Beginnings

 Spring is around the corner. In most cultures, spring is synonymous with beginnings. At a certain stage of life, “beginning” may seem like a thing of the past. But I would argue that beginnings are as much the domain of a 90 year-old as that of a 90-second old. And well they should be.

Think of an arrow flying through the air. It would seem to be the epitome of movement. And yet, at this very second, were we to freeze time, it would be still. In this frozen second, there is no past and no future for the arrow. Only now. And that is true for all of us. We have a tendency to merge what has happened and what will happen with what is happening now. But we are not guaranteed a split-second more of this life and, as a wise woman once told me, “the past is gone–give up all hopes of changing it.”

In this light, every second of our lives is a beginning. Every second is a chance to change direction, let go of the illusion that we can rearrange the past, and focus on all that we can truly influence: this moment. This is not to say that we are not accountable for the past; but we can change our perspective of it. Make amends. And it’s not to say that we cannot shift our trajectory as a means of influencing future moments. But make no mistake: influencing the future is not the same as controlling it.

There is a Buddhist concept called, “Beginner’s Mind.” It tells us that every moment is an opportunity to experience the wonder and awe of a child who is experiencing the world as new. That is because every moment is new–as much for anyone else as for a child. One major difference is that the child has less “past” to project onto the future. What if we experienced this moment without judgment, without assumptions, and with openness to having our hearts and minds experience the world from a fresh perspective?

Carl Jung says the symbol of the spiral suggests that we do come back around again, but not exactly to the same place. Therefore, while we can see the past when we pass a familiar spot on an inner ring, and while our remembrance of that past moment informs our thinking, we are not in the past. The rings of the spiral expand into infinity with every new second.

This year, when the beginning that is spring comes, remember that it might as well be the first spring of your life. The first tulip you see is the first time you have ever seen that very tulip as the person you are right now. The first baby bird, a wonder. And yourself, a mystery unfolding.

But how do we do this? How can we adopt beginner’s mind? Mindfulness is the key. Jon Kabit-Zinn says “…mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” This type of awareness can be honed through a meditation practice. And it is a practice–awareness grows through the practice of meditation just like muscles grow by being challenged through resistance training.

There are many ways to build a mindfulness meditation practice. Perhaps the simplest way is to download an app to your smartphone or google “meditation” and choose a YouTube video to guide you.

If you would prefer to learn in a class setting, there are many opportunities for that in Atlanta. The Atlanta Mindfulness Institute and The Shambhala Center are two excellent options in the Atlanta area, but there are many, many more to be found.

One of my favorite mindful awareness practices is called the “Three-Minute Breathing Space.” There are three steps:

  1. Become aware of what is happening in your experience of this moment. Observe it, but if you find yourself making judgements (too big, too cold, not ____ enough), notice it and let that go. Come back to just observing your experience.
  2. Turn your attention to your breath. Your focus was initially broad, but narrow it now to just noticing your breath. Again, do this with curiosity, not judgment.
  3. Finally, let your focus expand again to include your whole body, noting any sensations that are present. If you find yourself commenting on the goodness or badness of anything (too tight, too tingly, the wrong size, etc.) come back to just noticing the sensations without judgment.

You can take three minutes to do this practice at points in the day when you feel overwhelmed, stressed, or detached. This practice will help you find your way back to a more vivid experience of this very moment. The only moment there is.

Big Love

It’s February. The month of love. Or at least the month of Valentine’s Day–a holiday that many people either love or love to hate. Often those feelings depend on a person’s romantic status. And sometimes the whole idea can leave us a tad lonely. Are we loved enough? Are we, ourselves, being loving enough? Cue eating the whole box of chocolates that we may or may not have purchased for ourselves.

But what if the month of love were a reminder that love takes many forms? Every language and every culture has many words for love. Valentine’s Day may bring words like eros and passion to mind, but don’t those words just represent one kind of love?

There is a concept addressed in every spiritual tradition that, in English, is most often called “lovingkindness.” In the Bible it is hecedh. In the Buddhist tradition, it is metta. In Judaism, it is chesed. These words all point to the same kind of love: benevolence, or unconditional goodwill toward all living beings–one’s self included.

