Author Archives: Eric Stroo

Good Faith Estimate

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Good Faith Estimate

Effective January 1, 2022, a ruling went into effect called the “No Surprises Act” which requires practitioners to provider a “Good Faith Estimate” to individuals who are uninsured or utilize self-pay. The Good Faith Estimate (referred to throughout this document as “GFE”) works to show the cost of items and services that are reasonably expected for your health care needs for an item or service, a diagnosis, and a reason for mental health services. The estimate is based on information known at the time the estimate was created. The GFE does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur and will be provided a new GFE should this occur. If this happens, federal law allows you to dispute (appeal) the bill if you and your provider have not previously talked about the change and you have not been given an updated GFE.

Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request, or at the time of scheduling health care items and services to receive a GFE of expected charges.

Note: The PHSA and GFE do not currently apply to any individuals who are using insurance benefits, including “out of network benefits” (i.e.., submitting superbills to insurance for reimbursement). 

Timeline requirements: Providers are required to provide a GFE of expected charges for a scheduled or requested service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service. That estimate must be provided within specified timeframes:

  • If the service is scheduled at least 3 business days before the appointment date: no later than 1 business day after the date of scheduling;
  • If the service is scheduled at least 10 business days before the appointment date: no later than 3 business days after the date of scheduling; or
  • If the uninsured or self-pay individual requests a GFE (without scheduling the service): no later than 3 business days after the date of the request. A new GFE must be provided, within the specified timeframes if the individual reschedules the requested item or service.
Samaritan Center of Puget Sound recognizes every individual’s mental health treatment journey is unique and personalized. How long you need to engage in mental health services and how often you attend sessions will be influenced by many factors, including, but not limited to:
  • Your schedule and life circumstances
  • Your provider’s availability
  • Ongoing life challenges
  • The nature of your specific challenges and how you address them
  • Personal finances

You and your provider will continually assess the appropriate frequency of services and will work together to determine when you have met your goals and are ready for discharge and/or a new “Good Faith Estimate” will be issued should your frequency or needs change.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises 

Re-entry from Covid

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And Now… How Do We Think About Re-entry?

It’s spring. We can feel the changing, evolving season. Light that lasts longer. New growth appearing. A taste of warmer days to come. People venturing out of hibernation.

It’s been a long winter, a long year, and we’ve become accustomed to the many ways in which we’ve been separated from one another. Many of us are wondering what this season of re-entry–the emerging from separation–will look like. There’s a feeling of uncertainty, a forgetting of how everyday relationship with the outside world is done. Used to be done. Should be done. Can be done.

Some of us feel the questions more intensely than others. Instead of embracing the new freedom, we look at it with a raised eyebrow. Our habits of caution outweigh our impulse to engage. That can lead us to wonder in a self-critical way–about ourselves, our resilience, our ability to adapt.

We know that distressing situations can trigger our feelings of anxiety and depression. When this happens, we do well to remind ourselves of strategies that can help manage these feelings. We may have learned some of them through Cognitive Behavioral Therapy and the practice of Mindfulness. While they’re simple skills, they’re not easy to maintain when we’re feeling stressed. Our efforts, however, can be rewarding.
Here is a reminder of some of those useful strategies:

  • Stay in the present–don’t ruminate about the past or try to predict the future
  • Focus on what you can control and set aside what you cannot
  • Appreciate those things that are going well
    Maintain healthy habits of eating, sleeping and exercising
  • Seek out pleasurable activities and meaningful connection with others
  • Extend an attitude of generosity, both to yourself and to others

It seems fortuitous that our emerging from this highly restrictive year of the pandemic coincides with our calendar’s emergence from winter into spring. Access to vaccines and lower numbers of serious illness and death from the virus are allowing us to move about more freely. Sunny days are inviting us to come outdoors, shedding our raincoats and boots and woolen scarves.

So, is there a way to step into this re-entry, this emerging from separation into reconnection, with lightness, the spirit of spring? Can we bring what we’ve learned in this past year, about ourselves and others and reality itself, to a clearer and more compassionate understanding of what life is about? Will our inner conversations and our relationships with others thrive in this warmer climate? Will our sense of gratitude and hope speak to our experiences of loss and grief? Will we agree to move forward with a smile – one that may still at times be hidden by the masks we agree to wear but will surely be visible in our eyes.

