With the spread of the Coronavirus and it’s impact on the field of counseling, I know many people are scrambling to figure out how to adapt. In order to help my fellow colleagues who may be confused, overwhelmed by technology or just don’t have time to sort through all the new information, I am compiling this straightforward guide to begin doing TeleHealth free, easily and HIPAA compliant. While I don’t claim to be an expert in this field, I do have a little technical knowledge and connections with a lot of smart, informed therapists. This guide is specifically geared towards Oklahoma providers, but will hopefully apply to others as well. I will try to keep this updated as more information comes in. This information is compiled from my own research or gathered from comments from other providers, so use at your own discretion.

Unless otherwise stated, when I refer to TeleHealth I am referring to using HIPAA compliant software to have video and sound communication with a client at a secure site.

While it is in your best interest to follow HIPAA and ethical practices, the Department of Health and Human Services is exercising their discreation not to enforce many of the HIPAA requirements on telehealth and telephonic services during this crisis as explained here.(Thanks to Lee Dodd for that one)

**Updated 3/20/2020 9:35pm**

 

Regarding Insurance

Before getting to the How-To, here is what we know so far about insurance policies on TeleHealth during the Coronavirus Situation. These policies may or may not change when the circumstances change.

Private Pay is ideal in this situation because there are no restrictions other than making sure it is HIPAA compliant. You may want to figure out how to accept credit cards though if you do not already, but that’s another discussion.

HealthChoice has already been confirmed to reimburse TeleHealth in full, prior to the Coronavirus. Their policies can be found here. Just use Place of Service Code 02 and modifier GT* or GO. (*See Tricare/Humana for an explanation)

Optum/United Healthcare have released revised policies allowing TeleHealth during the Coronavirus. Those policies can be found here. It appears they have their own platform and policies, and their reimbursement is uncertain, but they said “You do not need join our virtual visit network in order to be reimbursed for the TeleHealth services you provide our members. Please continue to use standard CPT codes and a Place of Service of 02 for both video-enabled virtual visits and telephonic sessions to indicate the visit was conducted remotely.”

BlueCross/BlueShield OK has given mixed answers about telehealth, but most recent word is that they will be allowing TeleHealth. My good friend Cindy Freeman from the Oklahoma Christian Counseling Center said she spoke to Carol (Lore is out of town) at Blue Cross OK as of late afternoon on 3/17/20 and was told that it is to be billed with an 02 POS code and the usual CPT codes. Their website should be updated in the next day or two.

Tricare/Humana is covering TeleHealth. Reimbursement rates uncertain, but I assume it is the same. Use POS code 02 and a GT modifier*. (Thanks to AJ Brandon for providing the Link to these details) *According to the website, the GT modifier applies to “Synchronus” communication such as video chat, as opposed to something that goes back and forth like texting or messaging. 

Medicare has waived a lot of the restrictions for TeleHealth during this crisis. There are some unique issues and restrictions on this one, so just take a look at this detailed FAQ.  (From the CSWA via Elizabeth Fletcher)

Medicaid is allowing temporary use of telehealth and telephonic visits until April 30th. Use GT* modifier (no apparent indication that the POS code needs to be changed). The details can be found here.

Cigna sent me an email saying they are lifting restrictions on telehealth until May 31st. Use POS 02 and modifier 95. I will update with a link if I get one.

Aetna according to Lacey Leeanne she received an email and confirmed via phone call that Aetna is waiving all copays, coinsurance and deductibles for teletherapy.

Understanding the Issues

From what I have gathered, one of the main keys to using TeleHealth appropriately is choosing the right software. I won’t go into the details, but Skype and Facetime do not apparently pass muster for being HIPAA compliant. The following options have been the main ones I have found for free, unlimited, HIPAA compliant videoconferencing. Many of my colleagues have mentioned zoom, and I found out about the other options from this website.

Zoom (Here is the Link)

VSee (Here is the Link)

Doxy.me (This is the one I am using, found here.)

I found Doxy.me to be everything I needed in a super simple, professional looking package. It allows unlimited one on one videoconferencing for free and your clients can connect with you by following a link you send them, typing in their name and hitting a button. Since I am using this one, I will walk you through the process.

