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Author Archives: Meri Levy
Statement of Anti-Discrimination and Land Acknowledgment
As a psychotherapist that works with families from all ethnic and racial backgrounds as well as other marginalized groups, I want to affirm that I stand with our Black community and families of color, as well as LGBTQ+ people.
Through my work and life, I commit to doing my part to bring awareness to and dismantle systemic racism, sexism, homophobia, and transphobia, as well as other forms of discrimination and othering. As a straight, white cisgender woman, I recognize that I have been the recipient of unacknowledged and unearned privilege. I explicitly and publicly affirm my identity as an ally and commit to doing my own work to acknowledge and address racism, sexism, homophobia, and transphobia when I encounter them.
I recognize that discrimination also significantly affects the mental health and well-being of people of different faiths, those with disabilities, those with mental illness, and those who face weight stigma. In my life and in my psychotherapy practice, I am committed to addressing the impacts of discrimination with my clients and to taking a social-justice-oriented approach.
My home and office are on land formerly occupied by the Saklan tribe of the Bay Miwok people. I acknowledge that I live and work on stolen land and commit to continue to learn about and advocate for social justice for native people.
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION:
I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:
- Make sure that protected health information (“PHI”) that identifies you is kept private.
- Give you this notice of my legal duties and privacy practices with respect to health information.
- Follow the terms of the notice that is currently in effect.
- I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.
For Treatment, Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your person health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition. Disclosure of confidential information may also be required by your health insurance carrier or HMO/PPO/MCO/EAP in order to process claims. If your therapy sessions are covered by insurance, or if you seek reimbursement from your insurance, your treatment records may be disclosed.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.
Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:
When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
For law enforcement purposes, including reporting crimes occurring on my premises.
To coroners or medical examiners, when such individuals are performing duties authorized by law.
For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws.
Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.
The Right to Get a List of the Disclosures I Have Made.You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.
The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on September 20, 2013
How Doulas Can Help With Postpartum Depression
On Wednesday, I was invited to speak to a group of local doulas, the Mt. Diablo Doula Community, about prevention of Perinatal Mood and Anxiety Disorders (PMADs), as well as how to recognize the disorders and how to help their clients. I hope the presentation might be helpful for doulas who are wanting more information about these disorders and what role they can play in keeping moms healthy and happy. You can access the Presentation Here. Attachments to the presentation are the Edinburgh Postnatal Depression Scale and an associated Suicide Screening Interview.
Antidepressants: Yay or Nay?
For individuals who have struggled with depression, the decision of whether to try, or later to stay on antidepressant medication is often a difficult one. Some people swear they will never try an antidepressant, until or unless their depression becomes so debilitating that there seems to be no other option. For others, the promise of relief is so attractive that they jump into the decision to take antidepressants, but then they struggle with the question of whether the medication is a lifelong sentence.
To Take Antidepressants or Not to Take Antidepressants
There are no easy answers to this question (as is true for most important ones!). Studies show that individuals suffering from moderate to severe depression have better odds of recovery with a combination of therapy and antidepressants. However, for some people, changes in diet, additional exercise, and better strategies for coping with stress can work just as well. For debilitating depression, medication can often help to lift a person up enough to be able to meaningfully participate in therapy. But depression generally happens for a reason, and often changes in thinking patterns, relationships or career are necessary for a person to have more happiness and fulfillment in their life. Medication alone may not make these changes happen. Does relying on antidepressants to make life more bearable reduce the motivation to make needed life changes that will improve the quality of one’s life? The answer to that question may be different for every individual, and is something that can be explored in therapy.
Side Effects
Some individuals find great relief on antidepressants, and don’t have any bothersome side effects. But others experience weight gain, sexual side effects or other unwanted secondary effects from these drugs. Sometimes, switching medication can resolve these issues, but in some cases the antidepressants that work for the individual are the same ones that cause other problems. That is a common reason why some people consider going off medication and try to manage their depression in other ways.
Never Go Off Antidepressants Without Consulting Your Doctor
A reminder here is important; never go off antidepressant medication suddenly, or without the supervision of the prescribing doctor. Some of these drugs require an extended period of weaning to avoid serious withdrawal symptoms. And an important factor to consider is the possibility that if you wean off your antidepressant medication, the same medication may not work for you as well in the future. That is one factor that you need to weigh with your health provider when making this decision.
Issues Raised by Weaning Off Antidepressants
Individuals that decide in consultation with their doctor to wean off antidepressants face a whole other set of challenges. The fear of a relapse of depression can be the most difficult part. Coping with the symptoms of withdrawal can be challenging, and often brings up these fears. Also, people who go off antidepressant medication may find themselves more vulnerable to feelings of sadness, irritation, anger and stress than they are used to. Learning coping strategies for these emotions is very important. A really bad day can create a lot of anxiety that the depression may be returning, even if the emotions involved are normal and healthy. Therapy can be an helpful place for reality-testing in terms of what is healthy and what is a signal that depression may be returning.