GiveBIG: Washington Gives 2021

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Keeping Our Commitments: With Your Help

On May 4 and 5, Samaritan Center of Puget Sound is once again participating in the annual GiveBIG campaign. We know that many of you have taken this opportunity in the past to extend our ability to provide counseling for those who are unable to afford the cost of the care they need. Thank you.
In this year of so much uncertainty and pain, the need for psychotherapy has grown exponentially. Samaritan Center continues to provide high quality, relationally based, spiritually integrative psychotherapy that is affordable and accessible to all.
Your gift directly helps us provide essential mental health services to those in most need. By adopting a telehealth platform in the face of the coronavirus pandemic, we maintained the accessibility of our services, and as an unexpected consequence, we extended the availability of those services throughout the state.
We are immensely grateful for your partnership in making equitable access to mental health care a reality.
Thank you for considering participating in this year’s GiveBIG campaign.
With gratitude,
Beverley Shrumm, President
Samaritan Center of Puget Sound

Stepping Out in Faith

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These days we are all walking on water. Beneath us, supporting us, we experience not the solid ground of our once familiar lives—predictable routines, reliable institutions, and in-person engagement—but the deeply disturbing uncertainties, the chaos of this ongoing pandemic. Or worse. Some have experienced the disease firsthand, some have lost family or friends, some have lost businesses, jobs, homes, savings. Struggling to survive, fearing to go under completely, we are walking on water.

Reportedly, Jesus made it look easy; our own experience is more like Peter’s:
Peter got out of the boat, started walking on the water, and came toward Jesus. But when he noticed the strong wind, he became frightened, and beginning to sink, he cried out, “Lord, save me!”
We try to remain confident, to take things a day at a time, but these are terribly uncertain times, and despair is not far away. The pandemic has robbed us of so much, taking lives, separating us, and punishing those most who have the least.

Yes, we have learned the practices that can help to keep us healthy: washing, masking up, maintaining distance, limiting our “bubbles.” All that is surely good. But the measures we take to guard our health have come with a cost to our well-being. Even those who are fortunate to have jobs and health must nonetheless face separation and confinement, deprived of the many ways we gather: in schools and businesses and concerts and ball fields and places of worship.

We are all walking on water these days, and it is easy to become weary of the effort. It is easy to become afraid and to lose hope as the days have turned into weeks, and the weeks have turned into months, and the months threaten to turn into years before we can reclaim the freedom and togetherness that we long for. Faith is essential. Science will ultimately offer some relief from the threat; it is a source of understanding and a guide to tactics. But meanwhile, we need something in addition to tactics; we need to resist being overwhelmed by fear and isolation.

Many years ago, speaking to a conference of clergy, Ernest Campbell said, “The reason that we seem to lack faith in our time is that we are not doing anything that requires it.” Though we certainly could wish it otherwise, our time requires it. The disciplines of our time require it: to apply the best practices dictated by science, restrictive and repetitive as they may be; to cope with the disruptions and demands of these chaotic circumstances; and to bear the losses, which continue to mount with no clear end in sight. Faith gives us a focus beyond the turbulence of today on a real and hopeful but distant horizon.

I Will Not Give Up

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It was above the timber line. The steady march of the forest had stopped as if some invisible barrier had been erected beyond which no trees dared move even in a single file. Beyond was barrenness, sheer rocks, snow patches and strong untrammeled winds. Here and there were short tufts of evergreen bushes that had somehow managed to survive despite the severe pressures under which they had to live. They were not lush, they lacked the kind of grace of the vegetation below the timer line, but they were alive and hardy.

Upon close investigation, however, it was found that these were not ordinary shrubs. The formation of needles, etc., was identical with that of the trees farther down; as a matter of fact, they looked like branches of the other trees. When one actually examined them, the astounding revelation was that they were branches. For, hugging the ground, following the shape of the terrain, were trees that could not grow upright, following the pattern of their kind. Instead, they were growing as vines grow along the ground, and what seemed to be patches of stunted shrubs were rows of branches of growing, developing trees. What must have been the tortuous frustration and stubborn battle that had finally resulted in this strange phenomenon!