No matter which software you use, make sure to get a BAA printed out. That is what makes it HIPAA compliant. If someone wants to explain what a BAA is an why, feel free to share and I will update this section.

Also, informed consent is an important factor and some providers are creating documentation to address the issues related to TeleHealth. Please scroll to the bottom to see a detailed explanation of this issue from Elizabeth Fletcher and a suggested informed consent form from the American Pyschological Association.

Step by Step Guide

You and your client will both need a device that has internet access and a video camera and microphone. I also strongly encourage wifi or a wired connection so that you and your clients don’t use too much data. You may also want to consider having the option to plug in your devices so you don’t run out of power. I have found that IPads and IPhones work like a charm.

I broke down every single step, so this may look long, but it should only take about 5 minutes.

First time setup

  1. Go to Doxy.me
  2. Hit the “Get Started – For Free button.”
  3. Click on “I’m a Provider”
  4. Fill out the super short sign up page, check the boxes and hit “Sign Up”
  5. You will be taken to your dashboard. You can explore it and personalize if you want.
  6. Click on the “Account settings” button.
  7. Click on the BAA tab
  8. Fill in all the fields
  9. Hit generate BAA
  10. I advise you to download and print a copy for your records
  11. Hit the Pre-Call Test button at the lower left to make sure all your hardware is set. If there are problems, please contact doxy.me for support because that is beyond the scope of this guide. It worked first time for me.
  12. Hit the Back button on your browser to get back to the dashboard.

To start a videoconference

  1. Sign into your Doxy.me account and you’ll see the main dashboard
  2. Copy the link to invite someone to your waiting room and send the link to your client via text or email.
  3. Wait for your client to follow the link. All they will have to do (aside from any technical difficulties) is to type in their name and hit a button.
  4. Make sure to hit the button to “Turn on webcam” in the top right.
  5. The client should show up in the Patient Queue at the top left. Click on them and hit the button to start chat.
  6. Start doing TeleHealth

 

I hope this allays your fears and gives you everything you need to provide services during this difficult time. I invite my colleagues to comment and share any additional info so I can keep this guide updated and thorough.

Addendum: Informed Consent explanation courtesy of Elizabeth Fletcher.

“Informed consent” is a term used to refer to the ethical obligation therapists have to make sure that every part of our practice that affects patients is explained to them in language they can understand, and that they agree to it in writing only once they understand exactly what they’re agreeing to.

This is to make sure that no one who engages in psychotherapy experiences something that feels like a violation of consent, something that they didn’t expect or agree to experience, or any form of exploitation at all.

Trust is an essential part of the therapeutic relationship. The therapist is in a position of power and authority, and we have a lot of rules and guidelines that are designed to protect patients from even accidental abuses of that power. For example, if a therapist suddenly told a patient that they weren’t going to accept credit cards anymore, only cash, effective immediately, the patient might not realize that they have a right to know about changes like that ahead of time, and that it might be unethical or even illegal for their therapist to make such a change. The patient, concerned about having an interruption in their therapy, might think they have no choice but to agree right then and there. This would be an abuse of power by the therapist, and a violation of our obligation to obtain informed consent for our practices.

Instead, a therapist could provide a letter about their decision to stop accepting card payments at least a month in the future, their reasons for not accepting card payments, and some options to help patients with that transition. The therapist could then give each patient an opportunity to discuss the change in policy with the therapist and either give written consent or begin termination of the therapy with referrals to other providers. This would be abiding by the ethical obligation of informed consent.

So right now, as many providers are being proactive about protecting their patients’ and their own health and safety by not meeting in person, it is necessary for us to provide each patient with an opportunity to engage in informed consent. We will discuss the benefits and risks of telemental health and videoconferencing with patients before patients decide whether this is something they feel okay doing, or if they’d rather have a referral to a provider who is providing in-person sessions.

