Insurance Considerations for Mental Health Treatment

Nautilus Counseling is excited to offer new insurance-pay options through Sondermind as of today, March 12, 2024!  Clients who already use insurance for their sessions will receive information about being transferred over to the Sondermind platform. Clients who currently pay privately can view the list of accepted insurances here: Sondermind – Colorado.

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This blog post will cover the three major considerations for the folks who are considering the transition to insurance-pay, but are not yet sure.  These considerations are: finances, diagnosis, and privacy.

Finances

Many people have concerns about the cost of mental health treatment.  It is more financially feasible for many clients to bill through insurance versus paying a counselor privately.  However, make sure to read the fine print on your insurance plan.  You may still be liable for co-pays for every session, and co-pay costs vary widely.  Additionally, some insurance plans will not begin to cover care until your deductible is met for that year.  

Whether or not you bill through insurance, you may still be personally responsible for the costs of late cancellations or no-showed sessions, and the cost of missed sessions does not usually apply to deductibles.  

Diagnosis

Clients seek counseling for a wide variety of reasons, and sometimes these needs do not rise to the level of a diagnosable condition, such as those found in the Diagnostic and Statistical Manual – 5th edition (DSM-5).  Insurance will typically only cover mental health treatment if it aims to address a diagnosed condition.

This means two things for you, the client: 1) even if you are not interested in receiving a diagnosis, you may need to if you want to use insurance.  2) you may not be eligible to use insurance if your counselor cannot find sufficient symptoms to support a diagnosis and subsequent treatment plan.

Privacy

Billing through insurance usually means that your insurance agency has access to information about your mental health and treatment.  Sondermind will require a copy of the therapy notes for every session that is billed through insurance.  In private pay situations, only you and your therapist have access to your therapy notes and treatment plan, unless you explicitly authorize another party through a Release of Information form.  

Usually sharing mental health information with your insurance provider is not a problem, but certain individuals may have qualms with their private information being distributed more broadly than it must.  

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Current clients are welcome to contact Kara directly with questions about billing and insurance.  If you are a prospective client unsure about how to pay for counseling, feel free to schedule a free 15-minute consultation to discuss your options in greater depth.

End-of-Semester Organization Tool

Hello, blog! It has been a while. Nautilus Counseling has been prioritizing current clients instead of the website, but inspiration has struck again today and we are back!

As blog-readers already know, Kara has a passion for working with young adults, especially college students. With the Spring semester coming to an end, students are scrambling to complete all of their end-of-semester tasks including assignments and study time while also remembering to take care of themselves. Kara has created a document to help students stay organized in these busy last few weeks of the school year, available to download for free:

How to use this organizer:

  1. Use the “Exam Dates” chart to note the times and days of any final exams or other important end-of-semester events for your classes.
  2. Use the “Assignments” section to track non-exam assignments such as papers and projects. Under the “Status” Column, use “Scheduled” to indicate that you have already set a time/place to work on this task and “In progress” to indicate an assignment has been started but requires additional time to complete.
  3. The “Exam Study” section is intended to help students track how much time has been spent studying for individual exams by “chunking” study time instead of expecting it to be completed in one sitting. After listing exam classes and dates, first determine how much time you’d like to spend studying for a specific exam (example: 1 hour for your history exam, 2 hours for your psychology exam, and 3 hours for calculus) and note this in the “Time needed” section. Next, determine how long you’d like each of your study “chunks” to last (30 minutes? 45 minutes? an hour?) and write this in the blank line found on the top row. Each time you complete one study “chunk” of your selected length, check off one box until you have met your “Time Needed” goal.
  4. Finally, a “Self-care” chart has been included here to promote overall wellbeing. After all, you are a human as well as a student. Kara encourages clients to engage in self-care activities across different “domains”. Common domains of self-care include: physical, intellectual, spiritual, social, environmental, and financial. Identify an activity that makes you feel like the best version of yourself, then utilize the tracking chart in the same way you tracked your assignments.
  5. Use the additional “Notes” section under each chart to capture reminders or resources that are related to each section such as study groups, appointments with tutors or advisors, and deadlines for requesting to use academic accommodations.