We live in a highly polarized environment these days. At times, the outlook for unconditional brotherly/sisterly love seems bleak. But in the words of the Reverend Martin Luther King, Jr., “hate cannot drive out hate; only love can do that.”

Lovingkindness offers us the chance to lay down our anger, our defenses, our questions of whether we are loved or loving enough. It gives us a chance to reset our relationship with the world from one focused on not having enough love, to having so much love that we can give it unconditionally.

One way to cultivate lovingkindness is to practice it through meditation. There are many ways to do it and it can easily be adapted to prayer. One key element is that you begin with directing love to yourself.

Sitting quietly and comfortably, close your eyes and take a moment to notice the stillness of your body and the movement of your breath. Then offer yourself these statements of goodwill:

May I be safe.
May I be happy.
May I be healthy.
May I feel peace.

After repeating these to yourself, think of someone for whom you have neutral feelings–neither particularly positive nor negative. Perhaps the person who you stood next to in the check-out aisle or someone you work with but have never actually spoken to. Offer that person the same statements of goodwill:

May you be safe.
May you be happy.
May you be healthy.
May you feel peace.

Now think of someone for whom it is difficult to feel positive feelings. Someone your heart feels hardened to. Remember that they, too, suffer at times and (knowing that it costs you nothing), offer that person the statements of goodwill:

May you be safe.
May you be happy.
May you be healthy.
May you feel peace.

Finally, come back to yourself again. Offer yourself these words of kindness once more:

May I be safe.
May I be happy.
May I be healthy.
May I feel peace.
Now bring your focus back to your breath and body.

Research suggests that doing this practice regularly will make you feel more positively connected to others. It can be an active way to stop in the middle of your day and reorient your heart and mind when you have a sense of there not being “enough” love in your life. Emotions like loneliness, envy, or competitiveness might be a cue that a brief return to a bigger, more expansive, love-based approach could make your life, and the whole world, more loving and more kind.

It may be hard to remember how to do this exercise just from memory. If you would like a guided approach, try some of these options:

Lovingkindness Meditation from The Greater Good Center:

https://ggia.berkeley.edu/practice/loving_kindness_meditation

Lovingkindness Meditation by Jon Kabit-Zinn:

Lovingkindness Meditation by Sharon Salzburg: https://www.mindful.org/loving-kindness-takes-time-sharon-salzberg/

Mindful Transitions is Growing!

Happy New Year! We have so much to celebrate this year!

The need for in-home psychotherapy services in Metro Atlanta continues to grow, and we’ve been able to add more clinicians to meet that demand.

Janie Mardis, LCSW, and Stacy Ekmark, LCSW, recently joined our team of fabulous Clinical Social Workers. Read more about them below.

We are also so excited to announce that Amy McWilliams recently passed her clinical licensure exam to become fully licensed in Georgia. She is now accepting new clients!

We are excited about our ability to continue to grow. We have a strong commitment  to providing professional, compassionate, and timely therapy services to older adults.

Janie Mardis has over ten years of experience in counseling and case management. Working with older adults has always been one of her passions and she strives to provide care that recognizes both the potential challenges of aging as well as its many possibilities for growth, change, wisdom, and peace. 

Stacy Ekmark has a passion for geriatric mental health and wellness. She has prior career experience that includes adult and geriatric behavioral health and medical case management, assessment, individual and family psychotherapy.

Amy McWilliams  has 20 years of social work experience with the most recent being home health, hospice and the primary care setting. Amy unexpectedly fell in love the aging population while working in home health and hasn’t looked back. She has tremendous knowledge in navigating elder care resources and support.

Amy, Janie, and Stacy, like all of the Licensed Clinical Social Workers at Mindful Transitions, are Medicare providers and accept assignment. They provide psychotherapy and comprehensive clinical social work services to each of their clients, ensuring that they are connected to important services in the community and that their care is coordinated between all providers. Taking this holistic perspective that incorporates the whole system is important for the well-being and optimal functioning for each of our clients.

The Clinical Social Workers at Mindful Transitions work exclusively with older adults, most of whom live in independent living or assisted living communities. To learn more about the social work services at Mindful Transitions, please contact us at inquiry@mindfultransitions.com or (678) 637-7166.