 

INFORMED CONSENT CHECKLIST FOR TELEPSYCHOLOGICAL SERVICES (From the American Psychological Association)

 

Prior to starting video-conferencing services, we discussed and agreed to the following:
· There are potential benefits and risks of video-conferencing (e.g. limits to patient confidentiality) that differ from in-person sessions.
· Confidentiality still applies for telepsychology services, and nobody will record the session without the permission from the others person(s).
· We agree to use the video-conferencing platform selected for our virtual sessions, and the psychologist will explain how to use it.
· You need to use a webcam or smartphone during the session.
· It is important to be in a quiet, private space that is free of distractions (including cell phone or other devices) during the session.
· It is important to use a secure internet connection rather than public/free Wi-Fi.
· It is important to be on time. If you need to cancel or change your tele-appointment, you must notify the psychologist in advance by phone or email.
· We need a back-up plan (e.g., phone number where you can be reached) to restart the session or to reschedule it, in the event of technical problems.
· We need a safety plan that includes at least one emergency contact and the closest ER to your location, in the event of a crisis situation.
· If you are not an adult, we need the permission of your parent or legal guardian (and their contact information) for you to participate in telepsychology sessions.
· You should confirm with your insurance company that the video sessions will be reimbursed; if they are not reimbursed, you are responsible for full payment.
· As your psychologist, I may determine that due to certain circumstances, telepsychology is no longer appropriate and that we should resume our sessions in-person.
Psychologist Name / Signature:
Patient Name:
Signature of Patient/Patient’s Legal Representative:
Date:

 

 

Short story: I have a new phone number (405)808-7180

___________________________________________________

Long story:

So, I recently got a taste of my own medicine.

I have only had one phone number for my whole life. That sort of thing becomes sort of personal, and it is plastered in a million places all over the internet and more. Many of my colleagues keep separate numbers for personal and business use and perhaps I would be wise to consider that.

A couple days ago, my phone got turned off. We have been on a family plan for many years through some extended in-laws. It was hard to pass up unlimited data and nearly free phones for $50/mo for both my wife and I. But this had happened a couple times before. Perhaps I should have heeded the warning signs earlier. This time I decided it was time to gain some independence and get my own lines. I thought it would be easy to keep my own number.

However, when I got to the phone store, I was informed that there was a $2200 outstanding balance. Since I was not the authorized user, I did not have a right to my number anymore, even though I had it before joining this plan. To get my number transferred, the full balance would have to be paid AND I would need permission from the primary user. However, due to drama that is not mine to share, I really had no feasible way to reach this person.

Thinking about how hard it would be to contact all my clients, and all the insurance companies, and every other institution I do business with, plus all the potential lost referrals, I was kind of like a deer in headlights for a little while. I considered paying the balance in the hopes I could then call the primary and get permission. I considered driving across the city to start trying to track down the primary, but it was too late to do anything that night anyway. Surely there had to be some solution to this horrible problem.

And then the kind agent we were working with said the magic word.

“You’re just going to have to ACCEPT this is happening.”

I felt like I was talking to myself in a counseling session. I couldn’t fight this after how many times I have talked to other people about acceptance. But man, acceptance is hard. It just takes time to sink in sometimes.

So, I accepted it and soon thereafter actually felt much less stressed and more liberated.

Personally, I kind of like my new number. It has a nice pattern in my mind.

(405) 808-7180

That’s my new forever number.

Now to spend the next few days contacting everyone.

This message is for people who work too hard.

At some point when I was a kid, I vaguely recall that I was a perfectionist. If I worked on a project for school, I would try to go above and beyond, getting every little detail to the best of my ability. It didn’t seem right to stop when there was still more I knew I could do to improve. Perhaps you can relate to that feeling.

I think at some point I became a procrastinator, largely to prevent this perfectionism. If I only allowed myself two hours to do a project, then I would do the best I could in that two hours and working more on little details was not an option anymore.

Another thing that helped change my perspective on perfection was learning about the law of diminishing returns. This was an economic term that explained the very common phenomenon that the more effort you put into something, the less actual benefit. We humans usually assume that if something is good, more is better, but that is not always the case.

Consider: the first hour you spend studying for a test might get you a 70%, the next hour bumps that up to an 85% and another hour gets you an A at 93%. If you just need an A for your transcript, does putting another 3 hours in to make sure you get a 100% really benefit you? What about if you stay up all night studying and then you fall asleep during the test and fail it?

