A few years ago, I wrote an article for the Newsletter entitled "Enough Already," or "Why I Don't Accept Insurance." My life has taken an interesting turn since that time.

The article was written when I was in the full flower of my practice, with the phone ringing often enough that it seemed that there was some kind of stream that was feeding it. Along with fee-for-service clients, I was buoyed by referrals from an Employee Assistance Program, which helped me keep my hours full.

The first hint that something was happening was when the EAP referrals dried up. Calls and emails did not elicit any explanation for why this was happening. I assumed that I would have heard if there had been a complaint, but there was only that eerie quiet that comes with non-response.

I began to lose clients organically, either through their improvement or by moving away. Over time, the spaces in my schedule became longer. Also, some clients went on a bi-weekly schedule, with my agreement, so they became half-time work. I will admit to some sense of panic, initially.

I had raised my rates every summer and I did not pay particular attention to my website or the search engines to which I subscribed. As a result, there is a readiness on my part to blame myself, to look at this as my hubris playing out. There is truth to that, I am sure, but it also coincided with an unexpected spike in my blood pressure.

What has followed is a reexamination of my priorities and a willingness to step away from anything that insists on a commitment with which I do not want to engage. As a result, I have made quite a few people unhappy, but I have discovered that I have room to decide on what I want to do next. This article is part of that effort, as well as making contributions to the editorial page of the Baltimore Sun.

I have reapplied for credentialing with Blue Cross/Blue Shield, which seems happy to have me back. I applied to opt back in with Medicare, but I have to wait until my opt-out period is over in 2020. I was surprised at my comfort with taking insurance again. Perhaps it is because, in part, it is more in keeping with social work ethics.

The concept of thriving has transformed to having what I need and perhaps a little more, although having a little more than that would be fine. I am finding my voice with my articles, so I do not want to be so busy that I forego that time.

Now I walk a mile and a half and meditate for 20 minutes every day. I am focused on developing my local community. Sorry, folks, but I only drive to DC when I absolutely have to. I am at peace with where I have landed, and the phone does ring often enough that I am sure that my bills will be met. I believe that all of this has made me a better therapist, welcoming the engagement rather than being desperate for it. There may be another evolution yet, but at 71 years-old, it will have to be incredibly compelling.