Seven Types of Boundaries*
*According to Positive Psychology
We talk about boundaries all the time. In fact, I’m tired of using this word. If feels like it’s overused, yet somehow still misunderstood. I recently stumbled across the graphic from Positive Psychology on the 7 Types of Boundaries and just became completely enamored. Similar to the “types of wellness” and using those images or models to understand what can be missing and need nurturing in someone’s life, this boundaries graphic breaks better understanding of boundaries based on themes. Let’s dive in.
Time – How much time you spend with someone or doing something. Example: “I can only stay for 30 minutes.”
Mental – Freedom to have your own thoughts, values, and opinions. Example: “I respect your perspective although I do not agree.”
Emotional – How emotionally available you are to others. Example: “As much as I want to support you right now, I do not have the emotional capacity.”
Material – Monetary decisions, giving or lending to others. Example: “I already lent you money last week, so not again right now.”
Internal – Self-regulation, energy expended on self vs. others. Example: “I have been social all week, I need the weekend to myself.”
Conversational – Topics that you do and do not feel comfortable discussing. Example: “I would rather not be a part of this conversation.”
Physical – Privacy, personal space, your body. Example: “I prefer not to hug people I do not know.”
Although I’ve very vocal about saying how I’m not a Coach, I do think the information about understanding boundaries can be beneficial for all parents – regardless of if you’re working with a Coach or Consultant. Learning to understand types of boundaries may help with people understanding boundaries in general. Parents have so much more control than sometimes they realize, and often they give their power to their children without realizing it. It’s time to take back that power by learning to say no to better protect and preserve yourself.
For questions or comments contact Joanna.
Healthy Boundaries
It might be easier to understand what makes a boundary “healthy,” if we start by sharing some ways that boundaries can be “unhealthy,” or as I was describe – in effective. A very simple unhealthy boundary would be expecting other to know what you want or need. Unless you’re communicating it, no one can read your mind. Another very common unhealthy boundary is saying “yes” even when you don’t want to do something. Whether it’s because you don’t have the time or interest, it doesn’t matter. If you said yes and you wanted to say “no,” you’ll regret that unhealthy boundary of agreeing to do something you didn’t want to do. When there is chaos within a home, another common unhealthy boundary is when a person stuffs their feelings “to keep the peace.” By stuffing your feelings, you are setting yourself up to explode (or implode) at some point down the line. Feelings need to expressed, not stuffed. I could probably rattle off a lot more, but let’s not focus on the negative.
Below are some very common “healthy” boundaries. If you are a parent and learning about boundaries like taking water from a firehose, take a minute to read these, and then let them sink in.
Asking for what you need from those around you. Self-awareness, and self-advocacy.
Being comfortable saying “no.” This includes for anything - money, resources, your time, etc.
Making choices based on your values and beliefs. And if you don’t know these, take some time to sit down and identify what your values and beliefs are so you can ensure the choices you make are in alignment.
Feeling safe and valid when expressing your emotions. Learn to listen and not defend. The same goes for those people around you. If they can’t actively listen and acknowledge your emotions, you won’t feel safe to express them.
Feeling that you matter. Acknowledgement and validation.
Knowing your happiness is your responsibility and yours only. No one can make you feel anything.
Knowing that you’re not responsible for someone else’s happiness. Again, only they are responsible for how they feel. This is not your responsibility.
Being comfortable disagreeing. The world needs healthy discord. You don’t always have to go along with others. Stay firmly in what you believe, think, feel and if it’s a “agree to disagree”-type situation, that’s okay!
Acknowledging what you’re feeling. It’s time to learn to pay attention to what your body is telling you. Are you feeling tense? Are you feeling stressed? Are you feeling euphoric? Educate yourself on feelings other than happy, sad, and mad.
Being comfortable changing your mind. This is also allowed. Your decisions don’t have to be finite. Your values and beliefs can change. Be okay with indecision or changing your decisions. Don’t let fear paralyze you into not being able to shift when necessary. But also, this decision for change needs to be yours, not someone else pressuring you. That’s when we talk about “caving” into pressure.
When you learn to do some of the above, you will start to feel whatever weight is weighing you down start to lift. You’ll start to feel more confident in your stance. You’ll start to really learn about what matters to you, and how to protect that. Life isn’t about making others happy. If that’s your focus, you’ll go to sleep exhausted and defeated every. single. day. Take care of yourself. Healthy boundaries is a good way to start doing that.
For questions or comments contact Joanna.
Treatment Drift
As a consultant, this is sometimes the hardest thing to deal with once a young adult enrolls in their treatment program. Although I do my best trying to make sure that I frontload all the “what to expects” to parents, and do the same for the program with my experiences with the young adult and family - sometimes we get pulled in a different direction once the treatment process has started. This is what I refer to as going “off course.”
Let’s stick with this obnoxious navigating metaphor sequence, shall we? When I am making recommendations for treatment for the young adult and family, we are all on the same (map) page and understand the course for treatment. We see the horizon line off the distance, and understand we will have to weather some storms along the way, but for today - the seas may seem calm. There is hope in getting to the final destination. When I have a young adult that is all-in and doing the work and making changes, sometimes that’s when I start to see the parents struggle. Change is hard, right? We want it, until we feel how it impacts us and then we sometimes respond in sabotaging ways that cause “treatment drift.”
This article isn’t meant to be a vague story of navigating the treatment journey, but rather being very specific to what “treatment drift” can sometimes look like. Mind you, this typically starts to rear it’s ugly head about 2-3 months into the treatment journey. The young adult is “in it” and the parents really start to question everything. Their alignment with the treatment teams wains and then they start to demand more from the team. This, in turn, takes the team away from directly working with the young adult and instead takes a massive amount of energy and effort to help to get the parents “back on course.” Here are some very common examples I get from parents, that individually are never an issue, but when lumped together become a growing program. I get some serious push-back from parents in trusting a program and wanting to continue to pay for treatment when they start to collectively notice and make note of some of the following:
Staff traveling for personal or professional reasons. You need to anticipate this happening at least once while your child is in their care. It has nothing to do with your child, and it’s not going to negatively impact your child’s treatment journey either. You want these staff to have personal breaks to ensure they’re mentally well themselves. You always want them traveling for trainings or conferences because you want them to have their own continued education.
