Cutting the Healing

The emotional triage performed by therapists for the severely disabled is being eliminated by budget cutbacks

"What was growing up like for David McClain?"
The questioner, a woman with a pad and pencil in her lap, seems in no hurry for an answer. Silently she waits as the 30-year-old man in the wheelchair across from her writhes mutely in his seat. There's a long, slender ribbon of spittle dripping from his chin. The ribbon sways and lengthens until it touches his lap. With the back of one sharply inward-bent hand, he absent-mindedly smears it into his red beard.

Finally, in a voice so thick and distorted that it seems to form not a string of words but a single continuous, wheezing groan, he says, "It was like a mushroom."

Gently but firmly the woman prods him to explain what he means. "A mushroom? How so? How was it like a mushroom, David? What was it that made you feel like a mushroom?"

"Nobody ever told me anything," he answers. "I was always in the dark."
Still the woman persists. "Why was that? Who was it that kept you in the dark?" She's pushing the man, pressing him to reach deeper into the past, to grasp its pain. Her tone remains calm and friendly, but her body is tense as she sits motionless in her chair. For Ellen Savits, a Coral Springs psychotherapist with a unique specialty as counselor for people with severe physical disabilities, the session has reached a crucial threshold.

"My mom and dad," McClain finally replies. "They kind of sheltered me. I couldn't do nothing for myself. When I would ask my dad if I could help with the chores, he said, 'Don't worry, I'll do it for you.' Sometimes I used to sneak into the bathroom at night to try to clean it."

And suddenly McClain needs no more prodding, because now the dam has burst and he is launched on a reminiscence of childhood. He talks about his parents' smothering overprotectiveness. He also talks about his love for them, especially his mother, a talented amateur painter who taught him to draw and who brought out his own considerable artistic talent. "She would draw a cat, and I would draw a cat, too," McClain recalls with glistening eyes. "But hers was soft... more ladylike."

When he has finished, Savits softly guides him back from the depths of memory to the present moment. "David, now let's talk a little about some of the things you'd like to change in your life."

Well, there's a lot that he'd like to change in his life. He'd like to be able to walk and talk and live like an able-bodied person. But that isn't going to happen. There's no cure for cerebral palsy on the horizon.

So he concentrates now on things that he does have the power to change. Since the deaths of his parents eight years ago, McClain has been plagued by fear and self-doubt, traits that he recognizes and loathes but somehow hasn't been able to abandon. Without someone around to tell him what to do and make decisions for him, he says he feels lost. "Somehow I'm holding back," he says. His plight is reflected in his recent inability to finish a painting. "I sit in front of a blank canvas, and my mind just goes blank."

McClain's problems came to the fore last year, when he moved out of the group home he'd been living in since his parents' 1991 deaths and into a subsidized apartment. On his own for the first time in his life, he's found freedom hard to manage. Even the simple task of grocery-shopping has had him perplexed to the point that he's felt compelled to check in with his home-living coach, Debbie Isaza, before putting an item in his cart. "Hey, it's your money, David," Isaza remembers telling him repeatedly. "You shouldn't be asking me to make these decisions for you." It was Isaza who recommended that he seek therapy.

He thinks that, in the nine months he's been seeing Savits, he's made a lot of progress toward developing the assertiveness and confidence he'll need to get along in life. Still, he thinks he has a long way to go. "I have a tough time with authority figures," he says. "I still hate to make waves."

Progress or no, this counseling session could well be his last -- with Savits or anyone else. Last year's state Medicaid reform legislation included a small provision declaring that the program would no longer make copayments toward treatments covered by Medicare but not by Medicaid itself. Since Medicaid doesn't cover psychotherapy (although Medicare does), the new law has cost Savits an average of $6 per session. This may not seem like a huge decrease in revenue, but to Savits, whose entire practice is built on Medicaid-dependent clients, "it's the difference between paying rent and not paying rent."

In practical terms the new law is forcing Savits to choose between going without copayments entirely (an amount averaging between $200 to $300 a week in revenue), billing her clients for the copayments, or dropping some Medicaid-dependent clients in favor of clients with cash or better insurance. To her it's a no-win situation. She says she can't afford to lose the revenue the copayments bring in, but she's not about to start forcing clients like McClain to start coughing up money they don't have. ("The man can't afford a burger at Burger King," she says.)

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