Want personalized organizational support? Contact Kara today!

Orienting to College – Part 2: Social Life and Campus Resources

Please refer to Part 1 of “Orienting to College” for information on the structure of colleges and campus life.

Social Life

One major factor that predicts a person’s satisfaction with their school is the degree of engagement they have with their campus community.  Colleges are increasingly interested in supporting student involvement because it supports both student mental health and student retention.  

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Some students find their community within their residence hall or living community.  There are on-campus housing communities, often titled something like a “Living and Learning Community”, developed with a specific student major or interest in mind. You may consider joining one of these if you would like to be surrounded by students with similar academic interests.  Some RAs are helpful in facilitating interactions between residents regardless of student academic interest.  However, not all students find that they “click” with their residential neighbors and find their community elsewhere.

A very productive way to get involved with your school outside of residence life and academics is to join student clubs or organizations.  Many schools maintain directories of the organizations that exist on campus.  The office that manages this directory could be the Student Government on campus, an office called something like the Center for Student Engagement or Involvement, or something simple like Student Organizations.  At the beginning of each school year, it is common for there to be events like club fairs in which you can explore student organizations in one place and meet some students who are already involved in those groups.

Not all schools have “Greek life” like fraternities and sororities on campus, but they are a major attractor for some individuals seeking a social college experience.  Those who wish to join a Greek club such as a fraternity or sorority are usually expected to “rush”, which one could compare to applying for admission, for the group of their choice early into the academic year.  Though it is not usually open to first-year students, many Greek life groups have their own buildings in which upperclassmen members can reside.  

Campus Resources

So now you have the basics about living on campus and a few ideas for facilitating social interactions once you arrive, but what if you need help with something more specific?  Campuses have a wide variety of resources available to students ranging from academic help to mental health support to future planning – you just need to know where to find them.

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A great person to keep as a point-of-contact to ask such questions is your Academic Advisor.  You may not be assigned a specific academic advisor right away, but some schools may pair you with one before you arrive on campus.  Your Advisor’s main role is to guide you through your degree program and ensure you’ve taken all the necessary classes to graduate.  They also tend to know a lot about the supports offered in your specific college, so they would be a great person to reach out to if you are unsure who to contact about a need.

Tutoring options are typically available in some form at most universities, but whether they are free and/or included in the cost of tuition varies.  Your college or school might have its own tutoring offerings which your Academic Advisor and instructors should be able to tell you about.  For essay composition, your school may have a Writing Center that can provide feedback on all of your written work or assist you in the essay-writing process.   

I often say that “students are people first, then students” and people do get sick.  Whether you come down with the flu or encounter a mental health crisis, your school probably has someone available to assist you.  Campus health offices can often provide basic medical care for a reduced rate (though many schools still require students to carry health insurance in order to access this care – make sure you are up-to-date with your schools insurance requirements prior to arriving on campus).  Mental health services like counseling centers are also common fixtures on college campuses and again may offer free or reduced-rate services to students.

As mentioned before, students with disabilities might have specific needs for living on campus, accessing their academic work, or both.  Schools are required by law to provide disability accommodations to students who need them.  The office that provides these types of accommodations might be called Disability Services, Student Access Services, or the ADA Office.  Each school has their own process of approving accommodations but this usually includes the submission of medical documentation that confirms the presence and impact of a person’s disability.  

This list of campus resources could go on for pages if I wanted to list each resource that could possibly exist at a school, but I’ll spare you.  One final resource that I wanted to highlight is called an Ombuds office.  These usually only exist at larger institutions, but the Ombuds office is a place where you can consult with a campus expert (usually confidentially) about any issues you are experiencing.  They can then provide ideas for next steps based on their expert knowledge of the school’s offices and resources.  

The free download available below is called the “College Prep Scavenger Hunt”, and is your opportunity to gather information about your specific school all in one place.  Fill this document out before you arrive on campus and you will have a helpful one-stop guide for many of the questions you’ll encounter during your first semesters at school.  This document can be saved and used as reference throughout your first year, and beyond. 

