I Chose to Help

Many things have happened to me both personally and professionally in the last few years.  For some reason opportunities are being presented to me that are extremely helpful and can allow me to help others.  As the results of the election poured in it occurred to me that others were going to need as much help as we in the counseling/mental health community can give them.  The first week after the election I began exploring how I could help my community and maybe even others.  Relatively quickly after that I talked to someone on social media who was interested in funding the type of work I was interested in doing, with the caveat that the entity was a non-profit.  And so, more work began.

What I’ve discovered is that it’s difficult to set up a non-profit, but much easier than most folks think.  I’m going to share the information I was able to find and that which I was given by the IRS (which I’m happy to say the agent I spoke with was wonderful and gave great information.)

Every state (or commonwealth depending on where you live) has its own requirements for setting up a non-profit for 501(3).  Grantspace is the best source I was able to find online that gives very comprehensive information on what you have to do.  Another Google search for my residential commonwealth of Virginia pulled up even more specific information on what was needed.  Here is what I found on the Commonwealth of Virginia.  You will need to look up the state/commonwealth you want to operate out of before you start filling out forms.  Each state/commonwealth wants things done specifically, so if you find yourself getting frustrated with the research part make sure you’re taking lots of breaks.  This can be an extremely frustrating process, but it is worth it.

Once you’re somewhat familiar with your state’s requirements you need to come up with a name for your entity if you haven’t done that yet.  You will need to check with your state’s Corporation Commission Clerk’s office to see if the name you want is available in your state.  While you’re on the phone with them you might as well ask them if they have any helpful information on creating a non-profit entity.  I was told to call the IRS directly before I did anything else, which proved very helpful. 

After you’ve spoken to the clerk’s office you’re going to need an EIN number from the IRS for your entity.  Go to IRS.gov (the IRS agent I spoke with told me she’s had to tell several people who went to the wrong website and paid money for their EIN # that they could have gone directly to the IRS site and received the same # at no cost) and do a search for EIN #.  Again, talking to an agent before attempting this on your own is probably best.  I took extensive notes while on the phone with the IRS agent and the wording can still be confusing.

Once you have your EIN # your next step is to file through your state’s Corporate Commission Clerk’s office to get the business set up.  Again, make sure you’ve reviewed what’s required before you attempt this.

If you’ve already filed with your state then you can move on to the next step, which is going back to the IRS site and searching publication 557.  You’re going to want to read chapter 3 of publication 557 because you’re going to need the wording used to create your form 1023 wording.  Form 1023 is what the IRS uses to form a non-profit for 501(3) entity.  I was told by the friendly IRS agent that you can copy the language in publication 557 ch 3 directly or paraphrase it, but you need that type of wording in your form 1023.

Finally, we get to the cost of all this.  It differs between states (Virginia is $75 to file), but for the IRS it’s either a fee of $400 (if you think you’re going to gross less than $10,000 in your first year) or $850 if it’s higher than that.  You do have the option to try filing a 1023EZ which costs $275, but you have to qualify for that one.  Fill out the questionnaire on the IRS site to see if you can qualify for the form 1023EZ.  It can take up to three months for the IRS to process your form 1023.

And that’s it for the most part.  You’ll still need to open a business banking account (the EIN # will be helpful for that), but once you’ve got the bulk of that done you can actually start fundraising to begin your work.

I’m going to be using some of my Department of Veterans Affairs disability money to get my non-profit entity on its feet, and I know I’m lucky to have that option because not everyone does.  But if this is something you’ve decided on and you’re willing to make the investment of time, you will find a way to get the initial money together.  Talk to other members of the counseling/mental health field in your own community and see if this is something anyone else wants to do.  Don’t try and do this on your own – it’s a big project and you will need help from other people to carry it off. 

So many people in the United States are going to lose medical and mental health care because of the changes the new administration is implementing.  This is how I’m going to fight that, but each person much choose their own path.  Don’t forget to take care of yourself in your fight to help care for others.

Update
The website LegalZoom.com is a great resource.  Here's a link to their non-profit Pricing plans, but do be sure to see what you actually need before you purchase a plan.  You can take care of the EIN # and the name availability on your own, but having them draft the articles of incorporation paperwork is worth the lowest price plan.

Anxiety in Iron Man 3

Last night I got the rare opportunity to go see a movie at the theater all by myself.  I'm an introvert so going to the theater alone is something I enjoy, but because I'm married and have three kiddos, it's not something I get to do very often.  Iron Man 3 was the film I decided on and it was definitely worth the money.  While I was watching the credits at the end of the movie (it's a Marvel thing: they always throw short videos in at the end) it occurred to me that a few people I know on Facebook had commented on how they weren't crazy about the portrayal of PTSD in the film.  This led my brain into a whole discussion (with my very introverted self) on what Tony Stark was experiencing in the film.  And that is how this blog post came to be ;-)



Without getting too spoilery for those who haven't seen the film, the main character Tony Stark has been having issues since his experience in New York with the Avengers.  These issues include:  not being able to sleep, when he does sleep he dreams about New York, a feeling of being unsafe, having flashbacks to what happened in New York, and sometimes during the flashbacks having difficulty breathing and focusing on his surroundings.  (If you haven't seen the Avengers and want to know what happened in New York, go rent the DVD.)  

