When prospective clients contact my Cape Town based psychology practice for the first time, we invariable bring up the topic of  medical aid payment. For clients on medical aids, the question I get gets asked is – "will my psychotherapy treatment be covered by my medical aid"?

There are a number of aspects to this that you will need to clarify  before a definite answer can be given, for example:

1. Is the psychologist, counsellor or coach registered with the Health Professions' Council and with the Board of Healthcare Funders (BHF)?

Only professionally registered psychologists and psychological counsellors can claim from medical aids.

2. Is the registered psychologist, counsellor or coach charging medical aid (BHF) rates?

3. Does the psychologist or counsellor require you to pay upfront for your sessions and then for you to claim back the fee from your medical aid, or are they prepared to submit directly to the medical aid on your behalf?

4. Do you have sufficient funds in your medical aid account to cover number of psychology sessions required?

Each medical aid has its own benefit structure – some have a savings component for all out of hospital medical treatment, with psychology and psychotherapy treatment coming out of this "pot", while other medical aids have  a set annual  "ceiling" for psychotherapy (this is the annual amount that is "allowed", once this is exceeded the member has to pay for their psychology sessions themselves). Some medical aid plans, on the other hand are a combination of these two – there is a ceiling for claims but then once a certain amount has been spent on medical expenses above that ceiling, medical aid benefits again kick in.

In order to find out this information, you could contact your medical aid and quote the code 86205 which is the BHF code used for an hour of psychotherapy (which is the usual length for an individual psychology session)

5. Is the diagnostic code the psychologist will be using covered by your medical aid?

For some time the BHF have required health care practitioners to provide diagnostic codes for the treatments and procedures that are undertaken. This is also the case for psychologists. The coding system that is currently used is the ICD 10. When you visit your psychologist for the first time, he/she will do an informal or a formal assessment of your concern or problem, and will be required to note a diagnosis on the statement that is sent to your medical aid.

Some medical aids restrict benefits to particular problems or disorders and may sometimes, therefore, refuse to pay for certain types of issues.  Sometimes, too, medical aids may restrict benefits to certain categories of psychologists, depending on their scope of practice.

This will be a subject for a future post!

In my clinical psychology practice, however, I advise my clients to think more broadly about this issue – to think about their relationships.

 I therefore invite you to consider the current health of your relationships with:

1) Your partner/spouse, children and your family:

Ask yourself the following questions, for example…

Is your relationship as good as it can be? Are you able to be honest and authenitc with your spouse? Do you practise a way of interacting with your intimate partner which is respectful and considerate? When you asgue, do you do so in a constructive way, without resorting to "below the belt" tactics such as name-calling? (If there are problems in our intimate relationship it is invariably the case that the partner is blamed for this state of affairs. It is crucial that we each start by changing our own steps in our relationship dance!)

Are your relationhips with your children and your extended family as good as they could be? If you were to die tomorrow, have you told them how you feel about them or do you have "unfinished business"?  Is your will up to date?

2) Your friends and co-workers:

Are you sufficiently supportive and "there" for your friends and co-workers? Are you reliable, dependable and empathic?

3) Your community and environment:

Are you involved in community and volunteer activities? Do you consider your environment and recycle, for example?

4) Your pets

If your pets were able to rate you in terms of how well you meet their needs, what grade would you get? If you have a dog, do you walk him/her every day?

I am sure there are many more examples out there in the same vein and I would  be happy to receive your comments in this regard!

Of course, making resolutions is the easy part, like any form of behaviour change sticking to them consistently is a much more difficult thing and a topic in its own right for another post!

Couples who arrive for couple counselling often say that they are here to "work on their relationship" or to "improve their communication".

Often, though, each one arrives with the (often unconscious) intention of proving that they are right and that their partner is wrong and they try (hard) to convince the therapist that this is the case and to get the psychotherapist to see things from their point of view. Each person believes that if only their partner would change, then all will be perfect between them (as it was at the beginning of the relationship)!

When this is the case, it is important that each partner take on board that change needs to come from both individuals and both need to learn some sound relationship skills in order to get the relationship back on track.

In the next post I will write about hidden agendas relating to the goal of couple counselling – for example, when one partner wants to work on the relationship whilst their spouse is (sometimes privately) considering opting out.

What type of conflict negotiation strategy would suit you best?

Consider the following example:

A client, Jim,  came to see me for counselling the other day, complaining of high levels of stress. He is in a marriage with Sue, and they have three young children. He and his wife are partners in a number of businesses. He says that his wife wants to start her own business without any "interference" from him.

Jim and Sue have an extremely volatile relationship – Jim he is unsure as to whether or not he wants to remain married or get divorced.