Here’s another example. The big box store spends money to prevent shoplifting. They install some cameras, hire a guard and maybe put security devices on items. This is called “Loss Prevention.” They could spend even more money to hire more guards, employ extensive technologies and thorough methods, but if they did manage to completely prevent shoplifting, they would almost certainly have spent more money to prevent all the shoplifting than they saved by accomplishing their perfect goal.

I also started to realize that the “perfection” I was chasing was very narrowly focused. If I spend all weekend on a school project, I might see myself as a perfect student, but it would be imperfect of me to neglect my friends and family. If in theory you could be perfect in one area, it would almost always come at severe cost to other areas. But that first amount of effort in an area paid big dividends, and if I could settle for being good enough at something, then I would have time to spare to be good at many things. I started to wonder if perfection in the grand scheme of things was being a good student, a good son, a good friend, etc., and still have time to play and relax so that I actually enjoyed my life.

Consider the verse: “Some people, eager for money, have wandered from the faith and pierced themselves with many griefs.” 1 Tim 6:10 NIV.

I’ve always been struck by that term, “pierced with many griefs.” It’s so true. Money is important, but like I said before, we think that if something is good, more is better. There are many times in my life where I have opportunities to make more money. But I have recognized that the law of diminishing returns applies. If I do all the work on an investment, I might get a 7% return on investment. If I turn the management side over to someone else, then I almost eliminate my stress, and still get a 6% return on investment. How much is my peace of mind worth? Isn’t that part of the reason we chase money, because we think it will make our lives better?

Perhaps you aren’t into investing, but have opportunities to take on a second or third job. There are times where that may be necessary, but if those extra hours increase your income 10% but take up 100% of your free time, when do you plan to enjoy that extra money? Was it worth it? What if you work 12 hours a day to provide a nice home for your family, but they would rather live in a smaller house and actually have you home in the evenings?

Saving, budgeting and working hard are very important, but consider that the law of diminishing returns indicates that the first amount you spend on a task is most productive. Rather than spend 100% of your effort on the future, make sure to put some effort into enjoying today. Treating yourself occasionally and taking it a little easier can make those working decades much more enjoyable. You wouldn’t want to pinch every penny for forty years and have plenty of income to retire on, but not enjoy it because your health is too bad.

These are just intended to be a few more pieces of the puzzle to help with the usual needs for perspective and balance. I hope you find them as beneficial as I have. It’s always nice when five minutes of learning can improve the rest of your life. That’s a pretty good return on investment.

Just for an update, I wanted to share that my lack of blog updates does not mean that I am not actively counseling. In fact, just the opposite. As I have gotten busier, blog updates have taken a backseat to visiting with people. I am still accepting new clients and I try to keep a medium sized case load so everyone can get in without having to wait too long, and so I can give everyone the attention they deserve.

On another note, I have recently been accepted as a contracted in-network provider with Healthcare Highways Plus and Healthcare Highways Logix.

I’m not sure where I learned this lesson, so I’m afraid I do not know who to credit. Still, this is valuable wisdom that I really think they should teach in schools.

Many people desire to be more assertive, but I think that is sometimes a vague concept, which makes it hard to do. I once heard it explained in very simple, easy to understand terms that I want to share with you.

Perhaps you have heard of the term passive-aggressive, the idea that someone is nice to your face, but then hurts you when your back is turned. So, let’s imagine there is a spectrum of behavior with Aggressive on one end and Passive on the other. Assertiveness is not just a compromise of the two, it is a third option. And all of these terms can be summed up with these phrases:

Aggressive is the attitude “I matter and you don’t matter.” People are aggressive when they hurt others for their own benefit. When the mean kids in high school tore down other people to feel good about themselves, they had the attitude they mattered and their targets didn’t. Sometimes people are aggressive when they are hurt and then they feel justified hurting that person back. “Because of what they did, they no longer matter.” Violence, insults, threats, manipulation, theft, cruelty and selfishness are aggressive because the person is only concerned about getting their needs met.