It was as if the tree had said, “I am destined to reach for the skies and embrace in my arms the wind, the rain, the snow and the sun, singing my song of joy to all the heavens. But this I cannot do. I have taken root beyond the timber line, and yet I do not want to die; I must not die. I shall make a careful survey of the situation and work out a method, a way of life, that will yield growth and development for me despite the contradictions under which I must eke out my days.

In the end I may not look like the other trees, I may not be what within me cries out to be. But I will not give up. I will use to the full every resource in me and about me to answer life with life. In so doing, I shall affirm that this is the kind of universe that sustains, upon demand, the life that is in it.” I wonder if I dare to act even as the tree acts. I wonder! I wonder! Do you?

       This meditation was called to our attention by Samaritan therapist John Baumann, MDiv, LMHC, who sees clients in Seattle, Renton and Federal Way. John says: “I was introduced to Howard Thurman in 1995, some 14 years after his funeral.  Reading his biography brought a sense of wonder at the grace-filled and graceful manner in which he lived.  He spoke of offering a meditation a half hour before each Sunday service and discovering that calls for counseling began dropping.  I quickly ordered his book, Meditations of the Heart.  I find myself returning to it from time to time and each time I find a new jewel.  As always, the jewel seems to shine ever brighter as I read and reflect again and again.”

 

 

Meet Heather Macdonald

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Profile for HeatherDr. Heather Macdonald joins our clinical staff this spring, bringing with her a wealth of experience and depth of training. We are particularly excited to welcome her to our psychological testing and assessment program. Heather’s professional background includes working with young children, adolescents and adults in a variety of settings with a wide range of identified concerns. A licensed clinical psychologist since 2010, she has experience working with neurodevelopmental challenges, specific learning differences, complex developmental trauma, ADHD (in adults and children), and mood issues.

Working with Clergy. Heather also has a great deal of experience working with clergy around issues of leadership, mid-career questions, as well as pre-ordination evaluations. In her work with clergy she is careful to include perspectives on adult development and how this can impact behavior and functioning. In such work with spiritual leaders, she uses standardized and objective test batteries but focuses largely on the complicated intersections of personality structure, leadership style, spiritual calling, and social and psychological functioning.

Passionate about Assessment. Heather is committed to making the process of psychological evaluation deeply collaborative and therapeutic so that a person’s lived experience resonates with the results written in the final report. When viewed as a therapeutic intervention, assessment yields much more insightful results. The collaborative space of the assessment process necessarily includes multi-dimensional perspectives on identity and intersectionality.

She often asks, “Can psychological testing be a site of invitation, provocation, revelation, or promise? Can it be a space of apology, mourning, and forgiveness since the true suffering of the Other refuses to be put into language to begin with?”

Trained on Both Coasts. Prior to working at the Samaritan Center, Heather worked at the Danielsen Institute at Boston University and taught psychology at Lesley University in Cambridge, MA. She completed her MA degree in psychology at Seattle University and her doctorate at Pacific University in Forest Grove, Oregon. She sees clients at the Bellevue office and at the Samaritan main office in Seattle.

Alcohol Use Disorders: A Closer Look

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What would it be like for you to go 72 hours without alcohol? As part of Alcohol Awareness Month, the National Council on Addiction and Drug Dependence (NCADD) has invited all Americans to abstain from alcohol the first weekend in April (5th-7th). Taking a break from alcohol can be a great way to explore what role it plays in your life, even if you would not identify as someone who struggles with alcohol use.

As you probably know, drinking too much can harm your health. According to the World Health Organization, the harmful use of alcohol contributes to more than 200 diseases and injury conditions, most notably alcohol use disorders, liver cirrhosis, and cancers.1 An estimated 88,000 people (62,000 men and 26,000 women) die from alcohol-related causes annually, making alcohol the 3rd leading cause of preventable death in the United States.2

So what does responsible alcohol use look like? It may surprise you. Both the USDA and National Institute on Alcohol Abuse and Alcoholism (NIAAA) have developed recommendations to limit the risk of alcohol-related harm, suggesting that women should consume no more than 7 standard drinks per week and men should have no more than 14.3, 4

It is important to note that these recommendations define a standard drink as: 1.5 oz of hard liquor (40% alcohol), a 5 oz. glass of wine (12% alcohol), or a 12 oz. beer (5% alcohol).5 Step foot into one of the many breweries located in Seattle, and you will notice that it is difficult to find a beer whose alcohol content is 5% or less; similarly, most cocktails contain multiple shots of hard alcohol and the alcohol content of wine can vary drastically.  All of this to say, you may be having more than “one standard drink” with every drink you consume.

