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Move from compliance to authentic living.
 
Joanna Poppink, MFT
Depth Psychotherapist
serving Arizona, California, Florida and Oregon.
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Affirmations

Midlife Women: When Disapproval Validates and Approval Undermines

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Created: 29 July 2025

 

midlife woman walks away from narcissistic manipulation

Midlife women can walk away from manipulation   Photo by Mathias Reding on Unsplash

Midlife Women: When Disapproval Validates and Approval Undermines

By Joanna Poppink, MFT
Private Depth Psychotherapy for Midlife Women and Beyond
🌿 www.eatingdisorderrecovery.net

Introduction

Many midlife women who have survived narcissistic abuse find themselves confused by an unexpected dynamic: they feel validated by disapproval and undermined by approval. After years of navigating emotional control, they no longer seek praise from the narcissist—they brace against it. Approval often signals manipulation. Disapproval, though painful, can feel like confirmation that they’re growing beyond the narcissist’s reach.

These women enhance their homes, deepen their creativity, and expand their lives. And still, they imagine the narcissist—whether a former partner, adult child, parent, or friend—reacting. A frown. A stiff posture. A silent, judgmental stare. These signs of discomfort feel strangely satisfying.

Why? Because disapproval means they’ve done something the narcissist doesn’t control.

Over time, they begin to recognize the pattern: praise and criticism are not about truth—they are tools of manipulation. Praise rewards sacrifice and invisibility. Criticism punishes independence. Both tactics shrink a woman’s self-concept and tether her to roles that serve the narcissist’s ego.

This article explores how midlife women move through three psychological stages of awakening. It highlights how approval can undermine, how disapproval can validate, and how to rebuild a life that no longer performs for the narcissist’s gaze.

Stage 1: Believing the Narcissist’s Frame

“Their judgment must be right—so I’ll try harder to please.”

At this stage, the midlife woman accepts the narcissist’s worldview as her own. The narcissist—whether a partner, parent, adult child, sibling, or friend—offers selective praise for tasks that serve them: errands, emotional labor, invisibility. That praise feels like love, and criticism feels like truth.

She’s told:

  • “You’re amazing at organizing.”
  • “No one else could hold this family together.”
  • “You’re strong because you never complain.”
  • “You’re the perfect grandmother.”
  • “You’re so generous with the children.”

Each statement is wrapped in a compliment but binds her to a narrow identity. She is celebrated only when she stays small. Her creative dreams, career goals, educational pursuits, or even interior design decisions are seen as threats to the narcissist’s control.

She learns:

  • To equate usefulness with worth.
  • To associate approval with self-erasure.
  • To fear rocking the boat.

 

Claiming the Lost Self: An Essential Task for Midlife Women — a seven part series.
You may begin with the series introduction here.

Eventually, she forgets she once wanted more.

Stage 2: Doubt and Resentment Emerge

“Something doesn’t feel right—but I’m afraid to say it out loud.”

The midlife woman begins to question the imbalance. Her wins are ignored, her thoughts dismissed, her joy met with resistance.

She hears:

  • “The children miss you when you’re out doing your thing.”
  • “We can’t have a family gathering without you cooking.”
  • “You think your little classes are more important than us?”
  • “We need you to babysit—don’t you want to help the family?”

And then come the threats:

  • “If you leave, I’ll fight you for the children.” (Though the narcissist has never taken part in their care.)
  • “You’ll have to live in your parents’ guest room.” (Even though she’s building independence.)
  • “Everyone will blame you for breaking up the family.” (Though many already know the truth.)
  • “You’re too old to start over.” (Even as she feels herself just beginning.)
  • “No one will want you.” (Used to isolate and erode self-worth.)
  • “You’ll be penniless.” (Despite her skills, education, or legal rights.)

These threats are usually empty. The narcissist has no intention of following through. Their power lies in how effectively they freeze a woman’s progress.

At this stage, fear and resentment signal the beginning of awakening. A woman may not speak her truth aloud yet—but she’s starting to know it.

Stage 3: Awareness of the Control Mechanism

“Both praise and criticism were tools to keep me small.”

The midlife woman now sees the pattern with clarity. The narcissist’s praise feels false. Their disapproval feels strangely validating. Why? Because it confirms that she is no longer controllable.

She realizes:

  • Praise was doled out only when she complied.
  • Criticism was used to punish autonomy.
  • Threats were bluffs meant to keep her in place.