Sometimes things come up (like in a mental health treatment facility, this happens often!), so staff might need to ask to reschedule their calls with you. It’s not meant to be an inconvenience to you. Most parents I work with love consistency and keeping a standing weekly call. Just know sometimes, this might have to be shifted.
Accidents or inconveniences happen, and it’s never meant to be intentional (unless the program tells you otherwise and it was a therapeutic litmus test). Example: Your child is supposed to go to the grocery store, but because there were too many people who needed to go - there wasn’t space in the van for your child. They weren’t able to go to the grocery store until later that day.
Programs do get new staff, and sometimes staff leave (or get fired). Sometimes parents are alerted of this information, but most of the time they aren’t. It’s not important to be informed of this information unless it was a tragic situation, or impacted your child. These are reasons to be informed. This is a program’s worst fear to have your child impacted by traumatic staffing changes. If you don’t hear about it, you can assume it’s not important enough for you to know about.
If your child somehow communicates with you outside of the typical staff channels (i.e. letter writing through the therapist), you need to tell the staff. If you don’t, you’re keeping a secret. It’s not about protecting your child. It’s about protecting the quality of the treatment program and ensuring that there are no dangerous situations between clients that are being created without staff being aware. If someone is motivated to get connected to their parents outside of the typical lines of communication, they will make it happen. It’s just important that parents relay any communication then to the program.
Young adults will walk away from a program - whether it’s drug-seeking or needing to go to a hospital. You cannot assume that just because you found an amazing program that the participants there aren’t struggling with their substance use and mental health. I’m always stunned when parents say “how could the staff just let them walk out?!” Well, as you can imagine someone who is motivated and in active addiction - they will do what they need to go to feed that addiction. No program is locked (unless it’s a locked psychiatric hospital), so a young adult can walk at any point. Be understanding to the fact that other participants in the program won’t have a linear treatment process, just like your child probably won’t either. The important piece to this is “if they walk out, do they then walk back to the program?'“ If yes, that’s progress.
Just because you pay for treatment for a loved one does not make you are a staff member. You are not involved in all the nuances of running a program. If a program doesn’t give parents a daily or weekly schedule, it’s most-likely because they are trying to help you individuate and not hyper-focus on your own child’s schedule while in treatment. Take care of yourself, and that involves not being in-the-know of where you child is on an hourly basis. You don’t need to know where they are at all times while they’re in treatment. You know they are there, unless the program tells you otherwise. There’s nothing worse than a parent that demands to be in-the-know because they’re paying for treatment. Be mindful that this level of demand will warrant a reconsideration of your child being in their treatment program.
There are probably a lot more prime examples I could write, but the above are the most common that come top-of-mind. When you start to ask more questions, second guessing the treatment program and consider pulling your young adult out of treatment early, a program will not be able to make strides with your child. Without realizing it, you have become the identified priority family member needing treatment - not your young adult. And to really seal the deal, if you do pull them before the average length of treatment stay, you can bet that your child will not have made the significant improvements you were hoping to see. That’s the fastest way to be resentful for paying for treatment where you don’t see the long-term benefits of that investment. Not ideal.
And lastly, I’ll reiterate that a program ultimately has the say in the end if you, as the parent, are demanding more time of their staff than the young adult. When those scales are tipped, then sometimes the program needs to make an executive decision to discharge your family. Note that it doesn’t say discharge the young adult because they know that they can still work with them, but the parents have created the drift from the original treatment plan. When the parents become too much, a program can set sail without you. Don’t let yourself - your anxiety mostly - get in the way of your loved ones treatment.
For questions or comments contact Joanna.
Wow, Cool, Bummer, Ouch!
Memorize this. You’ll want to remember it and have it at-the-ready when the time comes. It’s not a matter of it, but when. I take no credit for this either, as a therapist once shared this with me and I was so smitten by the simplicity, I knew I had to write about it one day.
Parents are often reaching out to me for coaching. I try to do my best to not get pulled into the parent coaching role. Yes, I want to be approachable and help parents, but there’s also a line drawn in the sand of what is the role of the “consultant” and what is better served for a specific professional (read: parent coach) who can help guide the parents more clearly and effectively with proactive ways to communicate with a loved one. If you’re the type of parent that’s hellbent on not working with a parent coach, but you are still wanting guidance on how to prepare for communicating with your loved one when they step-down into a transitional program, then you need to familiarize yourself with these four words.
These are the only responses you’re allowed to make. Why? Because if you jump into solution-focused mode, problem-solving, or soothing for your loved one, then you have immediately brought yourself back to parenting a child, rather than you become a partner in their young adult journey.
When your young adult calls you, I always tell parents to think first: “are they asking for comfort or solutions?” Most of the time, it’s comfort. If it’s solutions when the young adult has been conditioned to know their parents will take care of every problem of theirs. So instead of diving into problem solving again, consider using one of the words in this title.
“Wow! That sounds amazing.” Period. Allow a pregnant pause of your young adult to elaborate.
“Cool! What will you do next?” Ask an open-ended question, but one that doesn’t drive the conversation in a specific direction. Let your young adult lead.
“Bummer! What are you going to do about it?” Remember – you want to put your young adult in the driver seat. You’re not solving this for them, but you can ask them how they plan to solve it for themselves.
“Ouch! That’s painful.” This one is often the hardest. You want to relieve any discomfort for your child. You need to allow them to experience their own discomfort and work through it. Otherwise, how will they ever survive when you’re gone? Seriously.
It’s easy to go back into a “fix-it” type routine, or worse, to ask questions to get to the content of what your child is telling you, rather than paying attention to the storyteller. Emotions matter. Connection matters. Active listening is the most important piece to that. It’s time for you to learn to just listen.
Let this be the beginning of your journey in switching the way you communicate with your young adult. And if the above turns out to be a heck of a lot harder than you anticipated, or you don’t understand the “why” behind doing this, then I’d encourage you to hire a parent coach for support.
For questions or comments contact Joanna.
