I’m an EMDR Convert

Call me weird but my niche is trauma. Over the last 25 years I have gotten really good at hearing, discussing all kinds of awful stories from clients. I can hold these stories, and at the end of the day, I go home and live my life as if some spacey force field surrounds me from absorbing the pain into my own heart. Recently however, I decided that I could not be a trauma therapist if I did not know anything about EMDR therapy. The most I remembered from the first time I heard about it (in around 1993) was about watching a pencil eraser go back and forth and somehow people felt better afterwards. It seemed a little like voodoo to me. But after the last 3 months of training, I decided that it’s more like magic.

Real magic, like having my own wand in Diagon Alley with Harry Potter and friends and knowing all the right spells and potions at my disposal. Okay let me qualify this: I am a total newbie. I literally just finished the second weekend at the Maigberger Institute in Boulder, Colorado, with the amazing Barb Maiberger. Barb teaches four groups per month, then follows them up with online meeting consultations. I have had a private practice for a few years and many of my established clients were psyched to try this modality with me and I have been able to witness some amazing things in a short period of time. So before I say more – just what the heck is EMDR therapy, you ask? Well, I am here to tell you, since one of the assignments is to draft an explanation for my clients.

Eye Movement Desensitization and Reprocessing therapy is a modality that can be used with adults, teens and young children. It has been extensively researched and shown to reduce symptoms associated with most kinds of traumas and generally disturbing events and emotions. There are 8 phases that will take place as the client is ready for them.

The treatment will use one or more of the following types of Bilateral/Dual Attention Processing stimulation (BLS). This keeps the client and therapist in the past and the present at the same time: Each client can choose what they prefer: Eye movement by following an object, hand buzzers, tone through headphones, tapping by the therapist or self-tapping.

EMDR Therapy does not erase memories, it merely takes the emotional connection away from an event so that a person can recall and discuss the events without distress or disturbance. Research has also shown that the brain continues to re-process even after the session and well into the future. Clients may experience dreams, flashbacks, emotions and other sensations following the treatments especially after the trauma work begins. This is normal as it shows that your nervous system is doing its work.

Many of you may have heard that in June 2019 the creator of EMDR, Francine Shapiro, passed away at the age of 71. She discovered the properties of her theory quite by accident, as many good ideas come along, and being open to something that the Universe was trying to tell her. As a graduate student in Psychology, she followed up with good old-fashioned inquiry and research and started nothing short of a revolution. People with long term traumatic symptoms – war veterans, crime victims, people with chronic pain got relief! Even after years of traditional therapies, within a few sessions, they were able to think about or talk about their traumas without feeling as though it was happening all over again. Like I said: Magic.

Ok, magic and science. One image that came up in my mind when watching my first demonstration on Day One was the idea of hypnosis. In the movies, we always see some Victorian doctor in a gray suit with a curly mustache swing a big, gold, pocket watch in front of someone’s face until they become sleepy. In this state, the doctor is able to access memories, or implant some suggestion that later comes out unknowingly as a behavior the doctor wanted the patient to complete. Okay, that is pretty creepy and not what the purpose of any legitimate therapy is. But the bilateral stimulation has definitely been known for a while as a powerful method for brain stimulation. Plenty of new science on the brain is out there and practitioners, writers, researchers are clamoring to have the next breakthrough: like plugging our heads into a screen and making images appear. I’m not so sure that is a world I am interested in, as my reality, anyway. I’ll take it as science fiction instead.

I am a convert now. I don’t hear all the stories as much in sessions. I find myself taking deep breaths with my clients, nodding, and saying “go with that,” a lot while observing waves of emotion in my clients through their tears, twitches and relaxation responses. They end their sessions looking like they just came out of a nice dream, stretching and smiling, yet they were fully awake in the room the whole time. I tried it while in training, as we have to do on one another, and discovered that a number of things that used to get me going on an angry rant are no longer bothering me. It is a very peaceful feeling, to be able to let it go. I have studied for 25 years to do play therapy, Cognitive Behavioral Therapy (CBT), Solution Focused Therapy, art therapy, and this is becoming my go-to and I don’t have to give up any of the above! I hope to keep going to get certified, which will take a couple years to do, so until then I will keep practicing, training, and consulting. Advice? Interested therapists should find an EMDRIA approved training, and don't cheap out on this one. There is too much to learn in what might look like a bargain. Potential clients: always look up where your therapist got their training, just in case they did cheap out! 

The Business of Helping

The past week and a half have been full of learning, mostly about things they just don’t teach us in Graduate school – and how could “they” have? This was 16 years ago, there was barely anything called “the internet” in those days. Things are so different so I have to adapt. I am in a program called Business School Bootcamp – a two week intensive on getting a private practice up and running successfully. Is it all about making gobs of money? No, although it is about value – the value of what I provide and the value a potential client places on getting well. But it’s about finding ways for us to meet – the client who needs my help and the therapist who needs clients, so they can both thrive in the world.

To pat myself on the back, I have done a lot of the things in the lessons already – I did a lot of planning before I went full time. There is more I can do to get my name out there and I am working furiously to do it. So much of it is about technology – just getting search engines to find your website. Researching what people type into a search engine and then matching those words and phrases into the fabric of my website – the part you don’t see, The Code. Dammit, Jim, I’m a therapist not a computer programmer! Ok maybe I am a little now? If you understand that above reference, then you know that I AM a Star Trek fan.  I’m not too old to learn a few things.