The very things that once brought criticism—her confidence, creativity, financial decisions, and spiritual growth—are now signs that she is alive and becoming whole.

She starts to act for herself:

  • She no longer imagines the narcissist’s reaction before redecorating or taking a class.
  • She doesn’t explain her decisions to win approval.
  • She feels discomfort but doesn’t shrink from it.

Disapproval becomes evidence of progress. Praise loses its spell.

Summary

Narcissistic abuse distorts emotional meaning. For midlife women, the cycle often looks like this:

  • Praise and criticism become tools of manipulation.
  • Approval rewards self-erasure.
  • Disapproval punishes autonomy.
  • Threats paralyze growth with fear.

Healing begins when a woman sees through the performance. She learns to live without the narcissist as her imagined audience. She reclaims the authority to define her own value.

FAQ

Q: Why did the narcissist’s approval feel good for so long?
Because approval was tied to safety. Many midlife women are conditioned to seek approval to survive—even at the cost of themselves.

Q: Why did I believe their threats?
Because the narcissist’s confidence masked their falsehoods, and because fear of abandonment can override logic—especially in long-term dynamics.

Q: Why does their disapproval feel validating now?
Because your actions no longer orbit their needs. Their disapproval confirms that you are becoming yourself.

Q: How do I stop performing for the narcissist, real or imagined?
Notice the performance. Ask: What would I do if I didn’t need anyone to approve? Then start doing that, in small ways, every day.

Resources

  • Judith HermanJudith Herman – Trauma and RecoveryTrauma and Recovery
  • Bessel van der Kolk – The Body Keeps the Score
  • Elinor Greenberg – Borderline, Narcissistic, and Schizoid Adaptations
  • Ramani Durvasula – Don’t You Know Who I Am?
  • Wendy Behary – Disarming the Narcissist

Related Articles on This Site

 Midlife Women Worksheet: Power After Narcissistic Manipulation

  • Eating Disorders and Narcissistic Abuse: Why you attract narcissists
  • Narcissistic Abuse from a Parent: how to heal
  • Power vs. Control: A Life-Changing Distinction for Healing and Survival
  • Outgrowing Relationships: a Powerful Act of Self-Love

Journal Prompts & Recovery Worksheet

Use the companion Narcissistic Abuse Recovery Worksheet to explore:

https://www.eatingdisorderrecovery.net/recovery-healing/worksheet-reclaiming-power-after-narcissistic-manipulation

  • What types of praise or criticism shaped your self-image?
  • Which threats from the narcissist still echo in your mind?
  • What do you want that you’ve been afraid to pursue?
  • Where do you still seek permission to exist?

Work with Joanna

If this article resonates with you and you’re ready to heal from narcissistic abuse, I invite you to explore the possibilities of depth psychotherapy for midlife women and beyond 📧 Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Joanna Poppink, MFT, licensed private psychotherapist, online, CA, OR, FL, AZ

📧 Email: This email address is being protected from spambots. You need JavaScript enabled to view it. for free telephone consultation appointment

Eating Disorder Behavior Panic Attack

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Created: 05 February 2017

eating disorder behavior panic attack

Path to healing

Summary

Eating disorder behavior as panic attack reveals how the body tries to regulate overwhelming emotion. Understanding this connection between body and psyche opens a path to genuine recovery through depth psychotherapy and emotional awareness.

Eating Disorder Panic Attack: The Hidden Panic Beneath Control

For many people, eating disorder behavior can be a form of panic attack. What appears to be control — counting calories, restricting food, purging, or exercising beyond exhaustion — is often the body’s attempt to stop inner chaos. The surface appears disciplined, but underneath lives panic, anxiety, and emotional overwhelm. The person may not tremble or gasp for breath as in a typical panic attack; instead, the panic shows itself through urgent and repetitive behavior around food.

Read more …

Diane Keaton Suffered from Bulimia

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Created: 13 October 2025

 

 

bulimia recovery  Diane Keaton

*pix   Diane Keaton RIP  Beloved and forever remembered   2025

(written in 2011) When I saw the headline, My five-year bulimia nightmare, by Diane Keaton, I felt pangs of sorrow and a tender connection with Diane. (Her book,Then Again, discusses her bulimia experience).

Read more …

Women's Compliance and Triumph: The Cost of Both in Midlife

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Created: 17 August 2025

Midlife woman and complianceMidlife Women and the Cost of Compliance: Which path do you take?