College is a Full-Time Job
This was my absolute favorite activity to discuss when I worked in higher education. When students would come into my office ambivalent about getting help, yet admitting they did need to change something, I would capitalize on blowing their mind with one tip. I talked about treating college like a full-time job to better help them understand what they needing to be doing to ensure they “didn’t get fired.” Let’s break this down.
Full-time jobs are often far more than 40 hours/week nowadays, but for the sake of this exercise, we’re saying a full-time job is 40 hours.
If the student is taking 15 college credits in the semester, that means they are typically in class (physically) for 15 hours; whether online or in-person. We all know that college classes require coursework outside of the classroom. There are equations out there getting to the number of hours of outside coursework required, but I think my example is the most simplistic.
40 – 15 = 25
That means that a student needs to plan in their weekly schedule to have 25 hours outside of their actual in-class time to be reading, studying, doing projects ahead of time, etc. Most of the college students I worked when I showed them this would immediately lose the color in their faces. I’d ask them to talk to me about how many hours outside of the class they were dedicating to studying. Most of them would say between 5-10 hours (at most!). Brace yourself for the question I would follow-up in asking these students.
“So, if you’re in college to earn a degree to then get a full-time job in your field, you want to treat school like it’s your current employer. You’re telling me that between in-class time and the time you spend doing work outside of class is only a total of 20 to 25 hours/week. If the university if your employer and they hired you to work 40 hours but you’re only working 20-25, what do you think your employer will do?”
Every single student had a lightbulb go off. “They’re going to fire me.” Read this as “they will put me on academic probation and then I’ll be kicked out.” The instantaneous comprehension of what the student needs to do to not “get fired,” clicks. There is no way they can forget to do the work needed or forget the amount of time they need to be putting in to treat school like a full-time job. Once they here this number, you just can’t forget it.
If a student ends up on academic probation even after having this information, then there needs to be a different conversation altogether. Specifically about whether or not being in college makes sense if they aren’t taking it seriously or aren’t putting in the effort needed to be successful (academically). This tip is helpful for all college students, no matter the semester.
For questions or comments contact Joanna.
The Value of a Therapeutic Consultant
When parents are navigating finding therapeutic resources for their offspring, it can often be a lonely road to walk down. That is, until you find other parents that are in a similar situation. Relief! Parent communities and support networks really can make or break a parent feeling isolated and unsupported in an emotionally charged time. Those connections sometimes lead to recommendations for therapeutic consultants or programs, but no single situation or treatment path is the same. When parents are referred to a therapeutic consultant, they often ask the question “what is a therapeutic consultant?,” followed by “what is the value of a therapeutic consultant?” I get asked this often and in the moment, it’s sometimes difficult to answer succinctly. Every family’s situation is different and how they see value in something is also individualized. Below you will find the top talking points that highlight the value of hiring a therapeutic consultant.
1. Therapeutic Consultant is not emotionally attached to your child.
Recommendations are made solely around therapeutic expertise and intimate knowledge and matchmaking of the program and people. Unlike a parent who may be worried about what they think will make the child happy/less mad - the Therapeutic Consultant is thinking about what is best for that young person and their family.
2. Therapeutic Consultants can be your “consumer advocate.”
When plans change, and they often do, the Therapeutic Consultant can quickly shift gears to seek out appropriate resources for your child. This allows you to focus on your own emotional needs as well as the situation at-hand with your child, knowing that you have a professional hustling behind the scenes for you.
3. Therapeutic Consultant is not in the trenches of the crisis with your child.
Therapeutic Consultants are informed of day-to-day chaos and struggles that you and your child are experiencing - but we’re not in the thick of it with you. We have the ability to gather information and continue to hold a 10,000-foot view to ensure we have clear vision around where you and your child are heading. This also allows us to have "brain-space" to make decisions free of the distraction of your child and anything else happening in your life.
4. Therapeutic Consultants have insider knowledge that parents won’t have.
Truth is, Therapeutic Consultants have insider knowledge parents will just not have immediate access to. That includes knowing about ownership changes, staff changes, or deaths. Therapeutic Consultants also subscribe to the philosophy of “what worked for Billy is not guaranteed to work for Johnny.” Not that it’s not a great program, just that milieu’s shift. It may just not be the right time. And there is not one standard program and staff for all people who are dealing with mental health or substance abuse disorder.
5. Therapeutic Consultants help with your investments.
Treatment is one of, if not the most important investment(s) you'll ever make as a parent with a child who needs help. You want to make sure it's a fully researched and vetted investment, and Therapeutic Consultants can help you assess that. Think of it this way: you wouldn't invest $50k+ on a retirement home for your parent based on the website and Google reviews. Or atleast I hope you wouldn’t!
6. Therapeutic Consultants’ expertise is knowledge of treatment programs.
This is not your area of expertise, no matter how smart, educated and intelligent you are. I often tell parents that they are certainly capable of researching and interviewing programs, but at the end of this day - this is my job. Why not bring on an expert in that space to help you?
Therapeutic Consultants themselves are an investment to bring into the fold. Just like programs, not all Therapeutic Consultants are the same. You will want to interview them to find out who is the expert in specifically finding the mental health or substance abuse resources for your child.
For questions or comments contact Joanna.
Things to Know Before Speaking with a Consultant
When asked by parents what the value-add is of a consultant, unless you do understand some of the nuts and bolts of what a consultant does/doesn’t do, then that’s hard to briefly answer. Our job is not to convince you to hire us. If you are finding yourself overwhelmed and in need of a guide through the treatment process, that is part of our value-add. Before being able to formulate and understand that fully, here are other things that are important to know.
Independent consultants are paid by the families, not by programs.
Insurance companies do not pay for our services. In the one instance that insurance does cover our fee, it’s because the consultant you’re working with is a Licensed Clinical Professional in the same state as you, and they are providing insurance codes for “Case Management.” This will only cover hourly support and not a full consulting fee. Programs who pay referents for patients are unethical. This is called patient brokering, and/or fee-splitting. Any consultant who says they are free to hire for families, it’s because the programs they refer to are paying their wages. Be mindful to only hire someone who identifies as independent. Some consultants require payment in full before services begin. Some do payment plans. Some will have specific payment methods. Just know that it’s the parent who is hiring the Consultant.