Giving Presence

This year, perhaps “the present moment” can be your greatest gift.

Funny how we spend our first 12ish (okay, maybe more like 25ish) holiday seasons thinking about presents. Yes, the holiday is multifaceted–love, family, food–but let’s face it: the presents were the focal point.

And then we mellowed a bit. We expanded. Presents were, well…just things. We had jobs—we could buy things. So what were the holidays about, then? Maybe there were kids and then we spent the next 12ish (okay, 25ish) years thinking about presents again. And then maybe there were grandkids. More presents. And by then some of us may have wondered, “is that all there is?”

Because, by then, life had given–and taken–much more. Over time we had come to see that it was not about stuff. It was about the other things…the bony hug from Mom, the way the cat went after the same shiny ornament every year, the scent of apple cider, the solemn, sacred silence of an icy winter morning.

Life has changed us and made us richer, more appreciative of what cannot be bought. And so here we are, aware of the profundity of it all, and yet, despite all this awareness, sometimes the “big moments” feel like a thing of the past. 

But that is an illusion. There are memories, and those are treasures. But they are artifacts. All that truly exists is what is happening now.

What do you see? The austerity of the bare branches–how many delicate shades of brown and gray?

What do you feel? The warmth of winter layers, comforting in their softness.

What do you hear? Perhaps the sound of your own breath, a sound that has been with you longer than any loved one.

What do you taste? Maybe traces of your most recent meal–the spice, the richness lingering on your tongue

And what do you smell? The metallic tang of cold winter air? The absence of things blooming, dormant in their generative rest.

This year, perhaps “the present moment” can be your greatest gift. Perhaps your presence–full, focused, unhampered by distraction, can be the gift you give yourself and those you come into contact with. This moment is all we have—we have no sway over what has passed and no access to what has yet to come.

Allowing Change to Happen

It’s finally fall! Like the leaves changing colors and the animals adapting to the cooler temperatures, fall is a time undeniable change.

And sometimes change is hard.

We often resist it. We make assumptions about what we think we want. We want to avoid change, we want to go back to the way things were before, or we want something to be completely different.

We have an illusion of control.

Yet, so many things happen to us—without our input. There is the story of the man who had his life turned upside down by a heart attack, the woman who lost her spouse to death and had to drop everything, the family who lost their home to a hurricane, the successful employee who was laid off when the economy tanked, the cyclist who was hit by a car, the pedestrian hit in a crosswalk, and so many more examples.

We have very little control over our lives.

Change is a normal part of life. Our job is not to control the change but to adapt and adjust. We are challenged with being mindful and finding joy despite the change.

Mindfulness helps us to stay present and connect with joy.

We can mindfully be aware of our current situation and observe it with a non-judgmental attitude. This shift in our attitude helps us to stop resisting the change in our lives.

So, what exactly is mindfulness?

Mindfulness is
1. Awareness
2. Of present experience
3. With acceptance

Mindfulness involves:
 ‘Stopping’
Paying attention
Becoming aware of present moment realities
Not judging whatever is happening as ‘good’ or ‘bad’

“The non-judgemental observation of the ongoing stream of internal and external stimuli as they arise”. Ruth Baer (2003)

“Keeping one’s consciousness alive to the present reality” (Thich Nath Hanh, 1976)

“Mindfulness is simply the knack of noticing without comment whatever is happening in your present experience” Guy Claxton (1990)

What Mindfulness is About:

Being present to our experience however distressing or upsetting it may be

Bringing us closer to difficulties but without becoming caught up in our reactions to difficulties

Slowly developing is a gentle grip on who we are
Settling in to our current experience in an alert, open-hearted way

You can start practicing Mindfulness today with this Take Ten Breaths Exercise.

Take Ten Breaths
1. Throughout the day, pause for a moment and take ten slow, deep breaths. Focus on breathing out as slowly as possible, until the lungs are completely empty, and breathing in using your diaphragm.
2. Notice the sensations of your lungs emptying and your ribcage falling as you breathe out. Notice the rising and falling of your abdomen.
3. Notice what thoughts are passing through your mind. Notice what feelings are passing through your body.
4. Observe those thoughts and feelings without judging them as good or bad, and without trying to change them, avoid them, or hold onto them. Simply observe them.
5. Notice what it’s like to observe those thoughts and feelings with an attitude of acceptance.