How cultural roles shape identity—and how to claim a life of your own

At a Glance

  • Compliance can appear as kindness or devotion—but often comes at a cost to women, erasing their autonomy and identity.
  • Midlife brings a reckoning: the roles once rewarded no longer fit or sustain us.
  • Suppressing needs and desires often leads to anxiety, depression, eating disorders, or compulsions.
  • Depth psychotherapy offers a path to rediscovering your authentic self and living life on your own terms.
  • Also see Worksheet: Midlife Women's Compliance, Reflections on Cost and Current Choices.

I. The Shape of a Life Not Chosen

For many women, compliance begins as a means of survival. It looks like kindness, generosity, and cooperation. But, beneath the surface, it can mean living according to pressures and expectations that originated outside of her true self.

These pressures aren’t always overt. Sometimes they arrive wrapped in love, guidance, or reward. Other times, they’re enforced through punishment or exclusion. Over time, they become internalized.

A woman learns to police herself. She believes her desires are excessive, her needs inconvenient, her longings shameful. She stays quiet. She adapts. She tries to be what is wanted.

By the time she reaches midlife, the shape she has formed herself into may be all she knows. But it doesn’t fit. It never did.

II. Where Compliance Comes From

From childhood, women are trained to please, adapt, and serve. Culture, religion, family, school, and peer relationships all participate in shaping this early conditioning.

  • A girl is praised for being quiet and cooperative.
  • She’s rewarded for meeting others’ needs before her own.
  • She’s criticized or excluded when she asserts herself.
  • Her education often prepares her to support others rather than lead.

Over time, she learns to take pride in being useful and supportive—even as her contributions are overlooked or absorbed into someone else’s success.

The tragedy isn’t just that others fail to recognize her value. It’s that she’s been conditioned not to claim it herself.

III. The Voice That Lives Inside Her

By adulthood, external control is no longer necessary. Compliance becomes self-policing. Now an adult, the woman hesitates to speak her mind. She shames herself for wanting more—more respect, more rest, more life.

Signs that compliance has become self-erasure include:

  • Reluctance to ask for recognition or support.
  • Avoiding conflict at any cost.
  • Dismissing her ambitions or desires before naming them.
  • Feeling guilty when setting boundaries.

And symptoms emerge: anxiety, depression, compulsions, fatigue, and eating disorders. These are often treated in isolation, but they’re rarely random afflictions.

“The self she has had to suppress to comply is demanding to be heard.”

(Read more: Women and the Stages of a Midlife Breakthrough)

IV. Outliving the Script

Women are raised into roles with clear cultural value: to be desirable, supportive, fertile, and emotionally available. These roles are rewarded—but they have an expiration date.

By midlife, a woman may find she no longer fits into any recognizable cultural category. She has outlived the script, but she hasn’t died.

“When a woman crosses a certain age, the culture doesn’t know what to do with her.”

For many, the response is to hold onto earlier roles with intense effort. We see it in:

  • Cosmetic surgeries and Botox treatments.
  • Rigorous exercise and restrictive diets.
  • Striving to preserve a youthful appearance to maintain social acceptance.

But when a woman shows up fully—intelligent, sexual, assertive—she risks criticism or mockery. Her presence challenges the narrative that she is supposed to disappear.

(Related reading: Midlife Women: When Disapproval Validates and Approval Undermines)

V. History Repeats

This isn’t new. During World War II, when men left to fight, women stepped into roles in factories, shipyards, and offices. “Rosie the Riveter” became a national symbol of women’s strength and capability.

But when the war ended, women were fired, sent back home, and expected to resume domestic roles so men could return to the workforce. Their competence was acknowledged only temporarily.

We see this pattern repeated: a woman is allowed to step forward only under exceptional circumstances—and only for a limited time.

VI. The Consequences of a Life Deferred

Long-term compliance has consequences. A woman who has spent decades shrinking herself, denying her needs, and internalizing blame may not recognize the cost until something breaks.

Common consequences include:

  • Depression and anxiety
  • Compulsions and addictions
  • Fatigue and chronic stress
  • Eating disorders and body image distress
  • Loss of identity and diminished self-worth

Too often, treatment focuses on the symptom rather than the cause. The compliance—the life lived under imposed roles—remains unexamined.