2. Consulting fees are not covered by insurance.
Insurance companies are medically-minded. That’s why you may see resistance to coverage for many mental-health-only treatments. Insurance companies will not validate that our services need to be covered by insurance. The same goes for EAP providers. They will only cover licensed mental health providers or certified life coaches that are pre-approved. If you have a Health Savings Account (HSA) you can use that to cover a consulting fee. If you don’t have an HSA, then you can keep the bill for the consulting service and share it with your CPA for your tax return.
3. Consultants do not “just” provide names of programs.
Working with a consultant is so much more than just getting a list of program names. In fact, giving names of programs without all information and assessing the situation of a client runs the risk of recommending inappropriate treatment recommendations. When a parent pushes to just get names of programs, it begs the question that they may not understand that timing can be everything. Just because a program was good for one client, doesn’t mean that the milieu has shifted significantly and may no longer be a fit. There’s a lot that goes into identifying what’s an appropriate recommendation at the exact time that treatment is being sought out.
4. If you are looking for in-network treatment options only, then you may not want to consider working with a consultant.
Consultants are constantly on the road touring programs. We do tour in-network and out-of-network programs. If a parent is only available to consider in-network treatment programs, then the best course of action is to pull a list of programs through your insurance portal. From there, parents need to pay attention to fit, clinical match, milieu, and any shifts in ownership to just name a few factors to consider. It is often when parents have accessed programs through their insurance and not had success that their scope of what they’re willing to support programmatically can expand to include resources that only consultants may know of. Sometimes consultants will work with parents on an hourly basis to review their in-network options. Be mindful that often consultants do not prefer to work hourly, so their hourly rate will represent their time and limitation to this level of service.
5. No consultant is alike.
We are all trained and certified differently. We all have different employment and life experiences. We all came into being a consultant through our own, unique path. We have expertise in who we work well with, and who we don’t. We have different consulting fees and timelines. We have different processes for how quickly we can onboard a client, or how quickly we can find program recommendations. We don’t always have space on our caseload. Some consultants work alone, and some work in a large practice. Some are a part of some national organizations, and some are unaffiliated by choice. Similar to finding appropriate treatment, it’s important to understand that you will want to explore different consultants to know who you will work well with.
The value-add sometimes is not tangible or understood right out of the gate, but it’s when you’re in the thick of looking for treatment options and needing support while navigating a rather messy healthcare system that their value is priceless.
For questions or comments contact Joanna.
Collegiate Athletes and Mental Health
Depending on the young adult, the sport, and the reason for treatment, where they go and what happens next really matters. Will they be returning to their home institution and team? What is their eligibility within the NCAA? How long will they be away, and will the program have discretion when it comes to clients? In the age of Name, Image, and Likeness (NIL) it’s even more important now that our student athletes get the correct care.
Googling “college student treatment program” is dangerous. What will you find? Hopefully this article, honestly. Mainly because it’s meant to educate you to not get sucked into the hidden search engine optimization (SEO) marketing that some treatment programs lean on for enrollment. Be wary. Those programs may say they work with college student athletes, and they might. But are they the best fit for your young adult? There’s a strong possibility it’s not a match.
Here's things you want to think about:
Have there ever been complaints for breach of confidentiality in the past? Famous people do go to treatment too. I would want to know if this program’s reputation is that they truly keep the anonymity of their patients are the forefront.
Is the program more young-adult-only focused? If not, I’d consider looking at a program that has a cohort of 18-30-ish year olds only. Why? Because the treatment focus will most likely include family therapy, and they will have familiarity in helping young adults who are college interrupted.
What types of physical activity is included in the program? If they say they go to the gym in town one a week, this would be a concern. Some programs are experiential and/or adventure-based so there will already be a lot of physical activity. For a more brick & mortar-type treatment program, you would want to ideally have a gym within the facility. It gets a gold-star if they have a personal trainer to individualize for each client too.
Ask them for a parent reference. Most programs will accommodate this. If they say they can’t, I’d be hesitant to continue pursuing the enrollment process. You want full transparency. That needs to come from other parents. Additionally, if the young adult also wants to speak with a current or former client who is also a student athlete, I’d request that as well. Student-to-student they get a real sense of what to expect and if the program truly is helping.
Who on their staff will collaborate with the coach and/or student-athlete academic services department. If they’ve never done that before or are scrambling to answer because they don’t have a dedicated person to do this, I’d read into that that they aren’t familiar with NCAA eligibility after all.
We often hear about professional athletes who go to treatment for mental health or substance abuse, but we rarely read about student college athletes who are taking a break to get help during their college years. Not that I want to change that narrative to make it more public, yet I do want to make sure that student athletes understand that it’s okay to get help. I also want them to know that they will want to find an independent consultant to help them navigate finding the right treatment program, rather than just going with what they find online or what someone may have mentioned in passing about being a good program. Treat getting mental health care like you did the college admission and athletics process – with time, intention, assessment, information gathering, and tours.
For questions or comments contact Joanna.
When to return to college after a Leave of Absence
The age-old question of whether the young adult is ready to return to campus after taking a leave of absence is hard to assess. The question is are they ready to return? Did they do the work they needed on themselves to get stronger to return? Are they returning too quickly? Is returning to the same institution the best idea? There’s a lot of ambiguity and there is no right or wrong answer. There is a way to simply assess readiness to return though.
First, I ask the question: Has the student really committed to wellness and building resiliency?
These are two key components to a young adult being successful outside of the classroom on a college campus. There’s even more pressure for this if they attempted college previously and it didn’t work out. Taking that break is key for them to focus on their wellness and resiliency. Then how do you gauge this?
I ask these three questions:
1. Who did they connect with to help with wellness and building resiliency?
This encompasses sleep hygiene, healthy eating, seeing a therapist, balance in stress load, doing things they enjoy, taking initiative to reflect on their previous academic experience to have insight and accountability of what skills they need to be able to return to do well the next time.
2. Did they attempt to take a class or two while connected to the people helping them build resiliency?
There is no way to assess is a student is ready to be a student if they didn’t take at least one college class while they were simultaneously focusing on their wellness and building resiliency. Being a student will continue to establish routine and focus on academic maintenance skills – but this time with the foundation of wraparound supports to do school differently.
