Dr Andrew Greenland: 0:00

Welcome to Voices in Health and Wellness, the podcast where we explore whole person healing, emerging care models, and the inspiring voices changing how we think about health. Today's guest is Marina Levist, a licensed clinical social worker, holistic psychotherapist, and certified hypnotherapist whose work sits beautifully at the intersection of mental health and functional medicine. Marina brings her personal health journey, marked by mercury toxicity and late autism diagnosis, into her mission of helping others reclaim health without over reliance on psychiatric medications. She's a powerful advocate for integrative care, ethical collaboration with healthcare providers, and expanding support for autistic adults navigating a system not built for their needs. So, Marina, thank you so much for your time and coming on the show this afternoon.

Marina Livis: 0:45

I'm really impressed by your summary. I couldn't have said it better myself.

Dr Andrew Greenland: 0:50

As long as it's accurate, that's the most important thing. I hope you have accurate by him.

Marina Livis: 0:55

Very well worded.

Dr Andrew Greenland: 0:56

Wonderful. So maybe we could start at the top and perhaps talk about a little bit about your journey, is what's led you into doing the work that you do.

Marina Livis: 1:05

Well, it's interesting. Um I was first in graduate school at Northwestern University and was in a master's program there for speech language pathology. And it was around that time that I started uh suspecting that I might be on the autism spectrum. I became obsessed with Temple Grandin and her books. And I also around that time started really getting curious about holistic health and holistic nutrition, and found myself instead of reading the books that are communication disorders based, which of course I was required to read, I was finding myself more drawn to books on nutrition and alternative medicine and Temple Grandin, of course. So those became my special interests, which, as anyone who knows even a little bit about autism, special interest is one of the traits. And it was then that I went through an interesting experience where I realized that this was not the path for me, even though I got into one of the best programs in the country. And ironically, I was in voice disorders class on the same week that I got a case of laryngitis where I literally could not speak, had no voice. And at the time I was already into the practice of meditation and I was practicing Buddhism as well, and I found myself really going inward and reflecting on what I should do with my career, what is this illness that I had really telling me? And the inner voice that I the message I received from my inner voice was clearly that I meant to be a therapist, just not a speech therapist. And I meant to be more of a mental health-focused therapist because at the time I was struggling with my own mental health. I was dealing with depression, which now looking back might have been heavy metal toxicity, but none of the doctors I was going to that were very reputable doctors really tested or checked anything beyond the surface. So all I knew was that I had this so-called chemical imbalance. But I I knew at that time I started to suspect there's more beneath the surface that I'm just not aware of. So that's kind of how it started for me.

Dr Andrew Greenland: 3:51

Interesting, fascinating. And you mentioned mercury toxicity and your autism diagnosis were big turning points. I mean, how did those shape not just your health but your identity and the work that you do?

Marina Livis: 4:03

Well, for me, when I found out after that was years later when I found myself working for the early intervention program in New York and really having suddenly a tough time remembering things, uh, having a tough time even showing up for work, feeling very scattered. Uh, it almost felt like a case of dementia, ADD, and depression in one. The psychiatrist I was working with at the time just wasn't helpful, just kept putting me on different antidepressants, SSRIs. And I knew I had to find another way. And because I was working with families through the early intervention program as a service coordinator, helping them get connected to services, and at the same time, I completed school for integrative nutrition as a health coach. I was already interested in learning about how you know the interface between integrative medicine and autism. I was interested in it more from the point of view of how can I help these families, how can I give them additional tools beyond what they were getting that was covered by insurance. And then there was this doctor, Dr. Levinson, who happened to come to New York City and was doing a lecture and how he's actually able to reverse autism through functional medicine or orthomolecular medicine. And I remember thinking to myself, well, if he can reverse autism, he could certainly reverse my depression. And uh I found myself on the next flight to Miami to see him, and all I had was maybe two weeks before I had to be back at work, and uh he just it felt like a miracle. He right away identified the root cause, which in my case was mercury toxicity, and a combination of that and a common SNP, a genetic mutation called MTHFR, that makes it difficult for the liver to detoxify. And so that perfect storm created what he called organic depression. And um, within a week of seeing him, I was back at my job functioning better than I had in years. It was just incredible, it was really like a miracle at the time. And so a year later, I decided to go back to school for social work. Um, and while I was in school, I ended up writing an academic paper about how depression is not a chemical imbalance in the brain, it's a body imbalance that affects the brain, and that's essentially the functional psychiatry framework that I now understand that was not popular at the time. So my professor was not happy with the topic of my paper, but he had no choice but to give me an A. Because I did my research, and of course, none of it was coming from my field. Um, but I was very proud of myself for doing that because the paper really reflected not just the research that was out there, but my lived experience. You can't argue with that.