Change is hard. It takes practice to develop an effective mindful, accepting posture towards what we cannot control.  If you’re feeling overwhelmed by changel, it may be helpful to talk to a mental health professional.

Mindful Transitions is a team of Clinical Social Workers that is dedicated to helping older adults and their families. We can help our clients work through difficult changes.  To learn more about our services, please call us at (678) 637-7166.

How to Respond to a Loved One’s Anger

In our last Mindful Minute, we shared information on Understanding the Anger Iceberg.

Beneath everyone’s anger lies more complex feelings.  The anger iceberg illustrates how anger is what is showing externally and that a person’s internal experience is often more raw and vulnerable.

You can read our newsletter here.

What the anger iceberg does not explain, though, is what to do when someone you love is directing their anger at you. Being around an angry person is very difficult. That anger can jeopardize that ability to maintain a loving relationship and have closeness. You want to get to what is under the anger.

Here are tips on responding to someone’s anger:

  1. Do not take it personally. Their anger is usually not about you.  Try taking a curious or investigative approach to the anger.  This shift in perspective, from defensive to inquisitive, may help you to really see what is going on. Remember, there is something beneath the anger. Is it fear? Loneliness? Frustration?
  2. Do not try to fix their feelings. The goal here is not to change or fix their anger.  You may not be able to calm the person down, but you can hear them. You can abandon any attempts to reason or defend yourself. Just listen. When a person stops trying so hard to convince you why they are justified in being angry, they may be able to move through their anger and access the feelings underneath.
  3. Restate what they need.  There is usually some unmet need that is going unheard and unmet. Can you identify that and bring the focus to that unmet need?
  4. Leave. If their anger is harmful, threatening, or destructive to you, leave.

Anger is usually an attempt to cover up some kind of pain or vulnerability—listen for that pain.

This is never an easy task, but to salvage meaningful, fulfilling relationships, it may be necessary. If you and your loved one are experiencing frequent, unresolved anger issues, consider getting help. Trained mental health professionals, like the Clinical Social Workers at Mindful Transitions, can help you work through the anger and salvage your relationship.  To learn more about our service, please call us at (678) 637-7166.

Medicare’s Open Enrollment—It’s Almost Time!


Each year Medicare offers its beneficiaries a chance to make changes to their Medicare coverage. This year, the dates for Medicare’s Open Enrollment are October 15-December 7, 2019.  

During Open Enrollment you can change your Original Medicare A & B to a Medicare Advantage Plan, change from one Medicare Advantage Plan to another, add or change your prescription plan, or change your Medicare Advantage Plan back to Original Medicare. The changes you make will go into effect on January 1, 2020.

Medicare is not a set it and forget it plan.

Most folks do nothing, allowing their coverage to stay the same. This decision could cost them tremendously in both financial and care options.

Each drug plan and Medicare Advantage Plan can change each year.  These changes impact providers and patients alike. 

Premiums, copays, or other out of pocket costs may go up unexpectedly, coverage may not be as robust as in years past, healthcare provider networks may change, and terms for providers may change, limiting providers willing to work with certain insurance carriers at all.  Please remember that our Mindful Transitions team does not accept ANY of the Medicare Advantage plans-only Traditional Medicare.  

It is important for you to review your coverage, your needs, and your options every year.

Here are a few tips from The Medicare Rights Center to get you started:

  • If you are looking for a new Part D plan, you can use the Plan Finder tool from www.Medicare.gov to compare options in your area. Before you use Plan Finder, make a list of the medications you take, the amount that you currently pay for them, and which pharmacies you like to visit. You will be able to get a sense of which plans cover the medications you need with the lowest costs and fewest coverage restrictions.
  • If you are shopping for a new Medicare Advantage Plan, you can use the Plan Finder tool to compare options in your area. You can also call 1-800-MEDICARE and ask about plans in your area. Once you have a list of your available options, you can visit their websites to learn more.
  • After you have researched plans and found one that you are interested in, call that plan directly to confirm what you learned online. Ask about your doctors and hospitals to check that they are included in your plan’s network. Check also that the plan includes all the drugs you need on its formulary, and that your pharmacies are in the plan’s network. Write down everything about this conversation, including the date of the conversation, who you speak to, and the outcome of the call.
  • Call 1-800-MEDICARE if you decide to enroll in a new plan. This is the best way to protect yourself if there are any problems with enrollment. Write down everything about your call, including the date of the conversation, who you speak to, and any information the Medicare representative gives you during the call. Remember to confirm all the details about your new plan with the plan itself before calling Medicare.
  • Be wary of solicitations and advertisements stuffing your mailbox (both snail mail and email). Medicare Advantage Plans have started sending out information about their plans, but they must follow certain rules.