At some point in the movie the idea of Tony having PTSD is introduced and he doesn't entirely deny that he may have PTSD.  It was unclear, but implied that Tony had not been seeing a counselor and had only spoken about New York to close friends.  Tony's way of dealing with his anxiety is to work continuously with Jarvis on his suits.  This has apparently become a bone of contention with his romantic partner, Pepper Potts.

Posttraumatic Stress Disorder (also known as PTSD) is listed in the DSM-IV-TR under the grouping of Anxiety Disorders.  This basically means that part of the root of PTSD is panic or anxiety of some sort.  PTSD (taken from the DSM-IV-TR so I will provide  a citation at the end of the post) "is characterized by the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma."  With only this short description of PTSD and by taking into account the above description of his changed behaviors, the character of Tony Stark could indeed be experiencing posttraumatic stress disorder.  But let's look at it a bit further, just for the sake of argument.

There are certain diagnostic criteria which must be met according to the DSM-IV-TR before a diagnosis of PTSD can be given.  I'm going to list the criteria which the character Tony Stark has exhibited and see if it is enough for a clinical diagnosis:
   1.  recurrent & intrusive distressing recollections of the event, including images, thoughts, 
        or perceptions
   2.  recurrent distressing dreams of the event
   3.  efforts to avoid thoughts, feelings, or conversations associated with the trauma
   4.  efforts to avoid activities, places, or people that arouse recollections of the trauma
   5.  restricted range of affect (for this criteria Tony Stark has virtually lost his ability to flirt 
        with anything female unlike the Tony of the previous two movies.)
   6.  difficulty falling or staying asleep
   7.  hypervigilance
   8.  duration of the disturbance is more than 1 month
   9.  The disturbance causes clinically significant distress or impairment in social, 
         occupational, or other important areas of functioning (for this criteria the main 
         disturbance has been in the relationship with Ms. Potts.)

For all intents and purposes Tony Stark as represented in Iron Man 3 does meet the minimum criteria for a diagnosis of posttraumatic stress disorder.  Now I'm going to point out something that most counselors are already aware of, but that the general populace may not be.  Diagnoses such as PTSD are made for insurance reimbursement.  They are also made so that medical doctors know which medications to prescribe to help treat the symptoms someone is experiencing.  A person who does not have a diagnosis may be suffering just as much from his/her symptoms as a person who has a diagnosis.    I think this is an important distinction that many people don't realize when it comes to the world of counseling and diagnosis.  Iron Man 3 and its portrayal of someone who was suffering from trauma can be used as an educational tool for those who may be unaware of what trauma can do to a person.  The ending of the film did seem to point to Tony heading in the direction of making a recovery and this may not always be the case for someone who has suffered trauma.  But there is hope at the end of the trauma tunnel, and I'm glad I was able to cobble this blog posting together ;-)

American Psychiatric Association.  (2000.)  Diagnostic and statistical manual of mental 
     disorders, 4th ed., text revision.  Washington, DC:  American Psychiatric Association.  

DSM-5's Integration with Managed Care

In May 2013 the APA's newest version of their Diagnostic and Statistical Manual of Mental Disorders is scheduled to be released, and with it the re-writing of many insurance policies will begin.  In light of events which occurred during 2012 it has also become obvious that the United States mental health care system needs reform.  Because insurance companies and their policies play such a large role in the U.S.'s mental health care system, it seems this could be a fantastic opportunity for all involved.  Insurance policies covering mental health care are in many ways going to have to be re-written to include the new criteria from DSM-5.  Since the policies are going to be revamped anyway, U.S.  insurance companies could use this opportunity to make policies including mental health coverage more affordable.  They could also consult with practitioners of mental health (ie:  LPC's, LMFT's, Psychiatrists, Psychologists, LCSW's, etc.) to include their recommended number of sessions for a diagnosed condition.  This could be a wonderful thing for the United States overall.  I will continue to be positive in my hope for an integration of the DSM-5 that will benefit all citizens of this great country, but it may not occur to insurance companies to utilize this opportunity for anything other than re-writing their policies to keep themselves from losing money.