Orienting to College – Part 1: Structure of a College and Living on Campus

This turned out to be a lengthy outline, so please see Part 2 of “Orienting to College” for the free download that accompanies this information.

August is right around the corner and with it comes the first day of classes at many universities and colleges across the country.  While exciting, the prospect of adjusting to new environments, classmates, and schedules can also be daunting.  Colleges have different structures and resources than most high schools so this post is intended to help familiarize incoming students with some of the lingo and departments found on most college campuses.

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Structure of a University

A university is defined as an institution of higher education that offers degrees from different “colleges” or “schools” under the university’s umbrella.  Each college or school has at least one major that a student can select, which will ultimately be reflected on their degree.  Smaller schools, like liberal arts colleges, may only have one college.  In this case, the school would not technically be a university.  

The people that teach in a college are all considered “faculty”.  Faculty members can include professors who are typically permanent employees of the university, as well as instructors and lecturers who may be graduate students, research fellows, or other temporary employees.  Of the faculty members, there is usually a Dean of a college, who is usually the most executive role within an academic department.  Deans oversee things like the development of the department’s curriculum, hiring of new faculty members, and managing disputes with students or other parties.

Those who work at a university but do not teach classes are usually considered “staff”.  Staff members include the people who work in offices like Campus Housing and Dining, medical professionals at your school’s health center, the postal worker in the mailroom, and many others.  The executives of the school such as the president and chancellors may be considered staff, or may have a separate title specific to administration.  

Living on Campus

Many schools require first–year students to live in their campus housing. Some schools have traditional dormitories in which two students share a single room, and a floor of rooms shares a common bathroom.  Another possibility is apartment-style residences in which students have shared or private bedrooms and a shared kitchen and bathroom within their unit.  Some schools have a combination of these features.  The office that manages campus housing is probably called Residence Life, Campus Housing, or Housing and Dining, or something similar.

If you require a specific living feature due to a disability or medical condition (this could include an attached bathroom, a bedroom with air conditioning, or a residence that is close to a dining facility to name just a few) then you should connect with your school prior to move-in and request this feature as a housing accommodation.  Sometimes it is the Campus Housing (or similarly titled) office that handles disability accommodations, and sometimes it is the same office that handles academic accommodations (discussed below in “Campus Resources” section).  If schools are unable to accommodate student’s residential needs, then they often waive on-campus housing requirements and assist students in locating appropriate off-campus housing.

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For those living on campus, residence halls often have a point-person for residents in or near the building.  Most often these individuals are called Resident Advisors or Resident Assistants (RA).  Residents are encouraged to reach out to their RA if they need information about the campus, or if they need assistance with issues related to their building, roommates, or neighbors.  

The variety of dining options on campus will vary based on the size and resources of your school.  Schools often have meal plans that students can opt into, which allow students to buy meals with pre-purchased credits instead of money.  Some dining halls only allow individuals to dine with such credits but many campus dining halls increasingly allow flexible payment options.  If your diet is restricted by medical necessity, you may be entitled to dining accommodations such as a waived meal plan requirement if the campus dining options do not meet your disability-related need.

Continued in Part 2: Social Life, Campus Resources, and FREE download.

Summer-before-College Series Introduction

A blog series for incoming students

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It is hard to believe that we are already halfway through July and weeks past the summer equinox!  As the days begin to shorten, many are planning on beginning new academic ventures in the coming fall months.  Whether you are a recent high school graduate, a student who took a break before returning to college, or a seasoned academic embarking on a new graduate degree, it may be helpful to get your bearings before you arrive on campus in the next few months.

I have lots of experience assisting students in their transition to college so I wanted to provide a resource for new college-goers as they embark on their journey in higher education.  The “Summer-before-College” series will include three parts presented over the next several months – think of this like a “packing list” for information (instead of Twin XL bed sheets) to keep handy in your first few semesters and beyond.  The parts of the series will be:

  • Part 1: Familiarizing yourself with your school
    • Download: New College Scavenger Hunt
  • Part 2: Familiarizing yourself with a college course
    • Download: The Anatomy of a College Syllabus
  • Part 3: Three skills for College Success
    • Download: Time Management Strategies for College Classes
  • … and, if inspiration strikes, maybe more in the future

This series is designed for students that have already confirmed their enrollment at a university or college, and is specifically designed with United States colleges in mind.  Comments have been left open for this blog post to see what other kinds of college-related guides would be helpful in the future!  If you are interested in information on applying for or choosing between colleges, picking a major, studying for finals, traveling abroad, or some other topic, please let me know in the comments below!