If you need additional help, please reach out to GA Cares at 1-866-552-4464 (option 4).

For more information please visit Medicare Rights Center.

All of the Clinical Social Workers are Medicare providers and accept assignment. We do not, however, accept any of the Medicare Advantage Plans.  If you want to learn more about our services, please visit our FAQ page, call us at (678) 637-7166, or email us at inquiry@mindfultransitions.com

Mindful Transitions Added Two More Social Workers!

In last month’s newsletter, we announced that Mindful Transitions is growing! Last month, we added Alisa Beattie, LCSW, and Amy McWilliams, LMSW, to our team!

We have seen an incredible surge in the demand for in-home psychotherapy services in Metro Atlanta in the last year. In response to that need, we continue to grow and stay committed to providing professional, compassionate, and timely therapy services to older adults.

Alisa has over 18 years of experience as a Clinical Social Worker, focusing on older adults for the last 10 years. She will be helping cover the Cumming, Gainesville, Alpharetta, Roswell, John’s Creek, Suwanee, and surrounding areas alongside our other clinicians who serve clients in that area.

Alisa, like all of the Licensed Clinical Social Workers at Mindful Transitions, is a Medicare provider and takes assignment. She will be providing psychotherapy and comprehensive clinical social work services to each of her clients, ensuring that they are connected to important services in the community and that their care is coordinated between all providers. Taking this holistic perspective that incorporates the whole system is important for the well-being and optimal functioning for each of our clients.

Alisa is currently accepting new clients.

Amy is a Licensed Masters Social Worker, working towards her clinical licensure. She will be working with our intake coordinator to help clients, families, and professionals inquiring about our services. Once she is fully licensed as a Clinical Social Worker, she will be accepting new clients.

Be sure to welcome Amy whenever you call into our office!

The Clinical Social Workers at Mindful Transitions work exclusively with older adults, most of whom live in independent living or assisted living communities. To learn more about the social work services at Mindful Transitions, please contact us at inquiry@mindfultransitions.com or (678) 637-7166.

To refer someone to Mindful Transitions, please download our referral form.

Understanding Medicare’s Mental Health Benefits

Original Medicare offers mental health benefits to beneficiaries needing mental health services. Here is a quick overview of those benefits:

Outpatient Services

Medicare Part B will pay 80% (once the Part B deductible is met) for outpatient counseling services. The remaining 20% would be the co-insurance paid by the patient (or a MediGap plan, if the patient has a supplemental plan).

Medicare allows its beneficiaries the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists.  Most of our clients prefer to find a provider who accepts Medicare and takes assignment. If a provider doesn’t accept assignment then Medicare will not pay for the services or reimburse a beneficiary for amounts paid to non-participating providers. The Licensed Clinical Social Workers at Mindful Transitions are all certified Medicare providers and take assignment.

Mental Health Screenings

In addition to psychotherapy, Medicare covers yearly depression screenings that must be done in a primary care doctor’s office or primary care clinic. This can help with appropriate diagnosis, treatment and follow-up. There is no cost for this screening. If your doctor hasn’t talked to you about your mental health, you can always request a screening.

Inpatient Psychiatric Services

The benefits for inpatient psychiatric services are paid by Medicare the same way that general hospital services are paid. There is a $1,340 deductible for each benefit period, $0 coinsurance for the first 60 days, and $335 co-insurance for days 61-90. Medicare pays for 80% of all mental health services provided while the patient is in the hospital. Medicare limits the number of psychiatric hospital stays to 190 days per lifetime; after those days are used up, the patient must pay for inpatient psychiatric care privately.  