3. Are they going about this alone?
If they’re isolated during this process, that will carry over to their on-campus life. They won’t have adults and peers to give feedback and help them build good habits during this time away. We need them to lean on their community during the time away from school to then build up their strength to find their community when they return to campus. Not having a sense of connection – even just one person – on a college campus is often a leading cause to a student feeling disconnected. That disconnected can lead to homesickness, depression, and disengagement.
When leaving a college campus, a young adult can be filled with shame, regret, fear, and embarrassment. If they aren’t with the right supports immediately after leaving campus, they will certainly associate those feelings with their time at that institution. Chances of them returning is unlikely even if they build resilience and focus on their wellbeing. They’re more likely to start fresh at another school. Having a clean slate without the time to focus on habit changes, wellbeing, and the resiliency needed to be a college student will literally create the same outcome, just at another institution. Be very wary in jumping ship without taking a break to focus on their needs is what will only reinforce the feelings of shame, regret, fear, and embarrassment. Let’s avoid doing that again if we can.
For questions or comments contact Joanna.
Fee-Splitting
When it comes to hiring someone to help provide services or navigate finding appropriate services, it’s hard to trust if you aren’t certain of the intentions of each provider. In seeking out help, you are in a very vulnerable and overwhelming situation. Sometimes, families blindly trust a provider and can only hope they aren’t being led astray. This is place of vulnerability inclusive of both Medical Providers and Mental Health providers. Behind the scenes you never know who is truly being honest about where they’re getting paid. Not sure what I’m referring to? It’s called fee-splitting.
Recently, I was asked by a therapy practice if I did fee-splitting with referrals. The casual nature of the question caught me off guard. I thought I’d always made it abundantly clear that I have integrity in being objective in making referrals for the clients I work with. I emphasize that I am an independent consultant, but apparently I need to emphasize that more. Any time I a tour a program or meet with a referral, I often say “I may refer to you next week, in two years, or maybe never at all,” because I want to ensure clear expectations that just because I’ve seen their program or met with their team doesn’t mean I have a client to refer. Apparently I didn’t have this business (and personal) value on display in flashing neon lights like I’d thought. So, I’m out to change that.
Fee splitting is defined as payment by a specialist to a third-party who referred a patient to that specialist. An example of this in the role of a Therapeutic Consultant would be if I referred a young adult client of mine to a specific therapist or program, and then that therapist or program paid me as a way of saying thanks for that referral. To be clear, this exchange has never, and will never, happen. I do get asked by parents often if I receive payment from programs, and I appreciate it when that question is asked. My answer is always, and will always be, “no.”
Here’s where it gets murky. According to the American Counseling Association, it’s not that fee-splitting isn’t legal, it’s just unethical. So technically, if you are hiring a specialist to work with, there is a possibility that behind the scenes there is fee-splitting. Same goes for the American Medical Association. It’s not illegal for a doctor to fee-split, yet if their licensing board finds out they risk losing their membership within AMA and their ability to practice medicine. When you see the money you can make this way, some providers are willing to risk it. I’m not one of those people.
I’m not licensed as a clinician. I’ve also said this before, but I’ve been certified as a Nationally Certified Counselor since 2013. I abide by the NBCC Code of Ethics, and in an effort to ensure I continue to remain objective for the clients I serve, I do not allow myself to be persuaded to refer a client to a program or professional because they are waiving the fee-splitting carrot. To those providers, I say “goodbye.”
For questions or comments contact Joanna.
Hatching Turtles
If you’ve ever seen baby turtles hatching and their pilgrimage to the ocean it’s a highly protected experience. Highly guarded. Not all of them will make it, but they each must try – as unassisted as possible. What you’ll hear from those volunteers who spend countless hours watching the eggs until they hatch is that when they are making their way to the ocean, although they may struggle, you must let them try. The only time you intervene to redirect them is when they are headed in the complete opposite direction of the ocean. You even watch them to see if they can figure that out on their own. Only if it becomes obvious that they might die without support do you pick them up and redirect them towards the sea.
Why would I share this? It goes together with the discomfort and direction that parents are experiencing nowadays with their young adults. I’ve witnessed more parents picking up their child to redirect them or get them “to the sea sooner” than ever before. This certainly eases the anxiety of the parent to ensure their child makes it, but, parents have stripped them from that experience to fight through to make it to the sea. It’s called failure deprivation. To build their strength, to dig deep, to believe that they can do it, to carry on even when they’re exhausted and want to give up. See the analogy now?
Parents – your job to help prepare them for the road (or in this case, preparing them for the trek across the sand), ends here. We’ve got to learn to let our young adults make it to the sea on their own. Yes, this absolutely will include you grimacing watching their struggle. But it’s through the struggle that they build that resiliency which will help them throughout the rest of their life. Resiliency is the only way someone won’t give up on themselves, and on life. Our young adults need this more than ever now.
For questions or comments contact Joanna.
Paying for Treatment with Insurance
It’s more and more common for families to wrap up an inquiry call with the question about my knowledge of what programs are in-network (INN) with their insurance, or what will be covered by insurance in-general. It’s in that moment that I usually hang my head. There’s so much to explain about this process, the conversation itself can take a minimum of 30 minutes just to go over the language, let alone understand policy details. To help families understand some level of what this all means, I figured it was time to write it down. Time to share in layman’s’ terms.
If you are looking for programs that are in-network with your insurance because that’s all your can afford, then you need to do these two things.
Understand your insurance policy to know whether or not you’ve met your deductible. If not, you’ll be paying until you hit that, and then insurance will cover (and only then, it will depend on your policy if it’s 100% coverage)
You probably won’t be hiring a consultant. Our job is not to know what programs are in-network with every insurance policy. In fact, that changes so much that it’s impossible to track. The fastest and cheapest route to know what’s in-network is to login to your insurance portal and search for levels of care that are included in your policy. Anticipate that this will be a fast experience through a treatment continuum, and try not to be stunned if they discharge your child out of treatment long before you think they’re ready to be back at home.
The best way to describe what to expect in-network vs. out-of-network is with this quote:
“Clinicians make suggestions, but Insurance makes decisions.”
