Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. He co-authors a weekly column in the Journal-World’s Pulse section, focusing on issues affecting young people.

Moderator

Hi folks: The chat will be a touch later than originally announced. Dr. Crenshaw will be here at 2 p.m. to take your questions about family issues.

Moderator

We’ll be getting underway shortly. Thanks for waiting.

Dr. Wes Crenshaw

Wes is in the house!

gwenthejayhawk

Hi Dr. Crenshaw. Do you believe it is productive if a couple needs marital counseling, to have the couseling separte with each person.

Dr. Wes Crenshaw

Well that’s a rather funny one, b/c I just left off with that issue last hour — and I know you weren’t the person posing it! I think that it is always best to start off with both parties in the first couple of sessions and then you can branch out later when it seems better to talk privately with each. HOWEVER, one of the fastest proven tracks to divorce is for each party to have their own private therapist. This is a great way to get someone on your side — but alienate your spouse in the process.

Sigmund

In todays LJW article on Medicaid paybacks by Kansas to the Feds you are quoted as saying, “I never understood how special ed got away with billing the way it did, frankly”; and “I have to say I’ve never understood how the community mental health centers have gotten away with what they do.” Could you expand your remarks and explain what you meant?

Dr. Wes Crenshaw

I could expand for hours. I even submitted a letter to the editor today. Could you narrow the question a bit so I can narrow my response?

grantsmom

I am in a relationship that I don’t know what we should do. WE have a 9mo old child. We fight and argue all of the time. I feel like I can’t do anything right. I feel like he is pulling me away from my family. I have times I want to leave him, but I dont want to leave him alone. I start to feel sorry for him. I dont want to put my child through all of the emotional up and downs we deal with. What should we do?

Dr. Wes Crenshaw

One of the best predictors of a good relationship is how others see it. So if your family doesn’t approve, you may have s.t. to worry about. One of the biggest hints that a relationship is not healthy is when one partner tries to pull the other away from family support. Ultimately that can lead to abuse — emotional or otherwise. One of the problems I see most often is that people get the relationship they “pay for.” If you aren’t going to hold your guy up the standards you believe in, then he isn’t going to meet those standards. Having a child btwn you is important, but it doesn’t lower the standards. State your expectations — stick with them — compromise when and only when it’s appropriate — and things will either get better, or the relationship will prove itself unhealthy. I think this is a great thing to talk over with a therapist.

Moderator

Wes, two therapy-related questions. You might be a bit biased here, but how often do couples and families find therapy beneficial?

Dr. Wes Crenshaw

The rule has always been a “rule of threes.” 33% get better; 33% don’t change and 33% get worse. Now proving that’s from therapy is another matter. I think that good therapists (wow — it would take me hours to explain that one) have a better hit rate than those who aren’t as solid. The reality is therapists are like car mechanics. Some are great and some aren’t. There are also serious problems that are life long and short term problems that lend themselves better to basic solutions. So one can’t really determine whether therapy is effective — only if the therapist is. By the way, I tend to believe that the therapist IS responsible for success in therapy. Some therapists think that’s the client’s issue. There is debate on this — but that’s my view.

Moderator

And following up on Sigmund’s question: What do you think has been the problem with special-ed and community health service practices in billing Medicaid?

Dr. Wes Crenshaw

I’m just going to paste my letter to the ed regarding mental health billing. It will upset some folks, but I have a long history both in and outside of community mental health and I believe I’ve earned my stripes: So here it is:

How would you feel if your insurance company allowed you to see physicians in only one practice in town? What if you tried to go to Kansas City, only to find you weren’t allowed to see anyone on the company’s list there? You’d be stuck with one provider, even if you didn’t care for their service or wanted to try something different.

As Dave Ranney notes in the Thursday July 13 edition of the Journal World, that’s exactly what SRS and the Association of Community Mental Health Centers have arranged for many years for Kansans with Medicaid. The Association has been able to limit Medicaid payments or mental health services only their centers and a handful of psychologists, psychiatrists, and psychiatric nurse practitioners. Clinical Social Workers who can see clients on any other insurance in Kansas have been expressly prohibited.