The thoughts and feelings around the decision to go on or off of antidepressant medication can be confusing. Therapy and consultation with your medical provider to sort through the questions and concerns raised by antidepressants is a good place to start.
For New Moms: When You’re “Just Not Yourself”
By Meri Levy, MFT
Being a new mother should be a joyous time in your life. But what if you’re not feeling like yourself after having a baby? About 10-15% or of new moms experience postpartum depression, which can begin any time during the first year after childbirth. Depression is a treatable illness that causes feelings of sadness, indifference, and/or anxiety.
Postpartum depression (PPD) is different from the “baby blues.” A majority of new mothers experience the “baby blues,” a period of sadness that isn’t debilitating and passes quickly. Symptoms of the “baby blues” include tearfulness, irritability, restlessness, and anxiety. But when symptoms of sadness, irritability or anxiety continue for more than two weeks or make it difficult to care for your baby, there is more going on and it’s time to reach out for help.
Symptoms of PPD include:
- Fatigue or lethargy
- Feeling sad, hopeless, helpless, or worthless
- Trouble sleeping/sleeping too much
- Loss of appetite/increased appetite
- Difficulty concentrating/confusion
- Crying for no apparent reason
- Lack of interest in the baby
- Fear of harming the baby or oneself
Symptoms can vary in severity, but persistent depression often causes new moms feel isolated, guilty, or ashamed.
You should tell your doctor if you have several of these symptoms for more than two weeks; if you have thoughts of suicide or thoughts of harming your child; depressed feelings are getting worse; or you are having trouble caring for your baby or yourself.
Depression is an illness. It is not a sign of weakness or of being a bad mother. It can be treated successfully, and getting help is the best thing you can do for your baby.
Risk Factors for PPD
Any new mom can develop PPD. Its causes may include hormonal and other physical changes, sleep disturbance, emotional adjustments and chronic stress. However, women are at increased risk of depression if they have a personal or family history of depression, if they are have experienced particularly stressful life events such as significant losses, a high-risk pregnancy or traumatic birth, or if they don’t have adequate support from family and friends.
Other Postpartum Conditions:
Postpartum Anxiety and Obsessive Compulsive Disorder
Many new moms experience anxiety rather than sadness after giving birth. Anxiety, panic attacks, irrational fears or intrusive thoughts, or images can be associated with Postpartum Anxiety or Obsessive Compulsive Disorder. Symptoms of a panic attack can include a racing heartbeat, unusual physical symptoms, a sense of impending doom, the feeling that you are dying, dizziness or nausea.
Posttraumatic Stress Disorder after Childbirth
New mothers can also develop post-traumatic stress disorder (PTSD) following a traumatic childbirth experience. PTSD involves reexperiencing the trauma through flashbacks or nightmares, having difficulty sleeping, and feeling detached or estranged from friends and loved ones.
Postpartum Psychosis
Postpartum psychosis is extremely rare but also very serious. It affects only two out of every 1,000 new moms. The symptoms are severe and may include insomnia, agitation, hallucinations, and extreme paranoia or suspiciousness. Postpartum psychosis is a serious medical emergency and requires immediate attention.
Treatment for Postpartum Disorders is Effective
If you believe you are suffering from a postpartum disorder, the first step is to talk to your doctor or mental health provider.
You should be evaluated by your doctor to rule out a medical cause that can contribute to depression.
Psychotherapy, medication or a combination of the two may be needed to get you back to feeling like yourself. But you must continue treatment even after you begin to feel better, because discontinuing treatment too soon can cause symptoms to recur.
The support of family and friends is also instrumental to your recovery. In addition, joining a support group for postpartum disorders can help overcome feelings of isolation, increase coping skills and provide social support.
Getting help is the most important step you can take for yourself and your baby. Untreated maternal depression is associated with developmental delays in babies, as well as potentially serious emotional consequences for your growing child.
How Partners Can Help
New moms suffering from Pospartum Depression and Anxiety need the support of their partner, as well as friends and family. Help with baby care and household responsibilities, provide an ear to listen or a shoulder to cry on, and be patient and understanding with her struggles. And make sure she gets help.
Partners also need to take care of themselves. Having a new baby is hard for partners too. And if the mother is depressed, you are dealing with two major stressors. Partners can also suffer from Postpartum Depression, a often undiagnosed problem.
How to help a partner suffering from a postpartum disorder:
- Encourage her to talk about how she is feeling. Listen without judging her. Instead of trying to fix the problems, just be there for her to lean on.
- Offer help around the house. Chip in with the housework and childcare responsibilities. Don’t wait for her to ask!
- Make sure she takes time for herself. Rest and relaxation are important. Encourage her to take breaks, hire a babysitter, or schedule some date nights.
- Be patient if she’s not ready for sex. Depression affects sex drive, so it may be a while before she’s in the mood. Offer her physical affection, but don’t push if she’s not ready for sex. She will recover in time!
- Go for walks with her. Getting exercise and sunshine can make a big dent in depression, but it’s hard to get motivated when you’re depressed. Help her by making walks a daily ritual for the two of you.