Insurance companies treat treatment like it’s meant to be a quick fix. We all know, healing takes time.
Programs that will offer to bill out-of-network (OON) benefits are wanting to make treatment accessible to families (as much as possible, depending on your OON benefits), yet refuse to allow the insurance companies to dictate treatment timeline. This is the best option that families who are looking to use their insurance can seek out.
Private pay treatment facilities are often providing superbills with codes for families to immediately submit for reimbursement after their loved one has been discharged from a program. There’s never a guarantee of anything being reimbursed, yet you’d get 100% of $0 if you didn’t try to get reimbursed. There are companies that exist out there specifically to help with insurance advocacy so the families don’t have to spend time fighting their insurance.
The most important piece in all of this though is that to try not to jump into anything unless you’ve gotten a verification of benefits. You need to know if there are exclusions for levels of care or specific types of treatment experiences. You also need to know if there is a pre-authorization requirement within a certain time of enrollment, otherwise insurance will immediately refuse coverage.
The scariest thing of all would be enrolling in a program that guarantees your insurance will cover a specific amount of time for treatment (ie certain number of days, or specific levels of care, etc.). That is never true. Nothing with insurance is guaranteed. And if insurance immediately stops paying, will you then be stuck with a $2,000/day private pay bill for a insurance-driven program? This is every family’s nightmare. What a crappy spot to be in for any family!
Be informed before you make a decision based on insurance. Especially if you are in a place of urgency or emergency, still do your due diligence to make sure you don’t get stuck with a large sum of money owed because you thought your insurance provider would cover treatment.
For questions or comments contact Joanna.
Returning to College after a Hospitalization
While a young adult is in a hospital detoxing near their college campus, the last thing on anyone’s mind is when they can return to school. And yes, when parents are inquiring about treatment programs, often they are asking about discharge timeline to ensure their kid will be back on campus before the start of the next semester. Let’s pause right there.
Your kid is detoxing in a hospital. You’re inquiring about treatment programs, and potentially, selecting the program based on whether they’ll accommodate you in letting your kid return to college before next term. Let that sink in again.
If your kid is hospitalized, college is not something that needs to be discussed right now. Period. Your kids’ health and wellbeing, however, is way more important in this exact moment. College isn’t going anywhere. Best case scenario, your kid will be in treatment far longer than the typical length of a winter break. Worst case scenario, they are required to reapply to be a student. This could go one of two ways, though.
First, it may be more appropriate for your kid to transfer. If they experienced traumas while on campus, it may be easier to start fresh somewhere new. Or, your kid tells you they need more time in recovery. They want to discover a passion so that when, not if, they return to college one day, they’ll be driven to a degree they are interested in. This is a fear most parents have. If your kid leaves college, they’ll never return. That is a very irrational fear. Again, your child’s help if far more important in this moment. To the point, if your focus as their parent doesn’t shift to them getting better, but rather, them returning to school, you could potentially lose your child, your adult child.
Don’t be that parent that is driving the college degree over mental health or substance abuse. Your kid needs to be stable, sober, and surrounded by a community of therapeutic professionals that can help them remain in that space of security and safety. When they’re ready, college will be there.
For questions or comments contact Joanna.
Tough Love
Boomers and Generation X do not like the idea of “tough love.” This generalization feels all-too-real right now. Parents who grew up with strict parents are uncomfortable filling their parent’s shoes. They do not like confrontation with their own children. And now, we have a generation (Millennials and Generation Z) who are still living at home or struggling to be independent. Why? I genuinely believe that it is because there was a lack of tough love through childhood.
No, I am not saying parents need to be authoritarian and punitive. What I am recommending, however, is that becoming friends with your kids should not be a priority until they are grown and out of the house. While they are under your roof, they live under your rules. If you do not have rules, you invite chaos. You can make gentle suggestions for your children to leave, and nowhere will a suggestion be taken seriously until a parent becomes firm and direct. Parents need to establish boundaries and abide by them, as do their kids. Without boundaries, your kids will rule the roost. Again, chaos ensues.
If any parent is reading this, know that it is okay to give tough love. I am not recommending you be like this 24 hours a day, 7 days a week. And yet, you do need to establish yourself in the parent role. If you are not a parent to your children, which includes regulating them, then what are you? And truly, your children want a parent to tell them what to do, whether they say that or not. They do need law & order within the home. They do want to butt heads with you, as you are allowing them to have a voice. Lean into the discomfort of the tough love approach. If you don’t, it could really impact your children.
For questions or comments contact Joanna.
Not Having a Driver's License
In working with young adults, most of my clients do not have their driver’s license. This has been perplexing to me over the years, as I compare my adolescent years to theirs. The moment I was able to have my learner’s permit and then get my license, I showed up at the door! There was not a moment to lose to be able to drive myself around. My clients on the other hand, seem to be terrified of growing up. Are you seeing this too?
Some have shared with me that there was never a reason since they lived in a big city. There is some understanding to that, but where is the logic in the “what happens when you need to get outside the city?” For some adult children, it is evident to me that their parents were terrified of them driving, so they just agreed to drive them around. At some point though, that chauffeur lost its sheen, and the young adult is now not interested in getting their license. Why bother when I can keep asking my parents to take me around? Lastly, and in line with the second example, this is a young adult who just didn’t want to leave home. Why do I need to get my license? I don’t have to go anywhere. Or better, why get my license? I’ve never been asked to contribute around the house or with my siblings. There are several other reasons someone may opt to not rush to get their driver’s license, but these are the most common reasons I am finding amongst my clients.
Not having your license is a burden, whether you see it that way or not. It is another example of your dependency on others. From the other lens, it is also another reason why parents may be taking care of their kids longer – dependency. It is time to bring back the excitement around getting a driver’s license. And if your adult child isn’t excited, that’s okay too. It’s non-negotiable to be dependent on other people to get your groceries, go to the hospital, or just get anywhere. It is time to grow up, and that requires following through with tasks (i.e. driver’s test) to become independent.
For questions or comments contact Joanna.
Is College Worth it Anymore?