I did a full assessment of Jim, and came to the conclusion that his relationship problems were causing the lion's share of his stress and recommended that Sue get involved in the process.

What type of intervention do Jim and Sue need?

As Jim reports that Sue says she is open to being involved, couple counselling or mediation are possibilities (both couple counselling and mediation are not  likely to work without buy-in from both parties).

Couple counselling would be my intervention of choice if the couple wished to work on their relationship whilst mediation would be a suitable strategy if the couple wished to concentrate on trying to resolve issues concerning their businesses.  Mediation would also be indicated if the couple decided that their marriage was no longer viable and that they wished to divorce. 

In order to mediate the business-related issues successfully, Jim and Sue could consider finding a conciliator – a mediator with an in-depth knowledge of the issues and domain under discussion – in this case business practices. (My partner, Ian Gillespie, was called on at a certain point in the process, therefore, as he has extensive business experience). A conciliator thus, because he or she has extensive knowledge in a particular area, may depart from a "pure" mediation approach by also providing information and advice.

Should, for arguements sake, this couple eventually decide to divorce, a facilitation clause in their consent paper would allow for a facilitator to be appointed post-divorce. The facilitator's role would be to look after the best interests of the children (in line with the Children's Act). Should the parents disagree on any matter relating to the care and contact of the children, the facilitator would step in and first attempt to resolve the conflict through mediation. However, if this proves to be unsuccessful, a facilitator has the power to make a decision about an issue,  and have it enforced by means of a directive.

So whether you decide on couple counselling, mediation, conciliation or facilitation, I suggest that, for your peace of mind, that  you make sure that the practitioner(s)  you choose is/are professionally qualified and accredited with relevant professional organisations such as the Health Professions Council and the Family Mediation Association of the Cape (FAMAC). 

I often ponder about how some relationships, which start out with some much love and caring, manage to deteriorate over time.

Of course, a number of researchers, such as Dr John Gottman, have looked into

this question in depth. Over forty years he has studied the dynamics of couples and relationships and has discovered that

happy couples work hard at understanding one another, and that they build up a mutual sense of safety and trust.

What is also vitally important is how couples deal with conflict. Happy couples tend to argue constructively. They do not let

their differences of opinion get to the stage where their arguements begin to erode the goodwill between them – they unconsciously (and consciously) “repair negativity” during conflict situations.

How does a couple successfully do this?

It is useful to, for example, have regular “meetings” with your partner (ideally on a weekly basis) where each of you gets a chance to air any problems or concerns (in connection with your partner and/or your relationship) that may have come up for you. Each person is given a chance to discuss what is on their mind. It is vital, though, thatyou both practice good “emotional attunement ” (Gottman, 2011) during these meetings – that you each listen to each other’s points of view in an open, accepting and non-judgemental manner (this is often very difficult!).  These meetings should be scheduled at times when you are both relaxed – such as at the weekend. We suggest that you find a 60 to 90 minute time slot where you can have have each others’undivided attention, with no outside distractions.

In this way you can often pre-empt and diffuse areas of potential conflict before they can snowball into dangerous, and potentially relationship damaging confrontations.

Why is it so difficult to stop our minds drifting to unpleasant and anxiety-provoking topics? Often this happens in the middle of the night, especially to insomniacs who often find that their thoughts prevent them from getting back to sleep.

Well, evolutionary psychologists put it down to the way in which our brains are wired, says Ronald Siegel in his article entitled “West meets East” in the September/October edition of Psychotherapy Networker (in which he discussed the link between psychotherapy and Eastern spiritual practices, such as mindfulness).

The arguement goes that the human beings of today have survived through natural selection only because, through thousands of years, they are the ones who were constantly on the lookout for danger and needed to be extremely adept at anticipating possible risks and life-threatening situations. So anxiety and fear kept you alive whilst happiness and complacency got you killed.

So, although the world has changed a great deal since the days of our cavemen ancestors, our physiology and the wiring of our brains have remained more or less the same, causing us to react to (usually) benign life events, such as traffic snarl-ups and work pressure, asif they were of the magnitude of a tiger hiding in the shadows, waiting to pounce.

So if we are wired for anxiety and stress, what can be done about it?

First it is necessary to develop an awareness of the problem. Then with the help of cognitive-behavioural techniques (CBT), relaxation training and mindfulness techniques it is possible to gain control of one’s thoughts and to calm down the mind. It is important to take on board that one’s thoughts are merely a product of one’s mind and are not necessarily accurate. It is quite possible to substitute more balanced thoughts for thoughts that lead to anxiety, stress and depression. This will help to calm the mind, paving the way for a more measured, focused and appreciative approach to life, including one’s relationships.