Passive is the attitude “You matter and I don’t matter.” Passive people say, “Whatever you want.” Passive people apologize when they have done nothing wrong. Passive people bend over backwards to prevent conflict or upsetting others. People are passive for a variety of reasons. They often call themselves people pleasers. Perhaps it started for noble reasons because they wanted to put others before themselves, because they did not want to be selfish, or they thought loving people means making them happy. Perhaps it was a bit more survival or emotionally based with the idea that making people happy would keep them from hurting you or leaving you. Still, the more you act like only the other person matters and you do not, the more you start to believe it. Most passive people accumulate negative self-esteem because acting like you do not matter eventually makes you feel like you do not matter.

Assertiveness is the attitude “You matter and I matter.” Assertiveness is respectful. Just because someone hurt you does not mean you hurt them back. Assertiveness is solution focused and realizes that speaking up for yourself provides vital information, listening to others provides information, and then you can find solutions that take everyone’s needs into account. Assertiveness sees the big picture. Whereas passiveness feels noble, it makes the other person into the villain. Being assertive may feel like being the bad guy, but it acts on the hope that the other person might join you in a healthy relationship. Even if they don’t, it still protects you and respects them.

And even if being assertive does not always get the outcomes you want, it usually gets you closure and moving on your way towards better things, rather than stuck in the anxiety of never-ending, unhealthy relationship patterns.

Social media is great for connecting people, sharing ideas and easily expressing opinions. It is woefully inadequate for debating. In fact, I think that debating on social media is largely counterproductive. It may feel good to express your opinions or criticize. It feels good to be on a soap box or to be a champion of a cause. I am certainly guilty of it myself, even when I’m aware of the problem. But I try to remember,

“Shutting up people who disagree with you is not the same as changing their mind.”

Most debating just promotes resentment, defensiveness and for people to crawl away to their corners. In my opinion, that is the main cause of the polarization in our society. What we need is for people to be able to listen. If you want to change someone’s mind, you don’t call them out in public. You take them aside, let them know you care, try to understand their point of view and gently encourage them to consider how they could do things better. This requires 2 things:

Tact and relationship.

Remember, social media is still a relatively new invention and new inventions like this transform society. And it takes a while for society to form rules on how to properly use new technology.

I propose that it is time to form a:

Social Media Code of Conduct

*** If you need to correct, criticize or change someone’s mind because of what they posted, do it over the phone or in person.***

Because,

1) if you don’t have a relationship with them to do that, you don’t have a relationship to effectively change their mind, it only promotes resentment in the world.

2) If you are not willing to put in that effort, that is a sign you are not willing to put in the effort to be understanding, tactful or respectful in your internet response either, so your efforts will be ineffective and only promote resentment in the world.

“It is too easy to be hurtful on the internet”

Now, I know many people will promptly argue that there is so much hate and ignorance in the world, they need to fight against it. And they also want to make sure to champion the rights of their friends and speak up for them in order that they know they are not alone.

I am not proposing that we just ignore bad behavior. If you feel you have to speak up, then phrase your replies in terms of speaking to those other people you are fighting for. Tell them that you agree with them and you are with them and what you believe.

But rise above, be the better person and leave out the comments directed at calling out bad behavior. When you feel you are right and feel obligated to try to change someone’s mind, remember that calling someone, or their ideas, ignorant, hateful, wrong, etc. on the internet simply does not work. It builds up walls, resentment and shuts down conversation. Again, if you really want to change someone’s mind, do it privately and lovingly.

And of course, there will always be extremists and close minded people. But your responsibility is not to change them, your responsibility is to stand up for what you believe in, in the right way. The ends do not justify the means.

So, if you agree with this Code of Conduct, please:

1) Adopt this code of conduct for yourself
2) Explain it to others (preferably in person, or you can share)

Thanks, and…

“be excellent to each other” – Bill S. Preston, Esq.

I’m going to admit something today.

I don’t like blogging.

I love talking to people. I love thinking about life, relationships, wisdom, etc. And I love sharing those things.

I even like the idea of having a blog, both to inspire others and maybe one day to provide lessons to my daughter after I’m gone. I have no shortage of lessons. I have a long list of topics and think of more things often that I am eager to express.