Wisdom for Newbies from Brené Brown

**Notice: This blog contains one explicit/curse word as cited by external source**

Nautilus Counseling will be officially opening next week, and the Universe has once again transpired to provide me with just the right resource for the occasion.  I recently discovered Brené Brown ’s podcast “Unlocking Us” and started with the very first episode.  As is often the case, the beginning was a very good place to start.

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Brené’s inaugural “Unlocking Us” podcast described the concept of “FFTs”, or “fucking first times”.  These can also be called TFTs or “terrible first times” for non-cursing individuals.  The name says it all – FFTs are situations that you have never before navigated.  You have no context or prior experience to lean on in this specific domain, so it will require more effort and time to navigate.  Brené relates this phenomena back to her own podcast launch amidst the COVID-19 pandemic; I relate mine to the imminent launch of my own business, especially the administrative and accounting pieces of it.

The concept of FFTs is helpful for three reasons:

  1. It names the experience
  2. It normalizes it
  3. It moderates expectations

Naming the experience helps to explain the chaos and uncertainty associated with this first-time experience, which allows one to normalize their messy reactions to the situation.  It is natural to feel anxious, unorganized, or underprepared when in the midst of an FFT!  

It is also natural, often imperative, to proceed with a series of trials and errors.  Without prior experience to guide you, FFTs remind us that we may have hiccups and even failures along the way.  This is the nature of an FFT.  It is with these learning experiences that we navigate out of FFT territory and, eventually, what once was an FFT becomes well within one’s comfort zone.

The Comeback – July 2022

Hello and welcome back to Nautilus Counseling’s blog! As all 5 of my current subscribers know, things have been pretty quiet around here as of late.

As all of my 5 subscribers also know, I lost my house in the December 2021 Marshall Wildfire outside of Boulder, Colorado – this is what has led to the aforementioned quiet.

In the months since, my partner and I have been busy relocating to the Western side of Colorado, making major career shifts, and acquiring a homefull of belongings. Amazingly, only 6 months after the fire, we are doing better than ever thanks to the support of our families, friends, and community. Now that we are getting settled into our new post-fire groove, I am delighted to announce…

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Nautilus Counseling has relocated to Grand Junction, Colorado and is STOKED to begin offering both online and in-person counseling starting July 2022. In addition to individual counseling services, the blog will be up-and-running again in the next few days, and I hope to have several written offerings available to you per month moving forward.

If you are located in the state of Colorado and are interested in scheduling a free 15-minute phone or video consultation with Kara, please email Kara@NautilusCounselingCO.com.

 Imposter Syndrome Part 2 – Social Influences

Last time on the blog, we looked at five different types of imposter syndrome, defined by Dr. Valerie Young.  This week, we are stepping back from the individual and looking at the cultural, structural, or organizational patterns that cause imposter syndrome to be so prominent. 

In a 2008 article, The Harvard Business Review has defined imposter syndrome as “a collection of feelings of inadequacy that persist despite evident success”.  For me, imposter syndrome has shown up as a lack of confidence in my skills as a counselor and businesswoman even though I have demonstrated competencies in these areas countless times.  Additionally, this doubt can lead to delays in getting started with projects due to individuals feeling as if they are “just not ready yet”, even though they are as prepared as they can be.

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Interestingly, the term “imposter syndrome” was first dubbed in the 1970s by researchers looking at the self-image of female graduate students.  I identify as a woman, and imposter syndrome impacts women and minority groups more frequently, perhaps because they have fewer role models to aspire towards.