Worse, a woman’s desire for autonomy, freedom, and vitality may itself be pathologized. She may be told she’s unstable, selfish, or erratic for refusing to comply. But the disturbance isn’t in her—it’s in the system that demanded her silence.

(Read more: Midlife Women as Consciousness Pioneers)

VII. She Is Not Alone

Some women, at great cost, stop complying. Not to rebel, but because they can no longer lie to themselves.

They begin to listen inwardly. They ask hard questions:

  • Who decided this life for me?
  • What if I want something different?
  • What does freedom look like for me?

At first, they may feel lost. There is no script for the woman who refuses to vanish. But she is not alone.

Across generations and cultures, more women are choosing to live on their own terms, meeting their true identities for the first time, and discovering how to stand, speak, and hold ground—even when the world pushes back.

Summary

Midlife often brings a quiet reckoning. The roles that once kept you safe no longer fit. Compliance may have protected you, but it has also constrained you.

You are not wrong for wanting more. You are not unstable for seeking freedom. You are discovering what has been limited and stepping into your authentic life.

And you are not alone.

 

FAQ: Midlife Women and the Cost of Compliance

1. What does “compliance” mean in this context?

In this article, compliance refers to shaping your life around other people’s expectations—family, culture, relationships, or society—often at the cost of your own needs, desires, and identity. It can look like cooperation or kindness but may involve self-suppression.

2. Why is compliance such a problem for midlife women?

By midlife, many women discover that the roles they were trained to fulfill no longer fit. Cultural scripts often prepare women to be supportive, modest, and self-sacrificing. But when those roles expire, many feel invisible, restless, or disconnected from their true selves.

3. How does long-term compliance affect mental health?

Lifelong compliance often manifests as:

  • Anxiety or depression

  • Eating disorders and compulsions

  • Chronic fatigue or burnout

  • Loss of identity and self-worth

These symptoms are often treated in isolation, but they may signal a deeper conflict between the self that complied and the self longing to emerge.

4. Can I recover a stronger sense of identity in midlife?

Yes. Midlife can be an opportunity to reclaim autonomy and authenticity. Through self-reflection, supportive relationships, and depth psychotherapy, women can:

  • Identify internalized cultural scripts

  • Reconnect with suppressed desires

  • Develop emotional strength and clarity

  • Begin living life on their own terms

5. How can depth psychotherapy help?

Depth psychotherapy creates space to:

  • Understand why and how you became a compliant woman                                                           

  • Explore suppressed needs and emotions

  • Process anger, grief, and longing without shame

  • Support the emergence of a more authentic identity

For many women, this is the first time they explore who they are beyond their roles.

6. How do I know if I’m ready to make changes?

You may be ready if you’ve been asking yourself:

  • “Is this really the life I want?”

  • “Who would I be if I didn’t have to please everyone?”

  • “What would freedom look like for me now?”

Feeling unsettled or dissatisfied isn’t a failure—it can be the beginning of rediscovering yourself.

7. Is it too late to change?

No. Age is never a barrier to personal transformation. Mature women often find that their lived experience, resilience, and wisdom become assets as they claim an authentic life—even when they’ve spent decades living by other people’s expectations.

 

Further Reading & Resources

From My Library

  • Midlife Women: When Rage Becomes a Healing Force
  • Midlife Women Worksheet: Power After Narcissistic Manipulation
  • Women and the Stages of a Midlife Breakthrough
  • Midlife Women as Consciousness Pioneers: Claiming Your Unlived Life

Feminist & Depth Psychology

  • Karen Horney — Feminine Psychology
  • Virginia Woolf — A Room of One’s Own
  • George Sand — Memoirs and Letters

An Invitation to Depth Psychotherapy

“If these themes resonate with you, I invite you to explore depth psychotherapy with me. Together, we can uncover the patterns holding you back, heal what has been silenced, and help you claim a life that is fully your own.”

Even if compliance shaped your life, it doesn’t mean your life was empty. You may have had sincere joy, delight, and meaning within the roles you were given. But those joys were often time-limited and role-limited. Now, in midlife and beyond, you may want more—and different. You may not even know yet what that “more” is.

Depth psychotherapy with me offers a space to discover it. Together, we explore what compliance has cost, what joy has already lived in you, and what is waiting beyond roles handed down by others. You don’t need to make this journey alone.