Partial Hospitalizations 

Partial hospitalization programs (PHPs) are structured programs provided as an alternative to inpatient psychiatric care. They are more intense than traditional therapy, are provided during the day, and  do not require an overnight stay. Medicare helps cover partial hospitalization services when they’re provided through a hospital outpatient department or community mental health center (assuming that the doctor and the partial hospitalization program accept assignment). 

Medications

Medicare usually covers medications used to treat mental health conditions under the Part D prescription drug benefit. The Part D formularies may limit which medications are covered and should be checked. Each Part D plan creates its own list of approved and covered drugs. The open enrollment period is a great time to review your plans’ formulary and to possibly switch to a new plan.

Medicare Advantage Plans

Medicare Advantage Plans also offer mental health services, but there are limits to their services. They have a narrow network of providers.  Each plan has to be explored individually to learn what they will provide.

Finding Providers

To locate a provider in your area that accepts Medicare assignment, use Medicare’s online tool at medicare.gov/physiciancompare. Type in your zip code, or city and state, then type in the type of profession you want locate, like “psychiatry” or “clinical social worker” in the “specialty” box.

The Licensed Clinical Social Workers at Mindful Transitions are Medicare providers and take assignment. In addition to providing psychotherapy, we also provide comprehensive clinical social work services to each of our clients, ensuring that they are connected to important services in the community and that their care is coordinated between all providers. Taking this holistic perspective that incorporates the whole system is important for the well-being and optimal functioning for each of our clients. We provide psychotherapy and so much more!

How to Create Joy

NPR recently published From Gloom To Gratitude: 8 Skills To Cultivate Joy.  This piece covered the methods and outcomes of a program designed for caregivers for people living with dementia.  Life Enhancing Activities for Family Caregivers (LEAF) is a 6-week positive emotion regulation intervention that taught caregivers 8 skills in an attempt to build more positive emotions alongside the negative emotions.

Here are the skills taught throughout the program:

  1. Take a moment to identify one positive event each day.   
  2. Tell someone about the positive event or share it on social media. This can help you savor the moment a little longer.   
  3. Start a daily gratitude journal. Aim to find little things you’re grateful for, such as a good cup of coffee, a pretty sunrise or nice weather.   
  4. Identify a personal strength and reflect on how you’ve used this strength today or in recent weeks.   
  5. Set a daily goal and track your progress. “This is based on research that shows when we feel progress towards a goal, we have more positive emotions,” Moskowitz says. The goal should not be too lofty. You want to be able to perceive progress.   
  6. Try to practice “positive reappraisal”: Identify an event or daily activity that is a hassle. Then, try to reframe the event in a more positive light. Example: If you’re stuck in traffic, try to savor the quiet time. If you practice this enough, it can start to become a habit.   
  7. Do something nice for someone else each day. These daily acts of kindness can be as simple as giving someone a smile or giving up your seat on a crowded train. Research shows we feel better when we’re kind to others.   
  8. Practice mindfulness by paying attention to the present moment. You can also try a 10-minute breathing exercise that uses a focus on breathing to help calm the mind.  

Many of the participants reported an improvement in mood and a decrease in depression just by employing these practices. The shift from what isn’t working to what is working, or from examining what is so bad to what may still be good, can make a big difference.

This ties into another piece recently published, this one by the New York Times, on Washing Dishes. The author reframes the drudgery of life’s tasks as the good stuff in life. 

“But lately I’ve been wondering what that time and space is for. Implied in the quest for convenience is a distinction between the life we deem worth living and the life we have to endure in order to get there. One is a possibility, the other an obligation; one is a means, the other an end. Look at dishwasher ads from the 1950s, when the appliance became commonplace, and you see narratives of a life reclaimed, an escape from the purgatory of work into the freedom of leisure. Life hacks, multitasking, the ruthless compression of our daily routine: We still frame the ordinary as something that exists only for the thing beyond it, as a hazard to be optimized away instead of an organism to be nurtured and interacted with.”

(The whole piece is short and worth reading.)

When there are hard things in life that we cannot change, maybe we can shift our perspectives just a little to open up the small joys.