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  • Writer's pictureEugene Roginsky


Over the years I had clients walk through my door describing symptoms of Depression (primary features of which are pervasive feelings of hopelessness and helplessness), Anxiety, Chronic Fatigue, Insomnia, Hypersomnia, IBS, and Irritability. As Psychotherapists we are well prepared to tackle all of the above complaints. But, what if the root sources of these conditions, had to do with stress over physical health? What if these symptoms were triggered by concerns over the health of a loved one? What if the individual merely needed to feel in control knowing that he/she had practical options on handling a health related situation that at the time of visit to a therapist felt new, confusing and overwhelming? What if the person who walked through my door felt helpless and hopeless because he/she could not figure out the next step in planning for the future of a sick family member?

All Psychology and Psychotherapeutic techniques aside, what I found over the years is that people want to know they have clear options when it comes to physical health of loved ones and themselves. Not knowing where to get the answers, amplifies the stress which almost always, when prolonged, leads to mental illness. No amount of therapy (traditional or eclectic) can help a client encountering complex situations that require explanations of healthcare.

Example: I have seen TOO MANY people experience feelings of frustration, anxiety, and helplessness when faced with very solvable situations involving their elderly parents. When a client happens to be a caregiver for an aging or sick relative, the symptoms mentioned in the first paragraph are often connected to feelings of guilt, fear, confusion, physical exhaustion, and loss of sense of self. As one of my clients said, “I am not me. I am a caregiver to my Mom. I have no other identity. The old me, is gone and she is not coming back.” There is help out there. One just has to know where to look.

After working closely with the medical community over the years, and teaching seminars in most local hospitals, CCRCs, and Nursing Homes, I found knowledge of the following information crucial to my Psychotherapy and Coaching Practice:

1. How do Hospitals work? What are the major networks in my area? Which healthcare providers are affiliated with these networks (Ex. Does the hospital network also own a Home Healthcare, Hospice, Non Medical Home Care, Skilled Care, etc.)? What are the various medical professions and disciplines (must know)? Who are the Case Managers/Care Managers/Discharge Planners in hospitals? Who are the hospitals’ decision makers, and how to have productive conversations with these people?

2. The difference between a Curative Model of healthcare and the Palliative Model. What do each of these models incorporate and how to know if one is right for a loved one or yourself? How to approach these discussions with Physicians?

3. What are the Signs and Symptoms of Dementia? What to look for and who to talk to when seeing these symptoms in a family member?

4. Similarities and differences between ALFs (Assisted Living Facilities), Independent Living Facilities, CCRCs, and Skilled Facilities? How to have discussions about living options with Physicians, Case Managers, Senior Advocates, etc? Who are the staff, (their titles and job descriptions) in ALFs, CCRCs, and Skilled Facilities? Basic knowledge of reimbursement and tentative costs involved. How does Medicare reimburse Outpatient Care vs. Inpatient care?

5. The differences between Home Health, non-Medical Home Care, Palliative Care and Hospice.

6. How to coach clients on having difficult life-stage conversations with family members? (Ex. “How do we tell Dad it is not safe for him to drive if that’s his only joy in life?”)

7. Safety options for seniors residing alone. (Ex. “Our Mom lives alone 200 miles away. Her health is failing and she is frequently confusing her many pills. She refuses to leave her home and live with us. We are worried sick and the situation is taking a toll on our family. What do we do?”)

8. What are Advanced Directives, DNR orders, Living Wills, Power of Attorneys, and who are the Next of Kin? (Ex. “Does one need a DNR to utilize the hospice benefit?”)

9. What are the similarities and differences between Geriatric Case Managers, Senior Advocates, Patient Advocates, Legal Guardians and Elder Law Attorneys?

10. CCP Options for low income clients. Social Service Programs in the area to assist clients with disabilities or temporary disabilities.

11. Dementia Units Vs. Home Care, making the right decisions with loved ones.

12. How to build a THINK-TANK of healthcare and mental-healthcare professionals.

Many (not all) Psychological conditions are triggered by medical conditions. (Ex. Mr. Smith is on his 2nd chemo-therapy infusion treatment. He is tired, depressed and frequently physically sick. He also resides alone and has a hard time finding transportation to the doctor. He is very confused about the many bills, and letters from insurance companies. Mr. Smith is overwhelmed, can’t sleep, and has a difficult time managing his anger.)


I am only scratching the surface of this endless topic. When it comes to healthcare, knowledge can mean the difference between a peace of mind coupled with feelings of control, and an assortment of emotional and psychological distress psychotherapy alone will have no effect on.

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