So when you, a potential client, looks for someone to pour your soul out to, you type in a search – counselor in Denver area – or something to that effect. A lot of calls and referrals come through Psychology Today and I am grateful for that. This week I actually Googled “PTSD counselor in Commerce City, CO” and my website popped right up. It was a happy moment for me. Once you find your list – how do you know that therapist is going to be right for you? Recently I am getting more Medicaid clients, and I am among very few in my area who accepts it as payment. Right away that puts me on the top of the list of people to call. But I want clients to want to work with me, not just because I take their insurance. I want to have a site that says “I’m your person! I get you, I can really help you, and you’re going to really like working with me because I’m the shiz-net.”

I also chose to be on the Medicaid panels because I see kids in foster care, and all too often families on Medicaid are referred to the county clinics, which are often staffed with new graduates, interns, who are less experienced and over worked. I know because I have been there. I can’t be the best therapist I can be by being overworked, underpaid and having to deal with issues that are harder than I can handle (if I were there ;D). There should be equal access to quality services. Or so I believe. I want these clients to find me so I needed to make it easy to find me. So that’s why you would pick me, or why you would pick someone else. You found a therapist who “speaks” to you through all this media noise. Only I have tried to cut out the noise.

Give me a call and interview me. Then interview someone else. Interview a third person? Why not? This is your healing and your future we are talking about. 

To Join or not to join?

If you are a therapist, you are providing a medical service. Mental Health care is a part of being healthy and having someone to guide you is just as important as having a doctor to give you a check up – check your vitals, run some blood work, treat an illness. So therapists are professionals who have the ability to be paid by health insurance. Now… there are hundreds if not thousands of companies – more so now than ever – that offer insurance and pay providers in their networks.

I started off working a full time job while seeing clients through 2 EAP providers - that’s Employee Assistance Programs. They don’t pay well but the client work is interesting. The credentialing was pretty easy as well. Clients usually self refer and have a limited number of sessions that the company pays for. Beyond that I offer a reduced rate for them to continue for the same number of sessions they got through their benefits.

How can any one therapist get credentialed with all of these companies? Recently, I joined Cigna, and it was a fairly painless experience. They were efficient about sending documents back and forth, my recruiter communicated with me often, when everything was done they credentialed me in 3 weeks, when they had up to 90 days. I have been told by another Cigna provider that they pay timely and have been good to work with. Their rates are similar to what I have seen, mostly Medicaid rates but clients usually have a co-pay. Medicaid credentialing, here in Colorado anyway, has been a completely different sort of animal.

One therapist in a cohort group I’m in on Facebook said she contracted out her credentialing to someone who does it for a living – a medical biller or something. I had no idea people did that although it makes sense because doctors who open a practice have to accept a lot of insurances and they have even more documents to provide. Do they have time for that? I don’t think so. My mother has offered to help me do billing and what not and I could add her to my profiles as an office person, but I would prefer to pay her and I can’t right now and I don’t think I really want to join more insurance panels. I can take any client with PPO benefits – meaning they can see someone out of network. They pay me then submit the bill to their insurance to be reimbursed. The last person who asked me about that discovered she had to meet a huge deductible before she would be reimbursed anything. I tried to sign up with her insurance but they are not accepting new providers in my county unless I can prescribe and/or speak a language not usual for the area, like Farsi or Somali.

Getting back to Medicaid. In Colorado, the State was divided into regions a few years ago and companies bid on regions. I live in Adams County – which is covered by BHI. I want to work with kids from Denver (foster care) and Morgan Counties, these are covered by ABC. A friend of mine said to apply at Colorado Access. They had no application – they said send us an email. They emailed back: we don’t need anyone right now. I thought, that can’t be true! I went on the State Medicaid site, was able to apply and be approved as of June 1. However, if you’re not part of one of the managed care entities, you will bill and not get paid. Sadly, I am not going to get paid for a few clients, but I am okay with that now. They needed the help, they got better and I am not going to take any more until I can get paid.

I finally reached someone about my questions with BHI and she was great at explaining all of this to me.  I sent in my documents, waited, and then was told that I passed round one and in a months she and the team would start round 2. I had to send her more documents, that I really could have sent her with the first round had she asked. I am very close to being done, I have clients in a rural county Human Service Agency waiting for me to start. That was the reason I got ABC coverage in the first place, otherwise I would have been declined (there is a need for therapists in the rural areas). There has been so much outrageous duplication and waste in these processes. Being a Black Belt in LEAN/Continuous Process Improvement, I have truly struggled to be patient with the inefficiencies.

CAQH is a national clearinghouse for billing. Cigna required me to join so they can pay me and credential me through this company, however Medicaid wanted my number as well. There are a few more similar companies, depending on which insurance panel you are on. Again, duplication. Now Colorado has a ballot initiative this fall for a single payer system. I can really see the benefit to this but man if I have to scrap everything I have done to date just to join that one I might lose my ever loving mind.

In the meantime, I do a few other things – I do paintingparties, I sell my art as much as I can, I have done a training on Primary Perpetration Prevention for foster parents through Foster Source, a new support agency a neighbor of mine started this year. I saved up before I quit so I could have flexibility and a nice summer with my kids. I signed up (aka invested) for a Business School Bootcamp for therapists because I need to know MORE of how to make this work. Marketing, networking, getting referrals, it’s all part of this thing we do and it is an entrepreneurial business. It is not a passive activity. While I want to help people of lower income and who have struggled more to get ahead, I deserve to make a decent living doing it. So do you!