In addition to the weekly guidelines highlighted above, the NIAAA recommends that daily consumption of alcohol is limited, no more than 3 drinks for women and no more than 4 for men, in order to reduce the risk of developing an alcohol use disorder.

What exactly is an alcohol use disorder? It is a clinical term describing a collection of symptoms related to alcohol use that cause significant distress and or impairment during the same 12-month period; these symptoms fall into four major categories including impaired control, social impairment, hazardous use, and pharmacological criteria (i.e. tolerance and withdrawal).  An estimated 16 million people in the United States have been diagnosed with an alcohol use disorder.6

The good news is that there is hope for recovery from an alcohol use disorder. In fact, it is estimated that between 42%-66% of people with substance use disorders achieve full remission7,8  and as many as 20 million individuals and family members are living lives in recovery from alcohol.9 Recovery is not a one-size fits all concept and it may include the use of self-help groups (i.e. AA, SMART Recovery, LifeRing, etc.) and/or formal treatment (i.e. medications, therapy); no single option is right for everyone, and treatment should reflect an individual’s unique history and hopes for their recovery.

Are you wondering if your relationship with alcohol may be problematic? Next steps might include speaking with your family, friends, or pastor; attending a self-help group; or speaking with a treatment professional in your area.

 

 

 

 

 

 

Do We Need an Alternative to Self-Esteem?

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Raising questions about the value of self-esteem can seem like modern blasphemy. So let me say up front that I am for it: Self-esteem is a positive attribute! Who has not witnessed the pain of shattered self-esteem in a friend who has lost love or a co-worker whose career has been derailed?

But the pursuit of high flying and unassailable self-esteem isn’t necessarily the golden road to mental health and happiness. Once proclaimed with certainty in schools and self-help seminars, the merits of self-esteem have been overstated. Especially when you consider the routes we take to keep a shiny and soaring self-esteem aloft: constant focus on competition, perfectionism, and narcissistic preoccupation.

There is a better way. A better model of healthy and sustainable self-regard. It is supported by research, and it is grounded in the wisdom of our faith traditions. It amounts to a practice of self-compassion as the principle for understanding and sustaining one’s worth. Failure and loss are the inevitable consequences of being human. One shares that condition with everyone else, no more and no less. And one offers oneself compassion in the unblinking awareness of that common experience of imperfection, just as one would offer compassion rather than condemnation to a friend.

A current researcher who has substantiated the claims for self-compassion is University of Texas-based psychologist Dr. Kristin Neff. Her experiments have substantiated the effectiveness of self-compassion, and she has gone further to refine tools for assessing one’s inclination to respond to one’s shortcomings with compassion rather than condemnation. Still further, she has developed a variety of ways to practice self-compassion as a route to health and healing. To get a brief intro to her work, check out her TED talk on youtube.com, https://www.youtube.com/watch?v=IvtZBUSplr4

As I have come to advocate for the value of self-compassion—in contrast to a primary focus on self-esteem—I become aware that its roots extend into the depth of my faith. I understand that we, you and I, share a common humanity and a common dignity as God’s creatures. That dignity lies not in some perfection that we have realized but in the path that we ascend together, accepting ourselves and one another with compassion.

The acceptance with which we embrace ourselves, our wonderful and flawed selves, is neither resignation nor complacency. This is crucially important: self-acceptance is realistic and hopeful, positive and not cynical. We regard ourselves with love, even as we commit ourselves to continue striving to be our best. Central to Christian faith is the exhortation to love your neighbor as yourself, and insofar as we strive to show compassion to our neighbor, we do likewise for ourselves. Success in one is inseparable from pursuit of the other.