Right now, I believe that is how most college students are currently feeling. Between the shift to online learning and the adjustments in social and residential environments, there is a rumble that is building. It is what most non-higher education affiliates were saying over the summer, but only now, are the enrolled students finally feeling it: understanding that it is not worth it.
If your college student is considering dropping out, do not force them to stay. Think about this from a mental health and financial standpoint. Will they struggle with depression because of isolation? Will their grades translate to decent grades if they stay? If not, it is not worth it. Mental health will far outweigh the need to “stay the course.” There is a lot of higher education statistics I could drop right now (i.e., percentage of students that matriculate to their sophomore year, and from there the abysmal rates that continue to drop within the 6-year graduation cohort). Realistically, if your kid is struggling right now in any arena related to their college experience, consider adopting this mantra for yourself: it is not worth it.
Now, stop the bus in letting them withdraw without a plan. They absolutely need a plan. Coming home to not be enrolled in classes, not work, and sulk about what they are missing out on sounds like a recipe for a boundary-less disaster. Always have a plan! Know that the need for a college degree and earning one, is not going anywhere. Colleges available for your adult child to attend will mostly remain. They can have a different experience in moving forward with their life - right now, that is worth it.
They need opportunities for life experiences. Options that include actual teaching and community building. If you think colleges campuses were the only place where this was available, you are wrong. Programs and opportunities have stepped up to the challenge providing a safe environment for young adults to grow and thrive, even during the pandemic.
Random quarantining, or back-to-back testing, is exhausting to the developing minds. They agreed to it when they registered for classes, but the reality is that one student may jeopardize an entire dorm. In a non-COVID world, the college experience was everything and more that a young adult craved. Now, with the vision of college not matching up to the reality of their situation, more and more students are over it. And it is not just first-year students either. I think we can anticipate that unless something drastic happens in the next three months, colleges will see an even more significant drop in enrollment for Spring 2021.
I don’t blame them. If I was in college right now, I’d say it wasn’t worth it either.
For questions or comments contact Joanna.
Dear Parents: An Expectations Letter about Transitional Programming
Dear Parents:
Congratulations on your young adult making it through a residential level of care! I wanted to share a couple articles that may be a resource to you during [insert your kid’s name] transition to [insert name of extended care/recovery program/sober living].
What to expect after enrolling your young adult in treatment (although this was written more so for the parents enrolling their young adult in a residential level of care, it does still apply for extended care too, especially now that [insert kid’s name] can communicate freely - which can be a good and bad thing).
Treatment is not a Quick Fix (This article speaks to how sometimes growth, transition, work can feel like we aren't making progress, but that's because change truly takes time). Similarly, the idea that "Transition is a Process, not an Event" also applies!
The difference between sobriety and recovery (this is important to talk about since he has attempted "sobriety" before).
The Art of Letting Go: How to be a Parent of Young Adult (You all have done such amazing jobs up until this point! Now that he's at [insert program name], it's important to make sure you're taking care of yourself!)
And most important, Treatment is a fit for the Young Adult, not the Parent (If you aren't getting the communication you want, you can advocate for it. If you don't like the therapist as much as you liked [insert name of wilderness therapist] remember what matters is that it's best for your kid!)
There will be some ups and downs with [insert name of program]. This is how it goes with every program, and every young adult. This is how it typically plays out:
Young adult is on a semi-high from graduating from wilderness/residential and is feeling pretty proud of themselves for this accomplishment
They are excited and slightly scared about their transitional program, even though they picked it
Because wilderness/residential is a fast pace, they anticipate (and parents do too) that young adult transitional programs/recovery programs will have a similar pace (which they don't).
Once the dust settles and they find things they don't love about the program, the young adult and parents can start to have a sour taste in their mouth and then start second-guessing this program being the right fit (often times, I will refer a parent back to all the work they did during wilderness/residential, as that will be key during this time).
You, as a parent, have to be okay with your young adult being uncomfortable at times. That could be because they don't get along swimmingly with their roommate, or they won't be able to sign up for classes for a couple weeks, or the people around them are new to them and they haven't made friends fast enough, etc. This is a great life lesson in reflecting it back on [your kid’s name] to learn to deal with his discomfort and advocate for himself. As long as he knows this is the place he picked and it was his choice and you wouldn't be bringing him home, he'll eventually start chugging along with the programming and really find a place for himself within the community and within the broader [insert city where program is located] area.
The first 5+ weeks tend to be the rockiest. This is usually when the dust settles for the young adult and their choice. If they view it as "being in a program" and struggle stepping out of that perspective, then it will be more painful. If they can look beyond that to seeing being in the program as a launching point to truly get out on their own, it can end up being the best place.
There will be ups and downs throughout the entire length of stay. This is also normal, as it replicates what life is like. There will be great days, and other days will be not-so-great. Now is the opportunity for you to also learn to allow [insert your kid’s name] to shift his relationship with you as being adult-to-adult (or as much as possible like this!), and more of a partner in him growing up, rather than being a parent responsible for their child. Hopefully that makes sense.
Let me know if you have any questions. I will continue to be in touch with [insert name of program] staff while [insert your kid’s name] gets settled. In the near future, I'll reach out to [insert your kid’s name] directly. Any of you can reach out to me at any time!
Be well,
Joanna
Helping your Kid avoid a Title IX Allegation
**Trigger warning: I will be discussing consensual sex and sexual assault. Please read with caution.
This is not something you think you must talk with your child about before they go off to school, and yet you need too. Prior to enrolling, they are required to complete an online sexual harassment and assault training. By completing this, regardless of how engaged they were in watching it, it will be held against them should someone on campus accuse them of sexual harassment or assault. As a parent, this will be your worst nightmare. Living in an era of Title IX Coordinators and colleges and universities doing their own investigations to protect their reputation, you do not want to have to deal with this. And if you did, you’ll wish you’d had this conversation with your child much sooner.
The majority of those accused will be young men. So, if you have a son heading off to college, this is even more important to discuss. Consensual sex is not consensual if there is alcohol involved; this can include anything oral. Period. For young people who are exited to explore new sexual relationships for the first time while in college, being accused of sexual misconduct is not something that is top-of-mind. If one of the partners wakes up and does not remember consenting, the moment they share that information, the university is investigating your child for sexual assault. It’s unrealistic to believe that a college student will be abstinent, and as a parent of a college student, this talk needs to be had.