I also recognize the need to have an internet presence for marketing purposes, and to let people know I am still actively practicing my counseling. But my frequency of posting has dropped from weekly, to biweekly and now I struggle to post monthly.

Simply put, the idea of sitting down to write seems like drudgery. It is something I want done, but not something I want to do.

And often counseling involves helping people address those sorts of struggles. We want to be better. We often know what we need to do, but we struggle with the actual doing.

I totally get that.

My one sentence definition of adulthood is: Doing things we don’t want for the things we do want.

But here I am writing this blog, so obviously something must have tipped the scales for me today, and I thought I would share what helped in case it might help others.

Most of the time when we struggle with decisions, we are struggling with short term and long term thinking. Sometimes all we have to do to change our decisions is simply go from thinking about our momentary happiness to just our daily happiness.

If I was doing what would make me happy right now, I would be taking a nap.

But I asked myself, what will make me happy at the end of the day. Having this task completed will make me happier at the end of the day than if I had taken a nap. Or, looking at it another way, I decided to make a sacrifice to benefit future me. And I’m sure future Me will be grateful. I’m kind of happy now just because I’m doing this nice thing for myself.

Now, admittedly, I asked myself a similar question this morning when I was going to workout, but it was raining outside. I decided going back to bed for 30 minutes while listening to the rain would be more rewarding than exercising and losing half a pound. And it was so very nice and I firmly stand by my decision.

Anyway, it’s a simple point. Don’t just do what feels good now, or avoids pain now. Start thinking, “what will bring me the most joy overall, or the least pain in the long run,” and see if that doesn’t help tip the scales when you’re struggling to get up and do that thing you know you should.

Future You will thank you.

Before I share my thoughts on the use of psychiatric medications for mood disorders, let me first clarify my lack of credentials.

Some people think the terms psychiatrist, psychologist and counselor are basically interchangeable, but there are some distinct differences. A psychiatrist is a medical doctor who is an expert in mental health and prescribes psychiatric medications. A psychologist is an expert in mental health with a Doctorate degree. A counselor is an expert in mental health with at least a Master’s Degree. All can provide talk therapy, but only a psychiatrist can prescribe medication and has extensive training in brain physiology, chemistry and the like.

I am a counselor.

So, when I share my opinion on psychiatric medications, it is from the perspective of someone who believes in the power of insight oriented solutions, a belief that changing circumstances and thinking is a means to make changes in a person’s mood and life. My opinions come from observations, rather than education and detailed understanding.

Many of my clients also make use of psychiatric medications, either prescribed specifically by a psychiatrist, or often by a primary care doctor. I have learned a lot from their experiences and insight, as well as by seeing the effects in their lives.

Some people are eager to find the relief they need in medication. Others are very resistant to using medication. I would say my initial attitude on medication was similar to those people who want to solve their problems on their own, by their own will power. Other people are afraid of becoming addicted, dependent or having side effects. It is an unfortunate fact that I have met some people who have ongoing suicidal thinking, depression or other lasting side effects from bad medication reactions.

But the research I have seen suggests that counseling and medication are more effective together than either one separately. I tend to simplify the matter by thinking of medication as something that can make the emotions less raw, and counseling helps people make real changes to their thinking and behavior. If you just take medication, you may feel better, but may not make any real changes. However, for some people, counseling alone is unlikely to be productive if the emotions are just too overpowering. For some people, medications may be like a scaffolding that is put in place while a structure is being built, but then can be removed when the building is complete.

However, for others, there is a legitimate ongoing chemical imbalance that needs ongoing treatment. I witnessed the reality of chemical imbalances when I saw my wife go through post-partum depression. Here was a woman just blessed with a beautiful new baby and she knew she was supposed to be happy, but every night she found herself weeping when it got dark. The doctors predicted it might happen because she had been producing chemicals for two and now suddenly she was getting all those chemicals just for one. And as the doctors also predicted, the depression went away after a few weeks. I saw the very real mood effects of a chemical imbalance. It was not due to external circumstances, my wife’s thinking or anything she had done wrong. She was aware of what was happening, but the feelings were still just as real and just as painful.