Joanna Poppink, MFT

Licensed in CA, AZ, FL, and OR, online appointments only

For a free telephone consultation, write: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Claiming the Lost Self: An Essential Task for Midlife Women — a seven part series.
You may begin with the series introduction here.

Midlife Women: When Rage Becomes a Healing Force

Details
Created: 01 August 2025

midlife women

The Narcissist’s Playbook: What One Midlife Woman’s Awakening Reveals Herself and Our World

By Joanna Poppink, MFT
Private Depth Psychotherapy for Women in Midlife and Beyond


Introduction: Midlife Woman Sees What Was Always There

Louise, a 63 year old now divorced professional woman with an active professional career, adult children and growing grandchildren, has spent a lifetime under the influence of narcissists.

She didn’t always know it. She remembered fragments—sharp criticisms, confusing praise, the constant undertow of self-doubt. But she couldn’t see the pattern clearly. Not yet.

Over time, with determination and support, she began to heal. She saw how the praise was a trap, the criticism a leash. She began to build her own life, one breath and boundary at a time. Yet even as she stepped into freedom, echoes of the past haunted her—unconscious beliefs, old fears, hidden loyalties to the very people who hurt her.

Then one day, Louise opened her phone.


Recognition on a National Scale

Her screen filled with alerts:

  • Medicare and Medicaid under attack

  • Public education gutted

  • Free speech threatened

  • Programs for hungry children slashed

  • Federal agents kidnapping people from public parks, homes, and shelters—disappearing them into detention centers

  • Local businesses closing, unable to survive

  • Asylum seekers and refugees brutalized

  • Global hunger ignored

A terrible recognition passed through her body.

This isn’t just politics. It’s personal.
These are the same tactics the narcissist used on me.

Gaslighting. Threats. Withholding care. Attacking vulnerability. Enforcing silence. Destroying hope. Hollowing out meaning.

She saw the narcissist’s playbook now operating on a national scale.


The Parallel: Personal Abuse and Public Betrayal

For those who’ve lived under narcissistic control, the tactics of authoritarianism are not abstract—they are familiar.

When you've been groomed to accept cruelty as love, and erasure as protection, it becomes easier to miss the signs in public life.

But once you see it, you can’t unsee it.

The rage rises. The body tightens. The grief comes. The betrayal feels total.

This midlife woman—like many midlife survivors—is not just reacting to headlines. She is reliving her trauma, this time reflected on the world stage.


This Midlife Woman's Rage Is Sacred

Louise feels her rage in her gut. Her throat. The base of her skull. Behind her eyes.
She feels sick. She’s exhausted. But beneath the weariness is a rising, ancient, undeniable truth:

She is furious.

And that anger is not a problem. It is a power.

Rage, when witnessed and directed, becomes moral clarity. It tells us what we will no longer tolerate—what must never be allowed again.


Therapeutic Steps Toward Healing and Action

How can Louise or any midlife woman carry this awareness—this grief, rage, and recognition—and not be crushed by it?

She must turn inward, ground herself, and choose how to live from this new level of truth.

1. Validate the Echo

  • Say to yourself: “This is real. What I’m seeing—and what I’m feeling—is real.”

  • You are not too sensitive. You are attuned.

2. Care for Your Body

  • Drink water. Walk in nature. Breathe deeply. Nap.

  • These are not escapes—they are strategic replenishment.

3. Channel the Anger

  • Write. Paint. Scream. Organize. Vote. Speak.

  • Let your rage fuel you toward protecting what you love.

4. Choose Your Focus

  • You don’t need to fix everything. Focus on one realm where you can take meaningful action—education, hunger, civil rights, the environment, community healing.

5. Connect with Others Who See

  • Find a group, a circle, a friend. Let your clarity grow stronger with others.

  • Mutual witnessing transforms pain into power.


Midlife Women's Reflection Questions

  • Where do I see the tactics of personal abuse echoed in public life?

  • What part of me is being reawakened by what I see around me?

  • What kind of world do I want to protect—and how can I begin, even in a small way, today?


You Are Not Alone

This moment of recognition is not a breakdown. It’s a breakthrough.

The woman in this story could be any one of us. She could be you.

You are not crazy. You are waking up.
You are not weak. You are responding with your full humanity.
And you are not alone.