The Association claims that this absolute monopoly is necessary because only they can serve the unique needs of these Kansans. This is of course a circular argument because only the center’s can bill Medicaid. This policy is not only bad for Kansans but it violates Federal Medicaid Policy and may lead to a multimillion-dollar payback. Everyone deserves a choice in mental health care. Medicaid recipients should call up their legislator and governor and demand Medicaid be paid to any qualified provider.

As for the special ed situation — schools were finding ways to bill medicaid that didn’t conform to the guidelines and the state didn’t police this sufficiently to catch it. When I said “I didn’t understand” I really meant it. It never made sense. And the feds now agree.

Moderator

Wes, you co-author the “Double Take” column with a teenager. How valuable are her insights in dispensing advice?

Dr. Wes Crenshaw

I can’t tell you how valuable they are. marissa’s been involved with DT since Jenny and I started it a couple of years ago. Marissa got questions for us, proofed some of the early columns, told me off several (hundred) times. I can’t tell you how much I’ll miss her. She’s one of the best kids I know. John Murray’s going to do a great job when he starts next month, but as with any loss, you really miss them. The kid side of the column is both on the page and behind the scenes. Marissa corrects me and gives me ideas of how to say things in a useful way. It’s more than a gimmick

Moderator

Do you ever disagree with her advice?

Dr. Wes Crenshaw

Oh yeah. The big one this year has been about whether we should trust teenagers or not. We talk on chat and text and email with some frequency and we were hashing this out. She says yes, I say no. It isn’t that I don’t like teens. I do. But I wasn’t a trustworthy teen and neither were most of us. Some worse than others. It puts kids and parents in a no-win situation to be “trusting.” Marissa hates this idea and she’s said it in the column. Of course I think she’ll agree with me in 20 years! But that’s just one we’ve argued about. And I admit she’s got a good point that teens “need to be trusted.” I just don’t agree at all.

supermom

My boyfriend, of a year, is jealous of my relationship with my x husband and always has been. I have two kids with my x so we are always talking and going to activities that the kids are in. So I do see him a lot but we have a better relationship now than we ever did married. However, I am committed to my new relationship and bring my boyfriend to as many of the activities that I can, but he is still so jealous that we end up fighting over it a lot. I say that the kids are young and I am going to be involved with their father on some level for a long time so he should get over it. And if he can’t what chance do we have? Is that selfish and wrong?

Dr. Wes Crenshaw

Well power to you! I love it when 2 parents bring in a kid and I don’t know they are divorced until half way into the session. As long as you keep GOOD BOUNDARIES with your ex (and that can be harder than you think) this is ideal for your kids. I get your b.f.’s issues on this and I might feel the same way — there is always some leftover emotional reactivity in these relationships, but he has to deal with trust and realize that he can’t control you into fidelity. So I have to go along with you and suggest he work through the jealousy. It’s rarely a helpful emotion.

Joel

Hi Wes!

I’m getting married in a week. Any pitfalls to beware during the first year?

Dr. Wes Crenshaw

Not more than 100. I STRONGLY urge you to go right now to our website www.ftimidwest.com and hit the bookstore. There you will find books by John Gottman that will teach you how to avoid divorce BASED ON RESEARCH — not just someone’s idea of what should work. We are working towards certification in this approach and think it is extremely valuable. He can predict with 90% accuracy whether a marriage will succeed or fail. So that makes for some great honeymoon reading. The other thing is that marriages fail because ppl wait an average of 6 years (THATS YEARS!!!!!) to get help after beginning to have problems. It is a lot cheaper to have marital therapy early on than wait til all hell breaks loose. So tune things up right along even in the first year. I can’t do better than his books in answering this important question.

Moderator

Thanks, Wes, for taking questions today. We’ll be back tomorrow at 1:30 p.m. with Shay Wildebor, a college hoops recruiting analyst. Submit your questions early here: http://www2.ljworld.com/chats/2006/jul/14/shay_wideboor/