonstrated that hypnotized patients show a decrease in left hemisphere activities and an increase in right hemisphere activities. The left hemisphere controls logical and deductive reasoning and the right hemisphere controls the creative and imagination functions of the cerebral cortex.
Can I Be Hypnotized?
The literature suggests that 75 to 80 percent of the general population can be hypnotized. In my own practice, I have found most people are able to hypnotized, if they are opened to the process and do in fact want to be helped by the intervention. Motivation is an important factor in determining whether hypnosis will work.
Unlike a fixed gaze induction -- the method you often see on TV -- in my Westport, CT office I do a progressive relaxation and imagery induction that gradually relaxes the patient, keeps their conscious controlling mind busy, so he or she can relax into the trance in a non-defensive manner. The progressive relaxation and imagery method works well with individuals who are anxious, and have a hard time shutting off their minds or fear losing control. It works like the magician who has the audience focus on what they are doing with their right hand to distract them from the actual trick being done with their left hand. It is my experience that even people who find it impossible to meditate are able to relax with hypnosis because their active mind are being occupied by the continuous verbal cuing of the hypnotist.
In order to achieve a decrease in symptoms or a reduction in bad habits, I utilize a combination of hypnosis and behavior modification. Like cognitive behavioral therapy (CBT), the patient learns techniques to reprogram negative thoughts and behaviors while in a trance. For example, the cigarette will taste bitter or take 3 sips of cold water and you will not feel anxious when you cross the bridge.
Will Hypnosis Help Me?
Prior to utilizing hypnosis, it is important for the clinician to do a comprehensive psychiatric assessment to determine if the person has the mental stability and ego strength to undergo such a procedure. Hypnosis is not for everybody. Hypnosis is not for individuals who suffer from severe thought or mood disorders. If a person is not psychologically stable, hypnosis, like many forms of deep relaxation, can have negative consequences, and lead to psychotic breaks or mood instability.
Hypnosis can be an excellent tool used as part of the psychotherapeutic process. I find it particularly helpful for individuals who suffer from anxiety. Many primary care physicians and psychiatrists refer their patients to me after all else have failed. Their patients tried all different types of psychotherapy and medications, but they are still anxious. In addition to general anxiety, panic attacks, phobias, obsessions and compulsions, hypnosis is an excellent tool in working with people who suffer from Post-Traumatic stress Disorder (PTSD). Hypnosis allows the psychologist to work on the traumatic issues in a safe and contained manner. By limiting the trauma work to the hypnotic session, the individuals gets to work through the trauma, while still being able to function normally when not in the doctor’s office.
How Long Does Hypnosis Take to Work?
I can often tell if a person will benefit from hypnosis in a couple of sessions. If the suggestions work, you should have results right away. However, hypnosis is an accumulative process and often takes numerous sessions to have a long term affect. Hypnosis alone cannot stop an addiction, eliminate an irrational fear, or modify how one thinks or behaves. Change takes insight and cognitive and behavior modification. In many cases hypnosis works best in conjunction with insight psychotherapy, cognitive behavioral therapy (CBT) and/or medication management. When it comes to anxiety, learning how to relax one’s body is essential. I often tell my patients how important it is to do both aerobic exercises as well as yoga or stretching to loosen bodily tension. As part of hypnotic exercise, I relax each part of the patient’s body and can see first-hand where they hold tension in their bodies. An important component of hypnosis is self-hypnosis; learning exercises to do at home on a daily basis in order to achieve behavior modification, symptom relief and significant reduction in daily stress.
Dr. Martin Klein is a clinical psychologist who practices in Westport and Fairfield CT. He works with children, adults and couples.