Resources for Support and Action

Psychological Healing

  • Joanna Poppink, MFT – Depth Therapy for Midlife Women
    🌿 https://www.eatingdisorderrecovery.net

  • The Body Keeps the Score by Bessel van der Kolk
    📘 https://www.besselvanderkolk.com/resources/the-body-keeps-the-score

Civic Awareness and Resistance

  • Protect Democracy
    ⚖️ https://protectdemocracy.org

  • States United – The Authoritarian Playbook
    📄 https://statesuniteddemocracy.org/report/the-authoritarian-playbook/

  • Gaslit Nation Podcast
    🎙️ https://www.gaslitnationpod.com

  • The Artist’s Way by Julia Cameron
    🎨 https://juliacameronlive.com/the-artists-way/


Call to Action

If this story resonates with you—if you’re waking up to the pain, the patterns, and the truth—know that support is here.

I work with midlife women who are reclaiming their voice, their power, and their vision for a more just and loving world.

I'm licensed for private online psychotherapy work in CA, AZ, FL, OR.

✨ To arrange a free telephone consultation, email me: This email address is being protected from spambots. You need JavaScript enabled to view it.


Summary

This article explores how a midlife woman’s awakening from narcissistic abuse parallels her growing awareness of national and global injustice. As she recognizes the same manipulative tactics in politics that once controlled her personally, she experiences rage, grief, and clarity. The post offers a therapeutic arc from overwhelm to empowerment, encouraging readers to honor their anger, care for their bodies, and take focused, values-based action.


FAQ

Q: Why does the news make me feel like I’m reliving my trauma?
A: Because you are witnessing patterns—gaslighting, cruelty, control—that mimic what you once survived. Your nervous system is responding to real danger and past memory.

Q: Is anger bad for my healing?
A: No. Anger is a natural, protective emotion. When acknowledged and channeled, it becomes fuel for healthy boundaries and right action.

Q: I feel overwhelmed. How can I do anything useful?
A: Start small. Choose one area of focus. Even one aligned act—calling a representative, writing a letter, comforting a neighbor—builds strength and integrity.

Q: Can psychotherapy really help with this level of pain?
A: Yes. Depth therapy can help you understand how past trauma shapes your reactions, build resilience, and reclaim your full self so you can live with clarity and purpose.

Claiming the Lost Self: An Essential Task for Midlife Women — a seven part series.
You may begin with the series introduction here.

Good Faith Estimate

Details
Created: 06 June 2022

Good Faith Estimate from No Surprise Act

Transparent information as part of the No Surprise Act. Your Good Faith Estimate shows costs and the diagnosis range.

Date of Client Contact:

Date of Good Faith Estimate:


Good Faith Estimate

This is NOT a legally binding contract. Any client can stop treatment when they wish and NOT be financially responsible for any appointments beyond the end of treatment.

 

Provider: Joanna Poppink, MFT

NPI:1427713270 EIN 87-4229305

Physical Location: 10573 West Pico Blvd. #20, Los Angeles, CA 90064

Alternate Location: POS 10 or 02 for telehealth

Common Diagnosis Codes: Below are common diagnosis codes; however, the list is not exhaustive. With that said, diagnosis codes can change based on many factors. Please let me know if you have any questions or concerns.

  • Adjustment Disorder (F43.23)
  • Bulimia nervosa (F50.2)
  • Social Anxiety Disorder (F40.10)
  • PTSD (F43.10)
  • Depression (F32.0-F33.3)
  • OCD (F42.9)
  • Generalized Anxiety Disorder (F41.1)
  • Eating disorder, unspecified (F50.9)
  • Anorexia (F50.02; F50.00)
  • Sleep terrors (F51.4)
  • Somatization disorder (F45.0)
  • State of emotional shock and stress, unspecified (F45.7)

(See more complete list of possible diagnoses at end of this document)

Joanna recognizes every client's situation, readiness and background contributing to her therapy journey is unique. How long you need to engage in therapy and how often you attend sessions will be influenced by unexpected or changing circumstances. If increased stress and anxiety develops during the challenging process of depth psychotherapy, it is not unusual for a client to request extra sessions and/or increase frequency of sessions.

Together we will continually assess the appropriate frequency of therapy and will work to determine when you have met your goals and are ready for discharge.

Where services will be delivered.

• I am currently only providing services via telehealth until further notice; as such, all benefits will be quoted as virtual unless indicated otherwise in the notes section of this document.