If someone had asthma, would you expect them to run a race without an inhaler? Thyroid conditions, blood pressure issues and many other medical conditions require ongoing medical treatment to manage symptoms, so should there be any shame in needing medication when there is a legitimate chemical imbalance? Do we expect people to just will power themselves through slipped discs or vertigo?

So, sometimes medications are in order for long term chemical imbalances and sometimes they are just temporary aids while people make the necessary underlying changes via counseling. Sometimes people are unsure which is the case. I usually just trust each person’s judgment. I have seen cases where people weaned off of medications as they made progress, but I always suggest this be done under advisement of a medical doctor. I have also seen some people start without medications and when they have thoroughly addressed their thinking, behavior, beliefs and circumstances and they still feel depressed or suicidal despite no discernible reason, then they usually feel satisfied that they have done their due diligence and a medical approach is in order.

At the end of the day, I just generally encourage people to stop worrying about the stigma and pressure about what others think they should do, and instead trust their own judgment about what they need.

 

When I was a teenager, one of my fondest memories was the summer that I had no responsibilities and my best friend practically lived at our house. We’d stay up all night playing video games and sleep all day. There seemed to be no end to the fun.

But on occasion, my friend’s mother would call and tell him that he needed to come home. We would ask what was the reason for the end to our fun and I still remember to this day, she would say, “He needs balance.”

As a teen, I just thought this was a lame excuse to ruin our fun.

But as I have gotten older, I have changed my tune. What I thought was foolishness, was just wisdom I did not understand.

Now I understand that more is not always better. You can have too much of a good thing.

The most obvious example is water.

Not enough water and you will die of thirst.

Too much water and you will die from drowning.

“The wise man avoids all extremes.” 1

I think learning about balance and moderation is a large part of maturity. I imagine I’m probably just preaching to the choir for most adults. But I wanted to point out a phenomenon about passing on wisdom that seems to be lost in most memes and debates.

To find balance and wisdom, you often have to be aware of both extremes. But when people are passing on their wisdom or hard earned life lessons, they are usually just warning you of one extreme. And when people put this in meme form or a post on social media, it is just one part of a complicated puzzle, almost always eliciting arguments and derision because other people are looking at another piece.

Consider some quotes you may or may not have heard to illustrate this.

“The squeaky wheel gets the grease” 2

and

“The nail that sticks out gets hammered” 3

 

“Never, Never, Never Give Up” 4

and

“You have to know when to quit”

 

“Do not answer a fool according to his folly, or you yourself will be just like him. “ 5

and

“Answer a fool according to his folly, or he will be wise in his own eyes. “ 6

 

“Black Lives Matter”

and

“Blue Lives Matter”

Often times people find a problem with something and assume the opposite is right, but in most situations the truth is somewhere in the middle. No one is 100% right or 100% wrong. I have learned some very valuable insights from some cruel people, because the source of wisdom does not always determine the quality of wisdom.

As they say, “A broken clock is still right twice a day.”

With modern media’s polarized debates and short attention span, people do not take the time to incorporate the points of both sides. Instead, one of the new favorite past times is to shut people up. People think that finding a flaw in someone’s point, or pointing out something they missed is equivalent to winning an argument. But I say:

“Don’t throw the baby out with the bathwater.” 7
“It is good to grasp the one and not let go of the other.” 1

Perhaps even thinking of it as an argument with two opposing sides is problematic. I think we need less debates and more discussions.

“Seek First to Understand, Then to be Understood “ 8

“We have two ears and one mouth so that we can listen twice as much as we speak.” 9

In my opinion, a good example of balance is a healthy two parent family. Often times you will see one parent being more compassionate while another parent is more authoritarian. Sometimes this can lead to arguments about parenting style, but when two people are able to respect what the other brings to the table, they usually do much better than either would alone. There are times when a child needs to be pushed, have consequences and allowed to fail. But there are also times when a child needs to be rescued and nurtured. Any one person is usually going to err on one side or the other and I have seen the devastating effects of both parenting styles in their extreme.

At the end of the day, figuring things out in life is tricky. There is no one right or wrong answer you can apply across the board. You can’t just take people’s advice at face value.