Being aware

I officially began my internship in April, but I've been at the same site since January.  And something I've noticed is that it takes much more out of me emotionally to work with couples than to work with families or individuals.  It makes sense for couples to have more going on, because they generally don't to to a counselor until things are bad for them.  But it really took me by surprise that couples can be more emotionally draining for me.  I suppose being aware of this and doing self-care are the best ways to handle it.  And of course knowing that ultimately the choice of whether or not to stay together is up to them, not me.

A Garden Metaphor

While I was in my garden the other day practicing self-care (gardening is akin to meditation for me) an odd little thought occurred to me.  I was weeding and as I was going through the process I realized how it could relate to counseling and mental heath.  


When weeding a garden it doesn't do much good to pull at pieces of the weeds or just pull the tops of them off because they'll keep coming back.  Using the proper tools for weeding will ensure getting to the root and pulling the entire weed up.  You can then put the pulled up weeds into a composting device and plant the seeds you wish to grow in your garden.


Just like with weeds, if you go into counseling but only pick at the issues bothering you, they will come back.  It will probably be aggravating and maybe even uncomfortable to get to the root of those experiences, but once they have been processed through you can learn from them and good will come of it - just like using weeds for compost.


And just like a garden, mental health must be regularly nurtured and worked on.  It does no good to plant a garden and then leave it on its own.  Gardens need to be watered and weeded regularly so that the seeds you planted grow into strong, healthy plants.  Counseling tends to be the same way....once the roots of the problem are dealt with a person may not need to talk to their counselor as often.  If the problem resurfaces as a weed, then going back to a counselor is a very good idea.


My garden will be growing tomatoes, peppers, herbs, climbing fruits, patience, inner strength, and humility.  What kind of seeds would you like to plant in your garden?

Unreasonable Expectations

Have you ever noticed that you have certain ideas of how things should be?  For instance:  when you think of a doctor a very specific image might pop into your mind complete with all the minute details you assume go along with the professional career of a doctor.  In my case I have a very fixed idea of what a counselor should and shouldn't do.  And when I realized last night whilst mentally berating myself for having to leave fieldwork early again because of my family responsibilities, I realized my idealized image of "counselor" just wasn't going to work.  


My idealized version of a counselor is someone who keeps the same hours and is available during those said hours for their clients.  Now, if life happens and keeps clients from attending sessions for whatever reason, that's perfectly find in my idealized vision.  But the counselor should always be there excepting emergencies.


The only problem is I can't be that person.  I have the responsibility of being a mother to three children who don't arrange to get sick around my work schedule.  I have the responsibility of being a military wife who rearranges everything so that when the military throws us weird curve balls in my husband's schedule he can make it work.  I can't be the counselor who is always at work during scheduled hours.  And I honestly don't know how much of a problem this is going to pose with attempting to finish my master's program.  


I'm extremely fortunate to have a fieldwork site that lets me set my own hours.  Both my site supervisor and the office manager are very supportive whenever I have to amend my normally scheduled hours.  But to finish my CACREP accredited program I have to attain a certain number of clinical hours within a certain amount of time...and I just don't know if that's going to be possible.


So today I'm going to write the fieldwork placement manager at my school and explain to her that I may be a single parent for 6 weeks at the beginning of April when I'm supposed to begin internship.  I also get to explain that I won't know until the Air Force schedulers inform us if this is actually going to happen.  (The Air Force trains its people in hurry up and wait at basic training and expect civilians to understand the concept, which almost never happens.)  I then get to see if I will be allowed to sign up for internship with the knowledge that for 6 weeks I won't be able to work any more hours than I have in practicum because part of my childcare (my husband) may be in another state.


My other major to do task today is to find a back-up babysitter.  Because having only one isn't really cutting it right now.


But the point of all this is that whether or not I get to finish this degree (which I REALLY want to do) I love my life.  I love my kids and my husband and the relative chaos we live in.  And I love counseling.  But I don't know that I'm going to be able to mesh the two right now...and I'm finding a way to be okay with that.


P.S.  The fieldwork manager at my school is willing to let me begin Internship at the reduced hours I may have to work.  Now I just need to find a potential full-time nanny and quite beating myself up over what I can't change ;-)

Just how Flexible are you?

Something being a military spouse teaches you is to be flexible.  Normally it doesn't matter when my husband's schedule gets all mucked up because I can switch mine around to accommodate it.  But I'm working on my practicum now.  And it makes it much more difficult when military things come up and I have to be flexible.  Thankfully I'm working at a practice with retired military practitioners who understand.  Because not just any site will let you re-arrange your schedule so your husband can test for MSgt.  Or go for some training thing for six weeks.  Or go to a retirement ceremony so that he's on a completely different schedule the next day.  But my site does that and I can't really express how grateful I am to have a site that understands the military family.


Things may get more interesting when I begin working on internship where I'm expected to work more hours.  Whatever the future brings, I'm very grateful for the people I work with.  They have made this slightly unsettling experience a joy.