Charges are not higher than the below listing:

One individual session is as follows: $300.00
Individual follow-up session - $300.00
Individual crisis session for first 45-minutes $300.00
Individual crisis session for each additional 30-minutes - $200.00

These charges DO NOT reflect an increase of any current charges for existing clients. Over time costs can be raised, never more than once a year and often far less. Clients who pay less than these charges will maintain this cost level unless notified of a rate increase.

Client Information

This Good Faith Estimate is specifically tailored for:

 

Name: ____________________________________________________________________

Date of Birth: _______________________________________________________________

 

Client’s Contact Preference: Rank in order 1, 2, 3, 4.

Post ______ Text______ Phone _____ Email _____

Client Diagnosis

As a therapist, I must diagnosis clients for both ethical, legal, and insurance reasons -- as well as required by the "No Surprises Act."

Your Good Faith Estimate diagnosis is:

Z13.30 Encounter for screening for mental health diagnosis

This diagnosis is only to satisfy the federal requirement for this form and is not a formal psychological diagnosis. A formal diagnosis occurs after an assessment has been completed, which typically occurs 1-5 sessions after beginning psychotherapy. If you choose to decline a formal diagnosis, I will not update this GFE.

It is within your rights to decline a diagnosis per state and federal guidelines.

 

Your Financial Responsibility Summary

For a good faith estimate: the amount you would owe if you were to attend therapy for 52 sessions in a year (weekly, without skipping any weeks for holidays, break, vacation, unplanned events/sickness, etc.). The "Good Faith Estimate" requires practitioners to provide an exact estimate and not a range.

 

Out of an abundance of caution and transparency, I will only quote weekly appointments.

 

Service: Individual Therapy 38-52 minutes

Billing Code: 90834

Provider Charge: $300.00

 

Charges are not higher than the below listing:

One individual session is as follows:                                        $300.00

Individual follow-up session -                                                    $300.00

Individual crisis session for first 45-minutes                           $300.00

Individual crisis session for each additional 30-minutes -     $200.00

These charges DO NOT reflect an increase of any current charges for existing clients. Over time costs can be raised, never more than once a year and often far less. Clients who pay less than these charges will maintain this cost level unless notified of a rate increase.

Good Faith Estimate Disclaimers:

• This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

• This Good Faith Estimate is designed for public information on Joanna Poppink’s website. After your initial free consultation with Joanna you will receive a personalized Good Faith Estimate tailored to your agreement with Joanna.

• The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

• The Good Faith Estimate does not include services not provided by your provider that you may need and that your provider may recommend. For instance, the Good Faith Estimate does not include the cost of seeking medication for mental health.

• The Good Faith Estimate is an estimate for services only and does not include other fees, such as fees for cancelling less than 24 hours in advance. These fees are outlined in the informed consent that is signed before the start of therapy services and that you have control over.

• This Good Faith Estimate is not a contract and does not obligate you to receive the services listed nor does it obligate you to receive the services listed by this provider.

• If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.

• You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

• You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

• There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

• To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 800-985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.

  • Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.

ICD-10 Mental Health Billable Diagnosis Codes in Alphabetical Order by Description Last updated 11/6/17 Page 1 of 17 IICD-10 Mental Health Billable Diagnosis Codes in Alphabetic Order by Description Note: SSIS stores ICD-10 code descriptions up to 100 characters. Actual code description can be longer than 100 characters. ICD-10 Diagnosis Code ICD-10 Diagnosis

F41.0 Panic Disorder (episodic paroxysmal anxiety)

F43.0 Acute stress reaction

F43.22 Adjustment disorder with anxiety

F43.21 Adjustment disorder with depressed mood

F43.24 Adjustment disorder with disturbance of conduct

F43.23 Adjustment disorder with mixed anxiety and depressed mood

F43.25 Adjustment disorder with mixed disturbance of emotions and conduct

F43.29 Adjustment disorder with other symptoms

F43.20 Adjustment disorder, unspecified

F50.82 Avoidant/restrictive food intake disorder

F51.02 Adjustment insomnia

F40.02 Agoraphobia without panic disorder

F40.00 Agoraphobia, unspecified

F50.02 Anorexia nervosa, binge eating/purging type

F50.01 Anorexia nervosa, restricting type

F50.00 Anorexia nervosa, unspecified

F41.9 Anxiety disorder, unspecified

F50.2 Bulimia nervosa

F60.7 Dependent personality disorder

F48.1 Depersonalization-derealization syndrome

F50.9 Eating disorder, unspecified

F40.231 Fear of injections and transfusions

F41.1 Generalized anxiety

F48.9 Nonpsychotic mental disorder, unspecified

F50.8 Other eating

F41.3 Other mixed anxiety

F43.8 Other reactions to severe stress

F45.8 Other somatoform disorders

F32.89 Other specified depressive episodes

F50.89 Other specified eating disorder

F41.8 Other specified anxiety disorders

F43.12 Post-traumatic stress disorder, chronic

F43.10 Post-traumatic stress disorder, unspecified

F51.9 Sleep disorder not due to a substance or known physiological condition, unspecified