The apostle Paul wrote in 2 Corinthians that he discovered his strength in his own weakness, his wisdom in his foolishness. This is not doormat Christianity: Paul was not strong because he was weak; he was strong because he could acknowledge and accept that he had inescapable weaknesses and failings. In his humility—in compassionate self-acceptance—he gained towering strength.

And so it is with us. In our capacity for clear-eyed humility, we find strength. In our relationship to a providential God who embraces humanity and all creation in a spirit of loving acceptance, we find a foundation for our own self-acceptance. And a greater capacity to love and be loved.

Welcome Katie Geiser, MSW

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Katie Geiser photo

The newest member of our clinical staff, Katie Geiser, is a Licensed Independent Clinical Social Worker Associate. We are tremendously excited to welcome her as a skilled clinician and a valuable addition to our cadre of child- and family-focused therapists.“My heart for this work lies in helping children, individuals, and families navigate the ups and downs that come with our movement through life”, attests Katie. She works with families and individuals, including youth and children. “I appreciate the opportunity to walk along side those I work with, supporting the journey of making meaning of it all with the goal of fostering resilience and personal strengths.”
In her work with children, Katie’s primary mode is creative play. “Play, the work of childhood (but so important for all ages!), is a wonderful vehicle for expression, stress relief, connection, understanding, learning and growth; I have over ten years of experience working with and learning within the play of children.”
With adolescents and young adults, she shifts focus; here, the emphasis is on “supporting critical thinking, defining the self, facilitating discernment (career, relationships, schooling, etc.) and supporting the important work of differentiation and individuation unique to this time of life.”
Born here in Washington, Katie received her B.A. in Psychology from Gonzaga University and went east to Smith College for her M.S.W. Prior to joining the staff at Samaritan Center, she was Clinical Supervisor for Kindle Farm School in Newfane, VT. While completing the final work for full licensure in the State of Washington, Katie offers her services on a cash basis (to include sliding scale). She sees clients at the main office, on Ravenna Blvd.
For more information on Katie Geiser, see her profile on this site.

The Ingredients

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Once upon a time, when one of my sons was an exchange student in Austria, this happened:

Sixteen-year-old Chris believed that Rice Crispy treats were the best dessert in the world. You probably know what I’m talking about — marshmallows melted in butter, then stirred into the snap crackle and pop cereal?  Well, somewhere during that year abroad, he mentioned that they didn’t have marshmallows in Austria.  A geographic design flaw, certainly.  In response, I sent Chris a bag of marshmallows and a box of Rice Crispy cereal so that he could make the best dessert in the world for his host family.  I thought it was a brilliant idea.  I still do.

But here’s the thing: as the years passed and family stories were told and retold, this became the story:  “Other mothers sent actual cookies to their kids,” Chris said. “My mom sent me the ingredients.”

This wasn’t the first (or last) time I felt like a flawed mother. On reflection, however, I’m thinking that Chris was accurately describing my parenting philosophy.  Parents are responsible for coming up with the right ingredients. The outcome — in this case, the cookies – also depends on what the child does with those ingredients. Another brilliant idea, don’t you think?

I don’t mean to imply that parenting is simple or time-limited. It’s certainly not a matter of “Here you go, kid. I’m outta here.” For me, the intriguing thing about parenting is its complexity, its durability and the way it constantly changes shape. It’s about the relationship between two particular people over time.

I once had the image of a teeter totter on a school playground.  When a child is small, the weight is all on the parent’s end and those little child legs are dangling in the air.  As the child grows up, the teeter totter evens out and both sets of legs can touch the ground as needed.  Later on, as the parent ages, the weight shifts toward the adult child’s end and sometimes it’s the parent’s legs that are dangling in the air.

Thinking again about the ingredients idea, I’m imagining that both parent and child, at whatever age and life stage, continue to offer each other ingredients for their relationship. And here again, complexity arises. The ingredients that are offered may not feel to the receiver as if they belong in their imagined recipe. Sometimes one person stops offering or accepting altogether.  Life circumstances change.

Perhaps even modest success relies on our willingness and our ability to continue to show up for the relationship —  reserving judgment, allowing for mistakes, trying to understand one another. That will determine the outcome.