Dr Andrew Greenland: 7:25

Totally. So tell us a bit um on that subject, tell us a little bit more about your practice and the typical patients that that come to you. What are they coming to you with and what's what's your kind of approach with them?

Marina Livis: 7:37

So I just started my virtual private practice this year, and I decided to focus it on working with other late diagnosed or late identifying autistic adults, mainly because at the time that I was late diagnosed, which was back in 2019, I faced a lot of discrimination. Um I really didn't have a lot of supports. I didn't even realize that there were other autistic therapists. Um, so it was quite a journey for me finding out more about how prevalent it actually is and the supports that are out there. So I really wanted to give what we call in the field a corrective emotional experience to my clients who in this day and age I think uh it's become a kind of trendy to look for a neurodivergent uh therapist, neurodivergent meaning someone who whose brain doesn't function in the same way as a neurotypical brain. Um and so I decided that's gonna be my focus. However, my focus is also making sure to tell every single client I work with that I do not support the practice of conventional psychiatry. Not to say that I'm against them taking Adderall or whatever it is that they choose to take, but it's just not the framework in which I view their condition. And so uh I encourage all my clients, if possible, to see a functional medicine doctor and for me to collaborate with that professional. And I'm finding that those that actually follow that advice do much better than those that do not. And I understand, especially here in the US, um, it's a an issue of what will insurance cover and what will insurance not cover. And unfortunately, functional medicine is not covered by insurance because, as we all know, insurance is not in the business of health, it's in the business of maintaining illness. It's a sick care system, not a health care system. And so being in the system, but trying to work outside of it has been quite a challenge.

Dr Andrew Greenland: 10:09

And I was gonna ask you on that note, what's your process for helping people to improve the quality of life without jumping straight to psychiatric medication?

Marina Livis: 10:17

So I uh I do EMDR therapy, which is trauma focused. Uh, they don't have to have PTSD to benefit from EMDR, but if they do, that's certainly a great modality. I also use hypnotherapy to address any kind of mental and physical ailments if they're open to it. I introduce them to different mindfulness practices, including EFT tapping. EFT is emotional freedom technique, and also different forms of meditation. I encourage them to I educate them about healthy nutrition and I encourage them to move away from ultra-processed foods if they haven't already, to consider going on a sugar elimination diet, to consider you know, various diet and lifestyle changes. And I'm not saying this from the perspective of a health coach, which I was before. I'm not like giving them, telling them this is what you should eat, this is what you should not eat. It's more in the form of psychoeducation, like FYI, your symptoms might improve if you try XYZ. So I I kind of uh help them be their own advocate.

Dr Andrew Greenland: 11:38

And in working with um autistic patients, what do you see are the biggest gaps in care for them right now if they're going elsewhere? And is you're saying that from somebody who understands this condition better than anybody, if you suffer it with yourself, you have a better understanding. But what gaps do you see in the care for for these patients?

Marina Livis: 11:57

The gaps I see is that a lot of individuals that are autistic or that have autism, however you want to put it, um have a multitude of underlying medical imbalance like conditions and body imbalances. And those body imbalances actually create the symptoms that we call anxiety, depression, inattention, etc. Um so I think the biggest gap is that if they're not seeing a functional psychiatrist, um they're constantly kind of in this hamster wheel of, oh, let's try this medication, let's try that medication. And most of them don't even get genetic testing to see which medications are appropriate for them, much less genetic testing to see if they have the MTHFR mutation, which is very common among autistic individuals. Um and so they express to me how frustrated they are with being part of the system. A lot of them don't want to take all these medications, but they're also suffering and they don't know what else to do. And so it's a very tough situation where you know there's layers of issues, but they're not being properly addressed by the medical system.

Dr Andrew Greenland: 13:26

I understand. And in terms of the challenges in doing the work that you do, because I guess you're fairly unique combining you know psychotherapeutic tools with a functional medicine approach, what's the challenge for you as doing this kind of work?

Marina Livis: 13:40

Well, the challenge for me is just knowing, almost like just from my own lived experience, knowing and suspecting that there might be some uh micronutrient deficiency, or there might be some parasite uh that you know maybe they would benefit from a parasite detox, or uh suspecting that well they might have celiac or gluten sensitivity, but uh they haven't been tested for it. Um, you know, all of these different things, but then not being able to, like not being a medical provider, not being able to write the script for them to get those things done. And sometimes even when I encourage them to speak with their conventional doctor about it, getting resistance, you know, being told, well, that's not necessary, or there's no proof that this is an issue.