Take a test to see if you have Prenatal or Postpartum Depression
Good Faith Estimate Notice
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
Under the No Surprises Act, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
Meri Levy, LMFT is an out-of-network provider and therefore is required to provider a Good Faith Estimate and to inform you that lower cost care may be available through an in-network provider.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
Reading Your Baby’s Cues
People have a physiological reaction to the sound of a baby crying. Our hearts pound, our blood pressure rises, and we start to sweat. This reaction causes most of us to try to stop the crying, regardless of how tired, irritable, or hungry we might be ourselves. And that’s a good thing. It’s how our babies learn to trust that their needs will be met and that the world is a safe place.
But sometimes (often!) new parents wonder what the baby is trying to say? What does the baby need? We run around randomly, trying different remedies: jiggling the baby, rocking the baby, changing her diaper, offering a breast or the bottle, or a pacifier. And sometimes the baby still cries. We desperately want to eliminate the cause of the crying, and we become frustrated, angry or guilty when we fail.
Read More…
Co-Parenting With a Partner
The First Year Can Be Rough, by Meri Levy, MFT
If you’re like me, I really thought that, despite my decision to breastfeed, my husband was so gung ho about being a Dad that we would share the parenting responsibilities pretty equally once our first child was born. I was in for a rude awakening. Breastfeeding meant that much of the time I was literally attached to my new baby, and when I was not, I had an easier time calming him than my husband did. And even when I didn’t, I couldn’t stand to have my husband trying to comfort our fussy baby without stepping in and trying to help. Whether due to biology or psychology, I was so attached to my new baby that I couldn’t tear myself away long enough to really get a break. As a result, I became more comfortable in the baby care role, and he became less.
There are many reasons why fathers often take a backseat in the early days with a new baby. Whether because of a hormonally-afflicted “helicopter” Mom, an inexperienced Dad, a baby who is more easily calmed by the mother, or gender-related attitudes about who does what, newborn care often falls disproportionately to the mother. And since Mom is generally recovering from childbirth, likely adjusting to breastfeeding, undoubtedly sleep deprived, and in the throes of huge hormonal changes, this disproportionate share can become a BIG PROBLEM. You know that saying that “if Mom isn’t happy, nobody is happy?” I think the truth of that statement is widely underestimated.
So, we’ve got a Mom who can’t let go to allow her partner to care for the baby, a Dad who is either mildly incompetent or feels he is (or is being treated like he is), a baby who’s getting used to being cared for by Mom, and a Mom who is at the end of her rope and feels like she just can’t get a break (and is not sure she would take one if she could). Not a recipe for a happy family.
Negotiating who does what, recognizing the barriers to fairly allocating parenting and household responsibility and actually making and carrying out a plan to address those barriers and create a cooperative, supportive and fair allocation of workload is one of the major tasks of the first year of parenthood. Working out a plan for who does what, figuring out how to set goals for change if change is needed, and implementing those changes, can make a world of difference.
I once read a study (and I don’t have a citation, but I like to believe that it is true) that claimed that of all the factors that might predict the well-being of children as they grow up (e.g. praise, affection, discipline, structure, etc.), the one variable that is most predictive of a child’s future well-being is the degree to which his or her parents have a cooperative relationship around parenting. So, if that is true, it matters less who does what (or if it is done correctly), and it matters more that parents are supportive of each other as parents and partners.
Becoming a Parent to Your Newborn
By Meri Levy, MFT
Regardless of your expectations, the arrival of a first baby is, first and foremost, a radical role adjustment for the new mother and father. As you grow from being a child to an adult and into a partner in an adult relationship, most of us experience shifts in our relationships as daughters or sons, sisters or brothers, and friends or lovers.
But the birth of a baby changes everything! Now perhaps your most significant role in life is as a parent. This is an altogether new role, and babysitting experience aside, there is no real preparation for it. But it is truly amazing to see how our babies foster and nourish our growth as parents, almost from the beginning.
While you adapt and grow to fill your new role, it can be difficult at times to hold onto formerly cherished roles, as a professional, a friend or lover, and an independent person in your own right. You may find that you are redefining yourself in ways that make these roles change (e.g. leaving behind a career, changing roles in your marriage, etc.)
Ultimately, however, we are ourselves. While we adapt to our role as parents, we also must adapt our view of parenting to include who we are as individuals — to allow ourselves to fit into our vision of a good parent.
Some mothers plan to stay at home full-time, but must still figure out if staying at home with their new baby is what makes them a happy mom. Or conversely, working mothers may find that they cannot leave their baby in another’s care. For fathers, you may have expected yourself to be the provider, but you still must figure out if spending the weekend satisfying that picky client at home is how you want to be a father — or if your partner is even the better choice as the bread-winner! And parents must weigh all sorts of other priorities, to friends, yourself, and the world, in figuring out how you will incorporate being a parent into your life.
No one can do this for you, because you are as unique a person as your new baby, and uniquely qualified to create the best family for your child.
If the process of evolving into the parent you want to be is more challenging that you thought, working with a therapist who specializes in this transition is a good way to work through your competing goals and figure out the path that is right for you.