And this can only lead to an inhanced feeling of happiness and contentment!

However, it is often far from clear what this actually entails!

I have seen many unhappy and disenchanted couples who arrive on my doorstep when their relationship is already on life support. How did they get to be this way, I wonder? What happened over the years to totally change the way they now see each other – as adversaries rather than lovers?

So what can couples do to prevent this decline?

Looking after our relationships is quite similar, it seems, to taking care of our finances.

I will use the analogy of the monthly budget. Some individuals, as soon as they get their monthly pay cheque, will spend it as soon as it hits their bank account, while other more mindful and careful spenders, will make sure that they have sufficient money for the month, being constantly aware of how long it will be before the coffers are replenished, and they will never allow themselves to reach the point where their account is bone dry! They will also regularly invest a certain proportion for a rainy day and for their retirement.

How does this relate to couples? Emotional goodwill in relationships is similar to currency. When partners consistently demonstrate to each other that they have their spouses’ back – that they are there for each other emotionally in times of need.  John Gottman speaks of the “emotional bank account” in a relationship.

Therefore, from this perspective, to “work on your relationship”, couples need to take the time to really understand what makes their partner “tick” as accurate empathy for your partner is only really possible if you truely know, and “get” your partner.

When you consistently show this support and caring, the goodwill balance in your relationship account will remain in significantly

in the black.

And when inevitable problems and arguements arise between you both, you will be in a much better position to weather the storm ( and economic recessions) with your relationship intact!

I wish I could talk to all other learners and students out there about the importance of keeping their thoughts focused and not to dwell on the possibility that they might not do well! I use the analogy of the trapeze artist on the high-wire. If he/she allows him/herself to think that they might fall, this will probably happen (it becomes a self-fulfilling prophecy).

It is therefore crucial for students to monitor their thinking and alter their thoughts if they notice themselves becoming negative.  A pattern of “what-if ” thinking, for example “What if I can’t answer the questions in the paper and I fail” should therefore be banished and replaced by thoughts such as “I will do the best I can”. These ideas come from Cognitive Behaviour Therapy (CBT). “What-if”"thinking, if not controlled, can lead to runaway feelings of anxiety and stress.

I also spoke to the students about the importance of practicing relaxation and mindfulness exercises to help with focus and to calm the mind. It is also essential to pay attention to one’s body and health at times of pressure and stress – to eat well, exercise and to get sufficient sleep.

By keeping your stress levels in a zone that is optimal for you by doing the above, you will be well prepared, physically and psychologically, for the road ahead. All you will need to add to this recipe for success is a great deal of focused study!

Please contact me if you have any questions about the above or any other aspect of stress management.

If you are a student I am sure that you are thinking a great deal about the forthcoming examinations! As a your future rests on getting good results the thought of the exams will be causing you some degree of stress!

Of course we all cope with stress in different ways and with varying degrees of success. Some of us have trouble sleeping whilst others suffer from anxiety, feelings of panic or physical ailments such as headaches and back pain.

If stress levels are too high or stress becomes chronic, it can seriously affect memory. Brain science has determined exactly why that is and how it works. However, all we need to know about this is that hormones and neurotransmitters that are released during the stress response (also called the “fight or flight” response) can block memory formation and retrieval. This is responsible for the common situation of “going blank” during an exam.

It is therefore imperative that students and learners take on board the essential knowledge and skills to enable them to gain control of their stress. These include cognitive behavioural therapy (CBT), relaxation training, visualisation and mindfulness training.

I will be presenting a workshop entitled “Preparing yourself for the Exams” in Claremont, Cape Town, On Saturday morning the 17th September. The workshop is open to Grade 11s and 12s and to students.

For more information about the workshop, please contact us.

Best wishes with your exam preparation!

a bit of spring cleaning!

At this time of year we often start to feel a personal sense of renewed optimism and purpose  - however, it is important not to overlook your relationship when doing your general overhaul – does it need a breathe of fresh air too?!

How can you accurately judge the current health of your relationship? (unfortunately we can often be in denial about this important issue).

Ask yourself (and your partner) the following questions:

* How good is your communication currently – can you talk openly and from the heart about yourself and your feelings to your partner?

* Are you caring, supportive and non-judgemental with each other?

* Can you have constructive arguements without resorting to criticism, avoidance and name-calling?

* Are you on the same wave-length emotionally?

* Do you enjoy each other’s company and do you regularly have fun together?

If the answer to any of these questions is “no”, it is probably a good time to get a relationship tune-up!

During September we are offering a special 4  ninety minute session package for couples in Wynberg, Cape Town

Feel free to Contact us for more information!