Dr Andrew Greenland: 14:38

So is it something you would like more therapists or family doctors to understand about what your approach can really offer if you had to kind of put down a few things that you would like them to really know that would help them to help their patients? What kind of things would you want them to know?

Marina Livis: 14:53

First of all, I would like them to know that genetic testing should be an absolute mandatory part of their practice. And I don't mean just testing to see which medications are appropriate for the patient, but testing to see if there's any SNPs, you know, single nucleotide polymorphism similar to MTHFR that are very common that might be a driving force to you know a lot of the symptoms. And also for them to do more detailed testing, not just the surface level blood work, and and in the case of heavy metals, for example, it's it's not enough just to do a blood test to check for heavy metals, as you probably know yourself. And so uh I would honestly make it mandatory for all doctors to go to IFM and to study functional medicine as part of their training, not as a you know, post-medical school thing, but it should be an absolutely integral part of uh medical education.

Dr Andrew Greenland: 16:07

So I don't disagree with you there. So I'm just for background for listeners, I'm a functional medicine doctor, and functional medicine is really taking a holistic approach to people and their complex chronic illnesses, looking at the whole dietary and lifestyle piece, but looking at them functionally, their biochemistry, their genetics, their gut microbiome, all the stuff that never really gets looked at in conventional medical world. And we put all these pieces together in our jigsaw puzzle and really can come up with a holistic approach that actually helps the patient treat their problems at the root cause and gets them well. That's essentially what functional medicine is. And it sounds like you're a big advocate for that with your work, but you also have the additional ability to layer in helping them psychotherapeutically as well. So I think that's an amazing combination. I don't think I've met anybody that does what you do.

Marina Livis: 16:51

Yeah, thank you.

Dr Andrew Greenland: 16:54

So, what are the challenges that you face right now? So you're doing this work, you've kind of found your niche, you've found the thing that you like to do, you're using the tools that you like to use, but what are the challenges in doing what you do right now?

Marina Livis: 17:08

Well, there's uh you know, the challenge I already talked about, and then there's also the challenge of insurance. I don't know if you know about the US insurance system, but we don't have national health care, unfortunately.

Dr Andrew Greenland: 17:22

And I know it very well, only from the point of view that I've had lots of conversations with people in North America, and the one thing that they all talk about is insurance. But very interesting to hear what your take on it is because everybody's got a slightly different nuanced approach on how they view the insurance thing.

Marina Livis: 17:37

So some of the practical challenges that have come up is there were some new autistic clients I started working with, um, and we were doing, you know, they they became more aware of uh, you know, what the symptoms, what diagnoses uh their symptoms uh were reflecting, and how their childhood experiences created the PTSD, for example, that they now you know had symptoms for today, but then I had to almost abruptly stop treatment because suddenly insurance uh decided to uh for whatever reason make me not part of the network, and I don't understand that. Um and you know, in those specific cases, the the clients who are unable to pay cash to continue therapy, so it's really unfortunate. Um, you know, there's all kinds of insurance problems that happen. Maybe there's issues with accurate insurance eligibility verification in the first place, because how do you explain that they have the same insurance and uh they've been paying for the treatment for months and months, and then all of a sudden they say, Oh, you're not a network, we can't pay for this anymore. Um, so the cost of getting therapy outside of insurance is prohibitive to most people, and that's a big barrier. And then the fact that insurance puts up so many barriers, like, oh, you have to meet your deductible first before we pay anything, or you have this co-pay, which may be too high for someone to pay. Um it's just they create more obstacles for uh proper care.

Dr Andrew Greenland: 19:34

So insurance is a big thing. Is there anything else that is a challenge or a bottleneck in the work that you do or the business that you run?

Marina Livis: 19:42

Yeah, um I think a lot of people question hypnotherapy. So hypnotherapy is just as powerful as AMDR for the treatment of anything like anxiety, depression, PTSD, all kinds of things. Um, but I'm finding that a lot of my clients who are all insurance-based, most of them, with the exception of maybe two, are afraid of trying hypnotherapy. And there's something, maybe it's because they've seen stage hypnosis and it was kind of freaked them out. Or maybe it's just that our in our society and our culture, hypnosis is frowned upon uh for various reasons. There's all kinds of um, you know, really inaccurate notions about what hypnotherapy is. So that's another challenge, is you know, I do a lot of psychoeducation about the power of the subconscious mind and hypnotherapy, and how much more um effective and powerful it is to work on the level of the subconscious as opposed to talking like you and I are doing at the level of the analytical conscious mind. And you know, it makes sense to my clients, but to most of them, it's also just scary to go into that experience.