There is a strong argument to be made for the idea that imposter syndrome is related to broad societal norms and familial socialization, but the culture of organizations and workplaces can also lead to increased feelings of being a “fraud”. Social worker Melody Wilding points to three major factors that can increase imposter syndrome: competitive “dog-eat-dog” relational patterns, unclear expectations and communications, and a lack of diversity in leadership and mentoring roles.  

An article by Mullangi and Jagsi also suggests that leaders combat imposter syndrome by “recognizing [and actively addressing] the subtle ways in which women [and minority groups] are socialized to behave in public spaces that can prevent them from being recognized for their contributions”. 

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For those of you in leadership roles, or hoping to address imposter syndrome more widely, here are a few specific suggestions, gathered from the thoughts of Melody Wilding, Samyukta Mullangi, MD, Reshma Jagsi, MD, Ruchika Tulshyan, and Jodi-Ann Burey:

  • Promote representation – hire diverse employees into leadership positions; ensure that guiding committees include women, people of color, LGBTQIA+ individuals, and newer employees; develop mentorships for underrepresented groups
  • Recognize bias – create structures for accountability and equity; require trainings for managers to understand systemic differences that may impact employees
  • Foster psychological safety – normalize discussions about self-reflection; be honest when you do not know the answers; create space for questions and collaboration; notice the ways in which employees talk about themselves and their performance; do not engage in gaslighting
  • Model human work patterns – respect work/life balance; encourage vacations; build in stress-management skills to professional development opportunities
  • Praise Accomplishments – focus on effort put in, instead of just the product turned out; celebrate incremental achievements instead of only the end goal 
  • Utilize feedback for growth – feedback allows for clarification of expectations, focus on strengths, and self-directed plan for continued learning

Combating imposter syndrome creates space for individuals to reach their highest potential, and ultimately benefits workplaces and institutions. With some effort in the areas listed above, hopefully more individuals will take solace in the truth that imposter syndrome is, at its core, a symptom of their success.

Imposter Syndrome Part 1 – Types of Imposters

It is time for our 2nd ever weekly blog for Nautilus Counseling!  This week, I thought it would be appropriate to focus on something that I am personally encountering as I plan to welcome new clients in the coming months – imposter syndrome. 

Imposter syndrome, also sometimes called “the imposter phenomenon” since it is not a true psychiatric diagnosis, is the experience of qualified individuals feeling unprepared or incompetent in their own subject area. This experience is widespread and found in all professional fields including healthcare, academia, management, creative arts, and technology.

This will be part one of a two-part series on this topic.  This week, we will look at the individual influences of imposter syndrome whereas next week we will look at the structural and organizational influences that perpetuate this phenomena.  

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While I believe that imposter syndrome is a symptom of the disease called inequity (more on this next week), I would like to outline several different types of imposter syndrome as described by Dr. Valerie Young.  Each of the types below is distinguished by its views on competence.  

  • The Perfectionist is primarily concerned with how something is done, specifically that it is done in the “right” way.  This can sometimes lead to micromanaging, or the opposite: withdrawing for fear of not delivering an A+ product or not doing everything correctly.  Often, even successes are underwhelming because they could have been done better.
  • The Natural Genius is convinced that anything worth doing should come easily, and that success should come effortlessly.  They have a very low tolerance for learning curves or being a novice.  
  • The Expert defines competence by how much knowledge or skill a person has.  While they often underestimate their own educational achievements, the confidence of an expert is blown if they do not know the answer to an obscure question.  These individuals may pursue additional degrees or training, far beyond what is required in their role.
  • The Soloist’s characteristics may be guessed by its name – these folks are adamant that competence is achieved independently, without assistance.  For soloists, any group successes do not count.  The soloist would rather exhaust themself or give up before asking for help. 
  • The Superperson (adapted from Young’s Superman/woman/student) aims to take on as many roles as possible to prove competence.  Superpeople are often superwomen who juggle multiple roles in their workplaces, families, and social circles.  They view themselves as inadequate when their many life demands catch up.   

To determine which subtype you may embody, you can ask yourself fill-in-the-blank questions like “An individual is qualified to ____  when  ___”, “I can trust that I’m competent at something if  ___”, and “I should always ___ in my pursuits”.  