F51.4 Sleep terrors [night terrors

F45.0 Somatization disorder

F45.9 Somatoform disorder, unspecified

F45.7 State of emotional shock and stress, unspecified

 

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Joanna Poppink, MFT, psychotherapist in private practice, licensed in CA, AZ, OR, FL. Working with midlife and older women. For a free telephone consultation, please e-mail This email address is being protected from spambots. You need JavaScript enabled to view it.

For a free telephone consultation, e-mail her at This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Claiming the Lost Self: An Essential Task for Midlife Women — a seven part series.
You may begin with the series introduction here.

Perfection, Restricting and Eating Disorders

Details
Created: 19 May 2024

Restricting, Eating Disorders and Striving for Perfection

Perfection as Safety through Restricting Food

  1. Perfectionism and Food Restriction as Coping Mechanisms: Individuals with eating disorders often strive for perfection by restricting food intake to manage anxiety and fear, equating thinness with safety and control. This drive serves as a way to soothe and distract from emotional suffering.
  2.  
  3. The Illusory and Exhausting Nature of Perfection: The relentless pursuit of perfection is unachievable and exhausting, leading to constant anxiety about maintaining an unattainable standard. This obsession undermines self-worth and emotional stability, impacting relationships and overall life satisfaction.
  4.  
  5. Path to Genuine Recovery: True safety and health come from abandoning the fantasy of perfection and embracing imperfection. Building trust with a therapist and committing to recovery allows individuals to develop internal strength, ultimately leading to more fulfilling and authentic lives.

Perfection is often the goal in early eating disorder recovery work. Whether clients suffer from bulimia, anorexia, compulsive overeating, or binge eating, the desire for perfection often looms large. When anxious and frightened, they may attempt to control their body shape and size by restricting their food intake in their drive to be perfect.

This drive to restrict food is viewed as a way to soothe, numb, and distract from suffering. The idea of becoming smaller can be thrilling because, in their minds, being thin and tiny equates to a fantasy of ultimate safety.

While self-improvement and striving for excellence are natural, the relentless pursuit of perfection is exhausting and can blind individuals to opportunities for joy and satisfaction.

How Perfection Relates to Restricting and Eating Disorders

Read more …

Binge Eating Healthy Food: Do I Have an Eating Disorder?

Details
Created: 01 June 2008

binge eating healthy food 1"Do I have an eating disorder if I only binge on healthy foods?

Desperate Hope

This question speaks of a desperate hope to find a way to be safe and healthy. You want to give yourself good nourishment. You want to take care of yourself. You want to live. Yet you know that a binge, even quality food, harms your body and your life.

Compulsion to Binge Eat

At the same time, you can't stop bingeing. Since you are helpless to stop, you try to make your binge and yourself as safe from negative consequences as possible.

Read more …

  1. Panic Attack Can Be Part of Your Eating Disorder Experience
  2. Slippery Slope Dangers: How to Stay in Eating Disorder Recovery
  3. Anxiety, Binge Eating, Intimacy Issues: The Fire Alarm Is Not the Fire
  4. Weight Loss Surgery and Eating Disorders
  5. Eating Disorder Body Fantasy and Path to Recovery
  6. "What to Look for in an Eating Disorder Treatment Center" Commentary
  7. Lots of Passionate Words but Nobody's There: Understanding Irritation and Fury in Relationships
  8. Eating Disorders at Work: What Should You Do?
  9. Night Eating and Weight Gain: Importance of Sleep
  10. Courage and Resistance through Psychotherapy
  11. Life Disruption: How to be prepared
  12. Emotional Holding in Depth Psychotherapy
  13. Depth Psychotherapy: How to Get the Most Out of It
  14. Protests and the National Guard: Finding Your Stability in Confrontation
  15. How Boundary Trauma Leads to Eating Disorders
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