Dr Andrew Greenland: 21:11

I completely resonate that. So I have trained in hypnotherapy in the past, I don't practice anymore, but you're right, it's one of the biggest things. You spend half the consultation explaining what hypnotherapy isn't because of the misconceptions that people have or pre preconceived ideas that people have from what they've seen on the media. And you have to kind of get rid of all of that before you can do the work. So I totally understand that one. Um, are people are the patients that come to see you um requesting hypnotherapy, or are you suggesting it as something that will be helpful to them and then you have to do this overcoming of their ideas?

Marina Livis: 21:44

Most of them are they're more likely to request EMDR because they've heard about it than to request hypnotherapy. So so far, my private practice clients, none of them have requested hypnotherapy up front. They've requested EMDR if if any kind of modality that was at the forefront. But I, like you said, have to, you know, even after starting EMDR, for example, the way I explain why hypnotherapy might be a good addition along with EMDR is if they have trouble recalling certain memory targets from those early childhood years. I find that hypnotherapy can help them with that. And so I actually just guided one autistic client who was just uh recently late diagnosed, and uh he was amazed, and I was I'm always um just in awe when I see you know the transformation after a hypnotherapy session. So it just so happened I led him in two hours of hypnotherapy yesterday over a virtual uh HIPAA compliant platform, and um you know it it was just amazing to see how much came out. A lot of emotions came out that that were suppressed, um, and a lot of uh awareness of certain childhood memories that we can now target through EMDR, not to say that we didn't work on them and process them through the hypnotherapy session, but we can do even more with those memories through EMDR, and we kind of stirred it up for him. So I am quite confident that you know his subconscious mind will give him some more clues as to what are some other memory targets we can address, even if we don't do any more hypnotherapy sessions. So I find that for especially for people that maybe had trauma in childhood and have uh amnesia, like for example, I can't remember most of uh what happened before immigration to the US from Eastern Europe. So a lot of my childhood memories are also kind of blurry, and I found that hypnotherapy has really helped me access even early memories of my birth, which was I had a traumatic birth experience. So I know this from again my own lived experience, which is one of the reasons I became trained in hypnosis. Um and you know, I find that at least for the clients that are able to go into trans states, which not everyone can, um, the combination of EMDR and hypnotherapy can be a great way to access those memories.

Dr Andrew Greenland: 24:48

Fascinating. So um you mentioned that you sort of treat autistic patients and autistic patients come to see you because you have an understanding, because you've had the condition yourself. How does that work from a marketing perspective? How do you sort of market what you do? Um, or does it just people gravitate to you through other means? I'm just very curious to know how this works.

Marina Livis: 25:09

So I created a psychology today profile where I don't openly state that I'm autistic, but I ask questions at the beginning of the profile like can you relate to this, can you relate to that? Um, you know, do you feel like uh you aren't understood or are misunderstood? And and to kind of help them uh as they read the profile, help them connect with me and realize, oh, this is someone who gets it. And then hopefully they then visit my website where in the about me section I talk about my story and I share openly about how it came about that I was late diagnosed, and then I have a whole page on autism and uh a page on the different, you know, for each modality. I have a page where I kind of explain not just why the modality is powerful, but why it's powerful for someone who's autistic. So visiting my website is definitely helpful.

Dr Andrew Greenland: 26:18

I guess you must be flooded because I mean you must be one of the very few people. Uh not only do you have a sort of understanding of psychotherapy and psychotherapy tools, functional medicine, but an understanding of the condition itself from lived experience. So I'm I'm guessing you must be flooded with demand.

Marina Livis: 26:36

Well, I can't say I'm at the point of being flooded yet. Uh they're slowly trickling in where you know maybe I'll get uh two or three new referrals uh through my website and possibly through psychology today. I think the algorithm with psychology today is working against me. They've I think from what I've gathered, uh they don't prioritize virtual therapists. Um so I've had to play around with it, like changing the wording, changing putting that I have an office location, which then confuses people when they call. So that's the other issue is um, you know, if they want an in-person therapist, that's not something that I offer. Um, I do virtual only. One thing I started thinking about is uh potentially doing a home visit, like one or two times, not each session, but you know, that can really make a difference for some clients. And so I I'm considering offering that as well.

Dr Andrew Greenland: 27:42

If you um could wave a magic wand and fix one thing about your practice, what would it be? If you went it was a bottleneck or a challenge, what would it be?

Marina Livis: 27:53

It would be insurance.