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Whatever comes up for you, consider creating an affirmation for its antithesis.  If you are an Expert type and define competence by knowing ALL of the related information, you could try something like “Knowledge is a journey with no end”.  If you are a Superperson, an affirmation could be “I am deserving of rest” or “It’s okay to say ‘no’”. Natural Geniuses can benefit from reminding themselves “every great accomplishment takes work and effort”.

Identifying your “imposter” type is just one step towards the self-awareness needed to combat imposter syndrome.  Tune in next week for more information on how imposter syndrome is perpetuated by systemic inequities, and some ideas to counter that as well!

Why Nautilus?


Photo by SARAH GRANGER on Unsplash

Welcome to the first ever blog post for Nautilus Counseling!  I thought it would be a good idea to start off with an explanation of the name I chose for this practice, so buckle up for my best attempt at describing this multi-layered symbol and metaphor, as well as its meaning to me.  

A spiral is a naturally occurring shape that is found commonly in nature.  They are the structures of galaxies and bacteria alike.  Philosophers and mathematicians have marveled over the prevalence of the “golden ratio” also known as Fibbonacci’s sequence.  To describe this sequence in non-academic terms, each number of the sequence is the sum of the prior two digits (0, 1, 1, 2, 3, 5, 8, 13; the 2 is found by adding the two numbers before it (1+1),the 3 is found by adding the two numbers before it (1+2)).  Aside from its mathematical underpinnings, spirals are found in art, religion, dreams, and mythology across space and time.  

The spirals that I was most familiar with growing up were those of seashells.  My childhood was spent in the Florida Keys where the natural beauty of the world is hard to ignore.  I remember being transfixed at an early age by seashells, wondering how thumbless waterbugs made such beautiful homes for themselves.  An important thing to remember about seashells is that the shell is not the creature (though there is a strong argument that it is an extension of that creature), but rather its perfectly ratioed shell is a product of the animal inside.  The nautilus specifically creates its shell in a quintessential Fibonacci spiral and also coincidentally is one of the oldest creatures to grace the face of the earth. 


Photo by Shaun Low on Unsplash

Herein lie the first two layers of the metaphor that inspired my business name.  The Fibonacci sequence parallels my beliefs about cognitive growth.  New chapters in one’s life are not random, but rather built off of the experiences, beliefs, and feelings that one has experienced in the past.  It also speaks to the idea of Fritz Perls’ “gestalt”, indicating that the whole of a creature is greater than the sum of its parts – indeed each section of a nautilus’ shell is greater than the building blocks that came before, but the shell in its entirety is what sustains life for the creature and inspires admiration from us humans.

It is also important to note that the shell and the animal are not one in the same.  The shell is what the animal shows to the world instead of its tender body.  This mirrors humans as well.  The front that we present in public (and often private) spaces does not usually reflect the complexities that lie within one’s consciousness.  In therapy, I hope to provide a safe space for clients to “come out of their shell” and take a look at how closely their public presentation matches their inner truth.  Some mollusks (and some humans) occasionally elect to discard their meticulously created homes altogether.  They become vulnerable, then sometimes find new shells that are a better fit.  This, too, can happen in counseling.  Within a space of trust and safety, you may decide that part of your public identity no longer matches your internal experience.  We can work together to thank this part for its service, then let it go.

To add one more layer to this metaphor, I will describe a beach.  While sitting on the sand, you can perceive all of the things above the water as you do in your daily life.  Every once in a while though, you can see a fish or fin hop into your perception from under the surface of the water.  For me, dry land represents our conscious self, and the ocean represents our unconscious.  Shells can wash up on shore to give us clues of the life that lives underneath just like emotions and dreams give us clues to the activity in our unconscious mind.  I hope that counseling will empower you to appreciate and inspect these little nuggets of insight as you would a beautiful, mysterious shell on the beach.  


 Photo by Bogomil Mihaylov on Unsplash

To me, therapy is a spiral process of discovering, growing, and integrating the many different pieces of oneself.  Sometimes we re-learn lessons in new ways and new contexts.  In those moments, this may feel like tedious work.  However, once you step back from your process of self-actualization, you may find that you have created something beautiful.