As a parent, you not only have to talk about consensual sex, you also need to talk about the “what happens if” Campus Police or Student Conduct contacts them for any reason. There is nothing more intimidating that law enforcement or legal authorities on campus. In that moment, your young adult needs to not say a word and ask for their lawyer. Anything they say can be incriminating, regardless of whether they are guilty of anything! Also, make sure they know not to delete anything. That includes texts, contacts, or any social media content or connection. College disciplinary infractions are not fun to mess with, but it is better to be settled within that system than to deal with the consequences in the criminal justice system.
Anticipate that if your child is accused of anything while on a college campus, especially a Title IX allegation, it will come across as a civil death. You will need to rally the troops to ensure your child gets the care that they need. The troops will include an Attorney who understands higher education, a Licensed Mental Health professional who is non-judgmental to someone accused of sexual assault and will keep confidence through the court system, a Therapeutic Placement Consultant who will help you and your child navigate finding a mental health and substance abuse treatment program, and an Educational Consultant prepared to help your child transfer to another school once this case is resolved. It’s a lot, but it’s better to know these people exist rather than wait until you immediately need them.
To summarize, talk to your kid before they go off to college. A decision they make while drunk and horny could truly change the course of their life, and your life, forever.
For questions or comments contact Joanna.
Bank of Mom & Dad
Right out of the gate I need to make it known - this title could read “Bank of Mom & Mom,” or “Bank of Dad & Dad.” This is not meant to be inclusive to only cisgender, heterosexual parenting units. This is meant to highlight the importance of parents understanding that after their child turns 18, they are not legally responsible to provide for them. What parents give is a gift and is not required. When, as a parenting unit, you are doling out money left and right with no return, or possibility for return, this is when you transition from being a parent to being a bank. There is a lot that parents do that they don’t have to.
To make note, you are paying for all the necessities of your child up until they become a legal adult. That includes food, water, shelter, healthcare, and clothing. Truly, the bare minimum needed for them to survive. Beyond that you may be providing items we view as essential, but we can live without. Items that fall within this category can be a vehicle, car insurance, a cell phone and a cell phone plan, a credit card (“just for emergencies”) and college tuition. They could go to college, or not. But you are most-likely still covering all of their living and partying expenses. This needs to end at some point. At first, you were really helping them launch on their own. At some point though, they realized they didn’t need to work so hard because you would continue to financially provide for them. In which case it transitioned from helping to enabling.
Now if your adult child struggled with mental health or substance abuse, it is important to note that the need to provide extra care will always be there. However, you will realize one day that you are, in fact, enabling and need to stop. If you are giving cash, it be spent at their discretion. You can give them money and say, “this is only to be spent on food,” but unless you are paying the bill directly, there is no guarantee where that money is going. Essentially, you could be funding their drug use. Let that sink in.
Adding up all these expenses and expecting your newly graduated-from-high-school adult child to be able to afford it all is not realistic. You can offer a plan for what you will pay for and how long, and after that point, your adult child is on their own. If you don’t establish that plan, or if you don’t follow through with that plan, it will be hard to ever get your adult child to leave home, or to ever be financially responsible for themselves. You have got to let them know the Bank is officially closed. At that point, you will see some severe emotional reactions that could include shock, rage, disbelief, or desperation. Until you hold that boundary and follow through with truly financially cutting them off, they will continue to milk the tit until the tit is bone dry. Don’t you want to enjoy at least some part of your retirement years?
Now you may be asking, “how the heck do I do this?” To which I would respond, there are a lot of ways this can play out. First, I would recommend hiring a Parent Trainer and Coach. Secondly, you need to hire a professional that will present programmatic options for your young adult so that they can learn to live on their own quickly. Both professionals will be instrumental in helping you gain the confidence in parenting an adult, rather than continue to struggle with having an adult child live in your home.
For questions or comments contact Joanna.
The Difference between a Suggestion and a Statement
When a parent contacts me, it is often because they have been making suggestions towards their young adult for years. They have been wanting their kid to grow up without support, and naturally leave the nest on their own. Sometimes those suggestions just are not strong enough.
When we are talking about a suggestion, we are merely putting something out there for another person to ponder. This is an idea for them to think through, and potentially act on. It is passive. When you have a young adult living at home that you are wanting to leave the nest, merely suggesting that your young adult move out may not be enough. If you truly want them to move out, you will need to be a little more direct.
Parents often cringe when I talk to them about being direct. I hear things like:
“If you are talking about a ‘tough love’ approach, it’s definitely not something I’m strong enough to do.”
“That makes me feel uncomfortable with the idea of suggesting homelessness.”
“I don’t want her to hate me.”
“We realize we probably could have been more direct sooner, but it’s been years and we just don’t know if he’ll listen to us.”
There is no judgement. My only rebuttal is that if the suggestions have not been working now, they won’t until the young adult decides to move out their own. That could be in six months, six years, or never. As a parent, if you are ready to be an empty-nester, you’re going to have to temporarily switch from suggestions to statements.
A statement is a command. It is not something to ponder, per say. When it comes to a parent stating to their young adult that they are officially no longer providing financial support, this is not up for negotiation. This is a stated fact. Again, it may feel unnatural since you have only been making suggestions. If a parent truly wants their kid to launch though, they are going to have to initiate the change.
Education around the difference between helping and enabling will be key. Once that is mastered, then a parent will move on to understanding what it looks like to hold a boundary for a young adult living at home. Often parents think that because their child is over the age of 18 that they can’t get them into treatment, and this is just not true. If your kid is cashing in on the Bank of Mom & Dad for food, housing, car payments, spending money, etc. then you absolutely have the power of persuasion. No young adult goes into treatment excited, that is nearly true for every single young person. But they will go willingly when their means for survival is tapering off.
Whether you have an 18, 28, or 38-year-old living at home and you are finding your suggestions for launching are not being taken seriously, the time to act is now. Do not waste another day sitting and resenting your child for not launching. Hire a professional to help you in helping your adult child launch.
For questions or comments contact Joanna.