Dr Andrew Greenland: 27:55

So I knew you were gonna say that.

Marina Livis: 27:59

So the reason the reason I say that, and it's been at the forefront of my mind, is you know, I hired a medical billing company when I started my practice, and I thought hiring a bidding a billing company is gonna make my life easier as a private practice therapist for the first time. But they are still dealing with insurance. In this case, it's Florida Blue Insurance. So the first mistake that was made was the insurance somehow, even though the company credentialed me, I was supposed to be an in-network provider. The insurance was showing me as still being out of network two months after credentialing. So there was a delay. I started seeing clients, I wasn't getting paid for all those sessions. There was a delay with even fixing that glitch of me showing as in-network. So my biller had to hold off on actually submitting claims until just last month when the glitch was finally fixed. Then a part two of the insurance problem came, of course, which I was kind of anticipating. And that's that the insurers suddenly uh told my biller, well, we're gonna pay like it's a rate of maybe $40 less than they originally had agreed to. And also they didn't even say that the rate is gonna be different based on the billing code, which it should be. For example, a 90791, which is the intake assessment code, is usually billed at a higher rate than a follow-up. So I don't know how this is happening or why, but the billers trying to reach the insurance to resolve the problem, still hasn't. It's been over a month now. I still haven't been paid. So the insurance takes their sweet time with actually sending me a check for I don't know what amount. So it's just the Crazy situation. In the meantime, I'm still seeing the clients because, for you know, clinical purposes, I can't just tell a client, oh, well, I can't see you for the next month and a half or two months or however it's long it's going to take for these issues to get resolved.

Dr Andrew Greenland: 30:18

I understand. Um if you had to go back to day one of building your practice, what would you do differently, if anything?

Marina Livis: 30:27

I might just be a cash pay therapist, but then I wouldn't be able to work with some of the clients who you know really would love to work with me, but can't if it requires not using their insurance. So that was one of the reasons. You know, I had some clients follow me from my agency job, and I wanted to have a practice where it combines um, you know, insurance uh offering um to build certain commercial insurance plans and cash pay for those that are able. And that was my intention. But had I known that it would be this complicated, I probably just wouldn't deal with insurance. And and I have my own therapist who is just cash pay, so I I totally understand now why she chose to go that route.

Dr Andrew Greenland: 31:22

I hear you. And I said this is a very common theme with um all of the North American clinics that I've spoken to. Insurance is the big stumbling block for most of them. Think about um the next six to twelve months. Where would you like your practice to be? And is there anything that's standing in the way?

Marina Livis: 31:38

So one of the big things I would like to see is um, you know, I I want to collaborate with a functional medicine doctor uh so that you know, when clients are open, I can say, well, I have this doctor that I already know that I collaborate with. So, you know, letting them know that if they choose to take that referral, that they could work with that doctor, and we can collaborate on their care from this more functional medicine perspective. Um, I've been trying to get all my um psychiatric nurse friends to do training through IFM or some other functional medicine training. Um, they're very slow to take me up on that. But yeah, I was just trying to figure out a way to make it so that someone um I already know or maybe someone I connect with in the near future would be willing to have this kind of referral partnership with me and collaboration because I think it would make uh continuation of care and you know uh the holistic model much easier to work with.

Dr Andrew Greenland: 32:57

Cool. And um, I I guess you want to grow and expand your practice. I suppose most people do. I mean, what what what would happen though if you had a sudden influx of new patients next week? What would be the first thing to break?

Marina Livis: 33:09

That would be kind of a challenge. Uh the thing is that I I know that a lot of private practice therapists often think about creating a group practice and hiring other clinicians, but um I don't think that's really my goal. And for me, it's more important that I work with clients who are aligned with me, and that every single client I work with is aligned with me because it's a win-win in this case. I understand very well how hard it is to find a therapist that's really aligned with you in terms of your values, your perspective, um, what you've your lived experience. Um, and so I would rather have a small caseload of aligned clients, a combination of cash pay and insurance rather than a large caseload of clients that may be better off with another therapist. And I'm very upfront about that during home consultations.

Dr Andrew Greenland: 34:13

Marina, thank you so much for your time and appearing on the show this afternoon. I think your story, your courage, and commitment to this kind of deeply integrated care is all very meaningful. And I think people listening will walk away not only feeling informed but also inspired. So thank you so much for your time this afternoon.

Marina Livis: 34:30

And thank you for taking the time to explain functional medicine to those listening, and that's helped hopefully for those of you who are listening who don't have uh an understanding of how functional medicine differs from conventional medicine. Um, hopefully, it's helped you to understand where I'm coming from.