Sometimes you need to listen to hard truths:

“The wounds of a friend can be trusted” 10

and sometimes you have to be able to rise above what everyone else is telling you:

“What is right is not always popular and what is popular is not always right.” 11

You have to sort it out for yourself and find that balance and what applies in any given situation.

“Memes are easy, life is hard.” 12

It is easy to get offended or assume the worst in someone when they make a point, thinking they don’t see the whole picture. For instance, I know that this blog about wisdom may sound arrogant, but I am aware that I fall short and make mistakes all the time. I know that striving for balance is hard. Those truths don’t make balance any less valuable.

The best wisdom understands both sides and the need to incorporate them properly.

One of my favorite quotes is a major part of Alcoholics Anonymous, where people struggle daily with moderation:

“God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference. “ 13

or:

“You got to know when to hold ’em, know when to fold ’em, Know when to walk away and know when to run.“ 14

P.S. I like quotes.
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Here is what I could come up with for sources:

1 – Ecclesiates 7:18

2 – American Proverb

3 – Japanese Proverb

4 – Winston Churchill

5 – Proverbs 26:4

6 – Proverbs 26:5

7 – German Proverb

8 – Steven Covey

9 – Epictetus

10 – Proverbs 27:6

Not long ago, I shared a blog post attempting to give adults a more understanding perspective of the teenager’s burden. Today, I thought I would share an analogy I often tell teenagers to help their perspective.

First, I start by pointing out that, if we are being honest, you probably feel like you are the main character in your story. Don’t be ashamed, I think that is pretty normal for everyone since we see life through our own eyes. And, again not to be offensive, truth be told, at the end of the day, one of the most important factors is that we are ok.

So, right now, how do you know you are ok?

This question is only difficult, because it seems too obvious. The answer is that you can immediately look and see. No ninjas are attacking you currently, I assume. (If so, I suggest dealing with that before finishing this blog.) You can tell you are breathing. If you need to double check, you can take a moment and feel your heart beating. You know you are ok in this moment. You may be anxious about your future, your next meal or some ongoing drama, but on the most basic level, you can tell you are alive.

Now, imagine through some miracle of magic or science, you could take your heart out of your body and put it in a box. And as long as your heart was ok, you were ok. Now, if you are really playing along and letting your imagination run with this, what do you think you would do with that box?

Most people say they would lock it up, hide it or never let it out of their sight.

Now, what if one of your buddies wanted to borrow your heart in a box? You know, just take it along with them and show some of their friends at the mall?

Most people wouldn’t allow that.

Now, what if it was absolutely imperative that your heart in a box underwent some maintenance? Suppose it has to be cleaned or repaired so that you can continue living. And what if, for some reason, you were not allowed to go with it. Suppose a friend was going to take it in for maintenance for you. How would you feel while it was gone?

Anxious, worried, unable to really relax or focus on anything else?

Would you call or text regularly to get updates from your friend that everything was ok?

You probably would not feel ok while your heart was out of your sight.

And what if your friend did not respond to a text? What if they were an hour late without letting you know why?

You would probably be terrified.

And when your friend got back later and said they took a detour to a another friend’s house, how would you feel?

Would you be livid? Would there be some choice words or worse?

If you really tried imagining this strange scenario, I bet you got a brief feeling of that roller coaster of emotions.

 

Well, when you have a child, it is like putting your heart in a box. For a parent, they are no longer the most important person in their life, their child is. Most parents are willing to die for their children.

And as soon as I make that connection, most teenagers suddenly get a glimmer of why their parents are so annoying. Always setting rules, texting constantly, showing so little trust. Now their anger that you were half an hour late makes sense, when it seemed so trivial before.

Really, given this perspective, it is actually a miracle that parents ever let their children out of their sight. Some don’t. But most parents realize that it has to happen. One of a parent’s main goals is to raise independent children, so at some point they know they have to let go. But this is why it is so hard. Letting go and trusting a child is one of the hardest things for a parent to do, and it is usually a difficult transition for the parents and the child. Just try to be understanding.

And don’t give your parents a heart attack for no good reason, ok?